Loss Of Lean Tissue Research Articles

The effects of resistance exercise on cardiometabolic health and body composition in obese or overweight individuals undergoing dietary weight loss interventions: A systematic review and meta-analysis

Obesity prevalence has tripled in over the past 35 years and has detrimental effects on physical and psychological health(1). Weight loss via dietary intervention is a mainstay for the treatment of obesity and reduces body fat(2), but also results in loss of lean tissue(3). A potential solution to mitigate the loss of lean tissue, and thus enhance the benefits of weight loss, is resistance exercise. The aim of the current systematic review was to examine the impact of resistance exercise on body weight/composition and markers of cardiometabolic health, as well as physical function, in people living with overweight or obesity undergoing dietary weight loss interventions.A search was performed in PubMed, Embase, CINAHL, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) based on the set inclusion and exclusion criteria. Systematic searches yielded N=5147 studies of which n=27 were relevant for inclusion after screening for eligibility. We included randomised controlled clinical trials of adult participants (18-65 years of age) with body mass index (BMI) ≥ 25kg/m2) that compared dietary weight loss interventions including resistance exercise with 1) dietary weight loss interventions including other non-resistance exercise and/or 2) dietary weight loss interventions without any exercise. Resistance exercise was classed as any form of resistance or muscle strengthening exercise (e.g. gym or home- based, supervised or non-supervised, used equipment or body weight only). Key data were extracted, risk of bias was assessed using the Cochrane risk of bias tool, and the quality of evidence assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Meta-analysis was performed including only studies that compared dietary weight loss plus resistance exercise interventions to diet-only (i.e. not including any other exercise) weight loss interventions to explore differences in body weight/composition and cardiometabolic health changes between diet plus resistance exercise and diet only interventions.Overall, resistance exercise in addition to diet-induced weight loss had no effect on weight loss (mean difference between groups: -0.32kg, 95% confidence interval [CI] -1.00 to 0.35; p=0.35) but did preserve fat free mass (between-group standardised mean difference (SMD): 0.40, 95%, [CI] 0.18 to 0.61; p=0.0003) and increase loss of fat mass (SMD: -0.36, 95% [CI] -0.49 to -0.23; p< 0.00001). Muscular strength was also improved (SMD: 2.36, 95% [CI] 1.38 to 3.34; p=0.00001) by the inclusion of resistance exercise. No effects of resistance exercise were seen in any of the other cardiometabolic markers studied, although data were limited.In people who are obese or overweight, the addition of resistance exercise to dietary restriction may enhance its beneficial effects. Current evidence, therefore, supports the inclusion of resistance exercise during weight loss to attenuate the loss of lean mass, increase fat mass loss and improve muscle strength.

Long-term sustained effects of the Look AHEAD lifestyle intervention on body composition among adults with type 2 diabetes.

The objective of the study was to test whether there are sustained effects of the Look AHEAD intensive lifestyle intervention (ILI), versus diabetes support and education (DSE), on weight and body composition 12 to 16 years after randomization. Participants were a subset of enrollees in the Look AHEAD dual-energy x-ray absorptiometry substudy who completed the final visit, composed of men (DSE = 99; ILI = 94) and women (DSE = 134; ILI = 135) with type 2 diabetes and mean (SD) age 57.2 (6.4) years and BMI 34.9 (5.1) kg/m2 at randomization. Dual-energy x-ray absorptiometry measured total and regional fat and lean masses at randomization, at Years 1, 4, and 8, and at the final visit. Linear mixed-effects regressions were applied with adjustment for group, clinic, sex, age, race/ethnicity, and baseline body composition. Weight and most body compartments were reduced by 2% to 8% (and BMI 4%) in ILI versus DSE in men but not women. ILI-induced loss of lean tissue did not show a lower percent lean mass versus DSE at 16 years after randomization. ILI-related changes in weight, fat, and lean mass were detectable 12 to 16 years after randomization in men but, for unknown reasons, not in women. There was no evidence that the intervention led to a disproportionate loss of lean mass by the end of the study.

