Restriction Of Energy Intake Research Articles

Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery

ObjectiveThis study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery.MethodFive female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA).ResultsThree super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences—including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours.DiscussionThis study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m2 but are severely restricting energy intake.

FGF21 and the Physiological Regulation of Macronutrient Preference.

The ability to respond to variations in nutritional status depends on regulatory systems that monitor nutrient intake and adaptively alter metabolism and feeding behavior during nutrient restriction. There is ample evidence that the restriction of water, sodium, or energy intake triggers adaptive responses that conserve existing nutrient stores and promote the ingestion of the missing nutrient, and that these homeostatic responses are mediated, at least in part, by nutritionally regulated hormones acting within the brain. This review highlights recent research that suggests that the metabolic hormone fibroblast growth factor 21 (FGF21) acts on the brain to homeostatically alter macronutrient preference. Circulating FGF21 levels are robustly increased by diets that are high in carbohydrate but low in protein, and exogenous FGF21 treatment reduces the consumption of sweet foods and alcohol while alternatively increasing the consumption of protein. In addition, while control mice adaptively shift macronutrient preference and increase protein intake in response to dietary protein restriction, mice that lack either FGF21 or FGF21 signaling in the brain fail to exhibit this homeostatic response. FGF21 therefore mediates a unique physiological niche, coordinating adaptive shifts in macronutrient preference that serve to maintain protein intake in the face of dietary protein restriction.

Severely restricting energy intake for 24 h does not affect markers of bone metabolism at rest or in response to re-feeding

PurposeIntermittent energy restriction commonly refers to ad libitum energy intake punctuated with 24 h periods of severe energy restriction. This can improve markers of metabolic health but the effects on bone metabolism are unknown. This study assessed how 24 h severe energy restriction and subsequent refeeding affected markers of bone turnover.MethodsIn a randomised order, 16 lean men and women completed 2, 48 h trials over 3 days. On day 1, participants consumed a 24 h diet providing 100% [EB: 9.27 (1.43) MJ] or 25% [ER: 2.33 (0.34) MJ] of estimated energy requirements. On day 2, participants consumed a standardised breakfast (08:00), followed by an ad libitum lunch (12:00) and dinner (19:30). Participants then fasted overnight, returning on day 3. Plasma concentrations of C-terminal telopeptide of type I collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP) and parathyroid hormone (PTH) were assessed as indices of bone metabolism after an overnight fast on days 1–3, and for 4 h after breakfast on day 2.ResultsThere were no differences between trials in fasting concentrations of CTX, P1NP or PTH on days 1–3 (P > 0.512). During both trials, consuming breakfast reduced CTX between 1 and 4 h (P < 0.001) and PTH between 1 and 2 h (P < 0.05), but did not affect P1NP (P = 0.773) Postprandial responses for CTX (P = 0.157), P1NP (P = 0.148) and PTH (P = 0.575) were not different between trials. Ad libitum energy intake on day 2 was greater on ER [12.62 (2.46) MJ] than EB [11.91 (2.49) MJ].ConclusionsTwenty-four hour severe energy restriction does not affect markers of bone metabolism.

Automated gradual reduction of milk yield before dry-off: Effects on udder health, involution and inner teat morphology

