Total Meal Research Articles

Hindbrain Actions of Cocaine‐ and Amphetamine‐Regulated transcript Peptide (CART) Revealed by Meal Pattern Analysis

CART is expressed in central nervous system (CNS) sites known to be important in the control of food intake, including the hypothalamus and hindbrain, as well as in the nodose ganglion of the vagus nerve whose central projections terminate in the nucleus tractus solitarius (NTS), an important site for peripheral feedback controlling appetite and associated motivated behaviors. Numerous groups, including ours, have demonstrated that CART inhibited food intake when administered i.c.v. in rats. In addition, others have demonstrated that central administration of antibodies to CART peptides increased feeding. These studies established the potential for endogenously produced CART peptides to be physiologically relevant regulators of food intake and overall glucose homeostasis. Those pharmacologically-based studies were corroborated by experiments using CART knockout animals and human studies which identified CART SNPs associated with metabolic dysfunction. Like other centrally-expressed anorexigenic peptides, CART exhibits functional changes in expression depending on metabolic status. In particular, CART expression is reduced in the fasted state, but returns to baseline levels upon refeeding, an effect that is conserved across multiple species. Combined, these findings suggest a critical role of CART in appetite regulation. Recently, we identified the orphan G protein-coupled receptor, GPR160, to be a cognate receptor for CART and defined the obligate role of CART signaling via GPR160 in nerve injury-induced pain sensation (PMID 31999650). Similarly, we have demonstrated the role of GPR160 in transmitting the anorexigenic action of CART (PMID 33206556) and described the localization of GPR160 on neurons and glia in hindbrain and forebrain sites known to be important in the control of ingestive behaviors including the dorsal vagal complex in the brainstem. In addition we now have established that CART administration in fourth cerebroventricle directly above the NTS exerts its anorexigenic action by not only limiting the amount of food consumed, but also by changing the patterning of the ingestive behavior. CART administration reduced the amount of food ingested per meal, the total number of food bouts, the number of food bouts per meal, and the duration of each meal, while increasing the interval between meals. Thus CART exerted significant satiation (meal bout based) and satiety (total meal amounts) effects. We have developed a transgenic rat line in which the gene for GPR160 is located within loxP sites and are examining the effects on meal patterning after compromise of receptor expression in selective brain areas, in an attempt to identify the critical sites of action of the peptide not only for the control of ingestive behaviors, but also CART's actions related to reward behavior and neuroendocrine function.

Can a Higher Protein/Low Glycemic Index vs. a Conventional Diet Attenuate Changes in Appetite and Gut Hormones Following Weight Loss? A 3-Year PREVIEW Sub-study

Background: Previous research showed that weight-reducing diets increase appetite sensations and/or circulating ghrelin concentrations for up to 36 months, with transient or enduring perturbations in circulating concentrations of the satiety hormone peptide YY.Objective: This study assessed whether a diet that is higher in protein and low in glycemic index (GI) may attenuate these changes.Methods: 136 adults with pre-diabetes and a body mass index of ≥25 kg/m2 underwent a 2-month weight-reducing total meal replacement diet. Participants who lost ≥8% body weight were randomized to one of two 34-month weight-maintenance diets: a higher-protein and moderate-carbohydrate (CHO) diet with low GI, or a moderate-protein and higher-CHO diet with moderate GI. Both arms involved recommendations to increase physical activity. Fasting plasma concentrations of total ghrelin and total peptide YY, and appetite sensations, were measured at 0 months (pre-weight loss), at 2 months (immediately post-weight loss), and at 6, 12, 24, and 36 months.Results: There was a decrease in plasma peptide YY concentrations and an increase in ghrelin after the 2-month weight-reducing diet, and these values approached pre-weight-loss values by 6 and 24 months, respectively (P = 0.32 and P = 0.08, respectively, vs. 0 months). However, there were no differences between the two weight-maintenance diets. Subjective appetite sensations were not affected by the weight-reducing diet nor the weight-maintenance diets. While participants regained an average of ~50% of the weight they had lost by 36 months, the changes in ghrelin and peptide YY during the weight-reducing phase did not correlate with weight regain.Conclusion: A higher-protein, low-GI diet for weight maintenance does not attenuate changes in ghrelin or peptide YY compared with a moderate-protein, moderate-GI diet.Clinical Trial Registry: ClinicalTrials.gov registry ID NCT01777893 (PREVIEW) and ID NCT02030249 (Sub-study).

