Changes In Waist Circumference Research Articles

Macronutrient composition of the diet and long-term changes in weight and waist circumference in the EPIC–Italy cohort

Background and aimsThe overall macronutrient composition of diet, rather than just calorie intake, may influence long-term changes of anthropometry. We investigated relationships between dietary macronutrient composition and long-term changes in weight and waist circumference in participants of the EPIC–Italy – the Italian section of the European Prospective Investigation into Cancer and Nutrition – study. Methods and resultsA total of 32,119 participants provided anthropometric measures at recruitment and 12 years later (mean). Diet at recruitment was assessed using validated semi-quantitative food frequency questionnaires. Weight and waist changes associated with replacing 10% of energy from one macronutrient with 10% of energy from another macronutrient were assessed by multivariable linear regression.Increased energy from total protein at the expense of any other macronutrient was significantly associated with increased weight and waist circumference. Increased starch at the expense of sugar and total protein was associated with significantly decreased weight and waist circumference; when starch replaced total fat, weight significantly decreased. Increased sugar at the expense of starch and total fat was significantly associated with increased weight and waist circumference; but increase at the expense of total protein was significantly associated with decreased weight and waist circumference. ConclusionOur results suggest that increasing protein at the expense of fat or carbohydrates, and reducing starch by increasing other macronutrients, might be associated with increased weight and waist gain.

Does propolis affect the quality of life and complications in subjects with irritable bowel syndrome (diagnosed with Rome IV criteria)? A study protocol of the randomized, double-blinded, placebo-controlled clinical trial

BackgroundIrritable bowel syndrome (IBS) is one of the most frequent and recurrent gastrointestinal diseases. However, up to now, no pharmacological agent has been approved to treat IBS. Emerging evidence showed that inflammation has a vital role in enhancing nervous system sensitivity and perception of abdominal pain in subjects with IBS. Propolis is an herbal substance with a broad spectrum of antioxidants, anti-inflammatory, and prebiotic properties, which might exert beneficial effects to reduce the severity of IBS. The current clinical trial aims to evaluate the efficacy of propolis supplementation on IBS.MethodsThis single-center, randomized, double-blind, placebo-controlled clinical trial will be performed to evaluate the effect of propolis supplementation in adult patients with IBS diagnosed with Rome IV criteria. Fifty-two eligible patients will randomly be allocated to receive a propolis tablet (450 mg, containing 100 mg polyphenol compounds) or identical placebo, twice daily for 6 weeks. The primary outcome of the trial is an improvement in IBS severity from baseline to the sixth week of intervention. The secondary outcomes include the change in weight, waist circumference, and IBS quality of life. We will use the paired sample t test or Mann-Whitney U test for the within-group comparison and independent sample t test or Wilcoxon rank-sum and chi-square test or Fisher’s exact test for the between-group comparison. Besides, a multivariable-adjusted mean effect will be computed using the ANCOVA test.DiscussionWe hypothesize that propolis supplementation would be useful for treating IBS through its antioxidants, anti-inflammatory, and prebiotic properties. This trial will show the results of propolis supplementation, whether positive or negative, on IBS. If the current trial confirms our hypothesis, propolis supplementation can be a new choice in adjunctive therapy of IBS.Trial registrationIranian Registry of Clinical Trials IRCT20190708044154N1. Registered on 26 December 2019. Updated on 13 February 2020. https://en.irct.ir/trial/40983SponsorTabriz University of Medical Sciences, Tabriz, Iran

Use of a Smartphone App for Weight Loss Versus a Paper-Based Dietary Diary in Overweight Adults: Randomized Controlled Trial

BackgroundMobile health (mHealth) tools may be useful platforms for dietary monitoring and assessment.ObjectiveThis study aims to evaluate the effectiveness of a mobile dietary self-monitoring app for weight loss versus a paper-based diary among adults with a BMI of 23 kg/m2 or above.MethodsA total of 33 men and 17 women aged 18-39 years participated in a 6-week randomized controlled trial. We randomly assigned participants to one of two groups: (1) a smartphone app group (n=25) or (2) a paper-based diary group (n=25). The smartphone app group recorded foods and dietary supplements that they consumed and received immediate dietary feedback using Well-D, a dietary self-monitoring app developed by our team. The paper-based diary group was instructed to record foods or supplements that they consumed using a self-recorded diary. The primary outcomes were weight, BMI, waist circumference, body fat mass, and skeletal muscle mass. We also examined changes in nutrient intake, including energy, carbohydrate, protein, fat, dietary fiber, vitamins, and minerals, using 3-day 24-hour recalls. Differences in changes between the two groups were analyzed using independent t tests or Wilcoxon Mann-Whitney tests. All of the data were analyzed using intent-to-treat analysis.ResultsThe mean number of days recorded was 18.5 (SD 14.1) for the app group and 15.5 (SD 10.1) for the paper-based diary group. The differences in changes in weight, BMI, and waist circumference were not significantly different between the app group and paper-based diary group (P=.33, .34, and .70, respectively). Similarly, changes in body fat mass or skeletal muscle mass did not differ between the two groups (P=.71 and .054, respectively). Although energy intake was reduced in both groups, there was no significant difference in changes in energy intake between the two groups (P=.98).ConclusionsThere were no differences in changes in anthropometric measures and nutrient intake between the app group and the paper-based diary group. Both mobile dietary self-monitoring app and paper-based diary may be useful for improving anthropometric measures.Trial RegistrationClinical Research Information Service KCT0003170; https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=11642<ype=&rtype=

