Weight Loss Trial Research Articles

MON-094 Aromatase Inhibitors and Weight Loss in Severely Obese Male Veterans with Hypogonadism: A Randomized Clinical Trial

Introduction: The prevalence of hypogonadism among males is influenced by aging and obesity. The increased expression of the aromatase enzyme in the adipose tissue of obese men leads to a high conversion of androgens to estrogen, exerting a negative feedback on the hypothalamus-pituitary-gonadal axis contributing to hypogonadotropic hypogonadism. Our objective is to determine if anastrozole, an aromatase inhibitor (AI), in combination with weight loss could have a positive effect on symptoms of hypogonadism and muscle strength, and to evaluate the impact on bone mineral density (BMD) and bone quality. Methods: Twenty-three obese men (BMI≥35kg/m2) aged 35-65 years old with hypogonadotropic hypogonadism were randomized in a 6-month double-blind placebo-controlled trial of weight loss (with diet and exercise) plus either anastrozole (n=12) or placebo (PBO) (n=11). The inclusion criteria were morning testosterone <300 ng/mL (mean of 2 measurements), estradiol >10.9 pg/mL, and LH <9 IU/L. The hypogonadal symptoms were evaluated by 4 questionnaires: IPSS, qADAM, IWQOL, and IIEF-5, and the muscle strength was measured by Biodex machine. The body composition and BMD were determined by DXA, and the bone microarchitecture by HR-pQCT. The hormonal levels, hypogonadal symptoms, muscle strength, and body composition were assessed at baseline, 3 months, and 6 months; whereas the BMD and bone microarchitecture were evaluated at baseline and 6 months. Results: Average weight loss at 6 months was -7.0±6.9% in the AI group vs -2.4±2.9% in the PBO group (p=0.12). At 6 months, testosterone levels increased by +95.2±66.3% in the AI group vs +0.8±29.4% in the PBO group (p<0.01), and estradiol levels decreased by -60.9±21.8% in the AI group vs +5.2±18.6% in the PBO group (p<0.01). LH levels increased by +66.6±89.3% in patients treated with AI and decreased by -4.8±24.2% in those who received PBO (p=0.06). There was no improvement of symptoms in the AI group (+18.9±48.7%) vs placebo (+7.8±34.1%) based on IIEF-5 questionnaire (p=NS) and no significant difference in muscle strength between groups. Lean mass was better preserved in the AI compared to the PBO group (-0.73±2.5% vs -3.60±2.70%, respectively; p=0.05). There was no change in spine BMD in the AI compared to the PBO group (-0.71±3.32% vs +3.22±4.90%, respectively; p=0.08), and no change in tibial trabecular bone area in the AI compared to the decrease in the PBO group (+0.12±0.68% vs -2.09±2.20%, respectively; p<0.05). Conclusion: AI plus weight loss improves the hormonal profile of severely obese men with hypogonadism and prevents weight loss-induced loss of lean mass without causing major side effect on BMD within 6 months of therapy. However, in this short-term study with limited sample size, we found no significant improvement in symptoms of hypogonadism. Further large and long-term trials are needed to confirm these results.

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

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

High Prevalence of Undiagnosed Hyperglycemia in Low-Income Overweight and Obese Hispanic Women in Oregon.

Overweight Hispanic women are at high risk for type 2 diabetes. A clinical diagnosis of hyperglycemia is often necessary to access interventions. We examined the prevalence of undiagnosed hyperglycemia among a group of low-income overweight or obese Hispanic women, who were receiving care at a Federally Qualified Health Center (FQHC). Among 196 overweight or obese Hispanic women (mean age 44 ± 10years, mean weight 86.8 ± 16.5kg, mean body mass index [BMI] 36.5 ± 6.4kg/m2) enrolled in a randomized clinical weight-loss trial, we compared A1C and fasting blood glucose (FBG) obtained at baseline with women's existing diabetes and prediabetes diagnoses in the medical record. According to the information in participants' medical records, 36% (70/196) had diagnosed diabetes, 20% (39/196) had a diagnosis of prediabetes, and the remaining 44% (87/196) had neither diagnosis. Among participants without a diagnosis of diabetes or prediabetes during the baseline screening for our study, 63% (55/87) had at least one test in the prediabetes range (baseline A1C and FBG were in prediabetes range for 39 and 55 participants, respectively), and 13% (11/87) had at least one test in the diabetic range (baseline A1C and FBG values in diabetes range for 3 and 11 participants, respectively). We found substantial prevalence of undiagnosed hyperglycemia among a sample of overweight and obese Hispanic women. It is possible that limited awareness of diabetes risk may be a barrier to patient compliance with screening recommendations.