Price of change: Does a small alteration to the price of meat and vegetarian options affect their sales?

Reducing meat and fish consumption in wealthier countries would help mitigate climate change, raising the question of the most effective ways to achieve this. Price influences the food people buy, but to our knowledge no published field study has assessed the impact on sales of experimentally altering the price of meat and vegetarian meal options. We ran an experiment across 106 mealtimes with 13,840 meal selections at a college cafeteria in the University of Cambridge (UK), introducing a small change to the price of vegetarian meals (decreased by 20p from £2.05 to £1.85) and meat meals (increased by 20p from £2.52 to £2.72). Total meal sales did not differ significantly before and after the price change. When controlling for other variables, changing price significantly increased the proportion of vegetarian sales by 3.2 percentage points (p = 0.036). However, there was no significant change in meat sales before and after the price change, although fish sales did decline by 2.8 percentage points (p = 0.010). When analysed by individual diners’ pre-experimental meal choices (N = 325), the price intervention significantly affected only the quartile of diners with the highest prior rates of vegetarian and vegan meal selection (“MostVeg” quartile), who increased their vegetarian meal selection by 13.7 percentage points (p = 0.011). Students mainly pay for meals on their university cards and rarely pay with cash, which may lessen the impact of a price intervention in this context. Our results suggest price changes may be one lever for increasing vegetarian meal consumption. Further field studies are needed to test different price changes, and in non-university populations.

Food insecurity, food skills, health literacy and food preparation activities among young Canadian adults: a cross-sectional analysis.

To assess associations between household food security status and indicators of food skills, health literacy and home meal preparation, among young Canadian adults. Cross-sectional data were analysed using logistic regression and general linear models to assess associations between food security status and food skills, health literacy and the proportion of meals prepared at home, by gender. Participants recruited from five Canadian cities (Vancouver (BC), Edmonton (AB), Toronto (ON), Montreal (QB) and Halifax (NS)) completed an online survey. 1389 men and 1340 women aged 16-30 years. Self-reported food skills were not associated with food security status (P > 0·05) among men or women. Compared to those with high health literacy (based on interpretation of a nutrition label), higher odds of food insecurity were observed among men (adjusted OR (AOR): 2·58, 95 % CI 1·74, 3·82 and 1·56, 95 % CI 1·07, 2·28) and women (AOR: 2·34, 95 % CI 1·48, 3·70 and 1·92, 95 % CI 1·34, 2·74) with lower health literacy. Women in food-insecure households reported preparing a lower proportion of breakfasts (β = -0·051, 95 % CI -0·085, -0·017), lunches (β = -0·062, 95 % CI -0·098, -0·026) and total meals at home (β = -0·041, 95 % CI -0·065, -0·016). Men and women identifying as Black or Indigenous, reporting financial difficulty and with lower levels of education had heightened odds of experiencing food insecurity. Findings are consistent with other studies underscoring the financial precarity, rather than lack of food skills, associated with food insecurity. This precarity may reduce opportunities to apply health literacy and undertake meal preparation.

Effect of food variety on intake of a meal: a systematic review and meta-analysis

ABSTRACTBackgroundMany studies have shown that food variety—the presence of multiple foods and/or sensory characteristics within and across meals—increases intake. However, studies report mixed findings, and effect size remains unclear.ObjectivesA systematic review and meta-analysis were conducted to 1) synthesize data across experimental studies that examined effects of variety on total meal intake, relative to a control condition with comparatively less variety; 2) quantify support for this effect; and 3) assist in the identification of important moderating factors (registration: CRD42019153585).MethodsIn November 2019, we searched the following databases for relevant experimental studies, published in English from 1980, with human participants: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, and OpenGrey. This search was updated in September 2020. Means, standard deviations, and sample sizes were extracted from included articles, and Hedges' g was used to calculate effect sizes. Risk of bias was assessed using the Cochrane Collaboration's tool.ResultsOf 7259 references identified in an initial search, 34 articles consisting of 37 studies contained sufficient information for review, and data from 30 studies (39 comparisons) were included in the meta-analysis. Results from a random-effects model showed a significant small to medium effect of variety on intake (in weight and energy), with greater variety being associated with increased consumption (Hedges' g = 0.405; 95% CI: 0.259, 0.552). However, heterogeneity was considerable across studies (I2 = 84%), and this was unexplained by subgroup analyses based on form of variety, test foods, sensory characteristics, age, sex, and body weight.ConclusionsOur findings support the conclusion that variety is a robust driver of food intake. However, risk of bias was high across studies, and this review highlights methodologic limitations of studies. It is recommended that further attention is given to the development of preregistered, well-powered randomized controlled studies in eating behavior research.

