Period Of Weight Loss Research Articles

Caloric restriction, physical exercise, and CB1 receptor blockade as an efficient combined strategy for bodyweight control and cardiometabolic status improvement in male rats

Obesity is critically associated with the development of insulin resistance and related cardiovascular and kidney diseases. Several strategies for weight loss have been developed but most of them exhibit a post-intervention rebound effect. Here, we aimed to design combined weight-loss strategies of caloric restriction, physical exercise, and administration of a CB1 receptor blocker to inhibit food intake that also accomplish the objectives of lost-weight maintenance and improvement of cardiovascular and renal function. Diet-induced obesity (DIO) was generated in Sprague Dawley rats for 12 weeks to test the effects of single or combined strategies (i.e. caloric restriction, mixed training protocol, and/or administration of appetite suppressant) on caloric intake, body weight, cardiovascular and renal functionality resulting from a weight-loss intervention period of 3 weeks followed by 6 weeks of weight maintenance. Consumption of a high-fat diet (HFD) caused a significant increase in body weight (5th week of the experimental period) and led to the development of insulin resistance, cardiovascular, and renal alterations. The different interventions tested, resulted in a significant body weight loss and improved glucose metabolism, aerobic capacity, electrocardiographic parameters, vascular expression of adhesion molecules and inflammatory mediators, and renal functionality, reaching values similar to the control normocaloric group or even improving them. Successful maintenance of lost weight was achieved along a 6-week maintenance period in addition to adequate health status. In conclusion, the weight-loss and maintenance intervention strategies tested were efficient at reversing the obesity-related alterations in body weight, glucose metabolism, aerobic capacity, cardiovascular and renal functionality. The beneficial action was very consistent for caloric restriction and physical exercise, whereas administration of a CB1 receptor blocker complemented the effects of the prior interventions in some parameters like body weight or aerobic capacity, and showed specific actions in renal status, increasing glomerular filtration rate and diuresis. Overall, the novelty of our study relies on the easy implementation of combined strategies for effective weight management that resulted in significant health benefits.

Bariatric surgery can acutely modulate ER-stress and inflammation on subcutaneous adipose tissue in non-diabetic patients with obesity

BackgroundBariatric surgery, especially Roux-en-Y gastric bypass (RYGB), is the most effective and durable treatment option for severe obesity. The mechanisms involving adipose tissue may be important to explain the effects of surgery.MethodsWe aimed to identify the genetic signatures of adipose tissue in patients undergoing RYGB. We evaluated 13 obese, non-diabetic patients (mean age 37 years, 100% women, Body mass index (BMI) 42.2 kg/m2) one day before surgery, 3 and 6 months (M) after RYGB.ResultsAnalysis of gene expression in adipose tissue collected at surgery compared with samples collected at 3 M and 6 M Post-RYGB showed that interleukins [Interleukin 6, Tumor necrosis factor-α (TNF-α), and Monocyte chemoattractant protein-1(MCP1)] and endoplasmic reticulum stress (ERS) genes [Eukaryotic translation initiation factor 2 alpha kinase 3 (EIF2AK3) and Calreticulin (CALR)] decreased during the follow-up (P ≤ 0.01 for all). Otherwise, genes involved in energy homeostasis [Adiponectin and AMP-activated protein kinase (AMPK)], cellular response to oxidative stress [Sirtuin 1, Sirtuin 3, and Nuclear factor erythroid 2-related factor 2 (NRF2)], mitochondrial biogenesis [Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α)] and amino acids metabolism [General control nonderepressible 2 (GCN2)] increased from baseline to all other time points evaluated (P ≤ 0.01 for all). Also, expression of Peroxisome proliferator-activated receptor gamma (PPARϒ) (adipogenesis regulation) was significantly decreased after RYGB (P < 0.05). Additionally, we observed that PGC1α, SIRT1 and AMPK strongly correlated to BMI at 3 M (P ≤ 0.01 for all), as well as ADIPOQ and SIRT1 to BMI at 6 M (P ≤ 0.01 for all).ConclusionsOur findings demonstrate that weight loss is associated with amelioration of inflammation and ERS and increased protection against oxidative stress in adipose tissue. These observations are strongly correlated with a decrease in BMI and essential genes that control cellular energy homeostasis, suggesting an adaptive process on a gene expression level during the caloric restriction and weight loss period after RYGB.Trial registration CAAE: 73,585,317.0.0000.5440

Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity.

