Percent Weight Change Research Articles

2007-P: Weight Change and Intentionality of Weight Loss Relate to Mortality Risk in the Postintervention (Years 8-16) Phase of Look AHEAD

The health effects of weight loss in older individuals with diabetes is unclear, perhaps related to intentionality of the weight loss. Look AHEAD (LA) is a randomized trial comparing intensive lifestyle intervention for intentional weight loss with diabetes support and education (control) in 5145 individuals (age 45-76 at baseline) with overweight/obesity and type 2 diabetes. We examined the association of weight change trajectories post-intervention (i.e., yrs 8 to 16; M± SD percent weight change= -3.10% ±10.1), and concurrent risk of mortality by comparing weight gainers (N=226), maintainers (N=1459), modest losers (N=2206), and steep losers (N=415). Both weight loss groups were older, more likely to be in DSE, and lost less weight in yrs 1-8. In Cox proportional hazards regression models, adjusted for sex, race, baseline obesity, age, and treatment, mortality risk among the 4 weight change categories differed significantly (p<0.0001). Relative to maintainers, the hazard ratio for death was non-significantly lower in gainers (HR= .58, 95%CI 0.30,1.11) but significantly higher in modest losers (HR=1.49, 95%CI 1.20,1.36) and steep losers (HR=1.87, 95%CI 1.39,2.53). Adjusting for weight change baseline to year 8 did not alter the associations. Subsequent analyses examined the difference in the hazard ratios for death in those who reported having lost >10 lb over 2 most recent 6-month assessments intentionally, unintentionally, or through the combination (intentional + unintentional), relative to maintainers (no weight loss>10 lb). Adjusted analyses showed that the HR for mortality was significantly greater in both the unintentional (HR=3.26, 95%CI 2.35,5.01) and the combination (HR=2.63, 95%CI 1.28,5.39), but not different in the intentional weight loss group (HR=1.05, 95%CI 0.61,1.81) relative to maintainers. These data suggest that unintentional weight loss is associated with increased risk of mortality in older individuals with diabetes. Disclosure R.R. Wing: None. J. Clark: None. M. Espeland: Other Relationship; Self; Boehringer Ingelheim International GmbH, Ironwood Pharmaceuticals. J.O. Hill: Stock/Shareholder; Self; Gelesis, Shakabuku LLC. R.W. Jeffery: None. K.C. Johnson: None. W.C. Knowler: None. R.H. Neiberg: None. K. Olson: None. H.O. Steinberg: None. H. Wyatt: Research Support; Self; National Cattleman’s Association, Novo Nordisk Inc. Stock/Shareholder; Self; Shakabuku LLC. Other Relationship; Self; FoodMinds. Funding National Institutes of Health

Self-Reported Weight and Height Among Idiopathic Intracranial Hypertension Patients.

Idiopathic intracranial hypertension (IIH) mostly affects overweight and obese women. Severe obesity is associated with poorer visual outcomes in IIH, and weight gain can precipitate IIH and increase the risk of recurrence. Conversely, weight loss can decrease intracranial pressure and is an effective IIH treatment. Therefore, accurate monitoring of weight and body mass index (BMI) is important to help guide the management of IIH patients. Our goal was to compare estimated and measured BMI among patients with presumed IIH and non-IIH controls to determine whether these vital signs should be systematically measured when evaluating patients for IIH. A retrospective chart review was performed of consecutive patients with reported and measured weight and height seen in one ophthalmology-based neuro-ophthalmology clinic for IIH between January 2, 2018 and September 10, 2018. Patients with IIH or presumed IIH were compared to non-IIH controls, matched according to age (±5 years), BMI (±5 kg/m unless ≥40 kg/m), sex, and race. Patients with confirmed IIH were asked to self-report their weight when seen in follow-up and they were weighed to compare their self-reported vs measured percent weight change. We included 379 subjects (140 patients; 239 controls) among whom 75 of the IIH patients were matched to non-IIH controls. Patients with presumed or definite IIH accurately estimated their height and generally underestimated their weight by a median of 1.8 kg (4 lb), resulting in a median BMI underestimate of 0.9 kg/m. There was no difference in BMI underestimation when comparing presumed or definite IIH patients to matched non-IIH controls while controlling for insurance status, smoking, diabetes, and vascular disease (P = 0.66). As BMI increased, all subjects underestimated their BMI more (by 0.9% per 10 measured BMI unit increase), when controlling for age, sex, and race (P < 0.003). Sixteen confirmed IIH patients were seen in follow-up. At initial neuro-ophthalmology consultation, these subjects underestimated their weight by a mean of 3.2%. At last follow-up they underestimated their weight by only 1.2% (P = 0.03). There was no evidence that IIH or presumed IIH patients had a different perception of their weight than non-IIH controls at initial neuro-ophthalmology consultation. Both patients and matched controls tended to underestimate their weight by the same amount, resulting in an overall BMI underestimation of approximately 1% per 10 measured BMI unit increase. Heavier subjects tended to underestimate their body weight and resultant BMI more, and IIH patients tended to estimate their weight more accurately at follow-up. Our results emphasize the need to systematically objectively measure the weight of presumed IIH patients seen in an ophthalmology clinic.