Breakfast and dinner insulin index and insulin load in relation to overweight in children and adolescents.

Hyperinsulinemia is related to the development of several chronic diseases, particularly obesity. Therefore, this study aimed to examine the association between the insulinemic potential of both total diet and meals, measured by the glycemic index (GI), glycemic load (GL), insulin index (II), and insulin load (IL), and overweight risk among children and adolescents. This cross-sectional study was conducted on 205 overweight and 146 normal-weight participants aged 6-18years. Overweight was defined as body mass index ≥ 85th percentile of Turkish growth-reference data. Through the use of standard methodology, dietary and meal GI, GL, II, and IL were derived from dietary data collected via a 3-day dietary record. Associations were investigated using multivariable-adjusted regression analysis. When controlling for potential covariates, a greater dietary II (OR 2.69, 95% CI 1.28, 5.68) and IL (OR 5.22, 95% CI 2.39, 11.38), as well as GL (OR 3.89, 95% CI 1.77, 8.56), was strongly associated with higher odds of overweight (both Pfor trend < 0.001). Furthermore, breakfast GL (OR 4.87, 95% CI 2.15, 11.01), II (OR 3.88, 95% CI 1.79, 8.39), IL (OR 4.93, 95% CI 2.20, 11.05) and dinner GL (OR 2.39, 95% CI 1.10, 5.20), II (OR 3.81, 95% CI 1.73, 8.41), IL (OR 3.63, 95% CI 1.67, 7.91) were found to be a significant independent predictor of overweight (all Pfor trend < 0.001) in pediatric population. Our results suggest that dietary insulin demand, particularly for breakfast and dinner, was independently associated with overweight in children and adolescents. These findings may shed light on the relevance of considering meal insulin demand while developing dietary strategies in this population.

Achieving realistic gastric emptying curve in an advanced dynamic in vitro human digestion system: experiences with cheese-a difficult to empty material.

Nowadays, in vitro digestion models have received growing interest in recent years to track the digestive fate of foods in the gastrointestinal tract. A major challenge in the development of more physiologically relevant in vitro gastric models is to simulate realistic gastric emptying. In this study, an advanced dynamic in vitro human gastric system was investigated for its potential in achieving the above. The mechanisms for controlling the gastric emptying rate by modulations of the peristaltic moving distance, the pylorus opening size/frequency, and the stomach tilting angle in relation to time are illustrated. With solid cheese, a difficult food material for emptying, different combinations of the operational parameters of the stomach system were evaluated. The system was steered to attain consistent gastric emptying curve with the theoretical data by optimizing operational parameters. By fitting the gastric retention data with a power-exponential model, which is a common approach for describing gastric emptying, the total meal achieved an average emptying half-time (t1/2) of 84.5 min and a curve shape coefficient (β) of 1.69, similar to the theoretical data reported in the literature, where the values of t1/2 and β were 85 min and 1.8, respectively (p > 0.05). Furthermore, the mean median particle size was significantly decreased from the initial 2.80 mm (cheese cubes) to the final 1.35 mm (p < 0.05). There are few particles greater than 2 mm observed in the emptied cheese digesta throughout the digestion process. These suggest the powerful gastric grinding and sieving capacity exhibited by the in vitro system. The current study demonstrates that a well-considered in vitro system can offer a reasonable approach for tracking the structural and physicochemical changes of foods during digestion in the stomach, which is practically meaningful.

Review of key findings from the OPTIWIN trial: Implications and future directions for medical weight management using total diet replacement

Over the past century, obesity and obesity-related comorbidities have become one of the greatest public health threats, and rates of morbidity and mortality continue to grow at alarming rates across the globe. Even modest amounts of weight loss from baseline can lead to significant improvements in quality of life, physical functioning, and remission of co-morbid conditions. Interventions to reduce excess weight vary from nutrition and surgical interventions, to pharmacotherapy, to lifestyle behavioral therapy. Findings related to the efficacy of various lifestyle behavioral interventions for the treatment of obesity continue to be mixed. The purpose of this article is to review key findings from the OPTIWIN obesity treatment trial, which tested the long-term effectiveness of a total meal replacement dietary intervention compared to a gold standard food-based lifestyle behavioral treatment for obesity. Overall, participants in the total meal replacement group lost significantly more excess weight and total fat mass, and demonstrated greater reductions in waist circumference during the active weight loss phase (baseline to 26 weeks), compared to the food-based group. These differences were maintained during the maintenance phase (26-52 weeks). The food-based group also had a higher proportion of non-responders (e.g., failure to lose ≥ 3% of their initial body weight) than the meal replacement group at 26 and 52 weeks. Implications for findings and future directions for medical weight management using lifestyle interventions and meal replacement methods are also discussed.