Anti-Inflammatory Effects Of Different Types Of Physical Exercises In Adults

A link between physical inactivity, central obesity, and inflammation likely exists suggesting physical activity and inactivity as critical regulators of systemic inflammation. PURPOSE: To investigate the responsiveness of a systemic inflammatory marker to different types of physical exercises. METHODS: A sample of 302 individuals from both genders was taken among (2013-2016) participants of the dynamic cohort "Move for Health", a lifestyle-modification program(LiSM) with supervised physical exercises and dietary counseling. The evaluation instruments were: IPAQ (long form-version 8); anthropometric, plasma analysis of high-sensitive C-Reactive Protein (hs-CRP) and physical fitness. After the clinical trial, the groups were assembled voluntarily in any of the exercise-protocols : hydro-gymnastics (HYD, 240min-400MET/week, n=50), high intensity interval training (HIIT, 240min-496MET/week, n=63), strength training in gym (ST, 360min-545MET/week, n=43) and mixed walking-strength (MIX, 30 min of walking 60-80% HRmax and ST, 540min-743MET/week, n=146). All groups received similar dietary counseling. Assessments were undertaken at baseline and after 10 weeks of supervised intervention. Continuous and categorized data were evaluated at 5% significance level. RESULTS: The 55.5 ± 10.8 years old sample, 88% females, 80.5% overweight, 91% reporting at least 150min/wk, 63% with good cardiorespiratory fitness, 78% good hand-grip strength but 73% presenting poor flexibility. At baseline, groups were similar and after intervention, all protocols incremented the baseline values of VO2max; flexibility (except in the HIIT) and muscle strength (only in ST and MIX). The level of physical activity increased only in MIX. Waist circumference(WC) reduced 1.3cm(HYD) to 2.2cm(ST), significantly in all but HIIT group. Us-CRP decreased significantly from 0.54(0.04-3.00) to 0.35(0.01-1.43) mg/dL, leading to a reduction of inflammatory stress (IS:CRP>_0.30mg/dL) from 44.7% to 29.8%. Except HYD, hs-CRP decreased in all other groups, while only HIIT reduced significantly(23%) the IS. CONCLUSIONS: The 10-wk LiSM was effective in reducing systemic inflammation, being more effective in HIIT and less in HYD, dissociable from WC changes and specific fitness improvements. Supported by CNPq and CAPES.

Randomized Face-to-face Vs. Remote Exercise Interventions In Overweight And Obese Subjects

PURPOSE: To compare the effect of face-to-face exercise intervention and wearable activity tracker-based remote intervention on anthropometry and metabolism in overweight and obese subjects. METHODS: All 50 overweight and obese subjects were selected[age: (43.81±9.75) yrs; body mass index: (27.29±2.61) kg/cm2; 30 males].CRF was measured with a graded exercise test by cycle ergometer. Body composition was measured by bioelectrical impedance analysis (BIA). Other indicators include anthropometric and biochemical characteristics (FBG, TC, TG, LDL-C, HDL-C) .Exercise intervention program:3 times/week, 60 min per session at 45%-65%VO2max,12 weeks. Two supervision modes: a traditional face-to-face group intervention, and an wearable activity tracker-based remote intervention with social networking platform(WeChat). RESULTS: After 12 weeks exercise training, BMI, fat%, neck circumference, waist circumference, FBG and TG were significantly improved in both face-to-face and remote groups . However, LDL-C and TC changed significantly only in the face-to-face group (decreased by 32.32±19.38%,4.47±19.48%, respectively) . The changes of neck circumference (-1.77±2.92 vs.-0.87±5.09 cm) and waist circumference (-3.76±5.52 vs. -0.39± 4.37 cm) were more significant in the face-to-face intervention group than in the remote intervention group. CONCLUSIONS: 12 weeks of face-to-face and wearable activity tracker-based remote intervention can improve the body composition and glycolipid metabolism of overweight and obese subjects, but face-to-face intervention may have more significant effect on improving the circumference, LDL-C and TC. Supported by Social Science Foundation of Jiangsu Province (BE2018752),Science and Technology Support Plan (Social Development) of Changzhou(CE20195046).