Life Events, Physical Activity, and Weight Loss Maintenance: Decomposing Mediating and Moderating Effects of Health Behavior.

This analysis helps clarify the individual and joint effects of moderate to vigorous physical activity (MVPA) in concert with significant life events (eg, divorce, marriage, job change or loss, pregnancy, etc) on weight following a behavioral weight loss intervention. Data from the Tracking Study weight loss trial were utilized to perform a 4-way decomposition of moderation and mediation of life events (≥ 1 vs 0) and MVPA (low <2500kcal vs high ≥ 2500kcal) on 24-month weight. The total effect of life events and MVPA on weight was estimated to be 1.63kg (95% confidence interval = 0.30 to 2.96; P = .02). The controlled direct effect of life events on 24-month weight suggested that experiencing at least one life event controlling for MVPA was associated with an increase of 2.31kg (95% confidence interval = 0.29 to 4.33) at 24 months. Other interaction and mediation estimates were not statistically significant. This analysis offers new potential for examining health behaviors that may act as both mediators and effect modifiers of health. Although more work is needed to understand the interaction of life events and MVPA on weight loss maintenance, findings help rule out mediation. Life events and MVPA should be considered for their unique effects on weight loss maintenance in the future.

Abstract P143: Late Success in Weight Loss Trials: Do Participants Start Losing Weight After 6 Months?

Background: Weight loss programs often start with an initial phase of intensive lifestyle coaching to facilitate early weight loss, with a typical weight loss goal of ≥ 5%. While early weight loss is associated with long-term weight loss success, less is known about those who do not lose weight in the initial phase. This study examines those without initial weight loss success, but lose weight later. Methods: Analyses included 346 obese adults from the POWER Hopkins weight loss trial and 673 overweight to obese adults from the PREMIER hypertension control trial. Mutually exclusive categories are based on weight loss success (≥ 5% reduction from baseline) at 6m and 12m: continued success (success 6m and 12m); regainer (success 6m then regained 12m); no success (no success 6m or 12m); and late success (12m success only). Results: No success (NS) was the most common category among control and intervention participants in both studies (see table). There were low rates of late success (LS) in POWER (intervention 5%, control 7%, p=.25) and PREMIER (intervention 5%, control 8%, p=.75). Within the POWER intervention, LS and NS were similar in age, sex, race, and baseline weight. Coaching contact rates were similar at 1-6m (LS 64%, NS 57%, p=.49) and 7-12m (LS 45%, NS 46%, p=.89). Within the PREMIER intervention LS had a lower baseline weight than NS (89 vs 99 kg, p=.01), but were similar in age, sex, and race. Coaching contact rates are similar at 1-6m (LS 77%, NS 72%, p=.23) and 7-12m (LS 66%, NS 62%, p=.58). Conclusion: Given the small fraction of intervention participants with late success (only 5%), alternative strategies are needed to address the large fraction of persons without initial weight loss success.

Abstract MP42: Association of Taste Perception for Sweet, Salt, Sour, Bitter and Umami With Fruit and Vegetable Intake Among Community-dwelling Men and Women in the PREDIMED-PLUS Trial