Lowering milk production of high yielding dairy cows before dry-off may be beneficial for both physical health and welfare of the cow. Extending the milking intervals as well as restricting energy intake are the commonly used approaches to decrease milk secretion, but are mostly accompanied by adverse side effects. Our objective was to elaborate a new technique for reducing milk production taking the natural process of weaning into account, i.e. the abatement of the calf`s milk removal when shifting its diet from milk towards solid feed. We tested a software module by which the degree of udder emptying can be gradually decreased through automated early removal of the milking clusters over 10.4 ± 1.8 days on 26 Holstein cows that were close to dry-off and free of mastitis (SCC < 100,000 cells/mL and negative bacteriology in quarter milk samples). Milk yield was compared to 30 conventionally milked control cows, which had the same initial milk yields and fulfilled the same udder health criteria. After the period of incomplete milking, milk production immediately before dry-off was 35.3 ± 12.9% less in the experimental cows compared to the control cows. As expected, the duration of milking decreased with time of incomplete milking. Neither SCC nor bacteriology findings were altered by leaving residual milk in the udder. Ultrasonographic investigation of pre- and post-milking teat characteristics showed that all traits of inner teat morphology except teat end width were less changed through the incomplete milking process when compared to the changes occurring in the conventionally milked control cows (differences in changes ranged from - 2.0% for teat width to - 27.9% for the distal teat canal`s surface). These findings suggest that the mechanical strain on the teat was considerably decreased with termination of the milking process before udders were completely emptied. After several days of incomplete milking, the perimeter and the surface of the distal teat canal of the experimental teats were even smaller before attachment of the clusters when compared to the pre-milking values of the control teats, which might reflect a strengthening of the teat canals` functional defense mechanisms against the invasion of potential pathogens. Assessments in the following lactation showed that neither milk yield nor udder health were impeded by the targeted automated reduction of milk production before dry-off. The software module tested herein thus provides an effective tool for facilitating the dry-off process.

FAKTOR YANG MEMPENGARUHI OBESITAS PADA WUS DI WILAYAH KERJA PUSKESMAS PAYUNG SEKAKI KOTA PEKANBARU 2019

ABSTRACT : Obesity is a state of imbalance between incoming energy and energy coming out for a long time. This excess energy will be stored in the form of fat and fat tissue so that it can result in weight gain. Obesity can be prevented by frequent physical activity by exercising regularly, consuming foods that are low in fat and healthy, maintaining weight in a healthy way. The purpose of this study was to determine the relationship of factors that influence obesity in Fertile Age Women in Payung Sekaki Health Center, Pekanbaru City. This type of research is quantitative with correlational analytic research designs with cross sectional techniques. This research was conducted on October 15 - November 15, 2019. The number of samples was 100 people with a purposive sampling technique. Data collection on knowledge, attitudes and exercise using a questionnaire, fiber intake with FFQ Semi Quantitative interviews. Data analysis was performed with univariate and bivariate data analysis with chi-square test. The results obtained by the incidence of obesity in WUS as much as 60%. Analysis of bivariate data with 95% CI level obtained by factors related to obesity is knowledge factor P value = 0.037 OR 0.405 (0.172 - 0.957, Attitude P value = 0,000, Sports 0.012 OR 3.523 (1,280 - 9,690) .Inrelated factors are intake fiber P value = 0.412. Therefore, prevention and response efforts need to be done by increasing public knowledge and awareness about eating patterns, limiting energy intake in accordance with daily energy needs.

Holistically addressing motivation and maladaptive traits in anorexia nervosa: Impact on prognosis and treatment outcomes

Anorexia Nervosa (AN) is a serious psychiatric disorder, characterized by restriction of energy intake, low body weight, intense fear of weight gain, and a disturbance in body weight self-perception. Severe and Enduring AN (SE-AN) is a long-lasting (typically 5-7 or more years and marked by several unsuccessful treatment attempts) form of AN. Traditional treatments, centering on weight restoration and core eating pathology, may be part of the reason rates of treatment dropout are high and long-term outcomes are poor, particularly in SE-AN. For SE-AN patients, who have a past marked by failed traditional treatment attempts, multidimensional treatments, addressing motivation to change and maladaptive traits, may improve a range of patient outcomes outside of eating-related symptoms, such as quality of life and interpersonal functioning.The objective of this narrative review is to briefly examine motivation-related factors (e.g., hope and readiness to change), experiential avoidance, perfectionism, and obsessive-compulsiveness, and the impact of treatment approaches incorporating these individual characteristics on various patient outcomes. In conclusion, a holistic, multidimensional, person-centred recovery approach that accounts for (a) illness severity/ chronicity, (b) individual traits, and (c) motivational factors (with a secondary focus on weight gain/eating pathology), could improve quality of life outcomes, particularly in SE-AN. Additionally, integrating patient perspectives, insights, and values into developing/testing novel person-centred interventions is paramount in order to holistically address the underlying biopsychosocial causes and perpetuating factors of AN, and to better understand the trajectory of chronicity.