Weight loss outcomes are generally worse for dogs and cats with class II obesity, defined as > 40% overweight

In pet dogs and cats, adiposity is most-often estimated clinically using a 9-category body condition score (BCS), with BCS 9 equating to ~ 40% overweight. Animals that are more overweight (> 40%) are seen in clinical practice but are not appropriately depicted by descriptions in the existing categories. To determine whether being > 40% overweight has clinical relevance, this study aimed to compare the outcomes of weight management in animals that were > 40% overweight with those < 40% overweight. Records of dogs and cats attending a specialist obesity care clinic, where adiposity is determined using dual-energy X-ray absorptiometry (DXA), were reviewed. Animals were assigned to two classes (class I ≤ 40% overweight: 118/398 [40%] dogs and 68/116 [59%] cats; class II, > 40% overweight: 180/398 [60%] dogs and 48/116 [41%] cats) based on DXA results, and weight loss outcomes were compared. Fewer class II dogs obesity completed weight management than class I dogs (P < 0.001), rate of weight loss was also slower (P = 0.012) and lean tissue loss greater (P < 0.001). Compared with class I, cats with class II obesity lost more weight (P = 0.048) albeit over a longer period (P = 0.043) leading to greater lean tissue loss (P = 0.004). Approximately half the pets presenting to a specialist clinic were have class II obesity (> 40% overweight), and some weight loss outcomes are worse for these animals.

Partial weight reduction protocols in cats lead to better weight outcomes, compared with complete protocols, in cats with obesity.

To date, there have been no studies comparing outcomes of cats with obesity following either complete or partial weight reduction protocols. Fifty-eight cats participated in this non-randomized observational cohort study, including 46 (79%) and 12 (21%) that underwent complete or partial weight reduction protocols, respectively. Weight loss outcomes, body composition changes and essential nutrient intake were compared between cats in the two groups. All cats remained healthy, and those on a complete weight reduction protocol lost a median of 23% (range 10-39%) of starting body weight (SBW) over 294 days (113-967 days), whereas those undergoing partial restriction lost 25% (10-41%) over 178 days (54-512 days). Neither duration nor percentage weight loss differed between groups, but those that followed a partial weight reduction protocol lost weight at a faster rate (0.81% per week) and required fewer visits (4-19) than those that followed a complete weight reduction protocol (0.61% per week, p = 0.028; 11, 4-40 visits, p = 0.009). Further, lean tissue mass declined in cats on a complete weight reduction protocol (pre: 4.20 kg, 2.64-5.72 kg; post: 3.90 kg, 2.76-5.24 kg, p < 0.001), whereas lean tissue mass was unchanged in cats on partial weight reduction protocols (pre: 3.45 kg, 2.79-4.71 kg; post: 3.41 kg, 2.90-4.59 kg, p = 0.109). In 33 (57%) cats, median intake of selenium per day was less than NRC AI and RA recommendations, whilst intake was under FEDIAF recommendation in 42 (72%) cats. Median intake of choline per day was less than NRC MR and RA recommendations in 22 (38%) and 53 (91%) cats, respectively, whereas it was under the FEDIAF recommendation in 51 (88%) cats. In a small proportion (12-14%) of cats, phenylalanine/tyrosine and potassium were under recommendations; besides these, no other essential nutrient deficiencies were seen, and there were no differences between cats undergoing complete and partial weight reduction. Partial weight reduction protocols in cats lead to quicker average weight loss, with the possibility that lean tissue loss might be minimized. Such protocols might be more suitable for older cats and those with marked obesity.

High-intensity interval training prevents muscle mass loss in overweight Chilean young adults during a hypocaloric-Mediterranean diet: a randomized trial.

The hypocaloric Mediterranean diet (MD) mainly reduces fat mass but inevitably causes a loss of skeletal muscle mass. High-intensity interval training (HIIT) seems to have advantages in preserving muscle mass during a hypocaloric regime. Our study compares body composition and metabolic changes in overweight and obese Chilean women and men after 3 months of weight loss treatment with a Mediterranean-type hypocaloric diet, HIIT, or a combination of both. The study included 83 overweight or obese women and men between the ages of 25 and 50. The subjects were randomly assigned to one of the three intervention groups: (1) MD, (2) EX, and (3) MD + EX. Baseline and post-intervention measurements included: (a) body composition by dual-beam densitometry, muscle, and fat measurements by thigh ultrasound and computed tomography; (b) handgrip and quadriceps muscle strength; (c) exercise performance by peak oxygen consumption, peak load, work efficiency, and exercise energy expenditure; and (d) metabolic parameters. Out of 83 participants, the retention rate was 49% due to low compliance with the interventions. As expected, the MD group resulted in significantly greater weight loss (MD -7%, EX -0.6% and MD + EX -5.3%) and appendicular fat mass loss (MD -11.1%, EX -2.9, MD + EX -10.2%) but was associated with significant lean tissue loss (2.8%), which was prevented by HIIT (EX -0.1 and MD + EX -0.6%). Metabolic and glycoxidative parameters remained unchanged, irrespective of changes in body composition. Hypocaloric diets remain the most effective means to lose weight and body fat. However, it induces a loss of lean body mass when not accompanied by exercise training. This study shows that HIIT prevents the loss of muscle mass caused by a hypocaloric Mediterranean diet.