Introduction: Emerging evidence suggests that differences in the ability to perceive individual tastes; sweet, salt, sour, bitter and umami, may influence food intake - amount and variety, thereby influencing diet quality, energy balance and cardiometabolic disorders. Objective: To explore the relationship between perception of each taste and intake of different categories of fruits and vegetables. We hypothesized that greater perception of each taste will be inversely associated with amount consumed. Methods: A cross-sectional analysis was performed on baseline data from participants (N=379) in the University of Valencia center of the PREDIMED-PLUS Clinical Trial; a multi-center weight-loss primary prevention trial of cardiovascular disease, among community-dwelling adults in Spain aged 55-75y diagnosed with metabolic syndrome. Taste perception was determined by challenging subjects with solutions of standard tastants representing sweet, salt, sour, bitter, and umami (400 mM sucrose, 200 mM NaCl, 34 mM citric acid, 5.6 mM phenylthiocarbamide [PTC], 200 mM monopotassium glutamate, respectively). Taste perception intensities were evaluated on a 0-5 scale. Food intake was assessed using a validated food frequency questionnaire. Outcomes included fruit and vegetable intake (servings/week), total and sub-groups (citrus and non-citrus fruits; cruciferous and non-cruciferous vegetables). Multivariable linear regression models were used to assess relationships between perception of each tastant and number of servings/week consumed, for total and square root-transformed sub-groups. Results: In the fully-adjusted models, controlling for sex, age, diabetes, smoking status, daily physical activity and weekly energy intake, there were inverse associations between sweet perception and intake of citrus fruit (β=-0.5; p&lt;0.01) and total vegetables (β=-1.1; 95% CI [-2.0, -0.2]), particularly non-cruciferous vegetables (β=-1.0; p=0.02); and positive associations between salt perception and intake of total fruit (β=0.9; 95% CI [0.02, 1.7]), particularly non-citrus fruit (β=0.6; p=0.03), sour perception and intake of cruciferous vegetables (β=0.1; p=0.04) and umami perception and intake of non-cruciferous vegetables (β=0.7; p=0.04). No significant associations were observed between bitter taste perception and fruit or vegetable intake. Conclusion: This marks the first exploration of taste perception as a determinant of fruit and vegetable intake among community-dwelling adults. Perception for each tastant differentially affected the amount and type of fruits and vegetables consumed, with sweet, salt, sour and umami perception emerging as significant predictors. These findings support a role of taste perception in guiding the amount and type of foods consumed, albeit in a more complex manner than originally hypothesized.

Long-term Association of Depression Symptoms and Antidepressant Medication Use With Incident Cardiovascular Events in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes.

To examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes. Preplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years. Depression symptoms, assessed with the Beck Depression Inventory (BDI), were analyzed both as a continuous and dichotomized variable (BDI score <10 or ≥10). ADM use was coded from participants' prescription medications. Four composite CVD outcomes were defined in the study protocol. Sex-stratified Cox proportional hazards models were adjusted for a range of baseline covariates. Depression symptoms were only significantly associated with a composite secondary outcome comprising CVD death, nonfatal myocardial infarction, nonfatal stroke, hospitalized angina, congestive heart failure, peripheral vascular disease, coronary artery bypass graft, and carotid endarterectomy. Significant sex interactions were observed for BDI score and BDI score ≥10. BDI score was significantly associated with higher probability of this composite outcome in men but was not associated with the outcome in women. BDI score ≥10 was positively associated with this composite outcome in men but was negatively associated in women. Exploratory analysis identified a significant BDI ≥10 × ADM use interaction for this composite outcome that differed in men versus women. Men with both BDI score ≥10 and ADM use compared with those with neither had 60% higher probability of the outcome, whereas women with both compared with those with neither had 50% lower probability. Sex differences in the association of depression symptoms and ADM use with incident CVD warrant further investigation.

Predictors of Lifestyle Intervention Attrition or Weight Loss Success in Women with Polycystic Ovary Syndrome Who Are Overweight or Obese.