P80 The Effect of Attendance on Anthropometric Outcomes of Children Completing a Pediatric Weight Management Program for Latino Families

<h3>Background</h3> Latinos have some of the highest rates of pediatric obesity compared to other ethnic minorities. Treatment efforts should include a multidisciplinary and culturally adapted approach. Program attendance has been shown to influence health outcomes, yet has not been explored with pediatric programs targeting low-income and ethnic minority populations. <h3>Objective</h3> To evaluate whether attendance improves anthropometric outcomes among Latino children who are overweight/obese and participating in a family based pediatric weight management program. <h3>Study Design, Setting, Participants</h3> Latino children participated in Vidas Activas y Familias Saludables (VALÉ), a multidisciplinary group-based program which focuses on diet, exercise, behavior modification, and adaptation to the Latino community. Latino children aged 5 to 9 years with BMI-for-age ≥85th percentile (overweight/obese category) were recruited through clinics and schools between 2017 and 2019. Participants and their families met approximately 90 minutes per week over the 10-week intervention. <h3>Measurable Outcome/Analysis</h3> Family attendance at each session was recorded. Anthropometric measurements including waist circumference, body fat (using bioelectrical impedance), height and weight for the assessment of BMI-for-age Z scores (compared to CDC growth charts) were measured pre-, and immediately-post the intervention. As data were non-normally distributed the relationship between attendance and anthropometric outcomes were analyzed via SPSS using Spearman correlation and Kruskal Wallis H test. <h3>Results</h3> A total of 57 participants completed both pre and post assessments with 7 who attended 0-40% of sessions, 12 attended 50-60%, 16 attended 70-80%, and 22 attended ≥90%. Although the median change in BMI, BMI Z, and waist circumference improved with higher attendance, no significant associations were observed between number of sessions attended and anthropometric outcomes. <h3>Conclusions</h3> Higher program attendance did not affect anthropometric outcomes of children participating in pediatric weight management program targeting low-income Latino families. The limited sample size available may have affected these results.

Effect of Lactobacillus sakei, a Probiotic Derived from Kimchi, on Body Fat in Koreans with Obesity: A Randomized Controlled Study.

BackgroundThe increased prevalence of obesity has led to increases in the prevalence of chronic diseases worldwide. There is interest whether probiotics have an effect on obesity, but the effectiveness and safety of only a few probiotics for the treatment of obesity have been reported. The purpose of this study was to investigate whether ingestion of Lactobacillus sakei (CJLS03) derived from kimchi causes weight loss in people with obesity.MethodsThis randomized, double-blind, placebo-controlled, clinical trial involved 114 adults with a body mass index (BMI) ≥25 kg/m2 who were assigned randomly to a CJLS03 or placebo group. The groups received two allocations of either 5×109 colony-forming units of CJLS03/allocation or the equivalent vehicle for 12 weeks. Demographic and biochemical parameters, and body composition including fat and muscle mass were measured at baseline and after 12 weeks. Changes in body fat, weight, and waist circumference were compared between the two treatment groups. Adverse events were monitored during study period.ResultsBody fat mass decreased by 0.2 kg in the CJLS03 group and increased by 0.6 kg in the placebo group (0.8 kg difference, P=0.018). After the 12 weeks, waist circumference was 0.8 cm smaller in the CJLS03 group than in the placebo group (P=0.013). BMI and body weight did not change after the 12 weeks. Adverse events were mild and did not differ between the two groups.ConclusionThese data suggest that L. sakei (CJLS03) might help people with obesity reduce body fat mass without serious side effects (ClinicalTrials.gov: NCT03248414).

Longitudinal relationships between changes in body composition and changes in selected metabolic risk factors (abdominal obesity and blood pressure) among South African adolescents.