360 Awardee Talk - weight loss strategies in horses

Abstract Almost half of the American horse population is reported to be overweight, with approximately 20% reported as obese. Excessive adiposity is associated with potential health consequences including joint disease, heat intolerance, insulin resistance, equine metabolic syndrome, and laminitis. Health management for affected horses includes strategies that not only decrease fat mass but also improve insulin dynamics, as insulin resistance is closely associated with the development of laminitis. Negative energy balance to achieve fat loss can result from decreased caloric intake, increased energy expenditure, or a combination of both. Decreased calorie intake can be achieved by limiting feed intake by reducing the amount of feed offered, limiting pasture intake (through the use of grazing muzzles or limiting time at pasture), and by selecting lower energy density feeds. Weight-loss research has suggested feeding forages at a rate of 1.5% of body weight (90% DM), balanced with appropriate amounts of amino acids, vitamins and minerals as needed. Some horses appear to be “weight loss resistant” and may require further restrictions under veterinary supervision (closer to 1.0 - 1.2% of body weight). Strict feed restriction may increase the risk of hyperlipidemia, colic, gastric ulcers, the onset of wood chewing behavior and/or the consumption of bedding. Several studies have reported significant weight loss with restricted dietary energy intake, though effects on insulin dynamics are varied. Forced exercise not only increases energy expenditure, but also results in more pronounced improvements on insulin dynamics. Light, moderate and heavier exercise protocols have resulted in improvements in insulin sensitivity, with greater benefits along with fat loss being associated with higher workloads. However, lameness may compromise weight-bearing exercise efforts. It is recommended that weight loss strategies for horses incorporate both dietary energy restriction and increased exercise when possible.

Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss.

The current obesity epidemic is staggering in terms of its magnitude and public health impact. Current guidelines recommend continuous energy restriction (CER) along with a comprehensive lifestyle intervention as the cornerstone of obesity treatment, yet this approach produces modest weight loss on average. Recently, there has been increased interest in identifying alternative dietary weight loss strategies that involve restricting energy intake to certain periods of the day or prolonging the fasting interval between meals (i.e., intermittent energy restriction, IER). These strategies include intermittent fasting (IMF; >60% energy restriction on 2–3 days per week, or on alternate days) and time-restricted feeding (TRF; limiting the daily period of food intake to 8–10 h or less on most days of the week). Here, we summarize the current evidence for IER regimens as treatments for overweight and obesity. Specifically, we review randomized trials of ≥8 weeks in duration performed in adults with overweight or obesity (BMI ≥ 25 kg/m2) in which an IER paradigm (IMF or TRF) was compared to CER, with the primary outcome being weight loss. Overall, the available evidence suggests that IER paradigms produce equivalent weight loss when compared to CER, with 9 out of 11 studies reviewed showing no differences between groups in weight or body fat loss.

Effects of dietary intake and nutritional status on cerebral oxygenation in patients with chronic kidney disease not undergoing dialysis: A cross-sectional study.

Dietary management is highly important for the maintenance of renal function in patients with chronic kidney disease (CKD). Cerebral oxygen saturation (rSO2) was reportedly associated with the estimated glomerular filtration rate (eGFR) and cognitive function. However, data concerning the association between cerebral rSO2 and dietary intake of CKD patients is limited. This was a single-center observational study. We recruited 67 CKD patients not undergoing dialysis. Cerebral rSO2 was monitored using the INVOS 5100c oxygen saturation monitor. Energy intake was evaluated by dietitians based on 3-day meal records. Daily protein and salt intakes were calculated from 24-h urine collection. Multivariable regression analysis showed that cerebral rSO2 was independently associated with energy intake (standardized coefficient: 0.370) and serum albumin concentration (standardized coefficient: 0.236) in Model 1 using parameters with p < 0.10 in simple linear regression analysis (body mass index, Hb level, serum albumin concentration, salt and energy intake) and confounding factors (eGFR, serum sodium concentration, protein intake), and the energy/salt index (standardized coefficient: 0.343) and Hb level (standardized coefficient: 0.284) in Model 2 using energy/protein index as indicated by energy intake/protein intake and energy/salt index by energy intake/salt intake in place of salt, protein and energy intake. Cerebral rSO2 is affected by energy intake, energy/salt index, serum albumin concentration and Hb level. Sufficient energy intake and adequate salt restriction is important to prevent deterioration of cerebral oxygenation, which might contribute to the maintenance of cognitive function in addition to the prevention of renal dysfunction in CKD patients.