Background/objectives: Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women. Weight management is a first-line treatment for PCOS according to international evidence-based guidelines. However, the factors associated with attrition or success in weight loss interventions are not known for women with PCOS. The objective of this study was to identify characteristics associated with attrition and weight loss success in women with PCOS and overweight or obesity undergoing weight loss interventions. Methods: Four randomised controlled clinical weight loss trials comprising energy restricted diets and/or exercise interventions of 2–8 months duration. The interventions were conducted over 2001–2007 in outpatient clinical research centres with n = 221 premenopausal women with PCOS and overweight/obesity recruited through community advertisement. The main outcome measures were attrition and ≥5% weight loss at 2 months and study completion. Results: Weight loss was 5.7 ± 2.9 kg at 2 months and 7.4 ± 5.3 kg after study completion (p < 0.001). Attrition was 47.1% and ≥5% weight loss occurred in 62.5% and 62.7% of women at 2 months and study completion respectively. Baseline depressive symptoms (OR 1.07 95% CI 0.88, 0.96, p = 0.032) and lower appointment attendance by 2 months (OR 0.92 95% CI 0.88, 0.96, p < 0.001) were independently associated with attrition. Lower appointment attendance over the whole study was independently associated with not achieving ≥5% weight loss at study completion (OR 0.95 95% CI 0.92, 0.99, p = 0.020). Conclusions: Despite high attrition, successful weight loss was achieved by 63% of women with PCOS in a clinical research setting. Higher baseline depressive symptoms were associated with greater attrition and higher appointment attendance was associated with lower attrition and greater weight loss success. These finding have implications for development of successful weight management programs in PCOS.

Pilot randomised controlled trial of Weight Watchers\xae referral with or without dietitian-led group support for weight loss in women treated for breast cancer: the BRIGHT (BReast cancer weIGHT loss) trial

BackgroundBeing overweight or obese following breast cancer diagnosis can increase cancer recurrence and mortality, so effective interventions for weight loss in this group could enhance survival. A pilot randomised controlled trial was conducted to assess whether a weight loss programme comprising generic Weight Watchers® referral offered to women treated for breast cancer with or without additional breast cancer-tailored dietetic support is feasible and shows promise for improving weight and quality of life (QoL).MethodsParticipants were randomly allocated to 3 groups: Weight Watchers® referral (for 12 sessions of meetings and digital tools) plus 5 breast cancer-tailored dietitian-led group support sessions (WW Plus: n = 14), Weight Watchers® referral only (WW: n = 16) or control (Weight Watchers® referral after 3 months, n = 15). Feasibility was assessed based on retention rate, recruitment and randomisation process, meeting attendance, suitability of the setting and outcome measurement tools, unintended consequences, cost and observations of the dietetic sessions. Outcomes were measured at 0, 3 (‘trial exit’) and 12 months post intervention.ResultsThe response rate to the invitation was 43% (140/327) of whom 58 were eligible and 45 (median age 61.0 years; body mass index 30.2 kg/m2) were randomised. Data from 38 (84%) and 30 (67%) participants were available at trial exit and 12 months respectively. Feasibility issues included slow recruitment process, lack of blinding throughout, weighing scales not measuring > 150 kg, lack of clear instructions for completing QoL questionnaire and workload and time pressures in delivering dietetic sessions. Participants had good attendance rate at group meetings and no serious unintended consequences were reported. WW Plus was most expensive to run. Mean (95% CI) weight change at trial exit was − 3.67 kg (− 5.67, − 2.07) in WW Plus, − 6.03 kg (− 7.61, − 4.44) in WW group and + 0.19 kg (− 1.45, + 1.83) in control group. About 40% of the WW Plus, 64% of the WW group and 56% of the control group lost ≥ 5% of their baseline weight by 12 months. All groups showed promise for improving QoL at trial exit but only the WW group maintained significant improvements from baseline at 12 months.ConclusionsThe trial procedures were feasible, with some modifications. This pilot trial indicates the benefits of providing free WW vouchers for weight loss maintenance and improving QoL but provided no evidence that including additional dietetic support would add any extra value. Further research with WW with long-term follow-up should be undertaken to assess weight loss sustainability and benefit on health outcomes in this patient group.Trial registrationISRCTN-29623418.

Log2Lose: Development and Lessons Learned From a Mobile Technology Weight Loss Intervention.