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.

Weight Change in Kidney Transplant Recipients: An Academic Medical Center-Based Study

Abstract Objectives Kidney transplant recipients often experience weight gain in the first year after transplantation and this weight gain is associated with higher rates of cardiovascular disease, new-onset diabetes, metabolic syndrome and loss of graft function. The purpose of this study was to examine the characteristics of transplant recipients at our institution and describe post-transplant weight change. Methods Utilizing the institution's research data repository, we searched for adult kidney transplant patients from January 2014 through February 2019. Percent weight change at 6 and 12 months was calculated as a percentage of total body weight from time of transplant. Weight gain was defined as an increase of 5% or more while weight stable was classified as no weight change or less than 5% gain. Weight loss was defined as losing 5% or more of body weight from baseline. Results Of 598 cases, the sample was predominantly male (n = 361; 60%), married (n = 355; 59%) and white (n = 415; 69%). At transplant, mean age was 51.3 ± 13.5 years and mean weight was 85.26 ± 20.10 kg (males = 90.62 ± 20.73 kg; females = 77.53 ± 16.33 kg). At 6 months post-transplant, 87% of recipients (n = 518) had recorded weights. Of those individuals, 26% (n = 133) experienced weight gain (mean + 11.9%; median + 9.9%), gaining on average 8.9 ± 5.09 kg. Thirty one % (n = 163) lost weight (mean −10.3%; median - 8.8%), and 43% (n = 222) were weight stable. At 12 months post-transplant, 78.1% (n = 467) of patients had recorded weights. Of those individuals, 42% (n = 195) experienced weight gain (mean + 13%, median + 10%), 18% (n = 86) lost weight (mean −10.95%, median - 8.94%), and 40% (n = 185) maintained baseline weight. Those who gained weight during this period experienced a 10.16 ± 6.00 kg increase. Conclusions Post-transplant weight gain is a critical issue among our institution's kidney transplant recipients with more than 40% gaining significant weight, placing them at risk for early mortality and decreased graft survival. Healthcare professionals should continue to educate and direct recipients to weight management programs to control the amount of weight gained following transplantation. Helping kidney transplant recipients prevent unnecessary weight gain is essential to their prolonged survival and quality of life. Funding Sources None.

Initial Weight Loss Among Breastfed Ugandan Neonates and Its Association with Subsequent Growth