BackgroundIncidence of childhood high blood pressure (BP) is increasing worldwide. This study examined the longitudinal relationship between changes in body composition (i.e. body mass index (BMI), waist circumference (WC) and percentage body fat) and selected metabolic risk factors (abdominal obesity and BP) among adolescents from the Tlokwe municipality in the North West Province of South Africa.MethodOne hundred and eight-six adolescents (81 boys and 105 girls) aged 14 to 16 years participated in the study. Body composition was measured following the International Society of the Advancement of Kinanthropometry standard procedures. BMI, abdominal obesity using WC measurement, and resting BP were determined. Analysis of variance (ANOVA) for repeated measures was calculated to determine changes in anthropometric measures and body composition as well as changes in BP. Additionally, Univariate analysis of variance with repeated measures and participants as a random sample was applied. Diastolic BP (DBP) and systolic BP (SBP) were used as dependent variables and sex, age, BMI, WC, and waist-to-height ratio as independent variables.ResultsSignificant changes were found for stature, BMI, body mass, WC, SBP, and DBP. BMI for the total group was significant and positively related to abdominal obesity in 2012 (r = 0.55; p < 0.01) and in 2013 (r = 0.77; p < 0.01) and to SBP (r = 0.26; p < 0.05) in 2012 and (r = 0.17; p = 0.43) in 2013. BMI among the boys was significantly and positively related to abdominal obesity in 2012 (r = 0.83; p < 0.01) and 2013 (r = 0.91; p < 0.01). For the girls, BMI was significantly and positively related to abdominal obesity (r = 0.49; p < 0.01) and to SBP (r = 0.32; p = 0.05) in 2012. Boys with a higher WC in 2012 had significantly increased DBP (p < 0.05). Boys measured in 2012 with greater WC and BMI show a significant increase in SBP.ConclusionsBMI was positively related to BP and abdominal obesity over time. Relatively high BMI and abdominal obesity significantly increased the likelihood of elevated BP over time, especially in boys. BMI was a predictor of abdominal obesity in boys, while in girls, BMI was a predictor of both abdominal obesity and SBP. In view of the future health implications of both abdominal obesity and elevated BP, urgent strategic interventions programs aimed at increasing physical activity and advocating for well-balanced dietary practices as well as importance of keeping normal blood pressure among South African adolescents are needed.

Treatment with anagliptin, a DPP-4 inhibitor, decreases FABP4 concentration in patients with type 2 diabetes mellitus at a high risk for cardiovascular disease who are receiving statin therapy

BackgroundFatty acid-binding protein 4 (FABP4) acts as a novel adipokine, and elevated FABP4 concentration is associated with obesity, insulin resistance and atherosclerosis. Dipeptidyl peptidase-4 (DPP-4) inhibitors, a class of antidiabetic drugs, have distinct structures among the drugs, possibly leading to a drug class effect and each drug effect. Sitagliptin, a DPP-4 inhibitor, has been reported to decrease FABP4 concentration in drug-naïve and sulfonylurea-treated patients with type 2 diabetes mellitus. Anagliptin, another DPP-4 inhibitor, was shown to decrease low-density lipoprotein cholesterol (LDL-C) level to a greater extent than that by sitagliptin in the Randomized Evaluation of Anagliptin vs. Sitagliptin On low-density lipoproteiN cholesterol in diabetes (REASON) trial.Aim and methodsAs a sub-analysis study using data obtained from the REASON trial, we investigated the effects of treatment with anagliptin (n = 148, male/female: 89/59) and treatment with sitagliptin (n = 159, male/female: 93/66) for 52 weeks on FABP4 concentration in patients with type 2 diabetes mellitus at a high risk for cardiovascular events who were receiving statin therapy.ResultsThe DPP-4 inhibitor had been administered in 82% of the patients in the anagliptin group and 81% of the patients in sitagliptin group prior to randomization. Serum FABP4 level was significantly decreased by 7.9% by treatment with anagliptin (P = 0.049) and was not significantly decreased by treatment with sitagliptin (P = 0.660). Change in FABP4 level was independently associated with basal FABP4 level and changes in waist circumference and creatinine after adjustment of age, sex and the treatment group.ConclusionAnagliptin decreases serum FABP4 concentration independent of change in hemoglobin A1c or LDL-C in patients with type 2 diabetes mellitus and dyslipidemia who are on statin therapy.Trial registration ClinicalTrials.gov number NCT02330406. Registered January 5, 2015, https://clinicaltrials.gov/ct2/show/NCT02330406

Independent and Interactive Associations of Fitness and Fatness With Changes in Cardiometabolic Risk in Children: A Longitudinal Analysis.