BackgroundProviding financial incentives has gained popularity as a strategy to promote weight loss, but questions remain about how best to utilize them. A promising mobile health strategy provides users with near-real-time financial incentives based on both the process of weight loss (behavioral modification) and actual weight loss. To maximize the impact of this strategy, a methodology is needed to close the gap between the desired behavior and the financial incentive. Leveraging mobile health tools—such as mobile phone apps, cellular body weight scales that transmit data to physicians and researchers, and text messaging for instructions and encouragement—has the potential to close this gap.ObjectiveThis study aimed to describe the development of an innovative technology-based solution and lessons learned from a feasibility trial—Log2Lose—that encouraged individuals to lose weight by providing near-real-time financial incentives for weight loss and/or dietary self-monitoring.MethodsWe recruited participants (N=96) with a body mass index greater than or equal to 30 kg/m2 for a 24-week weight loss trial. Participants received a behavioral intervention of biweekly, in-person group sessions and were instructed to log a minimum number of daily calories in MyFitnessPal and to step on the BodyTrace cellular scale at least twice per week. In a 2×2 design, participants were randomized into 4 groups to receive financial incentives for the following: (group 1) weekly weight loss and dietary self-monitoring, (group 2) dietary self-monitoring only, (group 3) weekly weight loss only, or (group 4) no financial incentives. Diet and weight data from the devices were obtained through application programming interfaces. Each week, we applied algorithms to participants’ data to determine whether they qualified for a monetary incentive (groups 1-3). A text message notified these participants of whether they met weight loss and/or self-monitoring requirements to earn an incentive and the amount they earned or would have earned. The money was uploaded to a debit card.ResultsOur custom-engineered software platform analyzed data from multiple sources, collated and processed the data to send appropriate text messages automatically, and informed study staff of the appropriate incentives. We present lessons learned from the development of the software system and challenges encountered with technology, data transmission, and participants (eg, lost connections or delayed communication).ConclusionsWith consistent and constant validation checks and a robust beta test run, the process of analyzing data and determining eligibility for weekly incentives can be mostly automated. We were able to accomplish this project within an academic health system, which required significant security and privacy safeguards. Our success demonstrates how this methodology of automated feedback loops can provide health interventions via mobile technology.Trial RegistrationClinicalTrials.gov NCT02691260; https://clinicaltrials.gov/ct2/show/NCT02691260

Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial

For low-carbohydrate diets, a public health approach has focused on the replacement of carbohydrates with unsaturated fats. However, little research exists on the impacts of saturated fat intake on the lipid profile in the context of whole-food-based low-carbohydrate weight-loss diets. The primary aim of this secondary analysis of the DIETFITS weight loss trial was to evaluate the associations between changes in percentage of dietary saturated fatty acid intake (%SFA) and changes in low-density lipoproteins, high-density lipoproteins, and triglyceride concentrations for those following a healthy low-carbohydrate (HLC) diet. The secondary aim was to examine these associations specifically for HLC dieters who had the highest 12-month increases in %SFA. In the DIETFITS trial, 609 generally healthy adults, aged 18-50 years, with body mass indices of 28-40 kg/m2 were randomly assigned to a healthy low-fat (HLF) or HLC diet for 12 months. In this analysis, linear regression, both without and with adjustment for potential confounders, was used to measure the association between 12-month change in %SFA and blood lipids in 208 HLC participants with complete diet and blood lipid data. Participants consumed an average of 12-18% of calories from SFA. An increase of %SFA, without significant changes in absolute saturated fat intake, over 12 months was associated with a statistically significant decrease in triglycerides in the context of a weight-loss study in which participants simultaneously decreased carbohydrate intake. The association between increase in %SFA and decrease in triglycerides was no longer significant when adjusting for 12-month change in carbohydrate intake, suggesting carbohydrate intake may be a mediator of this relationship. Those on a low-carbohydrate weight-loss diet who increase their percentage intake of dietary saturated fat may improve their overall lipid profile provided they focus on a high-quality diet and lower their intakes of both calories and refined carbohydrates. This trial was registered at clinicaltrials.gov as NCT01826591.