Abstract Objectives To describe initial newborn weight loss and its association with subsequent growth among at-risk newborn populations in Uganda. Methods We weighed 205 breastfeeding infants born at ≥2000 g in Kampala and Mukono, Uganda, to ± 5 g at &amp;lt;6 hours of age and at 1, 2, 3, 4, 5, 12 and 30 days of age. Data was collected on feeding and health outcomes. Percent weight change was defined as the difference between weight at &amp;lt;6 hours and subsequent weight, expressed as a proportion of birth weight. Fisher's exact and the Wilcoxon rank sum test were used for bivariate analysis of dichotomous and continuous variables, respectively, to account for outcome frequency. Results In this cohort, all infants were delivered vaginally and 99 (49%) were male (Table). Mean weight and length at birth were 3153 ± 415 g and 48.2 ± 2.0 cm, respectively; 9 (4%) infants were low birth weight (LBW). At 30 days of age, 199 (99.5%) of infants were still breastfeeding, 173 (85%) infants had received supplementary feeding during the first month, and 4 (2%) had received formula during the first month. Weight nadir occurred at 1.7 ± 1.3 days of age, when weight change was −5.6 ± 3.4% of birthweight. At 30 days of age, weight-for-age z-score (WAZ) ≤−2 occurred among 10 (5%) infants. Weight nadir was 9.3% ± 5.7% below birth weight for infants who eventually had 30-day WAZ ≤−2, compared to 5.4% ± 3.2% below birth weight for infants who eventually had 30-day WAZ &amp;gt;−2 (P = 0.005). In this cohort, 8 (90%) of LBW infants were born to primiparous mothers, compared to 59 (30%) non-LBW infants (P = 0.002). Infants of primiparous mothers were also more likely to have low WAZ at 30 days of age (70% vs. 31%; P = 0.02). Conclusions In this cohort of breastfed infants from Kampala and Mukono, Uganda, breastfeeding newborns lost about 6% of their birth weight at nadir, which occurred at an average of 1.7 days of age. Infants born to primiparous mothers appeared to be at greater risk of underweight at 30 days of age. Understanding the relationship between early weight loss and subsequent outcomes could inform the development of strategies to optimize growth. Funding Sources The Bill and Melinda Gates Foundation.

Racial/ethnic variations in weight management among patients with overweight and obesity status who are served by health centres.

This study sought to examine racial/ethnic variations in receipt of provider recommendations on weight loss, patient adherence, perception of weight, attempts at weight loss and actual weight loss among patients with overweight/obesity status at Health Resources and Services Administration-funded health centres (HC). We used a 2014 nationally representative survey of adult HC patients with overweight/obesity status (PwOW/OB) last year and reported the HC was their usual source of care (n = 3517). We used logistic regression models to assess the interaction of race/ethnicity and having obesity in (1) provider recommendations of diet or (2) exercise, (3) patient adherence to diet or (4) exercise, (5) perceptions of weight and (6) weight loss attempts. We used a multinomial regression model to examine (7) weight loss or gain vs no change and a linear regression model to evaluate (8) percent weight change. We found Black PwOW/OB (OR = 1.65) experienced greater odds of receiving diet recommendations than Whites. We found limited racial/ethnic disparities in adherence. Black (OR = 0.41), Hispanic/Latino (OR = 0.45), and American Indian/Alaska Native (OR = 0.41) PwOW/OB had lower odds of perceiving themselves as overweight. Black (OR = 1.68) and Hispanic (OR = 1.98) PwOW/OB had a greater odds of reporting weight gain, and Asian PwOW/OB (OR = 0.42) had lower odds of reporting weight loss than Whites. Disparities in provider diet recommendations among Blacks and Hispanics indicated the importance of personalized weight management recommendations. Understanding underlying reasons for discordance between self-perception and observed weight among different groups is needed. Overall increase in weight, despite current interventions, should be addressed through targeted racially/ethnically appropriate approaches.

Weight loss and persistence with liraglutide 3.0 mg by obesity class in the real-world effectiveness study in Canada.

SummaryObjectiveLiraglutide 3.0 mg is associated with clinically significant weight loss in clinical trials, but real‐world data are lacking. In this analysis, weight loss and persistence outcomes with liraglutide 3.0 mg were assessed across obesity classes, in a real‐world clinical setting.MethodsSecondary analysis of an observational, retrospective study of liraglutide 3.0 mg for weight management (as adjunct to diet and exercise) at six Wharton Medical Clinics in Canada. Patients were categorized by body mass index (BMI, kg/m2) into obesity class I (BMI 30–34.9); class II (BMI 35–39.9); and class III (BMI ≥40). Change in weight, categorical weight loss, time to maintenance dose (defined as the time to reach the full liraglutide 3.0 mg maintenance dose) and persistence were assessed for each class and for differences between classes.ResultsOf 308 patients, 70 (22.7%) had obesity class I, 83 (26.9%) obesity class II and 155 (50.3%) obesity class III. Similar percentage change in weight was observed between obesity classes (mean [standard deviation, SD]: −7.0% [6.0], −6.6% [6.0] and −6.1% [5.0], respectively; p = .640), and similar proportions achieved ≥5% weight loss (60.4%, 62.0% and 55.3%, respectively; p = .717) at 6 months. Mean time to maintenance dose (SD) was 64.2 (56.4) d, 76.4 (56.3) d and 71.4 (54.5) d for obesity classes I, II and III, respectively (p = .509). Persistence with medication was also similar between obesity classes (p = .358).ConclusionsThese findings suggest that real‐world treatment with liraglutide 3.0 mg, regardless of obesity class, is associated with similar clinically significant weight loss, time to maintenance dose and medication persistence.