Testosterone replacement for male military personnel - A potential countermeasure to reduce injury and improve performance under extreme conditions.

Tactical operators, inclusive of soldiers in the military, are reliant upon their physiological and psychological state in often volatile and extreme life or death situations that require correct decisions and precise actions to ensure operational success with minimal collateral damage. Accordingly, the development of physical and mental resilience are hallmarks of prophylactic and remedial programs designed to ensure military personnel are combat ready, thus optimising their capacity to perform at expert levels, while reducing their risk of injury or the severity of injury sustained. Unfortunately, despite best efforts, current practices have not overcome the significant logistical challenges confronting a military service member's routine exposure to moderate and severe energy deficits upon deployment, resulting from unyielding energy demands and restricted energy intake during missions [1]. Consequently, these episodes of semi-starvation under complex and extreme tactical environments produces a cascade of interlinked negative outcomes, including a hypogonadal endocrine state (suppressed testosterone production), loss of muscle-bone mass and strength, reduced functional capacity, compromised cognition, and a suppressed immune system, culminating in greater susceptibility to injury, illness and sub-optimal performance, jeopardising their own welfare and the welfare of their comrades.

Skipping Breakfast Before Exercise Creates a More Negative 24-hour Energy Balance: A Randomized Controlled Trial in Healthy Physically Active Young Men

ABSTRACTBackgroundAt rest, omission of breakfast lowers daily energy intake, but also lowers energy expenditure, attenuating any effect on energy balance. The effect of breakfast omission on energy balance when exercise is prescribed is unclear.ObjectivesThe aim of this study was to assess the effect on 24-h energy balance of omitting compared with consuming breakfast prior to exercise.MethodsTwelve healthy physically active young men (age 23 ± 3 y, body mass index 23.6 ± 2.0 kg/m2) completed 3 trials in a randomized order (separated by >1 week): a breakfast of oats and milk (431 kcal; 65 g carbohydrate, 11 g fat, 19 g protein) followed by rest (BR); breakfast before exercise (BE; 60 min cycling at 50 % peak power output); and overnight fasting before exercise (FE). The 24-h energy intake was calculated based on the food consumed for breakfast, followed by an ad libitum lunch, snacks, and dinner. Indirect calorimetry with heart-rate accelerometry was used to measure substrate utilization and 24-h energy expenditure. A [6,6-2H2]glucose infusion was used to investigate tissue-specific carbohydrate utilization.ResultsThe 24-h energy balance was −400 kcal (normalized 95% CI: −230, −571 kcal) for the FE trial; this was significantly lower than both the BR trial (492 kcal; normalized 95% CI: 332, 652 kcal) and the BE trial (7 kcal; normalized 95% CI: −153, 177 kcal; both P < 0.01 compared with FE). Plasma glucose utilization in FE (mainly representing liver glucose utilization) was positively correlated with energy intake compensation at lunch (r = 0.62, P = 0.03), suggesting liver carbohydrate plays a role in postexercise energy-balance regulation.ConclusionsNeither exercise energy expenditure nor restricted energy intake via breakfast omission were completely compensated for postexercise. In healthy men, pre-exercise breakfast omission creates a more negative daily energy balance and could therefore be a useful strategy to induce a short-term energy deficit. This trial was registered at clinicaltrials.gov as NCT02258399.

Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis.