Carbohydrate quality and human health: a series of systematic reviews and meta-analyses

Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre. We did a series of systematic reviews and meta-analyses of prospective studies published from database inception to April 30, 2017, and randomised controlled trials published from database inception to Feb 28, 2018, which reported on indicators of carbohydrate quality and non-communicable disease incidence, mortality, and risk factors. Studies were identified by searches in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, and by hand searching of previous publications. We excluded prospective studies and trials reporting on participants with a chronic disease, and weight loss trials or trials involving supplements. Searches, data extraction, and bias assessment were duplicated independently. Robustness of pooled estimates from random-effects models was considered with sensitivity analyses, meta-regression, dose-response testing, and subgroup analyses. The GRADE approach was used to assess quality of evidence. Just under 135 million person-years of data from 185 prospective studies and 58 clinical trials with 4635 adult participants were included in the analyses. Observational data suggest a 15-30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke incidence and mortality, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest consumers Clinical trials show significantly lower bodyweight, systolic blood pressure, and total cholesterol when comparing higher with lower intakes of dietary fibre. Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25 g and 29 g. Dose-response curves suggested that higher intakes of dietary fibre could confer even greater benefit to protect against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer. Similar findings for whole grain intake were observed. Smaller or no risk reductions were found with the observational data when comparing the effects of diets characterised by low rather than higher glycaemic index or load. The certainty of evidence for relationships between carbohydrate quality and critical outcomes was graded as moderate for dietary fibre, low to moderate for whole grains, and low to very low for dietary glycaemic index and glycaemic load. Data relating to other dietary exposures are scarce. Findings from prospective studies and clinical trials associated with relatively high intakes of dietary fibre and whole grains were complementary, and striking dose-response evidence indicates that the relationships to several non-communicable diseases could be causal. Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health. A major strength of the study was the ability to examine key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomised trials in a single study. Our findings are limited to risk reduction in the population at large rather than those with chronic disease. Health Research Council of New Zealand, WHO, Riddet Centre of Research Excellence, Healthier Lives National Science Challenge, University of Otago, and the Otago Southland Diabetes Research Trust.

A Step toward Understanding Diet Quality in Urban African-American Breast Cancer Survivors: A Cross-sectional Analysis of Baseline Data from the Moving Forward Study

Purpose: Little is known about the dietary behaviors of African-American breast cancer survivors (AABCS). We sought to describe dietary intake and quality in AABCS and examine associations with demographic, social, lifestyle, and body composition factors to potentially inform the development of effective dietary interventions.Methods: Baseline data from a prospective weight loss trial of 210 AABCS were assessed. A food frequency questionnaire was used to evaluate dietary intake and diet quality via the Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010). Linear regression analysis was conducted to determine the most influential variables on diet quality.Results: Mean HEI- and AHEI-2010 total scores were 65.11 and 56.83 indicating that diet quality needs improvement. Women were the least adherent to recommendations for intake of whole grains, dairy, sodium, empty calories, sugary beverages, red/processed meats, and trans-fat. Increased self-efficacy for healthy eating behaviors, more years of education (AHEI only), negative smoking status, smaller waist circumference, and increased physical activity (HEI only) were significantly associated with higher diet quality scores.Conclusion: Our findings suggest the diet quality of AABCS needs improvement. Intervention programs may achieve higher diet quality in AABCS by focusing on increasing self-efficacy for healthy eating behaviors.

Communication between patients and primary care physicians after behavioural weight loss: an observational study.

Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.

Enrollment Challenges: Recruiting Men to Weight Loss Interventions.

Obese men are at an increased risk of chronic disease and are far less likely than women to attempt weight loss. There is a need to successfully recruit men to weight loss clinical trials. Overweight and obese men were recruited to a 6-month, randomized, controlled weight loss trial. Initial recruitment efforts were aimed at men in the workplace with less than or equal to 2 years of college education. After unsatisfactory interest from men and businesses alike, recruitment strategy shifted to enroll men outside the workplace with any educational background. Recruitment methods included word of mouth, email and website advertisements, printed posters in local businesses and doctors’ offices, Facebook ads, and a 1-week newspaper ad campaign. Initial interest and enrollment was negligible with only 35 men enrolled in the first 7 months. The launch of a 1-week newspaper advertisement was the most useful recruitment technique and 102 overweight/obese men were successfully enrolled. Study retention remained high throughout the Gutbusters program, indicating targeted, effective recruitment, and not weight loss interest, may be the largest barrier to trial participation for overweight and obese men.