Study on banana, Bristle coir and jute mixed natural composites heat transfer properties analysis for insulation

In this experimental investigation based on natural composites such as banana, Bristle coir and jute mixed with different percentage based on weight for the insulation on cylindrical exhaust smog passage to identify the heat transfer properties analysis such as thermal conductivity, thermal resistance and temperature differences. In this investigation 50% of Bristle coir used for three combinations of natural composite only change in percentage of weight varied for banana fiber (25%, 20% and 15%)and jute fiber (25%, 30% and 35%). There are three different thicknesses of natural composites such as 2 mm, 4 mm and 6 mm considered for investigation.

Preoperative C-Peptide Predicts Weight Gain After Pancreas Transplantation

Transplant recipients are susceptible to cardiovascular complications, obesity, and increased insulin resistance after transplant. Here we assess weight gain in diabetic recipients after pancreas transplantation. This is a single-center study of 32 simultaneous pancreas and kidney and 5 pancreas after kidney transplant recipients from 2014 to 2018. Starting C-peptide levels ≤ 0.1 ng/mL were used to denote insulin nondetectability (n = 25) and C-peptide levels > 0.1 ng/mL as insulin detectability (n = 12). Hemoglobin A1c, body mass index (BMI), and weight following transplantation were assessed. Hemoglobin A1c at 1 year was 5.9% in the insulin nondetectable recipients and 5.6% in the insulin detectable group (P = .56). Average BMI after transplant was higher in the insulin detectable group 28.6 versus 24.4 kg/m2 (P = .03) despite no difference in starting BMIs (24.9 versus 24.0 kg/m2, P = .42). The insulin detectable group also had a larger percentage weight change from their starting weight 13.1% versus 0.9 % at 1 year (P = .02). Linear regression demonstrated that starting C-peptide was a significant predictor of weight gain posttransplant. Patients with elevated C-peptides at time of transplant are susceptible to rapid weight gain postoperatively. These patients may benefit from aggressive nutritional management.

Effects of Curcumin Supplementation on Quality of Life of Cystic Fibrosis Patients

Background: Cystic fibrosis (CF) is one of the most common genetic disorders in children. CF patients are susceptible to chronic lung infections and malabsorption. Although patient longevity is increased by multidisciplinary care, patients still suffer from respiratory failure and low quality of life. In this situation, CF patients tend to use complementary treatments. To the best of our knowledge there is no research about curcumin supplementation in CF patients; thus, we decided to investigate the effects of curcumin supplementation on anthropometric indices, and quality of life in children with cystic fibrosis. Materials and Methods This randomized control-controlled clinical study was conducted in Tabriz University of Medical Sciences, Iran. Forty CF patients were randomly sorted into intervention (n=20), and control (n=20) groups. Patients received 3 curcumin nanoparticles (80 mg; total dose 240 mg/d) for six consecutive months. Before and after intervention, height and weight were measured and quality of life of patients was evaluated by the Pediatric Quality of Life Inventory (PedsQL) 4.0 (CITE). Results: After intervention, the percentage of weight changes showed a significant increase in the curcumin group compared to the control group (7.48±4.68 vs. 4.15±4.68 kg, p=0.03). Following the intervention, only the percentage of change in emotional functioning scores was significant (p=0.01). Subjects in the curcumin group showed a trend towards more improvement in terms of percentage change in physical functioning (19.28±31.65 vs. 15.24±47.14), and school functioning scores (40.96±42.93 vs 23.90±14.82) compared with the control group. Conclusion Our findings suggest that curcumin may be a useful, inexpensive, and safe supplement in combination with conventional therapy to improve body weight in CF children.

The effect of dried Ziziphus vulgaris on glycemic control, lipid profile, Apo-proteins and hs-CRP in patients with type 2 diabetes mellitus: A randomized controlled clinical trial.