FRI-513 - Fat versus lean tissue loss in short term versus long term weight loss: a dynamic effect with implications for NASH trials

FRI-513 - Fat versus lean tissue loss in short term versus long term weight loss: a dynamic effect with implications for NASH trials

441. Association between Incident HIV-Associated Wasting/Low Weight and All-Cause Mortality in the OPERA® Cohort

Abstract Background HIV-associated wasting (i.e., progressive, involuntary weight loss with both fat and lean tissue loss; HIVAW) is an under-appreciated AIDS-defining illness; the 2012-2018 period prevalence was reported as 18% in a recent claims study in the United States. We aimed to assess the association between incident HIVAW/low weight and all-cause mortality in the era of modern combination antiretroviral therapy (ART). Methods In the Observational Pharmaco-Epidemiology Research &amp; Analysis (OPERA®) cohort, PWH without (a) any prior HIVAW/low weight, (b) malignancy within 3 years, and (c) opportunistic infection within 1 year who were active in care between 2016 and 2020 were followed through death, loss to follow-up, or study end (31OCT2021). HIVAW/low weight included a wasting or low BMI/underweight diagnosis (ICD codes, title search) or BMI &amp;lt; 20 kg/m2. Hazard ratios (HR) and 95% confidence intervals (CI) for the association between time-dependent incident HIVAW/low weight (exposure) and all-cause mortality (outcome) were estimated with extended Cox regression models. The adjusted model included age at baseline, race, ethnicity, and time-dependent covariates (log10 viral load, Veterans Aging Cohort Study [VACS] Mortality Index score). Viral load and VACS score were included as surrogate markers for ART use and comorbidities, respectively. Linear and quadratic terms of continuous variables were included. Results Of 67,119 PWH without prior HIVAW/low weight in OPERA®, 62,314 (93%) PWH had non-missing covariate data and were included in the models; baseline characteristics did not differ between the full and model study populations (Table 1). Over a median follow-up of 45 months (interquartile range: 27, 65), there were 4,755 (8%) cases of incident HIVAW/low weight and 1,354 (2%) deaths. In the adjusted model, PWH who experienced incident HIVAW/low weight had a significantly increased risk of death over follow-up than those who did not experience HIVAW/low weight (HR: 1.96; 95% CI: 1.68, 2.27) (Table 2). Conclusion In this analysis of 62,314 PWH in care, incident HIVAW/low weight was associated with twice the risk for all-cause mortality in the modern ART era. Particular attention needs to be paid to HIVAW/low weight among PWH to restore health and potentially reduce the risk of death. Disclosures Rachel P. Weber, PhD, AIDS Healthcare Foundation: Client of my employer|EMD Serono: Client of my employer|Gilead Sciences: Client of my employer|Janssen: Client of my employer|Merck &amp; Co.: Client of my employer|TheraTechnologies: Client of my employer|ViiV Healthcare: Client of my employer Laurence Brunet, PhD, AIDS Healthcare Foundation: Client of my employer|EMD Serono: Client of my employer|Gilead Sciences: Client of my employer|Janssen: Client of my employer|Merck &amp; Co: Client of my employer|TheraTechnologies: Client of my employer|ViiV Healthcare: Client of my employer Javeed Siddiqui, MD, MPH, Abbvie: Advisor/Consultant|Abbvie: Honoraria|Cumberland pharmaceuticals: Advisor/Consultant|Cumberland pharmaceuticals: Honoraria|EMD serono: Advisor/Consultant|EMD serono: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria Javeed Siddiqui, MD, MPH, Abbvie: Advisor/Consultant|Abbvie: Honoraria|Cumberland pharmaceuticals: Advisor/Consultant|Cumberland pharmaceuticals: Honoraria|EMD serono: Advisor/Consultant|EMD serono: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria Michael Harbour, MD, MPH, FACP, EMD Serono: Employee Amy L. Phillips, PharmD, EMD Serono, Inc.: Employment Brooke Hayward, SM, MBA, EMD Serono, Inc.: Employee Jennifer S. Fusco, BS, AIDS Healthcare Foundation: Client of my employer|EMD Serono: Client of my employer|Gilead Sciences: Client of my employer|Janssen: Client of my employer|Merck &amp; Co.: Client of my employer|TheraTechnologies: Client of my employer|ViiV Healthcare: Client of my employer Ricky K. Hsu, MD, Gilead: Honoraria|Merck: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria Gregory P. Fusco, MD, MPH, AIDS Healthcare Foundation: Client of employer|EMD: Grant/Research Support|Gilead Sciences: Client of employer|Janssen: Client of employer|Merck &amp; Co.: Client of employer|Theratechnologies: Client of employer|ViiV Healthcare: Client of employer.