Obesity is Only a Risk Number for Secondary Prevention – Failure of Randomised Weight Loss Trials

Introduction: Obesity is linked to a number of metabolic conditions which are risk factors for cardiovascular disease. An increasing number of weight loss medications have become available as an adjunct treatment of obesity along with recommendations for diet and exercise. None have been shown to have effect on mortality or cardiovascular outcomes. Overweight and obesity are increasing and correlated with first but not necessarily recurrent cardiovascular events (CVE). This study assesses the safety and efficacy of weight loss as measured in the large prospective randomised weight loss trials for secondary prevention. Methods: PubMed search for trials measuring the specific effect of obesity reduction on cardiovascular events up to March 2019. Results:Tabled 1TrialLOOK-AHEADSCOUTCRESCENDOLIGHTCONVENECAMELLIASOSSLEEVE-PASSNumber5100107441869589108800120004047264OutcomeCVECVECVECVECVECVECVECV RiskHR0.95 p = 0.511.16 p = 0.020.97 p = 0.680.88n/a0.97 p = 0.550.76 p = 0.01n/aDuration10 yrs3.4 yrs13.8 mths2.9 yrs5 mths3.3 yrs15 yrs5 yrsStatusTerminatedWithdrawnTerminatedTerminatedTerminatedNo effect on CVEPrimary objective successful Secondary under-poweredWeight loss benefit shown with decrease in comorbidities. Open table in a new tab Conclusion: Deliberate weight loss in patients with baseline CVD do not prevent recurrent CVD and in fact may increase risk. Current guidelines need revision.

Weight Bias Internalization Is Negatively Associated With Weight-Related Quality of Life in Persons Seeking Weight Loss.

Research has shown a negative relationship between weight bias internalization (WBI) and general measures of health-related quality of life (QOL), such as the Short Form–36. Less is known about the impact of WBI on weight-specific domains of QOL. This study examined the relationship between WBI and weight-related QOL, as measured by the Impact of Weight on Quality of Life (IWQOL-Lite) scale. Participants were 178 adults with obesity [71.3% black, 87.6% female, mean body mass index (BMI) = 40.9 ± 5.9 kg/m2] enrolled in a weight loss trial testing the effects of lorcaserin on weight loss maintenance. At baseline, participants completed the Weight Bias Internalization Scale (WBIS), the IWQOL-Lite and the Patient Health Questionnaire (PHQ-9, to assess symptoms of depression). Total scores for the IWQOL-Lite and its five subscales (Physical Function, Self-Esteem, Sexual Life, Public Distress and Work) were calculated. Linear regression analyses showed that WBIS scores were associated with the IWQOL-Lite total score and all subscales above and beyond the effects of demographic variables, BMI, and depressive symptoms (beta values = -0.18 to -0.70, p values < 0.019). The relationship between WBIS and the IWQOL-Lite scales did not differ by gender or race. WBI was associated with mental and physical aspects of weight-related QOL in a predominantly black and female treatment-seeking sample of patients with obesity. Prioritizing the development of interventions to reduce WBI may be important for improving weight-related QOL.

Associations between reliable changes in depression and changes in BMI, total body fatness and visceral adiposity during a 12-month weight loss trial.

We investigated associations between changes in depression and body composition over a 12-month weight loss trial. Of the 298 adults (BMI > 27 m/kg2), 219 with complete depression and body composition data were included. A 10-item Center for Epidemiologic Studies Depression Scale measured depression; dual-energy x-ray absorptiometry measured body composition. Multinomial logistic regression predicted reliable changes in depression by BMI, body fat (BF) and visceral adiposity (VAT). Multiplicative interaction terms tested modification by sex and ethnicity. Participants with increases in body composition were less likely to experience improvements in depression (BMI: RRR = 0.79 (0.68 – 0.91), p < 0.01; BF: RRR = 0.97 (0.94 – 0.99), p = 0.01; VAT: RRR = 0.99 (0.98 – 1.00), p = 0.02), but not worsening of depression (BMI: RRR= 1.29 (0.96 – 1.73), p = 0.10; BF: RRR = 1.04 (0.99 – 1.09), p = 0.15; VAT: RRR = 1.01 (1.00 – 1.03), p = 0.18). Sex and ethnicity interaction terms were not significant. However, the relationship was only significant among females, among non-Latinos for BMI and BF, and among Latinos for VAT. Our study supports the association between depression and obesity and highlights the need for longitudinal studies investigating VAT and depression in diverse ethnic groups.