Background: Alternate day fasting combined with a low carbohydrate diet (ADF-LC) is an effective weight loss regimen. Whether the weight loss induced by ADF-LC can improve sleep, remains unknown. Objective: This study examined the effect an ADF-LC diet on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity (n = 31) participated in ADF (600 kcal “fast day”; ad libitum intake “feast day”) with a low-carbohydrate diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period. Results: Reductions in body weight (−5 ± 1 kg, p < 0.001) and fat mass (−4 ± 1 kg, p < 0.01) were noted during the weight loss period, and these reductions were sustained during the weight maintenance period. Lean mass and visceral fat remained unchanged. The Pittsburgh Sleep Quality Index (PSQI) score indicated poor sleep quality at baseline (6.4 ± 0.7) with no change by month 3 or 6, versus baseline. ISI score indicated subthreshold insomnia at baseline (8.5 ± 1.0), with no change by month 3 or 6, versus baseline. The percent of subjects with high risk of obstructive sleep apnea at baseline was 45%, with no change by month 3 or 6. Wake time, bedtime, and sleep duration remained unchanged. Conclusion: The ADF-LC diet does not impact sleep quality, duration, insomnia severity or the risk of obstructive sleep apnea in adults with obesity.

Incidencia y factores de riesgo para el desarrollo de colelitiasis tras cirugía bariátrica

IntroductionObesity and rapid weight loss after bariatric surgery (BS) are risk factors for the development of cholelitiasis. The aim of this study is to know the incidence of the de novo symptomatic cholelitiasis (DNSC) after BS and to analyze the risk factors for its development. MethodsSingle-centre retrospective observational study of patients undergoing BS between January 2010 and December 2017. The incidence of DNSC has been studied and sex, age, comorbilities, surgical tecnique, initial BMI and percentage of excess BMI lost (%EIMCP) at 6th, 12th and 24th postoperative months have been analyzed. ResultsAmong the 415 patients who underwent BS, 280 have been studied since they were not previously cholecystectomized and had a preoperative negative abdominal ultrasound. Twenty-nine developed DNSC (10.35%), with a remarkably higher increase in cumulative incidence during the first postoperative year (5%, 95% CI 2,4-7,6). A higher percentage of excess BMI lost at the 6, 12 and 24 postoperative months was statistically significantly correlated with an increased risk of DNSC. ConclusionsIncidence of DNSC and cholecystectomy after BS are relatively high, mainly during rapid weight loss period and even more the higher the percentage of excess BMI lost is. Concomitant cholecystectomy during BS in case of preoperative cholelithiasis regardless of symptoms and the use of ursodeoxycholic acid during the period of greater risk for DNSC development are two therapeutic options to consider.

Binge eating predicts adherence to digital self-monitoring during behavioral weight loss

ObjectiveConsistent self-monitoring of dietary intake, weight, and physical activity predicts better outcomes during behavioral weight loss, but the factors that influence self-monitoring adherence are not well understood. This study attempted to fill gaps in the existing literature by examining whether pre-treatment eating behaviors predict adherence to digital self-monitoring during a behavioral weight loss program. MethodParticipants (N = 77) reported on binge eating, uncontrolled eating, and emotional eating at baseline, and were instructed to self-monitor their food intake, weight, and physical activity using digital devices (food logging app, Fitbit, and wireless “smart” scale) throughout the 12-week treatment. Adherence to self-monitoring was assessed using data captured from these devices. ResultsGreater baseline binge eating severity predicted greater adherence to self-monitoring of weight (ρ = 0.25, p = .03) and eating (ρ = 0.25, p = .03), but not self-monitoring of physical activity. Uncontrolled eating and emotional eating did not significantly predict self-monitoring adherence. ConclusionsIn contrast to previous research, this study found that participants with greater pre-treatment binge eating severity had better adherence to self-monitoring of eating, and for the first time established a relationship between binge eating severity and digital self-monitoring of weight in behavioral weight loss. Individuals with greater pre-treatment binge eating may exhibit characteristics, such as motivation or rigidity, that are beneficial during the initial period of weight loss. Future studies should determine if there are features of analogue versus digital self-monitoring that may explain this pattern of findings, and examine these associations longitudinally.

Effects of gradual weight loss on strength levels and body composition in wrestlers athletes.

Few investigations have evaluated isokinetic torque after a period of weight loss in wrestlers. Thus, the current study sought to investigate the effects of gradual weight loss in the precompetitive period on isokinetic peak torque in the upper and lower limbs and body composition in wrestling athletes. Eight elite athletes participated in the study (mean age 20.8±3.1 years). The athletes visited the laboratory on 2 occasions: during the period of weight maintenance (baseline) and during weight loss, in the precompetitive period (post). The variables analyzed were body composition through air displacement plethysmography (BOD POD) and peak torque (PT) of knee flexion and extension movements, and internal and external shoulder rotation in concentric action, at speeds of 60°/s and 180°/s, determined using an isokinetic dynamometer (Biodex Medical Systems; Shirley, NY, USA). A significant decrease was observed in body composition values, except lean mass. No significant differences were observed in the PT of the movements analyzed: Shoulder internal rotation (60°/s P=0.825; 180°/s P=0.245) and external rotation (60°/s P=0.149; 180°/s P=0.163) and knee extension (60°/s P=0.086; 180°/s P=0.630) and flexion (60°/s P=0.310; 180°/s P=0.239). Gradual weight loss did not affect the production of torque in the wrestlers before a competition. In addition, gradual weight loss contributed to a reduction in body fat, associated with an increase in percentage lean body mass.