Using digital imagery to quantify students' added sugar intake at lunch in Title I schools with universal free meals.

School meals are a major source of dietary intake for low-income students at high obesity risk. Associations between added sugar and obesity are well known, and the National School Lunch Program prohibits added sugar in fruit and juice; yet, no added sugar limits exist for other meal components. This study measured students' added sugar selection and consumption in school lunches and compared % of daily calories consumed from added sugar to the Dietary Guidelines for Americans (DGA) recommendations. In October 2016, this cross-sectional study was conducted in six Virginia Title I elementary schools (>90% racial/ethnic minorities; 100% free meals). Digital imagery plate waste methods assessed lunch consumption in N=1155, 1st-5th graders. Added sugar (g, %kcal) in foods and beverages selected and consumed were quantified, and kcal of added sugar consumed was compared to DGA recommendations. Students consumed an average 6.6g of added sugar from foods (grade differences; q=0.0012), and 3.6g of added sugar from beverages. Added sugar comprised ~10% of school lunch calories consumed from foods and ~35% of school lunch calories consumed from beverages. Added sugar in the total school lunch meal comprised ~2.5% of student's recommended daily calorie needs; thus, ~7.5% of daily calories from added sugar remained before students would have exceeded the DGA. Total added sugar consumption was within daily DGA recommendations. Findings contribute to previous reports that school-provided lunches are low in added sugar. Future research should examine added sugar consumed in school breakfast and lunch separately and combined.

GH.p-Modulus Study of Linear Elastic Glucose Theory Based on Data From 159 Liquid Egg Meals, 126 Solid Egg Meals, and 2,843 Total Meals Using GH-Method: Math-Physical Medicine, Part 12 (No. 364)

This article is Part 12 of the author’s linear elastic glucose behavior study. It focuses on a deeper investigation of GH.p-modulus through the comparison of the results from his neuroscience study of egg meals against his 2,843 total meals during the period of 5/5/2018 to 11/17/2020. In the comparison study, he can explore the potential range (variance) of GH.p-modulus values with special cases of 285 egg meals and general case of 2,843 total meals. As a result, it extends to connect the study of his eight hypothetical standard cases presented in paper No. 361 (Reference 17). Here is the step-by-step explanation of the predicted postprandial plasma glucose (PPG) equation using linear elastic glucose theory as described in References 9 through 19: (1) Baseline PPG equals to 97% of FPG value, or 97% * (weight * GH.f-Modulus). (2) Baseline PPG plus increased amount of PPG due to food, i.e. plus (carbs/sugar intake amount * GH.p-Modulus). (3) Baseline PPG plus increased PPG due to food, and then subtracts reduction amount of PPG due to exercise, i.e. minus (post-meal walking k-steps * 5). (4) The Predicted PPG equals to Baseline PPG plus the food influences, and then subtracts the exercise influences. The linear elastic glucose equation is: Predicted PPG = (0.97 * GH.f-modulus * Weight) +(GH.p-modulus * Carbs&amp;sugar) - (post-meal walking k-steps * 5) Where (1) Incremental PPG = Predicted PPG - Baseline PPG + Exercise impact (2) GH.f-modulus = FPG / Weight (3) GH.p-modulus = Incremental PPG / Carbs intake It is quite interesting to put the author’s 285 special egg meals experimental data side by side with his 2,843 total meals data together. The differences of the carb amount and GH.p-modulus values between the egg meals and total meals are vast and obvious. The neuroscience egg meals are offered as extreme cases for the GH.p-modulus boundary situations by having an extremely low carb intake amount per meal with an associated much higher GH.p-modulus value. However, the conclusions from the case of 2,843 total meals could offer general guidelines for type 2 diabetes patients who want to control their diabetic conditions via lifestyle management program. The author thinks that a general GH.p-modulus range of 1.0 to 5.0 is probably suitable for the majority of clinical cases (the author’s own range is 2.1 to 3.4). From a practical angle, a patient can use this GH.p-modulus value as a multiplier of his carbs/sugar amount and use a number of 5 as his multiplier to the post-meal walking k-steps and then plug them into the following “quick but not so dirty” formula in order to obtain the predicted PPG. Predicted PPG =FPG + (GH.p * Carbs) - (k-steps *5) Where the patient can attempt to use different numbers between 1 through 5 as the GH.p input value to determine the suitable GH.p-modulus. By using the above estimated PPG formula, diabetes patients can find their PPG level very quickly and accurately without delving into the details of the linear elastic glucose theory.