Short-Term Effects of Weight Loss after Bariatric Surgery on Respiratory and Skeletal Muscles’ Strength

Background: Bariatric surgery leads to weight loss and body fat percentage reduction, but patients are prone to lean tissue loss which itself reduces the quality of life, and increases the risk of deatand h. This study evaluated the effects of bariatric surgery and changes in Fat Mass (FM) and Fat-Free Mass (FFM) on the respiratory and skeletal muscles’ strength three months after bariatric surgery.&#x0D; Methods: After obtaining demographic information, anthropometric measurements and body composition analysis, including Body Mass Index (BMI), FM, FFM, Percent Body Fat (PBF), handgrip isometric force, respiratory muscle forces and spirometry volumes, were assessed before and three months after bariatric surgery in 50 men and women undergoing this surgery.&#x0D; Results: Weight, BMI, FM, PBF and FFM isometric muscle force were decreased significantly. In contrast, respiratory muscle forces and respiratory volumes were increased significantly three months after the surgery. Reduction in FFM 3 months after the surgery did not lead to a change in respiratory muscle strength (p-values≥0.05).&#x0D; Conclusion: According to our findings, FM and FFM along with weight and BMI decrease significantly after bariatric surgery. These alternations were accompanied by a significant increase in respiratory muscle strength but were not correlated with handgrip muscle force changes.

Nutritional Strategies to Prevent Muscle Loss after Bariatric Surgery

Obesity is a chronic non-communicable disease that has increased dramatically worldwide [1]. The 2015 National Health and Morbidity Survey (NHMS) showed that the prevalence of overweight, obesity and abdominal obesity in Malaysia had increased by 0.6%, 2.6% and 2.0% respectively as compared to the previous findings of NHMS 2011[2]. Thus, many approaches have been attempted including bariatric surgery. However, it is associated with complications like lean tissue loss, augmented bone loss and a high risk of postprandial hypoglycemia due to patients being unable to achieve adequate dietary protein and accelerated nutrient emptying. Hence, this review paper provides several findings on possible causes of muscle tissue loss and nutritional strategies to prevent muscle loss.&#x0D; &#x0D; Initially, a literature search was conducted from electronic databases like PubMed, Scopus and Google Scholar Science Direct. A total of 15 articles on nutritional strategies to prevent muscle loss after bariatric surgery that was published between January 2017 and May 2022 were retrieved. In this review, several causes of muscle tissue loss, its consequences on a patient’s health and nutritional strategies to preserve muscle protein are summarized in the following figures.&#x0D; In conclusion, bariatric surgery leads to the loss of lean body mass and fat-free mass due to a significant decrease in protein intake and rapid weight loss. This will lead to several consequences that impair basal metabolism and body functions and reduce life quality [7]. Regular and sufficient protein intake together with resistance exercise are essential for muscle preservation [4]. Further research should be continued to increase the understanding of the pathophysiology and related mechanism that causes muscle loss and develop appropriate treatment and possible modifications in current bariatric procedures available.

Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage.

Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage.

IFIT2-depleted metastatic oral squamous cell carcinoma cells induce muscle atrophy and cancer cachexia in mice.