Fecal Akkermansia muciniphila Is Associated with Body Composition and Microbiota Diversity in Overweight and Obese Women with Breast Cancer Participating in a Presurgical Weight Loss Trial

BackgroundAkkermansia muciniphila (AM) is a gram-negative, mucin-degrading bacteria inhabiting the gastrointestinal tract associated with host phenotypes and disease states. ObjectiveExplore characteristics of overweight and obese female early-stage (0 to II) breast cancer patients with low AM relative abundance (LAM) vs high (HAM) enrolled in a presurgical weight-loss trial. DesignSecondary analysis of pooled participants in a randomized controlled trial (NCT02224807). Participants/settingDuring the period from 2014 to 2017, 32 female patients with breast cancer were randomized to weight-loss or attention-control arms from time of diagnosis-to-lumpectomy (mean=30±9 days). InterventionAll were instructed to correct nutrient deficiencies via food sources and on upper-body exercises. The weight-loss group received additional guidance to promote 0.5 to 1 kg/wk weight-loss via energy restriction and aerobic exercise. Main outcome measuresAt baseline and follow-up, sera, fecal samples, two-24 hour dietary recalls and dual x-ray absorptiometry were obtained. Bacterial DNA was isolated from feces and polymerase chain reaction (16S) amplified. Inflammatory cytokines were measured in sera. Statistical analyses performedDifferences between LAM and HAM participants were analyzed using t tests and nonparametric tests. Spearman correlations explored relationships between continuous variables. ResultsParticipants were aged 61±9 years with body mass index 34.8±6. Mean AM relative abundance was 0.02% (0.007% to 0.06%) and 1.59% (0.59% to 13.57%) for LAM and HAM participants, respectively. At baseline, women with HAM vs LAM had lower fat mass (38.9±11.2 kg vs 46.4±9.0 kg; P=0.044). Alpha diversity (ie, species richness) was higher in women with HAM (360.8±84.8 vs 282.4±69.6; P=0.008) at baseline, but attenuated after weight-loss (P=0.058). At baseline, interleukin-6 level was associated with species richness (ρ=–0.471, P=0.008) and fat mass (ρ=0.529, P=0.002), but not AM. Change in total dietary fiber was positively associated with AM in LAM (ρ=0.626, P=0.002), but not HAM (ρ=0.436, P=0.180) participants. ConclusionsAmong women with early-stage breast cancer, body composition is associated with AM, microbiota diversity, and interleukin-6 level. AM may mediate the effects of dietary fiber in improving microbiota composition.

Relationship between long-chain omega-3 polyunsaturated fatty acid intake and ankle brachial index, pulse wave velocity and resting heart rate in a sample of overweight adults: A secondary analysis of baseline data in the HealthTrack study.

The present study aimed to explore the association between dietary long-chain omega-3 polyunsaturated fatty acid (LCn3PUFA) intake and cardiovascular risk indicators (ankle brachial index, resting heart rate and brachial-ankle pulse wave velocity) in a clinical sample of overweight and obese participants volunteering for a weight loss trial. This was a secondary analysis of baseline data from the HealthTrack study (n = 351). LCn3PUFA intake was calculated via a diet history and the association with ankle brachial index, resting heart rate and brachio-ankle pulse wave velocity was explored using linear regression after controlling for covariates. LCn3PUFA intake was inversely associated with ankle brachial index (R2 change = 0.021, F change (1, 339) = 8.864, P < 0.05) and resting heart rate (R2 change = 0.014, F change (1, 342) = 5.337, P < 0.05) but not with brachio-ankle pulse wave velocity (R2 change = 0.001, F change (1, 339) = 0.725, P > 0.05). In this clinical sample of overweight adults, LCn3PUFA consumption was significantly associated with a lower resting heart rate, adding to the current evidence on the potential benefits of LCn3PUFA consumption. It also supports the value of targeting a diet rich in this nutrient when planning future dietetic approaches. Relationships with ankle brachial index and pulse wave velocity require further investigation. Future research should assess the effect of changes in dietary LCn3PUFA intake on novel cardiovascular risk indicators.