Detailed GH.p-Modulus Values at 15-Minute Time Intervals for a Synthesized Sensor PPG Waveform of 159 Liquid Egg Meals, and 126 Solid Egg Meals Using Linear Elastic Glucose Theory of GH-Method: Math-Physical Medicine, Part 13 (No. 365)

This article is Part 13 of the author’s linear elastic glucose behavior study. It focuses on a deeper investigation of GH.p-modulus at 15-minute time intervals for a synthesized PPG waveform based on the comparison of the results from his neuroscience study on two types of egg meals during the period from 5/5/2018 to 11/17/2020. Here is the step by step explanation for the predicted postprandial plasma glucose (PPG) equation using linear elastic glucose theory as described in References 9 through 20: (1) Baseline PPG equals to 97% of fasting plasma glucose (FPG) value, or 97% * (weight * GH.f-Modulus). (2) Baseline PPG plus increased amount of PPG due to food, i.e. plus (carbs/sugar intake amount * GH.p-Modulus). (3) Baseline PPG plus increased PPG due to food, and then subtracts reduction amount of PPG due to exercise, i.e. minus (post-meal walking k-steps * 5). (4) The Predicted PPG equals to Baseline PPG plus the food influences, and then subtracts the exercise influences. The linear elastic glucose equation is: Predicted PPG = (0.97 * GH.f-modulus * Weight) +(GH.p-modulus * Carbs&amp;sugar) - (post-meal walking k-steps * 5) Where (1) Incremental PPG = Predicted PPG - Baseline PPG + Exercise impact (2) GH.f-modulus = FPG / Weight (3) GH.p-modulus = Incremental PPG / Carbs intake This study analyzes the glucose coefficient of GH.p-modulus at 15-minute intervals for two synthesized PPG waveforms associated with liquid eggs and solid eggs. The variation range of GH.p-modulus are between 15 and 22 with an average of 18.9 for solid eggs and between 10 and 14 with an average of 11.6 for liquid eggs. The average GH.p-modulus values of 18.9 for solid eggs and 11.6 for liquid eggs using every 15-minute intervals of the PPG values are comparable with the average GH.p-modulus values of 20.7 for solid eggs and 12.7 for liquid eggs using the average glucose values of 285 egg meals (Reference 19 of paper no. 363). However, a vast difference can be observed by comparing the 285 egg meals, where the GH.p-modulus are in double digits, against his 2,843 total meals (see Reference 19). His GH.p-modulus values of 2,483 total meals are 2.1 using finger PPG and 3.4 using sensor PPG, where the GH.p-modulus are in a single digit. The differences are caused by the neural communication model between the brain and internal organs. This neuroscience contribution factor has caused the higher solid egg meals PPG magnitudes in comparison with the lower liquid egg meals PPG values. Actually, the different peak PPG values of the two different physical states of egg meals, resulting from varying cooking methods, have the same carbs/sugar intake amount of ~2 grams and comparable exercise amount of ~4,500 steps. Although this paper does not focus on the neuroscience studies of egg meals, it is investigating the possible variance of GH.p-modulus. The study utilizes a step by step illustration of moving from (1) the difference between PPG and FPG, going through (2) Incremental PPG, then finally arriving at (3) Predicted PPG. By moving along with this calculation process, we can observe three waveform variances between liquid egg meals versus solid egg meals. As a result, the author has gained a great deal of inside knowledge and a clear picture of the characteristics and behaviors of the most difficult glucose coefficient, GH.p-modulus, as presented in his research work on linear elastic glucose behaviors for Part 13.