Common strategies for reducing body weight rely on limiting energy intake and restricting food choices. However, these strategies have often been proven ineffective in achieving long-term and sustainable weight reduction. More recently, mindful eating as an alternative weight management strategy has gained increasing attention, yet systematic reviews on intuitive or mindful eating published so far present contradictory results. We performed a systematic review and meta-analysis on randomized controlled trials on weight loss programs based on mindful or intuitive eating. We analyzed results using meta-regressions. We included a total of 10 studies and found a significant weight loss effect of mindful/intuitive eating strategies compared with nonintervention controls (-0.348 kg, 95% CI: -0.591 to -0.105, P = 0.005). However, there was no difference compared with conventional diet programs (P = 0.99). Reduction of BMI (-0.137 kg/m2 , 95% CI: -0.365 to 0.091, P = 0.240) or waist circumference (-0.358 cm, 95% CI: -0.916 to 0.200, P = 0.209) were not statistically significant. Mindful/intuitive eating could be a practical approach to weight control. Limitations of this study include the unbalanced sex, origin, place of residence of the participants, and the short duration of interventions. Future research should aim at investigating long-term effects and include a more heterogeneous study population.

Lingguizhugan decoction attenuates diet-induced obesity and hepatosteatosisviagut microbiota

BACKGROUNDObesity is a major risk factor for a variety of diseases such as diabetes, nonalcoholic fatty liver disease, and cardiovascular diseases. Restricting energy intake, or caloric restriction (CR), can reduce body weight and improve metabolic parameters in overweight or obese patients. We previously found that Lingguizhugan decoction (LZD) in combination with CR can effectively lower plasma lipid levels in patients with metabolic syndrome. However, the mechanism underlying CR and LZD treatment is still unclear.AIMTo investigate whether CR and LZD improve metabolic parameters by modulating gut microbiota.METHODSWe extracted the water-soluble components out of raw materials and dried as LZD extracts. Eight-week old male C57BL/6 mice were treated with a 3-d treatment regime that included 24 h-fasting followed by gavage of LZD extracts for 2 consecutive days, followed by a normal diet (ND) ad libitum for 16 wk. To test the effects of gut microbiota on diet-induced obesity, 8-wk old male C57BL/6 mice received fecal microbiota transplantation (FMT) from CR and LZD-treated mice every 3 d and were fed with high-fat diet (HFD) ad libitum for 16 wk. Control mice received either saline gavage or FMT from ND-fed mice receiving saline gavage as mentioned above. Body weight was monitored bi-weekly. Food consumption of each cage hosting five mice was recorded weekly. To monitor blood glucose, total cholesterol, and total triglycerides, blood samples were collected via submandibular bleeding after 6 h fasting. Oxygen consumption rate was monitored with metabolic cages. Feces were collected, and fecal DNA was extracted. Profiles of gut microbiota were mapped by metagenomic sequencing.RESULTSWe found that CR and LZD treatment significantly reduced the body weight of mice fed with ND (28.71 ± 0.29 vs 28.05 ± 0.15, P < 0.05), but did not affect plasma total cholesterol or total triglyceride levels. We then transplanted the fecal microbiota collected from CR and LZD-treated mice under ND feeding to HFD-fed mice. Intriguingly, transplanting the mice with fecal microbiota from CR and LZD-treated mice potently reduced body weight (44.95 ± 1.02 vs 40.53 ± 0.97, P < 0.001). FMT also reduced HFD-induced hepatosteatosis, in addition to improved glycemic control. Mechanistic studies found that FMT increased OCR of the mice and suppressed the expression and protein abundance of lipogenic genes in the liver. Metagenomic analysis revealed that HFD drastically altered the profile of gut microbiota, and FMT modified the profile of the gut microbiota.CONCLUSIONOur study suggests that CR and LZD improve metabolic parameters by modulating gut microbiota.

Influence of Energy Balance on the Rate of Weight Loss Throughout One Year of Roux-en-Y Gastric Bypass: a Doubly Labeled Water Study.