BackgroundInterferon‐induced protein with tetratricopeptide repeat 2 (IFIT2) is a reported metastasis suppressor in oral squamous cell carcinoma (OSCC). Metastases and cachexia may coexist. The effect of cancer metastasis on cancer cachexia is largely unknown. We aimed to address this gap in knowledge by characterizing the cachectic phenotype of an IFIT2‐depleted metastatic OSCC mouse model.MethodsGenetically engineered and xenograft tumour models were used to explore the effect of IFIT2‐depleted metastatic OSCC on cancer cachexia. Muscle and organ weight changes, tumour burden, inflammatory cytokine profiles, body composition, food intake, serum albumin and C‐reactive protein (CRP) levels, and survival were assessed. The activation of the IL6/p38 pathway in atrophied muscle was measured.ResultsIFIT2‐depleted metastatic tumours caused marked body weight loss (−18.2% vs. initial body weight, P < 0.001) and a poor survival rate (P < 0.01). Skeletal muscles were markedly smaller in IFIT2‐depleted metastatic tumour‐bearing mice (quadriceps: −28.7%, gastrocnemius: −29.4%, and tibialis: −24.3%, all P < 0.001). Tumour‐derived circulating granulocyte‐macrophage colony‐stimulating factor (+772.2‐fold, P < 0.05), GROα (+1283.7‐fold, P < 0.05), IL6 (+245.8‐fold, P < 0.001), IL8 (+616.9‐fold, P < 0.001), IL18 (+24‐fold, P < 0.05), IP10 (+18.8‐fold, P < 0.001), CCL2 (+439.2‐fold, P < 0.001), CCL22 (+9.1‐fold, P < 0.01) and tumour necrosis factor α (+196.8‐fold, P < 0.05) were elevated in IFIT2‐depleted metastatic tumour‐bearing mice. Murine granulocyte colony‐stimulating factor (+61.4‐fold, P < 0.001) and IL6 (+110.9‐fold, P < 0.01) levels were significantly increased in IFIT2‐depleted metastatic tumour‐bearing mice. Serum CRP level (+82.1%, P < 0.05) was significantly increased in cachectic shIFIT2 mice. Serum albumin level (−26.7%, P < 0.01) was significantly decreased in cachectic shIFIT2 mice. An assessment of body composition revealed decreased fat (−81%, P < 0.001) and lean tissue (−21.7%, P < 0.01), which was consistent with the reduced food intake (−19.3%, P < 0.05). Muscle loss was accompanied by a smaller muscle cross‐sectional area (−23.3%, P < 0.05). Muscle atrophy of cachectic IFIT2‐depleted metastatic tumour‐bearing mice (i.v.‐shIFIT2 group) was associated with elevated IL6 (+2.7‐fold, P < 0.05), phospho‐p38 (+2.8‐fold, P < 0.05), and atrogin‐1 levels (+2.3‐fold, P < 0.05) in the skeletal muscle. Neutralization of IL6 rescued shIFIT2 conditioned medium‐induced myotube atrophy (+24.6%, P < 0.01).ConclusionsOur results suggest that the development of shIFIT2 metastatic OSCC lesions promotes IL6 production and is accompanied by the loss of fat and lean tissue, anorexia, and muscle atrophy. This model is appropriate for the study of OSCC cachexia, especially in linking metastasis with cachexia.

Effect of 2-year caloric restriction on organ and tissue size in nonobese 21- to 50-year-old adults in a randomized clinical trial: the CALERIE study

Sustained calorie restriction (CR) promises to extend the lifespan. The effect of CR on changes in body mass across tissues and organs is unclear. We used whole-body MRI to evaluate the effect of 2 y of CR on changes in body composition. In an ancillary study of the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial, 43 healthy adults [25-50 y; BMI (kg/m2): 22-28] randomly assigned to 25% CR (n = 28) or ad libitum (AL) eating (n = 15) underwent whole-body MRI at baseline and month 24 to measure adipose tissue in subcutaneous, visceral, and intermuscular depots (SAT, VAT, and IMAT, respectively); skeletal muscle; and organs including brain, liver, spleen, and kidneys but not heart. The CR group lost more adipose tissue and lean tissue than controls (P < 0.05). In the CR group, at baseline, total tissue volume comprised 32.1%, 1.9%, and 1.0% of SAT, VAT, and IMAT, respectively. The loss of total tissue volume over 24 mo comprised 68.4%, 7.4%, and 2.2% of SAT, VAT, and IMAT, respectively, demonstrating preferential loss of fat vs. lean tissue. Although there is more muscle loss in CR than AL (P < 0.05), the loss of muscle over 24 mo in the CR group comprised only 17.2% of the loss of total tissue volume. Changes in organ volumes were not different between CR and AL. The degree of CR (% decrease in energy intake vs. baseline) significantly (P < 0.05) affected changes in VAT, IMAT, muscle, and liver volume (standardized regression coefficient ± standard error of estimates: 0.43 ± 0.15 L, 0.40 ± 0.19 L, 0.55 ± 0.17 L, and 0.45 ± 0.18 L, respectively). Twenty-four months of CR (intended, 25%; actual, 13.7%) in young individuals without obesity had effects on body composition, including a preferential loss of adipose tissue, especially VAT, over the loss of muscle and organ tissue. This trial was registered at www.clinicaltrials.gov as NCT02695511.