Background: Findings for associations between cardiorespiratory fitness (CRF) and cardiometabolic risk (CMR) factors are inconsistent, and the interactive association between CRF and fatness with CMR factors is unclear in children. Our study aimed to examine whether CRF and fatness are independently and interactively associated with CMR factors.Methods: We included 5,869 children aged 6–13 years in the analysis. Physical examinations, blood tests, and CRF were measured at baseline and 1 year later. Cardiometabolic risk score (CMRS) was computed by summing Z scores of waist circumference (WC), averaged systolic and diastolic blood pressure, glucose, high-density lipoprotein cholesterol (HDL-C, multiplied by −1), and triglycerides.Results: There was a high correlation between fatness and CRF in both boys and girls. High baseline CRF was independently associated with favorable changes in CMRS, BMI, WC, percent body fat (PBF), total cholesterol, LDL-C, and HDL-C (all P < 0.025). Improved CRF was independently associated with favorable changes in CMRS, BMI, WC, PBF, total cholesterol, LDL-C, HDL-C, triglycerides, and fasting glucose (all P < 0.0321). Baseline BMI was positively associated with changes in CMRS, WC, blood pressure, triglycerides, insulin, and HOMA-IR (all P < 0.0462). Low PBF at baseline was associated with favorable changes in CMRS, BMI, WC, blood pressure, HDL-C, triglycerides, insulin, and HOMA-IR (all P < 0.0423). The percentage of the total effect of baseline CRF on changes in CMRS, triglycerides, HDL-C, PBF, and WC mediated by baseline BMI was 66.0, 61.6, 40.3, 20.7, and 9.2%, respectively. Baseline CRF was a significant mediator for the association between baseline BMI and changes in CMRS (mediated by 4.3%), triglycerides (5.1%), and HDL-C (12.0%). An inverse association was found between baseline CRF and CMRS in children with high baseline BMI/PBF only. Improved CRF was associated with decreased BMI and WC in children with low baseline CRF.Conclusions: Fatness and CRF are each independently associated with changes in CMR factors. Fatness is a major mediator for the association between CRF and CMR factors, whereas the association between fatness and CMR factors is also mediated by CRF. The beneficial effect of high CRF on CMR factors was more evident in obese or unfit children.

Starch Digestion-Related Amylase Genetic Variants, Diet, and Changes in Adiposity: Analyses in Prospective Cohort Studies and a Randomized Dietary Intervention.

Salivary amylase, encoded by the AMY1 gene, is responsible for the digestion of carbohydrates. We investigated associations of AMY1 genetic variations with general and central adiposity changes considering dietary carbohydrate intake among 32,054 adults from four prospective cohort studies. A genetic risk score (GRS) was calculated based on nine AMY1 single-nucleotide polymorphisms, with higher AMY1-GRS indicating higher activity of salivary amylase. We meta-analyzed interactions between AMY1-GRS and dietary intake for changes in general and central adiposity over 5.5-10 years. We found that carbohydrate food intake significantly altered associations of AMY1-GRS with changes in BMI (P interaction = 0.001) and waist circumference (P interaction < 0.001). Results were consistent and significant in female cohorts rather than in male cohorts. Among women, higher AMY1-GRS was associated with more increases in adiposity if dietary carbohydrate food intake was high, while higher AMY1-GRS was associated with less gains in adiposity when the dietary intake was low. Also, in a 2-year randomized dietary intervention trial, associations of AMY1-GRS with changes in weight (P interaction = 0.023) and waist circumference (P interaction = 0.037) were significantly modified by carbohydrate intake. Our results suggest the importance of precision nutrition strategies considering participants' genetic adaptation to carbohydrate-rich diets in regulating general and central adiposity.

Testosterone replacement therapy: Pre‐treatment sex hormone‐binding globulin levels and age may identify clinical subgroups

Testosterone replacement therapy (TRT) improves health in some but not all men with type 2 diabetes (T2DM) and adult-onset testosterone deficiency (TD). Such heterogeneity is compatible with the concept of patient subgroups that respond differently to therapy. Use baseline SHBG and age to identify putative subgroups that demonstrate different responses in variables such as waist circumference and HbA1c following TRT. A randomized double-blind trial approach was used to recruit and randomize men with T2DM and adult-onset TD into placebo and TRT-treated groups. Multiple regression was used to study differences between groups. Baseline SHBG and change in SHBG (∆SHBG) were inversely related in the TRT group. Both median values of SHBG and age mediated the effect of TRT on ∆SHBG depending on whether baseline values were≤or>median (28.1 nmol/L, 63years, respectively). In men with both SHBG≤28.1nmol/L and age≤63years (subgroup 1), TRT was positively associated with ∆SHBG (c=4.67, 95%CI 1.17-8.16, P=.010) while in those with SHBG>28.1nmol/L and age>63.1years (subgroup 4) the association was inverse (c = -7.07, 95%CI -11.64 to -2.49, P=.003). The association between TRT and change (∆) in waist circumference, HbA1c and International Index of Erectile Function (IIEF) score differed between subgroups; in subgroup 4 but not subgroup 1, the therapy was significantly associated with ∆waist circumference, ∆HbA1c and ∆IIEF. Though the mechanism remains unclear, our finding of different responses to TRT in terms of change in waist circumference, HbA1c and IIEF score supports the concept of subgroups in men with T2DM and adult-onset TD. Our approach may provide a basis for identifying men who will or will not derive benefit from TRT though a larger study is required.