To investigate the influence of changes in energy balance and body composition on the rate of weight loss throughout 1year of Roux-en-Y gastric bypass. Variables were collected pre-, 6, and 12months (M) post-surgery from 18 women (BMI ≥ 40 and ≤ 50kgm-2, 20 to 45years). Total energy expenditure (TEEm), fat-free mass (FFM), and fat mass (FM) were measured by doubly labeled water. Self-reported energy intake (EIsr) was obtained from three non-consecutive food diaries. Metabolic adaptation was assessed via deviations from TEE predictive equation, and the calculated energy intake (EIc) via the sum of TEE and change in body stores. BMI significantly decreased (mean ± SD) from 45 ± 2kgm-2 to 32 ± 3kgm-2 at 6M, and to 30 ± 3kgm-2 at 12M after surgery. The TEEm reduced significantly at both time points when compared with pre-surgery (6M: - 612 ± 317kcalday-1; 12M: - 447 ± 516kcalday-1). At 6M, a metabolic adaptation was observed and the energy balance was - 1151 ± 195kcalday-1, while at 12M it was - 332 ± 158kcalday-1. Changes in the values of TEEm were associated with changes in body weight at 12M post-surgery. A significant underreporting was observed for EIsr (1057 ± 385kcalday-1) vs. EIc (2083 ± 309kcalday-1) at 12M post-operative. The higher rate of weight loss at 6M post-surgery was a response to energy imbalance, which was caused by high restriction in energy intake even with the presence of metabolic adaptation at this time. The EIsr was not sufficiently accurate to assess the energy consumption of this population. Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.

Acute liver injury and anorexia nervosa: a case report

Anorexia nervosa is an eating disorder characterized by restriction of energy intake leading to a significant decrease in body weight. While it is primarily a psychiatric disorder, numerous medical complications can occur. In this article we describe a case of a 25-year-old woman with a 12-year history of severe restrictive anorexia nervosa that was referred to the Emergency Service of our Hospital, transferred from a psychiatric institute, for severe weight loss, dehydration, and progressive increase in transaminases. During the hospital stay she developed an acute liver injury with an increase in transaminase level up to 40× the ULN. Infective and immunological causes of acute hepatitis were excluded. In the suspect of severe starvation acute liver injury, we performed a nutritional assessment and started parenteral nutrition. After 15 days of parenteral nutrition, she gained 2.5 kg of body weight and liver tests were drastically reduced and nearly normal.

The Current State of Weight-Cutting in Combat Sports-Weight-Cutting in Combat Sports.

In combat sports, athletes are divided into categories based on gender and body mass. Athletes attempt to compete against a lighter opponent by losing body mass prior to being weighed (i.e., ‘weight-cutting’). The purpose of this narrative review was to explore the current body of literature on weight-cutting and outline gaps for further research. Methods of weight-loss include energy intake restriction, total body fluid reduction and pseudo extreme/abusive medical practice (e.g., diuretics). The influence of weight-cutting on performance is unclear, with studies suggesting a negative or no effect. However, larger weight-cuts (~5% of body mass in <24 h) do impair repeat-effort performance. It is unclear if the benefit from competing against a smaller opponent outweighs the observed reduction in physical capacity. Many mechanisms have been proposed for the observed reductions in performance, ranging from reduced glycogen availability to increased perceptions of fatigue. Athletes undertaking weight-cutting may be able to utilise strategies around glycogen, total body water and electrolyte replenishment to prepare for competition. Despite substantial discussion on managing weight-cutting in combat sports, no clear solution has been offered. Given the prevalence of weight-cutting, it is important to develop a deeper understanding of such practices so appropriate advice can be given.

Can we cure type 2 diabetes?

Can we cure type 2 diabetes?

The role of intermittent fasting and meal timing in weight management and metabolic health.

Obesity remains a major public health concern and intermittent fasting is a popular strategy for weight loss, which may present independent health benefits. However, the number of diet books advising how fasting can be incorporated into our daily lives is several orders of magnitude greater than the number of trials examining whether fasting should be encouraged at all. This review will consider the state of current understanding regarding various forms of intermittent fasting (e.g. 5:2, time-restricted feeding and alternate-day fasting). The efficacy of these temporally defined approaches appears broadly equivalent to that of standard daily energy restriction, although many of these models of intermittent fasting do not involve fed-fasted cycles every other 24 h sleep-wake cycle and/or permit some limited energy intake outside of prescribed feeding times. Accordingly, the intervention period therefore may not regularly alternate, may not span all or even most of any given day, and may not even involve absolute fasting. This is important because potentially advantageous physiological mechanisms may only be initiated if a post-absorptive state is sustained by uninterrupted fasting for a more prolonged duration than applied in many trials. Indeed, promising effects on fat mass and insulin sensitivity have been reported when fasting duration is routinely extended beyond sixteen consecutive hours. Further progress will require such models to be tested with appropriate controls to isolate whether any possible health effects of intermittent fasting are primarily attributable to regularly protracted post-absorptive periods, or simply to the net negative energy balance indirectly elicited by any form of dietary restriction.