Treatment of glioblastoma multiforme with \u201cclassic\u201d 4:1 ketogenic diet total meal replacement

IntroductionGlioblastoma (GBM) has poor survival with standard treatment. Experimental data suggest potential for metabolic treatment with low carbohydrate ketogenic diet (KD). Few human studies of KD in GBM have been done, limited by difficulty and variability of the diet, compliance, and feasibility issues. We have developed a novel KD approach of total meal replacement (TMR) program using standardized recipes with ready-made meals. This pilot study evaluated feasibility, safety, tolerability, and efficacy of GBM treatment using TMR program with “classic” 4:1 KD.MethodGBM patients were treated in an open-label study for 6 months with 4:1 [fat]:[protein + carbohydrate] ratio by weight, 10 g CH/day, 1600 kcal/day TMR. Patients were either newly diagnosed (group 1) and treated adjunctively to radiation and temozolomide or had recurrent GBM (group 2). Patients checked blood glucose and blood and urine ketone levels twice daily and had regular MRIs. Primary outcome measures included retention, treatment-emergent adverse events (TEAEs), and TEAE-related discontinuation. Secondary outcome measures were survival time from treatment initiation and time to MRI progression.ResultsRecruitment was slow, resulting in early termination of the study. Eight patients participated, 4 in group 1 and 4 in group 2. Five (62.5%) subjects completed the 6 months of treatment, 4/4 subjects in group 1 and 1/4 in group 2. Three subjects stopped KD early: 2 (25%) because of GBM progression and one (12.5%) because of diet restrictiveness. Four subjects, all group 1, continued KD on their own, three until shortly before death, for total of 26, 19.3, and 7 months, one ongoing. The diet was well tolerated. TEAEs, all mild and transient, included weight loss and hunger (n = 6) which resolved with caloric increase, nausea (n = 2), dizziness (n = 2), fatigue, and constipation (n = 1 each). No one discontinued KD because of TEAEs. Seven patients died. For these, mean (range) survival time from diet initiation was 20 months for group 1 (9.5–27) and 12.8 months for group 2 (6.3–19.9). Mean survival time from diagnosis was 21.8 months for group 1 (11–29.2) and 25.4 months for group 2 ( 13.9–38.7). One patient with recurrent GBM and progression on bevacizumab experienced a remarkable symptom reversal, tumor shrinkage, and edema resolution 6–8 weeks after KD initiation and survival for 20 months after starting KD.ConclusionTreatment of GBM patients with 4:1 KD using total meal replacement program with standardized recipes was well tolerated. The small sample size limits efficacy conclusions.Trial registrationNCT01865162 registered 30 May 2013, and NCT02302235 registered 26 November 2014, https://clinicaltrials.gov/

Short- and medium-chain chlorinated paraffin exposure in South Germany: A total diet, meal and market basket study.

Short- and medium-chain chlorinated paraffins (SCCPs, MCCPs) are high-production volume industrial chemicals that have been previously reported to occur in food, packaging material and the environment. This study presents an assessment of dietary exposure for consumers in Southern Germany based on three different sampling approaches: (i) a classical market basket study (n=154), (ii) the analysis of ready-made meals from restaurants (n=10), and (iii) a total diet approach (n=21). In 35% of the samples, CPs were below the method limit of quantification. Highest amounts of SCCPs and MCCPs were found especially in extra virgin olive oils (EVOOs) and fish. Homologue patterns indicated the partial removal of CPs during the refining of (other) edible oils. Ready-made meals contained only low amounts of CPs equal to estimations based on market basket samples. Total diet samples from the same hospital were generally comparable with each other regardless of diet, although vegetarian meal plans with high amounts of cheese and other dairy products contained up to an order of magnitude more CPs than other diets. Taking all approaches into account, calculated daily exposures for adults ranged 35-420ng/kgbw/day for ΣSCCPs and 22-840ng/kgbw/day for ΣMCCPs, which is between one and two orders of magnitude higher than the current dietary intake of polychlorinated biphenyls (indicator PCBs) in Europe.

Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight.

Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.

Sodium intake among adolescents who eat inside and outside the home. Campinas-Brazil