1998-P: Waist Circumference Change in the First Year of the Look AHEAD Trial Is Associated with Risk for Cardiovascular Morbidity and Mortality

Look AHEAD found no difference between intensive lifestyle intervention (ILI) for weight loss and diabetes support and education (DSE; control) in cardiovascular (CVD) outcomes among individuals with overweight or obesity and type 2 diabetes (T2DM). This secondary analysis evaluated the association between change in weight and waist circumference (WC), a possible proxy for visceral adiposity, and risk for CVD outcomes. We classified Look AHEAD participants (n=4590) into one of four categories based on change in weight and WC from baseline to Year 1 (increase/increase, etc.) to examine the association between the categories and primary (myocardial infarction, stroke, hospitalized angina, CVD death) and secondary (primary outcomes and CABG/PTCA, hospitalized congestive heart failure, carotid endarterectomy, PVD, and total mortality) CVD outcomes from Year 1 to end of active treatment (median of 9 years). Cox proportional-hazards regression models were used to 1) compare ILI participants in the four categories to DSE and 2) evaluate the four categories within treatment groups using the group that decreased WC and weight as the reference. Compared to DSE, individuals in ILI who increased WC and weight and individuals who increased WC but decreased weight both had greater risk of secondary CVD outcomes (HR[95%CI]: 1.95 [1.33, 2.86] and 1.35 [1.02, 1.80] respectively). In analyses stratified by randomization group, DSE participants did not differ in cardiovascular events across categories. Individuals in ILI who gained WC (regardless of weight loss or gain), had increased risk of primary and secondary CVD outcomes compared to individuals in ILI who decreased weight and WC. Increased WC during weight loss treatment, regardless of weight loss or gain, is associated with greater risk for CVD outcomes in individuals with T2DM. This emphasizes the importance of measuring WC in clinical practice and testing interventions focused on decreasing WC. Disclosure K.L. Olson: None. R.H. Neiberg: None. M. Espeland: Other Relationship; Self; Boehringer Ingelheim International GmbH, Ironwood Pharmaceuticals. K.C. Johnson: None. W.C. Knowler: None. A.E. Staiano: None. L.E. Wagenknecht: None. R.R. Wing: None. Funding National Institutes of Health

708-P: Medical Prescriptions of Fresh Vegetables Improve Clinical and Psychosocial Outcomes for Adults with or at Risk of Type 2 Diabetes (T2D)

For adults with T2D, food insecurity and low socio-economic status are major barriers to accessing nutritious food, leading to compensatory consumption of foods harmful to health. In particular, consumption of fresh vegetables is well below recommended levels in the United States. The aim of this project was to examine the health impact of improving access to fresh vegetables through the use of medical prescriptions for organic vegetables for adults with or at risk of T2D (ADA Risk Calculator). Over 12 weeks (and after obtaining informed consent), participants provided baseline clinical information and then received weekly medical prescriptions of 21 servings of locally sourced organic vegetables at three community based distribution centers in Santa Barbara, CA, after which baseline measurements were repeated. No additional structured nutrition education was provided. Overall, 145 adults (74% Hispanic/Latino, aged 53 [42-62] years (median [IQ range]), 78% female, with (31%) or at risk of T2D have been enrolled. At entry, 62% were food insecure which reduced to 37% after 12 weeks (p&amp;lt;0.0001) associated with lowering of systolic blood pressure (SBP) (-2.5 [95%CI: -4.8 to -0.2] mmHg, p=0.035) which was greater for those with an initial SBP &amp;gt;130 mmHg (-6.8 [95%CI: -11.7, -1.9] mmHg, p=0.005), and a reduction in waist circumference (0.9 [95%CI -1.6 to -0.2] cm, p=0.002). The change in waist circumference was also significant with baseline high-risk values of &amp;gt;88 cm (p=0.02) for women and &amp;gt;102 cm (p=0.02) for men. Median weight also fell slightly (-0.45 kg, p=0.04). For participants with a baseline HbA1c &amp;gt;7.0%, this reduced significantly (-0.6 [95% CI -1.2 to -0.05] %, p=0.01). Overall self-reported sleep quality, mood and pain (100 mm visual analogue scales) also improved (all p&amp;lt;0.001). Medical prescriptions of organic vegetables are associated with measurable clinical and psychosocial benefits for adults with or at risk of T2D. Disclosure M.A. Kujan: None. N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. C. Conneely: None. V. Chen: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc. Funding U.S. Department of Agriculture (2018-01793)

Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART)

BackgroundThere is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). MethodsIn this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. ResultsAt least 296 participants and approximately 75 peer supporters will be enrolled. DiscussionDespite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes.Trial Registration: The ClinicalTrials.gov registration number is NCT03689530.

Body Mass Index, waist circumference or sagittal abdominal diameter: Which parameter is better correlated with body fat changes in postmenopausal women after combined training protocol?