Injuries and rapid weight loss in elite Korean wrestlers: an epidemiological study

ABSTRACT Objectives The purpose of this study was to reveal the relationship between rapid weight loss and injury patterns during the training of elite wrestlers, expected to represent South Korea. Methods Since 2019, data for elite wrestlers have been collected prospectively by the Korean Training Center. The data were stratified by sex, wrestling style, weight class, injury location, injuries during the weight-loss period, and weight loss method. The χ2 test was used to compare groups. The risk of injury was indicated by the Poisson rate with a 95% confidence interval (95% CI). Results There were 120 male Greco-Roman, 120 male freestyle, and 100 female freestyle wrestling. The mean weight loss among wrestlers was 5.52 (±1.44) kg, and the mean duration of weight loss was 7.96 (±3.31) days. In general, all wrestlers used similar weight loss methods. We recorded 914 injuries in 340 athletes. Wrestlers had significantly higher injury rates during weight loss periods than during other periods of training (23.18 VS 11.93; p < 0.001). Most injuries occurred in the lower extremities (38.0%), followed by the upper extremities (25.9%), trunk (24.8%), and the head and neck area (11.3%). The injury severity was significantly influenced by sex, wrestling style, and weight class. Conclusion Rapid weight loss is related to the incidence of sports injuries in wrestlers. Most injuries occur during rapid weight loss periods in South Korean elite wrestlers. Moreover, the injury site and injury severity depend on sex, wrestling style, and weight class.

"One stop" liver-focused endoscopy: EUS-guided portal pressure gradient measurement technique.

Referral for abnormal liver chemistry is one of the most frequently encountered reasons for visits to gastroenterologists and hepatologists, particularly given the versatility and vulnerability of the liver.1Kwo P.Y. Cohen S.M. Lim J.K. ACG clinical guideline: evaluation of abnormal liver chemistries.Am J Gastroenterol. 2017; 112: 18-35Crossref PubMed Scopus (395) Google Scholar Here, we present a 40-year-old man with class III obesity, essential hypertension, and hyperlipidemia who was referred for further diagnostic workup of his abnormal liver chemistry. Despite periods of significant weight loss, his liver transaminases had remained elevated over the prior 10 years (alanine aminotransferase 20-93 U/L, aspartate aminotransferase 20-71 U/L). Diagnostic workup included an abdominal ultrasound with evidence of hepatic steatosis and transient elastography (Fibroscan) that demonstrated a liver stiffness of 12.8 kPa, S3 (marked steatosis), and F3 (severe fibrosis). After reviewing the risks, benefits, and alternatives, the decision was made to perform an EGD to evaluate for stigmata of portal hypertension and an EUS to obtain a liver biopsy specimen and portal pressure gradient (PPG) measurements. The patient was intubated and remained in the supine position for the entirety of the procedure (Video 1, available online at www.VideoGIE.org). Initially, an EGD was performed, with no endoscopic evidence of varices or stigmata of portal hypertension. Next, the EUS examination was performed. The left lobe of the liver appeared diffusely hyperechoic, suggestive of steatosis. Real-time elastography was then performed on the left and right lobes of the liver to assess liver stiffness. The region of interest was positioned over the hepatic parenchyma, and an average of 10 measurements was obtained from each lobe of the liver. Mean liver stiffness was 11.5 kPa. The EchoTip Insight Portosystemic Pressure Gradient Measurement System (Cook Medical, Bloomington, Ind, USA) then was set up, involving a 25-gauge FNA needle, noncompressible tubing, a compact digital manometer, and heparinized saline solution. The middle hepatic vein was first identified and punctured using a transgastric approach. Once the needle tip was seen within the vessel, approximately 1 to 2 mL of heparinized saline solution was used to flush the needle. The pressure reading on the manometer was obtained and recorded once stable. This process was repeated a total of 3 times, including repeat flushes of heparinized saline solution to obtain the mean hepatic vein pressure measurement. Next, the umbilical portion of the left portal vein was identified, and using the aforementioned approach, the process was repeated 3 times to obtain the mean portal vein pressure measurement. The PPG was calculated by subtracting the mean hepatic vein pressure (16.4 mm Hg) from the mean portal vein pressure (23.4), which measured 7 mm Hg (consistent with preclinical portal hypertension). Last, EUS-guided liver biopsy was performed. Using a 19-gauge EUS–fine needle biopsy needle primed with heparin, we performed a transgastric puncture to obtain a sample from the left lobe of the liver. This process was then repeated using a transduodenal approach to obtain tissue from the right lobe of the liver. Liver core was then expressed onto a slide and sent to surgical pathology. The patient was discharged home after endoscopy without any adverse events. Surgical pathology from the liver biopsy revealed mild steatohepatitis with stage 0-1/4 fibrosis (Fig. 1). On outpatient follow-up, the patient was started on a stricter diet and exercise regimen for weight loss. EUS-guided applications have been increasing over the past decade; today, both endoscopy and echoendoscopy offer tremendous diagnostic information to help guide management in the workup of liver disease.2Samarasena J. Chang K.J. Endo-hepatology: a new paradigm.Endosc Ultrasound. 2018; 7: 219-222Crossref PubMed Scopus (6) Google Scholar In particular, EUS-guided liver biopsy has emerged as a safe and minimally invasive approach and an alternative to a percutaneous technique and now can be paired with EUS-guided real-time elastography and PPG measurement.3Huang J.Y. Samarasena J.B. Tsujino T. et al.EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.Gastrointest Endosc. 2017; 85: 996-1001Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar,4Shah A. Martinez I.C. Valentin N. et al.Efficacy and safety of endoscopic ultrasound-guided liver biopsies in parenchymal liver diseases: a systematic review and meta-analysis.Am J Gastroenterol. 2018; 113: S565-S566Crossref Google Scholar Here, we demonstrate the safety and technique of EUS-guided PPG measurement in the diagnostic workup of abnormal liver tests. Dr Sharaiha is a consultant for Boston Scientific and Apollo Endosurgery (terminated). All other authors disclosed no financial relationships. https://www.videogie.org/cms/asset/91a9cbf3-9569-4652-812c-a82edde33120/mmc1.mp4Loading ... Download .mp4 (65.17 MB) Help with .mp4 files Video 1“One stop” liver-focused endoscopy: EUS-guided portal pressure gradient measurement technique.