SAT-096 Later Timing of Energy Intake Associates with Higher Fat Mass in Adults with Overweight and Obesity

Background Emerging literature suggests that later timing of energy intake and sleep are related to obesity (1-3). However, few studies have assessed both meal and sleep timing in adults with obesity, and it is not clear whether eating later in the day is associated with shorter sleep duration or higher adiposity. Understanding whether temporal feeding and sleep patterns are associated with body composition will help in the design of novel weight loss and maintenance interventions aimed at altering the timing of lifestyle behaviors. Methods Thirty-two overweight and obese adults (90% female sex, age 36.4±6.4 years, and BMI=33.4±5.5 kg/m2) were recruited to participate in an ongoing weight loss trial comparing daily caloric restriction to time-restricted feeding. Participants simultaneously wore an activPAL accelerometer on the thigh and an Actiwatch on the non-dominant wrist for 7 days in a free-living environment to assess waking sedentary behavior and nighttime sleep, respectively. A cell phone application (MealLogger) was used to photograph and timestamp all caloric events during the 7-day period to determine daily feeding duration, which was verified using a continuous glucose monitor. Assessments were performed at baseline and will be repeated at 12 weeks following completion of the weight loss intervention. Correlation analyses were performed on baseline data to determine associations among the duration and timing of daily energy intake and sleep. Results are reported as mean±SD. Results On average, participants consumed energy over 11.0±1.9 hours during the day and slept for 7.2±0.7 hours at night. The clock time of the last caloric event averaged 7:54pm ± 93 min. Later meal timing (midpoint of the feeding window) was positively correlated with later sleep timing (midpoint of the sleep window, r = 0.67, P = <0.0001) but did not impact sleep duration. A later feeding midpoint correlated with higher BMI (r = 0.49, P = 0.005) and fat mass (r = 0.55, P = 0.001). Conclusions We used a novel set of methods to show that individuals with overweight and obesity may be eating later into the day. In addition, later meal timing was associated with higher BMI and fat mass. Future studies are needed to compare the timing of energy intake and sleep in normal weight versus obese individuals. These findings support ongoing studies by our group investigating whether restricting energy intake to the early part of the day lowers obesity risk. References (1) McHill et al., Am J Clin Nutr. 2017 Nov;106(5):1213-1219. (2) Baron et al., Obesity (Silver Spring). 2011 Jul;19(7):1374-81. (3) Garaulet, Gomez-Abellan, Physiol Behav. 2014 Jul;134:44-50. Sources of Research Support: This research has received funding from the NIH

Overeating, caloric restriction and breast cancer risk by pathologic subtype: the EPIGEICAM study

This study analyzes the association of excessive energy intake and caloric restriction with breast cancer (BC) risk taking into account the individual energy needs of Spanish women. We conducted a multicenter matched case-control study where 973 pairs completed lifestyle and food frequency questionnaires. Expected caloric intake was predicted from a linear regression model in controls, including calories consumed as dependent variable, basal metabolic rate as an offset and physical activity as explanatory. Overeating and caloric restriction were defined taking into account the 99% confidence interval of the predicted value. The association with BC risk, overall and by pathologic subtype, was evaluated using conditional and multinomial logistic regression models. While premenopausal women that consumed few calories (>20% below predicted) had lower BC risk (OR = 0.36; 95% CI = 0.21–0.63), postmenopausal women with an excessive intake (≥40% above predicted) showed an increased risk (OR = 2.81; 95% CI = 1.65–4.79). For every 20% increase in relative (observed/predicted) caloric intake the risk of hormone receptor positive (p-trend < 0.001) and HER2+ (p-trend = 0.015) tumours increased 13%, being this figure 7% for triple negative tumours. While high energy intake increases BC risk, caloric restriction could be protective. Moderate caloric restriction, in combination with regular physical activity, could be a good strategy for BC prevention.