Adults with Crohn\u2019s disease exhibit elevated gynoid fat and reduced android fat irrespective of disease relapse or remission

Crohn’s disease (CD) is a debilitating inflammatory bowel condition of unknown aetiology that is growing in prevalence globally. Large-scale studies have determined associations between female obesity or low body mass index (BMI) with risk of CD at all ages or 8– < 40 years, respectively. For males, low BMI entering adult life is associated with increased incidence of CD or ulcerative colitis up to 40 years later. Body composition analysis has shown that combinations of lean tissue loss and high visceral fat predict poor CD outcomes. Here, we assessed dietary intake, physical activity and whole or regional body composition of patients with CD relapse or remission. This anthropometric approach found people with CD, irrespective of relapse or remission, differed from a large representative healthy population sample in exhibiting elevated gynoid fat and reduced android fat. CD is associated with mesenteric adipose tissue, or “creeping fat”, that envelops affected intestine exclusive of other tissue; that fat is localised to the android region of the body. In this context, CD mesenteric adiposity represents a stark juxtaposition of organ-specific and regional adiposity. Although our study population was relatively small, we suggest tentatively that there is a rationale to refer to Crohn’s disease as a fatty intestine condition, akin to fatty liver conditions. We suggest that our data provide early insight into a subject that potentially warrants further investigation across a larger patient cohort.

Intestinal-derived FGF15 protects against deleterious effects of vertical sleeve gastrectomy in mice

Bariatric surgeries such as the Vertical Sleeve Gastrectomy (VSG) are invasive but provide the most effective improvements in obesity and Type 2 diabetes. We hypothesized a potential role for the gut hormone Fibroblast-Growth Factor 15/19 which is increased after VSG and pharmacologically can improve energy homeostasis and glucose handling. We generated intestinal-specific FGF15 knockout (FGF15INT-KO) mice which were maintained on high-fat diet. FGF15INT-KO mice lost more weight after VSG as a result of increased lean tissue loss. FGF15INT-KO mice also lost more bone density and bone marrow adipose tissue after VSG. The effect of VSG to improve glucose tolerance was also absent in FGF15INT-KO. VSG resulted in increased plasma bile acid levels but were considerably higher in VSG-FGF15INT-KO mice. These data point to an important role after VSG for intestinal FGF15 to protect the organism from deleterious effects of VSG potentially by limiting the increase in circulating bile acids.

Nutritional Care in Acute and Chronic Illness

Nutrition is essential for maintaining good health and preventing diseases, especially in patients suffering from acute or chronic diseases, infectious diseases, or critical illnesses because dietary intake involves both quantitative and qualitative changes and may disturb energy homeostasis (Richardson & Davidson, 2003). The metabolism of patients with critical illnesses is categorized as hypercatabolic, with significant loss of lean body tissue facilitated by the immune-neuroendocrine response of acute critical illness (Mechanick & Brett, 2005). Therefore, facing hunger during a period of physiological stress because of disease or treatment, results in an increased basal metabolic rate, accelerated protein breakdown, and increased energy and nutritional requirements in response to tissue damage, infection, and inflammation. This situation will develop rapidly into malnutrition or further exacerbate malnutrition because of inflammation and metabolic stress associated with diseases and injuries (Wortinger & Burns, 2015). The inflammatory response triggers the neurophysiology of patients and severely affects digestive behavior (Konsman & Dantzer, 2001), especially in terms of increasing demand for protein to provide amino acids for immunoglobulin and acute-phase protein production, both of which are fundamental to proper immune system functions. Under conditions of severe nutrient deficiency, the protein catabolism of the viscera and skeletal muscle for energy and protein generation will occur quickly in the acute phase. This catabolism has the potential to affect the cardiovascular, respiratory, immune, and all other body systems (Chan, 2015). Therefore, malnutrition during hospitalization may initiate immunosuppression and increase the risk of bacterial spread and sepsis, delayed wound healing, impaired organ function, prolonged hospitalization, and morbidity and mortality (Chan, 2015). As severe malnutrition is related to poor illness or treatment outcomes, which is associated with longer hospitalization and increased medical expenses, assessing patients' nutritional status and providing adequate nutritional care are critical. A nutritional assessment that includes body weight, physical condition and muscle condition, and calculation of resting energy requirements must be included as a standard part of the initial examination received by each patient. The results of this assessment should be considered together with the patient's illness status to formulate a nutritional care plan to provide the nutrition (energy, protein, essential fatty acids, and micronutrients) necessary to meet daily requirements, minimize metabolism, and break down proteins to support the immune system and wound healing (Chan, 2010). It is necessary to provide patients with full-spectrum nutrition and be aware that overeating may also cause metabolic and gastrointestinal complications, liver dysfunction, increased carbon dioxide production, and respiratory muscle weakness (Chan, 2010). Natural food should be provide the main source of nutrition as much as possible, and patients should be encouraged to eat a high-quality, complete diet. Although nutritionists may contribute to the assessment and design of nutritional plans for patients in clinical practice, their limited availability in hospitals disallows their providing the individualized attention required by each patient (Xu et al., 2017). Nurses have the most contact with patients and are most sensitive to their illness conditions. They are able to quickly assess the patient's nutritional needs according to changes in the situation, make referrals, and provide consultations on diet modifications. As the nutritional status of patients is involved in their treatment and physical recovery, nurses have always shouldered inter-professional responsibilities and played an essential role in the nutritional care of patients (Xu et al., 2017). For hospitalized patients and residents of long-term care institutions, nurses are able to pay attention to their nutritional related problems during the process of care, respond rapidly to nutrition-related treatment needs, and participate in the transdisciplinary professional team to prevent patient malnutrition.