We aimed to evaluate the effect of dried Ziziphus vulgaris [Z. vulgaris] consumption on liver enzymes, blood pressure, inflammatory status, glycemic control, and lipid concentrations in type 2 diabetes patients. Seventy-six diabetic participants (aged 20-65years) randomly assigned to intervention (n=38) and placebo (n=38) groups. The intervention group received 30g/day dried Z. vulgaris for 12weeks. At the end of the study, there was a significant reduction in the percentage change of weight, body mass index [BMI], insulin, homeostasis model assessment-insulin resistance [HOMA-IR], Apoprotein B100 [ApoB100], and high-sensitive c-reactive protein [hs-CRP] in the intervention group compared to the controls. Also, increased values of quantitative insulin check index [QUICKI] and Apoprotein A-I [ApoA-I] in Z. vulgaris group compared to the controls were observed. In conclusion, consumption of dried Z. vulgaris fruit could have beneficial effects on improving the glycemic control and reducing the cardiovascular risk factors in the diabetic patients. PRACTICAL APPLICATIONS: In the present study we found that consumption of 30g/day dried Z. vulgaris fruit in patients with type 2 diabetes for 12weeks has beneficial anti-inflammatory, anti-hyperglycemic, and anti-hyperlipidemic effects on type 2 diabetes mellitus [T2DM] patients compared to the control group. Thus, it seems reasonable to design a large-scale clinical trial to determine the potential adverse effects of higher doses of this fruit and identify the therapeutic doses for the complementary treatment in T2DM medication. The medication with this popular fruit as an ingredient could be easily accepted by diabetic patients and may reduce the dependency and dosage of some of the routine diabetes medications which often have some adverse side effects.

Thermogravimetric Analysis and Mass Spectrometry Allow for Determination of Chemisorbed Reaction Products on Metal Organic Frameworks.

Thermogravimetric analysis (TGA) is a technique which can probe chemisorption of substrates onto metal organic frameworks. A TGA method was developed to examine the catalytic oxidation of S-nitrosoglutathione (GSNO) by the MOF H3[(Cu4Cl)3(BTTri)8] (abbr. Cu-BTTri; H3BTTri = 1,3,5-tris(1H-1,2,3-triazol-5-yl)benzene), yielding glutathione disulfide (GSSG) and nitric oxide (NO). Thermal analysis of reduced glutathione (GSH), GSSG, GSNO, and Cu-BTTri revealed thermal resolution of all four analytes through different thermal onset temperatures and weight percent changes. Two reaction systems were probed: an aerobic column flow reaction and an anaerobic solution batch reaction with gas agitation. In both systems, Cu-BTTri was reacted with a 1 mM GSH, GSSG, or GSNO solution, copiously rinsed with distilled-deionized water (dd-H2O), dried (25 °C, < 1 Torr), and assessed by TGA. Additionally, stock, effluent or supernatant, and rinse solutions for each glutathione derivative within each reaction system were assessed by mass spectrometry (MS) to inform on chemical transformations promoted by Cu-BTTri as well as relative analyte concentrations. Both reaction systems exhibited chemisorption of glutathione derivatives to the MOF by TGA. Mass spectrometry analyses revealed that in both systems, GSH was oxidized to GSSG, which chemisorbed to the MOF whereas GSSG remained unchanged during chemisorption. For GSNO, chemisorption to the MOF without reaction was observed in the aerobic column setup, whereas conversion to GSSG and subsequent chemisorption was observed in the anaerobic batch setup. These findings suggest that within this reaction system, GSSG is the primary adsorbent of concern with regards to strong binding to Cu-BTTri. Development of similar thermal methods could allow for the probing of MOF reactivity for a wide range of systems, informing on important considerations such as reduced catalytic efficiency from poisoning, recyclability, and loading capacities of contaminants or toxins with MOFs.