We aimed to verify whether exercise-induced changes in body mass index (BMI), waist circumference (WC) and sagittal abdominal diameter (SAD) are correlated with changes in body fat (BF) in postmenopausal women. Seventeen postmenopausal women performed combined training three times a week, for 12 weeks. Correlations of delta (Δ) BMI, Δ WC, and Δ SAD with Δ total BF, Δ android and Δ gynoid fats were performed. Weight, BMI and android fat decreased over time. A tendency of reductions in gynoid fat was found (p=0.070). Delta BMI was positively correlated with Δ total BF (r=0.56; p<0.05), Δ android fat (r=0.64; p<0.05), and Δ gynoid fat (r=0.72; p<0.05). The Δ WC was only correlated with Δ gynoid fat (r=0.55; p<0.05). The Δ SAD was not correlated with all the Δ body fat parameters evaluated. We conclude that changes in BMI were better associated with body fat changes induced by combined training when compared to WC and SAD in postmenopausal women. The patients were part of a 12-week training study (ClinicalTrials.gov Identifier: NCT03200639).

Changes in the Gut Microbiota During a Weight Loss Intervention of Daily Caloric Restriction Versus Intermittent Fasting: The DRIFT2 Randomized Clinical Trial

Abstract Objectives Intermittent fasting (IMF) is an alternative to the standard weight loss approach of daily caloric restriction (DCR). Although altered gut microbiota has been linked to obesity and may influence weight loss, it is unknown how the gut microbiota is impacted by these weight loss strategies or its association with responsiveness. In this study, we examine the gut microbial diversity and composition during an intervention of DCR versus IMF. Methods Fecal microbiota communities were profiled by 16S rRNA gene sequencing in 59 individuals with overweight and obesity (mean BMI: 33.1 (SD: 4.4) kg/m2, age: 40.7 (SD: 9.8) years; 76.3% female) undergoing a comprehensive, group-based behavioral weight loss intervention of DCR (n = 25) versus IMF (n = 34) at baseline and 3-months into the intervention. Mixed effects linear regressions, permutational ANOVA, and ANCOM were used to examine differences in gut microbiota over time and by intervention group, and regression-based methods were used to examine the association between baseline gut microbiota and percentage change in weight and waist circumference. Results Overall, participants lost 5.9 (SD: 3.7) kilograms at 3 months. Weight loss within groups is not reported, as the trial is ongoing. Alpha diversity increased in both intervention groups (P &amp;lt; 0.034), with no significant differences between groups (P &amp;gt; 0.847). Microbiota composition (beta diversity) changed significantly (R2 = 7.1%; P = 0.001) over the course of the intervention, with no significant differences between groups (P &amp;gt; 0.325). Numerous taxa showed changes over time with differences between groups (FDR &amp;lt; 0.05). Baseline gut microbiota composition significantly predicted change in waist circumference (P = 0.009) but not in weight (P = 0.172). Conclusions Our results support that a behavioral weight loss intervention of reduced energy intake impacts gut microbiota with some differences between DCR and IMF, which may provide insight into the physiological effects of these weight loss approaches. The baseline gut microbiota was significantly associated with decrease in waist circumference. These results may inform ways to target the gut microbiota before initiating weight loss in order to improve responsiveness. Funding Sources NIH NIDDK R01; AHA Innovative Project Award.

Increased Protein Density During Weight Loss Is Correlated with Reduced Abdominal Obesity and Body Mass Index and Improved Body Composition

Abstract Objectives There is a clear link between abdominal obesity and chronic diseases. Dietary changes leading to substantial weight loss reduce obesity and improve health; however, no viable dietary treatment program exists that produces clinically significant, cost-effective, and sustainable weight loss. To test the hypothesis that a diet dense in lean proteins and fiber is inversely associated with abdominal obesity while maintaining skeletal muscle mass (SMM), we evaluated the correlation between mean protein and fiber density and changes in BMI, waist circumference and SMM during weight loss. Methods Thirty adult males and females participated in this ongoing, 2-year dietary weight loss program. The Individualized Dietary Improvement Program focused on reducing caloric intake and increasing protein (7–11 g/100 kcal) and fiber (1.8–3.2 g/100 kcal) density to desired ranges. Participants attended 19 group educational sessions, 3 individual counseling appointments, self-weighed daily, and submitted monthly 24-hour dietary recalls. BMI, waist circumference and body composition (InBody) measurements were collected at baseline and after 6 months. Results At 6 months, 25 participants (24–70y) remained in the study with 18 completing all body measurements. Mean weight loss (n = 25) was −2.2 ± 0.5 BMI points (–5.2 ± 1.3% of initial body weight) and mean waist circumference reduction (n = 18) was −6.5 ± 1.3 cm from baseline. Significant increases in protein and fiber density were seen from baseline to month 2 (P &amp;lt; 0.05). There were direct inverse associations between mean protein density and both reduced waist circumference (P &amp;lt; 0.01) and reduced BMI (P &amp;lt; 0.01). Fiber intake had no significant impact on weight loss, and maintenance of SMM did not significantly correlate with mean protein density. However, only 11.0 ± 3.2% of weight lost was due to the loss of SMM, supporting the efficacy of the program. A significant positive correlation (P &amp;lt; 0.01) existed between fat mass loss and protein density, with 74.3 ± 4.7% of excess body fat accounting for total weight lost. Conclusions Increased protein density correlates with accelerated loss of fat mass, greater reductions in abdominal adiposity, and may protect SMM from degradation during weight loss. Funding Sources This research is supported by the NIBIB of the NIH and the USDA NIFA.