Abstract Background Excessive sodium consumption (&amp;gt;2g/day) is one of the risk factors for the development of cardiovascular diseases, which impact the world's public health systems. Rapid urbanization, busy life, the high availability of ultra-processed foods and the short time for meals, especially inside the home, are factors that interfere in the population's food choices. Objective To estimate sodium intake according to the place of meal consumption and its association with demographic, socioeconomic and salt-related variables. Methods Cross-sectional population-based study, carried out with 901 adolescents aged 10 to 19 years, who answered the Food Consumption and Nutritional Status Survey, ISACamp-Nutri 2015. The mean sodium intake was estimated by the 24-hour recall and the association with the independent variables, using linear regression. Results Sodium consumption among adolescents was 3.52 g/day (95% CI 3.42-3.63). Those who consumed at least one meal away from home had an excess of 0.19 g/day (P = 0.012) of sodium, which corresponded to a 6.1% increase compared to adolescents who had eaten exclusively at home. Of the total meals eaten by adolescents, 15.9% are taken outside the home, with 6.6% eating at school and 9.3% in different places. There was a significant increase in sodium consumption among adolescents who had breakfast CR = 0.16g (p = 0.032), afternoon snack CR = 0.09g (p = 0.002) and dinner CR = 0.30g (p = 0.029) outside the home. Conclusions sodium consumption by adolescents exceeded the WHO recommendation. Eating at least one meal away from home was associated with a higher sodium intake among these individuals. Regulatory measures in the food industry and strategies for food and nutrition education are relevant to reduce sodium consumption in this age group. Key messages High sodium consumption among adolescents, exceeding WHO recommendations. Eating outside the home was associated with a higher sodium intake.

Order of meals at the counter and distance between options affect student cafeteria vegetarian sales.

Altering the order in which meals are presented at cafeteria counters has been proposed as a way of lowering meat consumption, but remains largely untested. To address this, we undertook two experimental studies involving 105,143 meal selections in the cafeterias of a British university. Placing vegetarian options first on the counter consistently increased their sales when choices were widely separated (>1.5 m; vegetarian sales as a percentage of total meal sales increased by 4.6 and 6.2 percentage points) but there was no evidence of an effect when the options were close together (<1.0 m). This suggests that order effects depend on the physical distance between options.

Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet.

SummaryBackgroundDetection of the mild ketosis induced by severely energy‐restricted diets may be a clinically useful way to monitor and promote dietary adherence. Mild ketosis is often assessed using urine dipsticks, but accuracy for this purpose has not been tested.ObjectiveTo determine the accuracy of urine dipsticks to detect mild ketosis during adherence to a severely energy‐restricted diet.MethodsTwo hundred and sixty three (263) fasting urine and 263 fasting blood samples were taken from 50 women (mean [standard deviation, SD] age 58.0 [4.3] years and body mass index 34.3 [2.4] kg/m2) before and at six time points during or for up to 10 weeks after 16 weeks of severe energy restriction, achieved with a total meal replacement diet. The amount of ketones (acetoacetate) in the urine was classified as ‘0 (Negative)’, ‘+/− (Trace)’, ‘+ (Weak)’ or ‘++ (Medium)’ by urine dipsticks (Ketostix, Bayer). The concentration of ketones (β‐hydroxybutyrate) in the blood was measured with our reference method, a portable ketone monitor (FreeStyle Optium, Abbott). The diagnostic accuracy of the urine dipsticks was assessed from the percent of instances when a person was actually ‘in ketosis’ (as defined by a blood β‐hydroxybutyrate concentration at or above three different thresholds) that were also identified by the urine dipsticks as being from a person in ketosis (the percent ‘true positives’ or sensitivity), as well as the percent of instances when a person was not in ketosis (as defined by the blood monitor result) was correctly identified as such with the urine dipstick (the percent ‘true negatives’ or specificity). Thresholds of ≥0.3mM, ≥0.5mM or ≥1.0mM were selected, because mean blood concentrations of β‐hydroxybutyrate during ketogenic diets are approximately 0.5mM. Sensitivity and specificity were then used to generate receiver operating characteristic curves, with the area under these curves indicating the ability of the dipsticks to correctly identify people in ketosis (1 = perfect results, 0.5 = random results).ResultsAt threshold blood β‐hydroxybutyrate concentrations of ≥0.3mM, ≥0.5mM and ≥1.0mM, the sensitivity of the urine dipsticks was 35%, 52% and 76%; the specificity was 100%, 97% and 78%; and the area under the receiver operating characteristic curves was 0.67, 0.74 and 0.77, respectively. These low levels of sensitivity mean that 65%, 48% or 24% of the instances when a person was in ketosis were not detected by the urine dipsticks.ConclusionUrine dipsticks are not an accurate or clinically useful means of detecting mild ketosis in people undergoing a severely energy‐restricted diet and should thus not be recommended in clinical treatment protocols. If monitoring of mild ketosis is indicated (eg, to monitor or help promote adherence to a severely energy‐restricted diet), then blood monitors should be used instead.