Comparing Methods for Assessment of Nutritional Status in Hemodialysis Patients: A Review

The global number of hemodialysis patients has an increasing trend and is still one of the most important protein-energy malnutrition with high morbidity and mortality. Therefore, proper assessment of nutritional status of these patients seems essential. In this review, we compared several methods of nutritional assessment in these patients. It was shown that subjective methods such as subjective global assessment (SGA) were widely used with good validity and accuracy. Malnutrition-inflammation score (MIS) as another common method evaluated the patient’s physical and mental condition based on the level of inflammation. Mini Nutrition Assessment (MNA) as another method assessed the nutritional status of elderly hemodialysis patients, but the interpretation of the results is based on the specific conditions of renal patients. Assessment of body composition by bioelectrical impedance has been one of the most accurate nutritional assessment methods predicting the risk of malnutrition based on the amount of lean tissue loss in the body, but it requires advanced equipment and high financial cost. There are other assessment methods, such as normalized protein catabolic ratio (nPCR) that tries to determine malnutrition based on the amount of dietary protein intake, which is nearly the metabolized protein in the body. Using them alone or in combination with other methods was demonstrated to be beneficial.

Development and packaging of a leucine-rich composite flour for treatment of moderate wasting in children aged 6 – 24 months

Wasting, categorized as either severe or moderate, is a form of child malnutrition that manifests with a low weight-for-height Z-score. Previous treatment methods for moderate wasting, which affects approximately 300,000 children in Kenya, were ineffective as they lacked a mechanism to replace the accelerated loss of lean tissue. Supplementation with leucine, maybe a safe and effective method for treating moderate wasting. At a high dosage, leucine activates the mammalian target of rapamycin within the muscles which enhances gain of lean tissue. Leucine supplements are currently inaccessible to populations affected by moderate wasting in Kenya. The objective of this study was,therefore,to formulate a leucine-rich composite flour (TheraPEM) from locally available foods for treatment of moderate wasting. Six composite flours were prepared using combinations of beans (Phaseolus vulgaris), groundnuts (Voandzeia subterranea), and foxtail millet (Setaria italica) selected for their high leucine content, local availability and relatively low cost. Nutrient composition analysis and sensory evaluation were conducted on each of the six flours. The three preferred flours in terms of sensory attributes were subjected to accelerated shelf-life evaluation to determine changes in peroxide value, fat acidity, moisture content and total viable count. Kraft paper, gunny bags and plastic containers were the packaging materials used.All six flours met the Codex Alimentarius food standards for minimum energy density (80 kcal/100g) and maximum fat content (27 %) in processed cereal-based foods used for complementary feeding of infants and young children. They all also met the required &gt; 1050 mg leucine per 100 grams of flour. Formulations 2, 3 and 5 had the most preferred sensory attributes and were thus subjected to accelerated shelf-life evaluation. At the fifth month, fat acidity was least in the flours packaged in plastic containers. There was no peroxide formation in any of the three samples during the storage period. The study generated six formulations that meet the minimum requirement for leucine in treatment of moderate wasting but formulation 3, had the most preferred sensory attributes. It is recommended that formulation three be subjected to a study to further validate its effectiveness in the treatment of moderate wasting prior to release for up-scaled use.