Ameliorative Effect of Propolis Against Thioacetamide Induced Hepatorenal Injury in Adult Male Rats. Kidney Injury Molecule-1 (KIM-1) a Biomarker of Renal Injury

Abstract Background: Thioacetamide (TAA), a known industrial toxic agent, is extensively used in animal studies for induction of hepatic necrosis, fibrosis and cirrhosis, also reported to be nephrotoxic through induction of oxidative stress. Propolis, bee glue, is known by its antioxidant and anti-inflammatory properties. Aim of Study: This work aimed to evaluate the potential protective effect of propolis on TAA-induced hepatorenal damage and to evaluate the efficacy of Kidney Injury Molecuole-1 (KIM-1) in early detection of renal injury. Material and Methods: This study was performed on 24 adult male albino rats, divided into 3 groups; (I) Control group, (II) TAA-group (TAA was given in a dose of 50mg/kg /day intraperitoneally, 5 days/week for 2 weeks), (III) TAA-propolis treated group (TAA was given in the same way as in TAA-group, propolis was given in a dose of 500mg/kg/day by gavage, 5 days/week for 2 weeks). All studied rats were subjected to determination of initial and final body weight, body weight percent change, absolute and relative liver and kidney weight, as well as assessment of hepatic function by serum Alanine Transaminase (ALT) and Aspartate Transam-inase (AST), renal function by serum urea, creatinine and potassium (K+) level, with determination of renal tissue oxidative stress markers; Malondialdehyde (MDA) and Glu-tathione-S-Transferase (GST), inflammatory marker; Mye-loperoxidase (MPO), renal tissue damage marker; Kidney Injury Molecule-1 (KIM-1). In addition, specimens of liver and kidney were taken and processed for light microscopic studies. Results: TAA induced hepatotoxic and nephrotoxic effect that was evident by the significantly increased serum ALT, AST, urea and creatinine, with significant decrease in serum K+ level as well as significantly increased renal tissue MDA, GST, MPO and KIM-1 when compared with control group. Treatment with propolis caused significant reduction in serum ALT, AST, urea and creatinine, with significant elevation in serum K+ as well as significant reduction in renal tissue MDA, GST, MPO and KIM-1 when compared to the TAA group, but still significantly higher compared to controls except for urea. These results were confirmed by the histopathological findings. Conclusion: Propolis could partially ameliorate the TAA induced hepatorenal damage, which might be related to attenuation of oxidative stress and inflammation. Moreover, KIM-1 could be beneficial in detection of renal injury.

A48 COLITIS FAVORS THE EXPANSION OF BACTERIA THAT ACTIVATE PAR2 AMPLIFYING INFLAMMATORY RESPONSE

Abstract Background Proteolytic imbalance has been described in patients with inflammatory bowel disease (IBD) and in different models of experimental colitis. Although the proteases reported to be increased are mainly from the host, the role of bacterial proteases has recently emerged, as they can promote inflammation, in part, through activation of Protease-activated receptors (PARs). PAR2 deficient mice are resistant to inflammation and PAR2 activation affects multiple aspects of the tissue response to injury. However, PAR2 communicates with other receptors such as toll-like and other PARs, which are important in multiple immune signaling pathways. Thus, the direct implication of PAR2 in colitis, and specifically the activation of the external domain by microbial proteases, remains unclear. Aims To study the role of PAR2 and bacterial proteases in experimental colitis. Methods C57BL/6 and protease-resistant PAR2 (R38E-PAR2) mice, in which activation site of PAR2 is missing, were given 3.5% dextran sodium sulfate (DSS) in drinking water for 5 days followed by 2 days of water. Control C57BL/6 (wild-type) and R38E-PAR2 mice received only water. Percent weight change was evaluated along the study. Fecal microbiota (16S Ilumina), expression of proinflammatory genes (Nanostring), gut permeability (Ussing chamber), proteolytic activities (colorimetric assay) and bacterial translocation (plating) were measured in all mice at sacrifice. Inflammation was determined by analyzing stool consistency, fecal blood and by microscopic scores (Cooper score). Bacteria with proteolytic activity were isolated using agar-media with protein as main nutrient and bacterial capacity to release the external domain of PAR2 was tested in cells harbouring luciferase at the PAR2 N terminus. Results Wild-type, but not R38E-PAR2 mice, had increased expression of several pro-inflammatory genes, such as tnf, map3k and tlr, gut dysfunction and increased intestinal permeability, increased bacterial translocation into spleen and altered microbiota profiles following DSS treatment. DSS induced colitis in both mouse strains, but clinical and microscopic scores were significantly lower in R38E-PAR2 compared with wild-type mice. DSS increased the abundance of opportunistic pathogens such as Enterococcus and Staphylococcus only in wild-type mice. Proteolytic phenotype of these bacteria, and their capacity to cleave the external domain of PAR2, was confirmed. Conclusions Mice lacking the activation site of PAR2 are protected from DSS-induced colitis. DSS treatment leads to expansion of bacteria releasing active proteases, which may mediate injury through PAR2. These results suggest that intestinal injury promotes microbial proteolytic imbalance which in turn, exacerbates inflammation. Funding Agencies CAG, CCC, CIHR

Effects of proactive and rescue enteral tube feedings on weight change in children undergoing treatment for high-grade CNS tumors.