3-Year effect of weight loss via severe versus moderate energy restriction on body composition among postmenopausal women with obesity - the TEMPO Diet Trial

We have previously shown that a severely energy-restricted diet leads to greater loss of weight, fat, lean mass and bone mineral density (BMD) at 12 months in postmenopausal women with obesity than a moderately energy-restricted diet. We now aim to evaluate whether these effects are sustained longer term (ie, at 36 months). 101 postmenopausal women were randomized to either 12 months of moderate (25 to 35%) energy restriction with a food-based diet (moderate intervention), or 4 months of severe (65 to 75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for 8 months (severe intervention). Body weight and composition were measured at 0, 24 and 36 months. Participants in the severe intervention lost ~1.5 to 1.7 times as much weight, waist circumference, whole-body fat mass and visceral adipose tissue compared to those in the moderate intervention, and were 2.6 times more likely (42% versus 16%) to have lost 10% or more of their initial body weight at 36 months (P < 0.01 for all). However, those in the severe versus moderate intervention lost ~1.4 times as much whole-body lean mass (P < 0.01), albeit this was proportional to total weight lost and there was no greater loss of handgrip strength, and they also lost ~2 times as much total hip BMD between 0 and 36 months (P < 0.05), with this bone loss occurring in the first 12 months. Thus, severe energy restriction is more effective than moderate energy restriction for reducing weight and adiposity in postmenopausal women in the long term (3 years), but attention to BMD loss in the first year is required. Trial registrationAustralian New Zealand Clinical Trials Registry Reference Number: 12612000651886, anzctr.org.au.

Beyond Body Weight-Loss: Dietary Strategies Targeting Intrahepatic Fat in NAFLD.

Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent liver disease in industrialized countries. It is regarded as the hepatic manifestation of the metabolic syndrome (MetS) resulting from insulin resistance. Moreover, insulin resistance impairs glycogen synthesis, postprandially diverting a substantial amount of carbohydrates to the liver and storing them there as fat. NAFLD has far-reaching metabolic consequences involving glucose and lipoprotein metabolism disorders and risk of cardiovascular disease, the leading cause of death worldwide. No pharmaceutical options are currently approved for the treatment of NAFLD. Exercise training and dietary interventions remain the cornerstone of NAFLD treatment. Current international guidelines state that the primary goal of nutritional therapy is to reduce energy intake to achieve a 7%–10% reduction in body weight. Meal replacement therapy (formula diets) results in more pronounced weight loss compared to conventional calorie-restricted diets. However, studies have shown that body mass index (BMI) or weight reduction is not obligatory for decreasing hepatic fat content or to restore normal liver function. Recent studies have achieved significant reductions in liver fat with eucaloric diets and without weight loss through macronutrient modifications. Based on this evidence, an integrative nutritional therapeutic concept was formulated that combines the most effective nutrition approaches termed “liver-fasting.” It involves the temporary use of a low calorie diet (total meal replacement with a specific high-protein, high-soluble fiber, lower-carbohydrate formula), followed by stepwise food reintroduction that implements a Mediterranean style low-carb diet as basic nutrition.

Applying First-Order Perturbation Theory of Quantum Mechanics to Predict and Build a Postprandial Plasma Glucose Waveform (GH-Method: Math- Physical Medicine)

The author presents his techniques of applying first-order perturbation theory of quantum mechanics to predict and build a postprandial plasma glucose (PPG) waveform based on the “perturbation factor” of carbs/sugar intake amount. This is a part of his GH-Method: math-physical medicine research methodology. Initially, he applied segmentation pattern analysis to analyze his 1,825 meals with 23,725 PPG Sensor data collected during a period of 5/5/2018 - 12/13/2019. His two segments are based on both “first factor” of meal’s carbs/sugar intake amounts and “second factor” of post-meal walking steps. His low-carb meals occupy about 2/3 of the total meals (1,209 meals with 8.5 grams per meal) and high-carb meals occupy about 1/3 of the total meals (615 meals with 27.1 grams per meal). His post-meal walking steps are comparable (4,238 vs. 4,282 steps). A standard waveform (curves) contains 13 data points for each PPG curve and one input data for each 15-minute time segment. Glucose variance is an extremely complex biochemical and biophysical phenomenon. After a diabetes patient collects and establishes an initial waveform with an accurate input dataset, we can then predict the glucose behavior and then draw a new approximate PPG waveform according to one prominent perturbation factor, such as carbs/sugar intake or post-meal exercise. Therefore, a patient will have the ability to predict his PPG behavior before consuming his meal or initiates his post-meal exercise.