Gene expression of the immunoinflammatory and immunological status of obese dogs before and after weight loss.

Obesity is characterized by a low degree of chronic inflammation state that, along with metabolic modifications, promotes important changes in the animal’s organism. Adipose tissue actively participates in inflammation and immunity, and several defense cells of the organism may, therefore, be involved in the diversity found between obese and ideal weight individuals. Studies regarding this subject have shown immune cell changes in humans and rats, however, the literature is scarce in relation to dogs. Thus, the present study aimed to evaluate the gene expression profile of immunoinflammatory response and the lymphoproliferation of obese dogs before and after weight loss. Eight female dogs, neutered, of different breeds, aged between 1 and 8 years (4.74±3.19), obese, with body condition score (BCS) of 9 out of a 9-point scale and body composition determined by the deuterium isotope dilution method were included. The obese dogs were enrolled in a weight loss program and after losing 20% of their initial weight became a second experimental group. A third experimental group consisted of eight female dogs, neutered, aged between 1 and 8 years (3.11±0.78) and with ideal BCS (5 out of a 9-point scale). Gene expression of immunoinflammatory cytokines (resistin, leptin, adiponectin, TNF-α, IL-6, IL-8, and IL-10) was assessed by qRT-PCR and immunity was assessed by lymphoproliferative response using the flow cytometry technique. The data that presented normal distribution was evaluated by analysis of variance by the PROC MIXED of the SAS and when differences were detected, these were compared by the Tukey test. Regarding the gene expression data, the procedure PROC GLIMMIX was adopted and the methodology of generalized linear model was used, in which the Gama distribution proved to be adequate. Values of p<0.05 were considered significant. The mean weight loss period of the animals included in the study was 194.25 ± 28.31 days and the mean weekly weight loss rate was 1.02 ± 0.82%. The average fat mass, both in percentage (P<0.001) and in kilograms (P = 0.012), was higher in the obese group (40.88%; 8.91kg), returning to normal and without difference between the control group (19.16%; 3.01kg) and after weight loss (22.10%; 4.11kg). The weight loss program resulted in an increase in percentage of lean body mass (P = 0.001), 55.50% in obese animals vs 77.90% in obese dogs after weight loss, the latter with no difference when compared to the control group (80.84%). The obese group presented increased gene expression of resistin and IL-8 in relation to the weight loss group (P = 0.002). In adiponectin, the obese group presented increased mRNA gene expression when compared to the weight loss group (P = 0.003). The evaluation of lymphocyte proliferation showed differences between the group of obese animals before and after weight loss (P = 0.004). Weight loss resulted in an increase in the lymphoproliferation rate (18.48%) compared to obese dogs at the beginning of the study (10.71%). These results indicate that weight loss modulates the immunoinflammatory response of obese dogs and may present important benefits to health and longevity of dogs.