TX Sprouts: A School-Based Cluster Randomized Gardening, Nutrition, and Cooking Intervention: Effects on Obesity, Blood Pressure and Diet

Abstract Objectives To assess the effects of a one-year school-based gardening, nutrition, and cooking cluster randomized controlled trial, called TX Sprouts, on dietary intake, obesity markers, and blood pressure. Methods Sixteen schools were randomly assigned to either the TX Sprouts intervention (n = 8 school) or to delayed intervention (n = 8 schools). The intervention arm received: formation/training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly during school hours; and nine parent lessons. The delayed intervention received the same protocol one year later. Primary child outcomes were measured at baseline and after one school year included: changes in dietary intake (fruit and vegetables servings via screener), height, weight, waist circumference, body composition, and blood pressure. Ten multiple imputations and generalized linear mixed models with schools as the random cluster were used to assess differences in changes in primary outcomes between intervention and control groups. Results Of the 4239 eligible students, 3135 (74%) of students consented and completed baseline clinical measures and child surveys. Participants were 47.4% male and average age was 9.2 years. Approximately 64% were Hispanic, and 69% were economically disadvantaged with attendance to TX Sprouts lessons was 95% of the intervention children. Ninety-one % of children completed both pre and post measures. Intervention group compared to control group resulted in increases, mean change (SE), in vegetable intake [+0.33(0.13) vs. 0.03(0.11) serv/d; P = 0.003]. There was a significant race/ethnicity by sex interaction (P = 0.01) for diastolic blood pressure, with Hispanic males in the intervention group compared to Hispanic males in the control group having reductions in diastolic blood pressure [−2.5(1.0) vs. +0.8(1.10) Hg/mm; P = 0.021). There was no effect of the intervention on any of the obesity parameters. Conclusions The TX Sprouts intervention targets the school nutrition environment, and may provide a sustainable approach to increase vegetable intake and reduce blood pressure in low-income, primarily Hispanic children. Funding Sources NIH/NHLBI (1R01HL123865, 2015-2020), Whole Kids Foundation, Home Depot, Sprouts Healthy Communities Foundation.

Investigating Effectiveness of a Pritikin-Based Cardiac Rehabilitation Program on Patients with Heart Disease

Abstract Objectives The primary objectives of this study were to: assess change in dietary habits and health outcomes [body mass index (BMI), weight loss, waist circumference (WC), blood pressure, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and Hemoglobin A1c (A1C)] among patients following completion of an intensive cardiac rehabilitation (CR) program. Methods This retrospective cohort study involved de-identified data obtained from an electronic medical record (EMR) program and from an excel spreadsheet maintained at a hospital in Arkansas. Data were available from 138 adults, age 29 to 89 years, with a pre-existing heart condition or event, and who completed a 12-week CR program at the hospital's Clinic. Dietary habits were evaluated using the 24-question Rate Your Plate (RYP) survey at initial visit, and discharge. RYP and weight data were also available for a group of patients (n = 18) completing a 3-month follow-up visit. Results There was a statistically significant (P &amp;lt; .0001) mean increase (8.24; 95% CI, 7.03 to 9.45) from the pre-RYP score (51.05 ± 7.43) to the post-RYP score (59.29 ± 6.58). There was a statistically significant (P &amp;lt; .0005) median decrease in weight (−2.00 lbs.) after post-intervention (193.50 lbs.) compared to pre-intervention (195.50 lbs.). There were also significant (P &amp;lt; .05) differences between pre- and post-measurements of BMI, WC, LDL, total cholesterol, and triglycerides. Follow-up data indicated significant changes in the RYP score (P &amp;lt; .0001) and weight (P = .020) were maintained at 3-months follow-up. Conclusions A 12-week CR program including nutrition education and counseling is effective to help patients with CVD or previous heart events improve their dietary habits. There were noticeable changes in diet scores, WC, BMI, and weight loss, with patients being able to sustain weight loss at their three-month follow-up visit (a 5% weight loss). Funding Sources N/A.