Children with high-grade CNS cancers frequently experience malnutrition during treatment. We assessed the effects of proactive enteral tube (ET) placement/enteral tube feedings (ETF) on weight in infants/children with high-grade CNS tumors treated with aggressive chemotherapy. We conducted a retrospective study of patients age 0 to 19 years treated for new high-grade CNS tumors between 2002 and 2017 at a tertiary pediatric hospital system. Patients underwent placement of proactive ET (≤ 31 days postdiagnosis; n = 45), rescue ET (> 31 days, due to weight loss; n = 9), or no ET (n = 18). Most received surgically placed ET (98%), with percutaneous endoscopic gastrojejunostomy or gastrojejunostomy tubes favored to allow jejunal feeding. The majority of patients with ET used ETF (91%). Using mixed-effects regression models, we examined differences in mean weights between ET/ETF groups across the first year of treatment. We also evaluated observed weight changes. All infants (n = 22, median age, 1.5 years) had proactive ET placed and 21 of 22 used proactive ETF. Infants showed an initial increase in mean percentage weight change that eventually leveled off, for an estimated increase of 10.4% over the year. For the pediatric cohort (n = 50, median, 8.1 years), those receiving proactive ETF experienced weight increases (+9.9%), those with rescue ETF experienced an initial decline and eventually rebounded for no net change (0.0%), and those with no ETF demonstrated an initial decline that persisted (-11.9%; P interaction < .001). Analysis of observed weights revealed nearly identical patterns. Proactive ETF was effective at maintaining weight and/or facilitating weight gain over the first year of treatment and was acceptable to patients/families.

A randomized controlled trial of a theory-based weight-loss program for couples.

Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples. Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months. Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02). Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effectiveness of Lifestyle Intervention for Type 2 Diabetes in Primary Care: the REAL HEALTH-Diabetes Randomized Clinical Trial.

Intensive lifestyle interventions (LI) improve outcomes in obesity and type 2 diabetes but are not currently available in usual care. To compare the effectiveness and costs of two group LI programs, in-person LI and telephone conference call (telephone LI), to medical nutrition therapy (MNT) on weight loss in primary care patients with type 2 diabetes. A randomized, assessor-blinded, practice-based clinical trial in three community health centers and one hospital-based practice affiliated with a single health system. A total of 208 primary care patients with type 2 diabetes, HbA1c 6.5 to < 11.5, and BMI > 25kg/m2 (> 23kg/m2 in Asians). Dietitian-delivered in-person or telephone group LI programs with medication management or MNT referral. Primary outcome: mean percent weight change. 5% and 10% weight loss, change in HbA1c, and cost per kilogram lost. Participants' mean age was 62 (SD 10) years, 45% were male, and 77% were White, with BMI 35 (SD 5) kg/m2 and HbA1c 7.7 (SD 1.2). Seventy were assigned to in-person LI, 72 to telephone LI, and 69 to MNT. The mean percent weight loss (95% CI) at 6 and 12months was 5.6% (4.4-6.8%) and 4.6% (3.1-6.1%) for in-person LI, 4.6% (3.3-6.0%) and 4.8% (3.3-6.2%) for telephone LI, and 1.1% (0.2-2.0%) and 2.0% (0.9-3.0%) for MNT, with statistically significant differences between each LI arm and MNT (P < 0.001) but not between LI arms (P = 0.63). HbA1c improved in all participants. Compared with MNT, the incremental cost per kilogram lost was $789 for in-person LI and $1223 for telephone LI. In-person LI or telephone group LI can achieve good weight loss outcomes in primary care type 2 diabetes patients at a reasonable cost. ClinicalTrials.gov Identifier: NCT02320253.

Failure Trends of High-Voltage Porcelain Insulators Depending on the Constituents of the Porcelain

The aging of porcelain insulators is responsible for the failure of power utilities. Porcelain insulators from different places in South Korea, possessing various aging times and years of installation, have been investigated to carry out lifetime statistics. These samples have a mass of 36,000 lbs and are operated at 154 kV. X-ray fluorescence (XRF) and scanning electron microscopy (SEM) were performed on the porcelain bodies of the samples collected. XRF and SEM revealed trends in the weight percentage of SiO2, Al2O3, and Fe2O3 in the porcelain bodies of the collected samples. The SiO2 and Fe2O3 weight percentage reduced to 8.93% and 73.17%, respectively, in sample C compared to A. However, the Al2O3 weight percentage increased to 16.23% in sample C compared to sample A. This change in weight percentage of SiO2, Fe2O3, and Al2O3 contributed toward enhancing the mechanical and electrical properties of the insulators. Mechanical load tests with electrical voltage (M&amp;E), thermal and mechanical load tests (T&amp;M), and hardness tests (HRB) were performed to evaluate these characteristics. Experiments revealed an increase of 90.9% in the inequality factor (K) in sample C compared to A. The impact of constituents of porcelain on the lifetime expectancy of a porcelain insulator was reported by implementing statistical strategies, such as the Weibull distribution.

The Effect of Starting the Protein-Sparing Modified Fast on Weight Change over 5 years

Ketogenic diets have been highlighted as a way to lose weight while experiencing reduced hunger. The protein-sparing modified fast (PSMF) induces ketosis but may be difficult to maintain. To track weight loss for individuals initiating PSMF versus all other diets (e.g., balanced, high protein) for up to 5 years. Retrospective cohort study PARTICIPANTS: Adults who discussed the PSMF with a clinician between 2007 and 2014 INTERVENTION: Initiating the PSMF diet versus other diets MEASURES: The main outcome was percent weight change up to 5 years. Demographic and health data were collected using electronic health records. We fit regression models including age, sex, race, insurance, new medication prescriptions, and specialist visit to identify the effect of PSMF diet on percent weight change. We grouped patients by percent weight change at each year (≥ 5% loss, 4% loss to 4% gain, ≥ 5% gain) and used Pearson χ2 tests to compare proportions. Of 1,403 eligible patients, 879 (63%) started the PSMF. The PSMF group was slightly younger (52 vs. 54 years, p < 0.01) and had a higher body mass index (41.9 kg/m2 vs. 40.4 kg/m2, p < 0.001). In the adjusted analysis, the PSMF group averaged 3% more weight loss than the other group over the 5-year follow-up (95% CI - 3.5, - 2.0, p < 0.001). PSMF patients lost more weight initially, but by year 4, there was no difference between diets (1.6% versus 1.3%, PSMF versus other diets, p = 0.12). Patients starting the PSMF were more likely to experience ≥ 5% weight loss at 1 year (55% vs 20%, p < 0.001) and 3 years (33% vs. 23% p < 0.05), but not 5 years (34% vs 29%, p = 0.16, PSMF versus other diets, respectively). In clinical practice, the PSMF achieves rapid weight loss in the first 6 months, but only a small percentage of patients maintained significant weight loss long term.

Association of anthropometry and weight change with risk of dementia and its major subtypes: A meta-analysis consisting 2.8 million adults with 57 294 cases of dementia.

SummaryUncertainty exists regarding the relation of body size and weight change with dementia risk. As populations continue to age and the global obesity epidemic shows no sign of waning, reliable quantification of such associations is important. We examined the relationship of body mass index, waist circumference, and annual percent weight change with risk of dementia and its subtypes by pooling data from 19 prospective cohort studies and four clinical trials using meta‐analysis. Compared with body mass index–defined lower‐normal weight (18.5‐22.4 kg/m2), the risk of all‐cause dementia was higher among underweight individuals but lower among those with upper‐normal (22.5‐24.9 kg/m2) levels. Obesity was associated with higher risk in vascular dementia. Similarly, relative to the lowest fifth of waist circumference, those in the highest fifth had nonsignificant higher vascular dementia risk. Weight loss was associated with higher all‐cause dementia risk relative to weight maintenance. Weight gain was weakly associated with higher vascular dementia risk. The relationship between body size, weight change, and dementia is complex and exhibits non‐linear associations depending on dementia subtype under scrutiny. Weight loss was associated with an elevated risk most likely due to reverse causality and/or pathophysiological changes in the brain, although the latter remains speculative.