The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery.

Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. Single bariatric center. Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.

Injuries and Rapid Weight Loss in Elite Adolescent Taekwondo Athletes: A Korean Prospective Cohort Study

Abstract Objectives To report injury patterns associated with training activities of elite adolescent Taekwondo athletes who are expected to represent South Korea in the future. Methods Beginning in 2019, we prospectively collected data on elite adolescent Taekwondo athletes at the Korean Training Center. The athletes were assessed by sports medicine doctors, and data were stratified according to sex, weight class, injury location, injuries during the weight loss period, and weight loss method. We used χ2 tests were used to compare groups. Injury rates were expressed as Poisson rates with 95% confidence intervals. Results There were 117 male and 102 female elite adolescent Taekwondo athletes. The mean weight loss among athletes was 3.37 (±1.23) kg, and the mean duration of weight loss was 7.53 (±3.40) days. In general, all athletes used similar weight loss methods. We recorded 846 injuries (annual average, 3.98 injuries/athlete). In general, female athletes had higher injury rates than their male counterparts. Additionally, the athletes had significantly higher injury rates during weight loss periods than during other periods of training. When all athletes were considered, most injuries occurred in the lower extremities (63.2%), followed by the trunk (14.2%), upper extremities (16.3%), and the head and neck area (6.3%). The injury severity significantly influenced the body regions in weight categories. Conclusion Rapid weight loss is related to the incidence of sports damage in athletes. Most injuries occur during weight loss periods in South Korean elite adolescent Taekwondo athletes. Moreover, the injury rate and injury severity depends on weight class.

Liraglutide Augments Weight Loss After Laparoscopic Sleeve Gastrectomy: a Randomised, Double-Blind, Placebo-Control Study.

Both laparoscopic sleeve gastrectomy (LSG) and liraglutide cause a significant weight loss. We evaluated the effect of liraglutide in comparison with placebo on total weight loss (TWL) and excess body weight loss (EWL) and when added in initial weight loss period after LSG in obese individuals. Participants with BMI > 30kg/m2 undergoing LSG were randomised to receive either liraglutide (subcutaneous) in increasing does of 0.6mg/day until maximum tolerated dose of 3.0mg (L-L group) or placebo (L-P group) from 6weeks post-operative until 6months. Weight, BMI, %TWL, %EWL, HbA1c, fasting plasma glucose, HOMA-IR, resolution of type 2 diabetes mellitus, hypertension, dyslipidaemia, sleep apnea and quality of life were evaluated. Primary end point was %TWL and % EWL at post-operative 6months. Thirty participants underwent LSG, and 23 were randomised to receive liraglutide (n = 12) or placebo (n = 11).The mean dose of liraglutide in L-L group was 1.41 ± 0.49mg/day. Patients in L-L group had %TWL of 28.2 ± 5.7 and %EWL of 58.7 ± 14.3 as compared with 23.2 ± 6.2 (p = 0.116) and 44.5 ± 8.6 (p = 0.043) in L-P group at 24weeks, respectively. BMI decreased by 11.7 ± 3.5 in L-L group compared with 9.5 ± 4.0 in L-P group (p = 0.287). All patients with diabetes or pre-diabetes had resolution of dysglycemia in the L-L group as compared with 50% in L-P group. However, there was no significant difference in resolution of other obesity-related comorbidities between two groups at 24-week follow-up. Liraglutide added early after LSG significantly augments weight loss from LSG in obese individuals. The study protocol was registered at clinical trials.gov.in with NCT: 04325581.

Accuracy Of Multi-frequency BIA In %Fat Change During Weight Loss Among Competitive Girl Runners

Periodical measurement of %fat with accuracy is crucial for optimizing the health and performance in competitive runners who need strict weight control. Multi-frequency bioelectrical impedance analysis (MFBIA) is feasible for routine use but the evidence of the accuracy is limited to cross-sectional evaluation and no data is available for tracking of %fat change in competitive runners. PURPOSE: To determine the accuracy of MFBIA for evaluating the decrease in %fat by weight loss among competitive girl runners. METHODS: The data of %fat were obtained from consecutive 25 freshmen long distance runners over 5 years in the same girlʼs high school team and were retrospectively analyzed. The team regularly participated in the All-Japan high school Ekiden championship. MFBIA was performed at the preparatory season (PRE) and repeated after 5.6 ± 0.5 months at the competitive season (CMP) with dual energy X-ray absorptiometry (DXA) as reference. Weight loss period was defined as that between PRE and CMP and changes in %fat (Δ%fat) was calculated by subtracting %fat in PRE from those in CMP. Bland-Altman analysis was used to evaluate the validity of MFBIA compared to DXA for Δ%fat. Statistical significance of the mean difference between MFBIA and DXA was assessed by paired t-test. P<0.05 was considered as statistically significant. Written informed consent was obtained from the runners and their parents. RESULTS: %Fat by DXA vs. MFBIA at PRE and CMP were 19.7 ± 5.6 vs. 17.9 ± 5.4% and 12.7 ± 3.1 vs. 12.2 ± 2.6%, respectively. Thus, systemic error (the mean difference) of Δ%fat between the 2 methods was 1.2 percentage points [pp] (DXA, -6.9 vs. MFBIA, -5.7pp, p=0.008). Random error (the limits of agreement) was -3.0 to 5.5pp and no proportional error was observed between MFBIA and DXA. CONCLUSIONS: The small size of systemic error (mean difference) allow the use of MBIA to evaluate a group mean of Δ%fat. However, due to the large random error size relative to the low level of %fat of the competitive runners, caution should be taken to use MFBIA for individual monitoring of %fat change during weight loss period.

Nondigestible Carbohydrates Affect Metabolic Health and Gut Microbiota in Overweight Adults after Weight Loss

The composition of diets consumed following weight loss (WL) can have a significant impact on satiety and metabolic health. This study was designed to test the effects of including a nondigestible carbohydrate to achieve weight maintenance (WM) following a period of WL. Nineteen volunteers [11 females and 8 males, aged 20-62 y; BMI (kg/m2): 27-42] consumed a 3-d maintenance diet (15%:30%:55%), followed by a 21-d WL diet (WL; 30%:30%:40%), followed by 2 randomized 10-d WM diets (20%:30%:50% of energy from protein:fat:carbohydrate) containing either resistant starch type 3 (RS-WM; 22 or 26g/d for females and males, respectively) or no RS (C-WM) in a within-subject crossover design without washout periods. The primary outcome, WM after WL, was analyzed by body weight. Secondary outcomes of fecal microbiota composition and microbial metabolite concentrations and gut hormones were analyzed in fecal samples and blood plasma, respectively. All outcomes were assessed at the end of each dietary period. Body weight was similar after the RS-WM and C-WM diets (90.7 and 90.8kg, respectively), with no difference in subjectively rated appetite. During the WL diet period plasma ghrelin increased by 36% (P<0.001), glucose-dependent insulinotropic polypeptide (GIP) decreased by 33% (P<0.001), and insulin decreased by 46% (P<0.001), but no significant differences were observed during the RS-WM and C-WM diet periods. Fasting blood glucose was lower after the RS-WM diet (5.59±0.31mmol/L) than after the C-WM diet [5.75±0.49mmol/L; P=0.015; standard error of the difference between the means (SED): 0.09]. Dietary treatments influenced the fecal microbiota composition (R2=0.054, P=0.031) but not diversity. The metabolic benefits, for overweight adults, from WL were maintained through a subsequent WM diet with higher total carbohydrate intake. Inclusion of resistant starch in the WM diet altered gut microbiota composition positively and resulted in lower fasting glucose compared with the control, with no apparent change in appetite. This trial was registered at clinicaltrials.gov as NCT01724411.

2008-P: Roux-en-Y Gastric Bypass Surgery Can Modulate ER Stress and Inflammation on Subcutaneous Adipose Tissue in Nondiabetic Patients with Obesity

Roux-en-Y gastric bypass (RYGB) is the most effective and durable treatment option for reducing adiposity and control abnormalities of metabolic syndrome in patient with severe obesity. Some studies have shown that the initial effect of RYGB on improving metabolic parameters is due to caloric restriction. However, the impact of RYGB on adipose tissue is still under debate. We evaluated 13 obese, nondiabetic patients (mean age 37 years, 100% women, BMI 42.2 kg/m2) one day before surgery, 3 and 6 months (M) after RYGB. Changes in anthropometric, biochemical e gene expression were evaluated with ANOVA and Pearson’s correlation analysis. BMI, fat mass and blood pressure decreased after 3M and 6M (P≤0.05 for all) compared with baseline. Analysis of gene expression in adipose tissue collected at surgery compared with samples collected at 3M and 6M Post-RYGB showed that interleukins (IL6, TNF-α, and MCP1) and endoplasmic reticulum stress (ERS) genes (EIF2AK3 and CALR) decreased during the follow-up (P≤0.01 for all). Nonetheless, genes involved in energy homeostasis (ADIPOQ and AMPK), cellular response to oxidative stress (SIRT1, SIRT3, and NRF2), regulation of adipogenesis (PPARγ), mitochondrial biogenesis (PGC1α) and amino acid metabolism (GCN2) increased from baseline to all other time points evaluated (P≤0.01 for all). We also observed a strong positive correlation between PGC1α, SIRT1, and AMPK with BMI at 3M (P≤0.01 for all) and ADIPOQ and SIRT1 with BMI at 6M (P≤0.01 for all). Our findings demonstrate that weight loss is associated with amelioration of inflammation and ERS and increased protection against oxidative stress in adipose tissue. These observations are strongly correlated with a decrease in BMI and essential genes that control cellular energy homeostasis, suggesting an adaptive process, in a gene expression level, during the caloric restriction and weight loss period after RYGB in patients without diabetes. Disclosure R. Ferraz-Bannitz: None. C.R. Welendorf: None. P.O. Coelho: None. W. Salgado Jr.: None. C.B. Nonino: None. R.A. Beraldo: None. M. Foss-Freitas: None. Funding Ribeirao Preto Clinical Hospital-FAEPA

Changes in Body Weight in Relation to Appetite During 6 Months of Alternate Day Fasting with a Low Carbohydrate Diet

Abstract Objectives Alternate day fasting (ADF) has been shown to lower body weight and improve subjective appetite by increasing fullness over time. What remains unknown, however, is whether carbohydrate restriction during ADF would provide additional weight loss benefits by helping to lower hunger as well. Accordingly, this study examined the effect of 6-months of ADF combined with a low carbohydrate diet on fasting and postprandial appetite ratings. The relationship between changes in appetite and body weight was also examined. Methods Adults with obesity (n = 31) participated in ADF (600 kcal “fast day” alternated with an ad libitum “feast day”) with a low-carbohydrate background diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3- month weight loss period followed by a 3-month weight maintenance period. Results Body weight (P &amp;lt; 0.001) decreased by 5.5 ± 0.5% by month 3 (end of weight loss period) and by 6.3 ± 1.0% by month 6 (end of weight maintenance period). Subjective hunger and fullness did not change during the weight loss period, or the weight maintenance period. Hunger and fullness were not related to changes in body weight during the weight loss or weight maintenance periods. Fasting insulin decreased (P = 0.03) by − 24 ± 8% by month 6 relative to baseline. Fasting glucose and homeostatic model assessment of insulin resistance (HOMA-IR), remained unchanged over the course of the study. Conclusions These findings suggest that ADF combined with a low carbohydrate diet is an effective way of lowering body weight. However, these weight loss benefits are not related to improvements in hunger or fullness. Funding Sources Nestle Health Sciences.

Effect of an mHealth Intervention Using a Pedometer App With Full In-Person Counseling on Body Composition of Overweight Adults: Randomized Controlled Weight Loss Trial.

BackgroundIn clinical practice, it is difficult to convey the benefits of sustained physical activity to adult patients with excess weight or obesity. For this purpose, a goal-setting walking prescription may be an effective strategy.ObjectiveThis study aimed to determine the efficacy of the intervention of a pedometer app in setting a goal to reach 10,000 steps per day in adults.MethodsOverweight adults (n=98; mean body mass index 32.53 [SD 4.92] kg/m2) were randomized to one of two conditions (control or intervention). Both groups downloaded a pedometer app that recorded their daily step counts and were given a daily walking goal of 10,000 steps. Subjects participated in a 24-week in-person behavioral weight control program and were asked to monitor their daily levels using the pedometer app. Baseline data were recorded and followed up weekly. Only the intervention group had structured information delivery, a personalized physical activity prescription, and follow-up on number of steps per day.ResultsThe results show that regardless of sex or age, prescribing walking increased the number of steps per day by 4806 step on average (standardized β coefficient=–0.813, SE=427.586, t=–11.242, P<.001).ConclusionsThese results could have implications for improving self-monitoring in overweight adults during periods of weight loss. Health professionals should analyze the implementation of tools that permit them to prescribe, follow up, and encourage the achievement of a goal of physical activity in overweight or obese patients.Trial RegistrationClinicalTrials.gov NCT03845478; https://clinicaltrials.gov/ct2/show/NCT03845478

Bacterial fecal microbiota is only minimally affected by a standardized weight loss plan in obese cats

BackgroundResearch in humans and mice suggests that obesity influences the abundance and diversity of gastrointestinal (GI) microbiota, and that an “obese microbiome” influences energy metabolism and fat storage in the host. Microbiota membership and composition have been previously assessed in healthy cats. However, research investigating the effects of obesity and weight loss on the cat’s fecal microbiota is limited. Therefore, this study’s objective was to evaluate differences in fecal microbial abundance and biodiversity, as well as serum cobalamin and folate concentrations in obese cats, before and after weight loss, and compare to lean cats.Fourteen lean and 17 obese healthy client-owned cats were fed a veterinary therapeutic weight loss food at maintenance energy requirement for 4 weeks. At the end of week 4, lean cats finished the study, whereas obese cats continued with a 10-week weight loss period on the same food, fed at individually-tailored weight loss energy requirements. Body weight and body condition score were recorded every 2 weeks throughout the study. At the end of each period, a fecal sample and food-consumption records were obtained from the owners, and serum cobalamin and folate concentrations were analysed. DNA was extracted from fecal samples, polymerase chain reaction (PCR) was performed, and products were sequenced using next-generation sequencing (Illumina MiSeq).ResultsNo significant differences in the relative abundance of taxa and in biodiversity indices were observed between cats in either group (P > 0.05 for all tests). Nevertheless, some significantly enriched taxa, mainly belonging to Firmicutes, were noted in linear discriminant analysis effect size test in obese cats before weight loss compared to lean cats. Serum cobalamin concentrations were significantly higher in lean compared to obese cats both before and after weight loss. Serum folate concentrations were higher in obese cats before weight loss compared to after.ConclusionsThe association between feline obesity and the fecal bacterial microbiota was demonstrated in enriched taxa in obese cats compared to lean cats, which may be related to enhanced efficiency of energy-harvesting. However, in obese cats, the fecal microbial abundance and biodiversity were only minimally affected during the early phase of a standardized weight loss plan.

Changes in the salivary proteome of beagle dogs after weight loss

Being overweight or obese represents an important health issue in humans and pets. The aim of this study was to investigate changes in the salivary proteome of overweight beagles after induced weight loss to better understand the physiological changes involved in this process. Five overweight/obese neutered males of pure breed beagles were evaluated. During the 3-mo period of weight loss, each animal received a strictly controlled amount of a low fat commercial diet per day. Body condition scores (BCS), body weight (BW), and serum biochemical parameters (total cholesterol, triglycerides, and C-reactive protein) were assessed weekly. Quantitative proteomics analysis by SWATH was used to evaluate the salivary proteome changes induced by weight loss treatment. BCS, BW, serum total cholesterol concentration, and abundances of 23 salivary proteins differed significantly between before and after treatment. Some of the altered protein amounts, namely of peptidyl-prolyl cis-trans isomerase, fructose-bisphosphate aldolase C, and 78-kDa glucose-regulated protein, increased after weight loss. These proteins are related with the immune system, inflammatory status, oxidative stress, and glucose metabolism. The results obtained suggest a potential use of salivary proteins in monitoring physiological changes in dogs subjected to weight loss. Moreover, the type of changes identified reinforces the postulated physiological improvements, which weight loss induces. Further research is needed to determine whether the changes observed in this study are due to weight loss, dietary changes, or a combination of both.

Reduction of Cholelithiasis after Bariatric Surgery

Abstract Background: Gallstones are common in the Bariatric patients and may be formed during rapid weight loss period. A rational approach to the management of the gallbladder should be incorporated into bariatric surgical practice. It has been recommended that patients undergoing roux-en-y gastric bypass have routine cholecystectomy regardless of gallstone status. A combined prospective and retrospective study to evaluate the outcome of cholecystectomy rates in Bariatric patients have one of three bariatric procedures (LRYGB, LSG, and LGB), evaluated with a median follow-up 24 months. The highest cholecystectomy rate was found in LRYGB group (10.6%) and the frequency was highest within the first 6 months (3.7%). Aim of Study: To evaluate the prophylactic measures for prevention of gallstone formation after bariatric surgery and to identify risk factors. Patients and Methods: A total of 120 obese patients were included in the study. Pre-operative assessment was performed, including: History, examination, obesity evaluation (body weight, BMI, waist circumference), full laboratory study, gastroscopy, and abdominal ultrasonography. After laparo-scopic sleeve gastrectomy, patients were divided randomly into: Group 1 (control), Group 2 (urso-deoxycholic acid), and Group 3 (ezetimibe) and Group 4 (combined drug therapy). Patients were scheduled for 3, 6, and 12 month visits for assessment. Results: A significant reduction in gallstone formation was found in group 3 ezetimibe (5.5%) and group 4 com-bined medication compared with the group 1 (17.6%). A statistically significant increase in % excess weight loss was observed in patients with gallstones (38.5%) versus patients without gallstones (28.2%). Percentage of gallstone formation during first 6 months post-operatively was double that during the next 6 months in both the control and treatment groups. Conclusions: The rapid weight loss after bariatric surgery is the most important predisposing cause for gallstones for-mation. These can cause serious problems such as acute cholecystitis, choledocholithiasis and pancreatitis. Clinicians should be cautious in terms of cholelithiasis in patients with complaints of abdominal pain during the post-operative followup period. In such a case, the abdominal ultrasound should definitely confirm.