Ingestion of a Pre-bedtime Protein Containing Beverage Prevents Overnight Induced Negative Whole Body Protein Balance in Healthy Middle-Aged Men: A Randomized Trial

Age related muscle wasting leads to overall reductions of lean body mass, reduced muscle strength, and muscle function resulting in compromised quality of life. Utilizing novel nutritional strategies to attenuate such losses is of great importance in elderly individuals. We aimed to test if a complete dietary supplement containing 25 g of milk proteins and ingested in the evening before bed would improve protein metabolism in terms of whole body protein balance over a 10 h overnight period following ingestion of the test drink in healthy middle-aged male subjects. In addition we also assessed the rates of muscle protein synthesis during the second half of the night in order to see if previously reported extended amino acidemia during sleep results in increased rates of muscle protein synthesis. Seventeen healthy middle-aged male subjects (59.4 ± 3.2 year) consumed a dietary supplement drink at 21:00 containing either 25 g milk protein concentrate, 25 g maltodextrin, 7.75 g canola oil (treatment group), or an isocaloric protein void drink (placebo group). Muscle protein synthesis was assessed from a muscle biopsy following the continuous intravenous infusion of 13C-phenylalanine for 5 h (from 03:00 to 08:00). Whole body protein balance was greater in the treatment group (−0.13 ± 11.30 g prot/10 h) compared to placebo (−12.22 ± 6.91 g prot/10 h) (P ≤ 0.01). In contrast, no changes were observed on rates of muscle protein synthesis during the second half of the night. Ingestion of a dietary supplement containing 25 g of milk proteins significantly reduced the negative protein balance observed during the night. Therefore, pre-bedtime protein ingestion may attenuate overnight losses of lean tissue in healthy elderly men. Despite increases in aminoacidemia during the second part of the night, no changes were observed in the rates of muscle protein synthesis during this time.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02041143.

The efficacy of exercise in the treatment of established obesity

______________________________________________________________ Objective. The objective of this narrative review was to examine cross-sectional empirical data on the efficacy of adequate doses of daily physical activity in the treatment of established obesity. Methods. Information obtained from Ovid/Medline and Google Scholar through to June 2019 was supplemented by a search of the author's extensive personal files. Results. Randomized controlled trials have shown a small but consistent effect of exercise programmes in reducing the body mass and body fat content of the obese. Some non-randomized trials have adopted larger volumes of exercise (2-4 MJ/day), and weight losses of 10 kg or more have then been observed. Dieting has generally given a greater weight loss than exercise, but some of this apparent advantage has reflected a greater loss of lean tissue. Changes in lean tissue mass have under-estimated the beneficial impact of exercise programmes by 2-3 kg, while exaggerating the benefits of dieting by 2-3 kg. Fat loss seems to occur a little more easily in men than in women, and it is also easier to mobilize abdominal fat than subcutaneous fat. The minimal dose of physical activity recommended by public health authorities seems insufficient to deal with established obesity; adults need 150-250 minutes of exercise per week, incurring an additional weekly energy expenditure of 4.8-8.0 MJ, and children may require even larger doses of activity to counter obesity. High intensity programmes save time and may be somewhat more effective for any given energy expenditure than longer periods of moderate activity. A combination of dietary restraint and heavy exercise can cause an 8.5 kg loss of fat over 8 weeks. However, long-term adherence to high intensity programmes is more problematic. It may be helpful to split a single session of aerobic activity into several shorter segments. Causes of a limited response to exercise include an insufficient exercise prescription, poor programme adherence, and a compensatory increase of food intake, compounded by reductions in resting metabolic rate, spontaneous leisure activity and NEAT. Meta-analyses have typically shown weight and fat losses of around 10 kg with 3 months of combined dieting and exercise, but in a few instances much greater weight losses have been reported. Moderate exercise sessions have sometimes added little to dieting alone, but it remains unclear whether more rigorous physical activity programmes might lead to a greater fat loss. Exercise is helpful in preserving lean tissue; it also confers many ancillary health benefits such as enhanced cardio-respiratory fitness, and it may limit the regain of weight after the completion of formal treatment. Resistance exercise is particularly helpful in conserving lean tissue. In a long-term perspective, lifestyle activities may more effective than a formal exercise programme. Much of initial weight loss is often regained within a year, but continued exercise and dieting conserve at least 3 kg of the initial weight reduction. Conclusions. Moderate exercise alone has less effect upon obesity than rigorous dieting, but benefits are larger if the exercise dose can be increased. Exercise helps to conserve lean tissue, and plays an important role in weight maintenance. The challenges to health professionals are to develop safe methods of reaching an effective dose of exercise in those who are obese, and in sustaining the enthusiasm of such individuals for an active lifestyle once initial weight goals have been attained.

Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer

BackgroundPancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy. MethodsThe diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values. ResultsSeventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03–1.17, p = 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08–1.35, p = 0.001). ConclusionsSarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk.