Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates

Obesity and its management in primary care setting

Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on a portion of cases worldwide. In young children with severe obesity however, recessive mutations, i.e., leptin or leptin receptor deficiency should be sought. Much more has been learned about the far-reaching impact of obesity on complications, including cardiovascular disease, liver and kidney dysfunction, diabetes, inflammation, hypertension, sleep, cancer, and the eye. Preventive strategies, particularly in children, are crucial for reducing obesity rates and mitigating its long-term complications. While dietary modifications and lifestyle changes remain the cornerstone of obesity prevention or treatment, recent advancements have introduced highly effective pharmacological options complementing weight-reduction surgery. Newer medications, like incretin-based therapies including glucagon-like peptide-1 agonists (GLP-1RA), have demonstrated remarkable efficacy in promoting weight loss, offering new insights into margining obesity-related conditions. Primary care providers, whether treating adults or children, play a pivotal role in preventing obesity, initiating treatment, and making onward referrals to specialists to assist in managing obesity and obesity-related complications.

The impact of dietary interventions on cardiometabolic health

Obesity and cardiometabolic diseases are leading causes of morbidity and mortality among adults worldwide. These conditions significantly contribute to and exacerbate other major causes of illness and death, including cancer, neurodegenerative diseases, and chronic kidney disease. The growing burden of these diseases has increased the interest of modern medicine in understanding metabolic processes and health, with diet emerging as a pivotal modifiable factor, alongside physical inactivity and smoking. In this review, we discuss the pathophysiological and evolutionary foundations of metabolic processes that may link "unhealthy" nutrition to obesity and cardiometabolic diseases and review the current literature to assess the effects of various diet interventions and patterns on cardiometabolic parameters. Special emphasis is placed on summarizing the latest, albeit partially contradictory, evidence to offer balanced dietary recommendations with the ultimate aim to improve cardiometabolic health.

Therapeutic hyperthermia promotes lipid export and HSP70/90 during machine perfusion of human livers

Liver transplantation is the only curative option for end-stage liver disease. Donor shortages necessitate the use of higher risk donor livers, including fatty livers, which are more susceptible to ischemia-reperfusion injury. Machine perfusion has improved graft utilization and is typically performed at hypothermic (8-12°C) or normothermic (35-37°C) temperatures. Here we studied the impact of mild hyperthermia (40°C) as a therapeutic intervention for fatty livers using in-depth proteomic and lipoprotein profiling of whole organ perfusion and precision-cut liver slices. We observed proteomic changes with metabolic alterations over time, evidenced by a significant increase in lipid export in whole organ perfusions. Furthermore, PCLS showed significant upregulation of metabolic processes and heat shock protein response after 24 h of hyperthermia. Machine perfusion under hyperthermic conditions may be a potential strategy to improve the utilization of fatty liver grafts, ultimately expanding the donor pool and improving transplant outcomes.

A systematic review of evidence that environmental contaminant exposure impedes weight loss and glycemic control during calorie-restricted diets in humans

Calorie-restricted diets cause weight loss and can drive type 2 diabetes remission. However, many patients struggle to achieve clinically relevant weight loss, and the reasons are not well understood. Chemical exposure is associated with obesity and type 2 diabetes development, and some evidence from preclinical experiments suggests it can limit the clinical benefits of calorie restriction. We systematically reviewed the evidence for the effects of environmental chemical exposure on mass loss and glycemic control during diet-induced weight management in humans (PROSPERO: CRD42022339993). Of 222 unique citations, only six papers directly examined this question. Only one targeted people with type 2 diabetes. One linked phthalates and parabens, but not bisphenols, with slower fat loss. Two showed per- and polyfluoroalkyl substances were not associated with mass loss, but with faster subsequent mass regain. One linked impaired adiposity improvements with air pollutants. Two papers reported weight loss-induced elevation in plasma organochlorines associated with altered glycemic control. The risk of bias largely arose from the potential for deviation from the intended diet, and statistics and reporting. The role of chemical exposure in impeding the effectiveness of weight management programs needs to be better understood to provide suitable support to people living with obesity and type 2 diabetes.

Obesity and Hypertension: Etiology and the Effects of Diet, Bariatric Surgery, and Antiobesity Drugs

Obesity-related hypertension (HTN) is a growing global health concern, being a significant contributor to cardiovascular morbidity and mortality. The article reviews the complex pathophysiological mechanisms involved in the link between obesity and HTN, including neurohormonal activation, inflammation, insulin resistance, and endothelial dysfunction. The role of adipokines, specifically leptin and adiponectin, in blood pressure regulation is highlighted, along with the impact of advanced glycation end-products on vascular function. We discuss the effectiveness of lifestyle therapies, including weight loss, and diet for the management of obesity HTN. We also discuss the utilization of pharmacologic agents, including GLP-1 receptor agonists, and the impact of bariatric surgery on long-term blood pressure control. Despite enhanced treatment, significant barriers to treatment exist, including obesity stigma, limited access to health care, and adherence problems. Future research must focus on personalized approaches, like pharmacogenomics, to optimize hypertension treatment in the obese.

The Association Between Lifestyle Interventions and Trimethylamine N-Oxide: A Systematic-Narrative Hybrid Literature Review

BACKGROUND

Trimethylamine N-oxide (TMAO) is a gut- and food-derived molecule. Elevated TMAO concentrations have been associated with an increased risk of cardiovascular disease (CVD) and all-cause mortality, highlighting its significance as a potential biomarker for adverse health outcomes. Given these associations, it is hypothesized that lifestyle interventions, such as healthy dietary patterns and exercise, could reduce TMAO concentrations. The aim of this systematic-narrative hybrid literature review was to evaluate the relationship between various lifestyle interventions and TMAO.

METHODS

MEDLINE (via PubMed®), Scopus®, and grey literature were searched until July 2024 for eligible clinical trials. Case reports, case series, case studies and observational studies were excluded, as well as studies that investigated food products, nutraceuticals, dietary supplements or have been conducted in the pediatric population.

RESULTS

In total, 27 studies were included in this review. While some dietary interventions, such as plant-based, high-dairy, very low-calorie ketogenic diet or the Mediterranean diet, were associated with lower TMAO concentrations, others-including high-protein and high-fat diets-were linked to an increase in TMAO concentrations. Studies that incorporated a combination of nutrition and exercise-based intervention presented neutral results.

CONCLUSIONS

The relationship between dietary interventions and TMAO concentration remains controversial. While certain interventions show promise in reducing TMAO levels, others yield mixed or contradictory outcomes. Further research, including well-structured RCTs, is needed to investigate the aforementioned associations.

Using Metabolic Testing to Personalize Behavioral Obesity Treatment

Background

There are large individual differences in weight loss and maintenance. Metabolic testing can provide phenotypical information that can be used to personalize treatment so that people remain in negative energy balance during weight loss and remain in energy balance during maintenance. Behavioral testing can assess the reinforcing value and change in the temporal window related to the personalized diet and exercise program to motivate people to maintain engagement in healthier eating and activity programs.

Objective

Provide an expository overview of how metabolic testing can be used to personalize weight control. Ideas about incorporating behavioral economic concepts are also included.

Methods

A broad overview of how resting metabolic rate, thermic effect of food and respiratory quotient can be used to improve weight control. Also discussed are behavioral economic principles that can maximize adherence to diet and activity protocols.

Results

Research suggests that measuring metabolic rate can be used to set calorie goals for weight loss and maintenance, thermic effect of food to increase energy expenditure, and respiratory quotient to guide macronutrient composition of the diet and maximize fat loss. Developing programs that foster a strong motivation to eat healthier and be active can maximize treatment success.

Conclusion

Incorporating metabolic measures can personalize behavioral weight loss programs, and the use of behavioral economic principles can increase the probability of adherence and long-term success in weight control.

The mediating role of social support in behavioral changes and weight loss outcomes among overweight Appalachian adults

Social support plays a key role in behavioral changes, especially in Appalachian populations. We examined the mediating effect of social support in behavioral changes and corresponding weight loss outcomes among Appalachian adults. Data were from a group-randomized trial that compared a 12-month faith-based weight loss intervention to an active control group among overweight Appalachian adults in churches. Participants from the weight loss intervention who completed the 12-month assessment were the focus of this analysis. Baseline and 12-month data on weight, social support for eating habits (SSEH) and physical activity (SSPA) from family, friends, and church family, physical activity, and dietary intake were collected. Logistic and linear regression models evaluated mediating effects of SSEH and SSPA on the association between intervention attendance and behavioral changes and corresponding weight loss outcomes. Most participants (n = 243) were female (76.2%), white (97.5%), and married or living with a partner (81.2%). After the 12-month intervention, participants lost weight (1.1 ± 0.3 kg), increased fruit and vegetable intake (0.4 ± 0.1servings/day), reduced caloric intake (322.9 ± 42.2 kcal/day), improved SSEH from family, and increased SSPA from the church family (all P < 0.05). Increased SSEH from family mediated 62% of the association between intervention attendance and fruit and vegetable servings per day. Each 100 kcal decrease in caloric intake was associated with decreased weight and BMI at 12-months (0.2 ± 0.1 kg, P = 0.003; 0.1 ± 0.02 kg/m2, P = 0.002). Our study demonstrated the mediation effect of social support for healthy eating on the association between intervention attendance and fruit and vegetable intake, which underscored the critical role of social support and calorie intake among Appalachian populations in losing weight. The study was pre-registered at clinicaltrials.gov (#NCT02121691).

Estimation of the Burden of Ischemic Heart Disease in the Tabasco Population, Mexico, 2013-2021

INTRODUCTION

The burden of disease measures the total impact of diseases on a population, considering incidence, prevalence, disability, and premature mortality. This study analyzes the burden of ischemic heart disease (IHD) in Tabasco, Mexico, from 2013 to 2021. Ischemic heart disease has a significant incidence of 21,203,479 cases worldwide, and nationally (inside Mexico) a total of 221,747 cases, with more than 9,137,791 deaths due to this pathology globally.

OBJECTIVE

To analyze the burden of ischemic heart disease in Tabasco, Mexico, during the 2013-2021 period.

METHODS

An observational, descriptive, longitudinal, and retrospective study was conducted in Tabasco. The study population consisted of 2,402,598 people according to INEGI, with a sample of 927,000 adults (462,000 men and 465,000 women). Data were used from the General Directorate of Health Information, IHME, and the World Bank. Analyses were performed in Microsoft Excel, calculating measures of central tendency, dispersion, and Disability-Adjusted Life Years (DALYs).

RESULTS

The DALYs in the adult population of Tabasco were: 2013-23,932; 2014-28,132; 2015-30,197; 2016-30,683; 2017-31,839; 2018-38,599; 2019-40,046; 2020-42,307; and 2021-55,723, totaling 297,576 DALYs from 2013 to 2021.

DISCUSSION

Ischemic heart disease increased in incidence and mortality in both men and women during the years analyzed. The increase in DALYs indicates a greater impact of ischemic heart disease in Tabasco compared to countries like Costa Rica.

CONCLUSION

The burden of ischemic heart disease from 2013 to 2021 represents a significant loss of quality and years of life in the population of Tabasco, Mexico.

Weight Reduction with GLP-1 Agonists and Paths for Discontinuation While Maintaining Weight Loss

Worldwide, nearly 40% of adults are overweight and 13% are obese. Health consequences of excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, and increased mortality. Treating obesity is challenging and calorie restriction often leads to rebound weight gain. Treatments such as bariatric surgery create hesitancy among patients due to their invasiveness. GLP-1 medications have revolutionized weight loss and can reduce body weight in obese patients by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP-1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. They carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are rarer. There may be a loss of lean body mass as well as premature facial aging. A significant disadvantage of using these medications is the high rate of weight regain when they are discontinued. Achieving success with pharmacologic treatment and then weaning to avoid future negative effects would be ideal.

Effectiveness of a Food Education Program for healthcare workers: a pilot study in a Total Worker Health© approach

Introduction

Obesity has been identified as a crucial cause of non-communicable diseases, especially for healthcare workers who often take a brief lunch break with high energy and micro- and macronutrients deficient food.

Methods

Our study aims to investigate the clinical and economic effectiveness of the "Food Education Program" (FEP) among healthcare workers having weight problems. Four questionnaires were administered before and after FEP to explore the risk of psychological injury ("Psychological Injury Risk Indicator"), mental and general health status ("Goldberg's General Health Questionnaire-12" and "Short Form-36 health survey") and eating behavior ("Eating Attitudes Test"). The Return on Investment (ROI) was calculated on the base of absenteeism reduction in the 1-year period after FEP.

Results

Fifty-one participants (78.4% females, mean age: 52.04 ± 8.94) were included in the study. They were mainly nurses (56.9%). 54.9% were obese and 43.1% overweight. The success rate was 32.1%; the reduction in BMI was more evident in the overweight participants than the obese subjects. A significant reduction of waist-to-hip ratio, glycosylated hemoglobin, total and LDL cholesterol, and an increase in vitamin D was observed (p-value: 0.047, 0.002, <0.001, 0.001, and 0.03). Scores on general health significantly improved (p-value <0.001 and 0.011). A mean per capita reduction of 3.70 days was observed in 1-year period after the intervention, with a ROI of 6.97.

Conclusion

Food Education Program represents a successful program to improve psychophysical wellbeing of healthcare workers through healthy nutritional plans, also having a notable positive impact on the organization, including its financial accounts.

The Close Link Between Obesity and Cardiovascular Disease: Current Insights and Remaining Challenges

Obesity is a global public health crisis, contributing to chronic disease development and poor prognosis. A large body of evidence consistently demonstrates that increased adiposity leads to many cardiovascular diseases (CVDs) and complications, such as coronary artery disease, heart failure, and arrhythmias, via direct and indirect mechanisms. Therefore, weight management is crucial to reduce and prevent cardiovascular risk. The recent emergence of glucose-like peptide-1 receptor agonists shows remarkable weight reduction and cardiovascular prevention. Despite the clear benefits, controversies and challenges on obesity-related CVD remain. This review aims to provide a comprehensive understanding of obesity-related CVD and explore current remaining tasks.

Team Approach: An Interdisciplinary Framework for Weight Loss Before Total Joint Arthroplasty Surgery

» Obesity is a public health concern, with 41.9% of the US population classified as obese. Obesity increases the risk of chronic disease, type II diabetes, cardiovascular diseases, etc., leading to increased morbidity and mortality. Obesity has been identified as an independent risk factor of postoperative complications, including infection and impaired wound healing, following elective surgery. In total joint arthroplasty, it has been well elucidated that obese patients are predisposed to higher rates of postoperative complications, longer hospital stays, and increased cost of stay.» Obesity is influenced by the interplay between many societal, behavioral, and socioeconomic factors and requires a multidisciplinary approach to treatment. The patient's care team should be well versed in nutritional counseling, behavioral health counseling, medication management, and surgery to allow for a comprehensive approach.» Orthopaedic surgeons, dietitians, nutritionists, weight-loss physicians, and bariatric surgeons all play a critical role in treating this patient population. This review highlights the roles of these practitioners in developing an interdisciplinary framework to help patients with hip and knee arthritis lose weight before joint replacement surgery. Not only will this afford more patients the quality-of-life benefits that come with a hip or knee replacement but will also serve to decrease the complication rates associated with this patient cohort.» The aim of this review was to educate orthopaedic surgeons on various strategies that can be used to best optimize these patients for successful joint replacement surgery.

The past, present, and future of behavioral obesity treatment

Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.

HPV Vaccination Program in Indonesia: Effectiveness, Dose, Scale-Up Costs, Future Prospects, and Policy Recommendations

BACKGROUND

Among females, Cervical cancer affects more frequently than any other type of cancer in Indonesia. Cervical cancer and illnesses linked to HPV infection are potentially preventable through vaccination.  The aim of his study was to describe the characteristics of the available vaccines, the  policy, and the implementation of HPV vaccination in Indonesia.

METHODS

A scoping review was performed by collecting information from previous studies, including general information about vaccines, vaccine efficacy, effectiveness, and safety.

RESULTS

Approved HPV vaccine products in Indonesia have proven efficacy, effectiveness, and safety. Procuring vaccines through GAVI/UNICEF and the government has both advantages and disadvantages. Alongside the limited supply, numerous research studies show that dosage reduction to a single dose provides equal protection compared to 2-3 doses. The benchmark implementation of the single dose has been done in many countries, ranging from high-income to low-middle-income countries. Therefore, considering other countries and Indonesia's high population and vaccination burden, proposed updates for vaccination programs are recommended to achieve the cancer elimination target by 2030.

CONCLUSION

Improvement of vaccination programs using single-dose HPV vaccine to prevent cervical cancer requires a coherent framework, sufficient funds, effective management of stakeholder interests, and sensitivity to contextual factors.

Machine-learning approaches to predict individualized treatment effect using a randomized controlled trial

Recent advancements in machine learning (ML) for analyzing heterogeneous treatment effects (HTE) are gaining prominence within the medical and epidemiological communities, offering potential breakthroughs in the realm of precision medicine by enabling the prediction of individual responses to treatments. This paper introduces the methodological frameworks used to study HTEs, particularly based on a single randomized controlled trial (RCT). We focus on methods to estimate conditional average treatment effect (CATE) for multiple covariates, aiming to predict individualized treatment effects. We explore a range of methodologies from basic frameworks like the T-learner, S-learner, and Causal Forest, to more advanced ones such as the DR-learner and R-learner, as well as cross-validation for CATE estimation to enhance statistical efficiency by estimating CATE for all RCT participants. We also provide a practical application of these approaches using the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) trial, which compared the effects of high versus low-fat diet interventions on 2-year weight changes. We compared different sets of covariates for CATE estimation, showing that the DR- and R-learners are useful for the estimation of CATE in high-dimensional settings. This paper aims to explain the theoretical underpinnings and methodological nuances of ML-based HTE analysis without relying on technical jargon, making these concepts more accessible to the clinical and epidemiological research communities.

Testing a Personalized Behavioral Weight Loss Approach Using Multifactor Prescriptions and Self-Experimentation: 12-Week mHealth Pilot Randomized Controlled Trial Results

Background

Behavioral weight loss (WL) interventions typically follow standard diet and activity prescriptions for intervention duration to produce an energy deficit. Though average weight losses in these programs are clinically meaningful, there is heterogeneity in weight outcomes. Personalized diet and activity prescriptions may help increase the potency of WL programs by reducing this heterogeneity.

Methods

This 12-week pilot study randomized participants (n = 35; BMI 34.6 ± 4.9 kg/m2, 34% with HbA1c 5.7%-6.4%) in a 3:1 ratio to a Personalized Behavioral Weight Loss (PBWL) or standard BWL and compared the feasibility and efficacy of these approaches. Both groups received a study mobile app, smart scale, activity tracker, and weekly telephone coaching sessions; PBWL participants received a continuous glucose monitoring device. PBWL participants had goals for 1) macronutrient composition (low fat or carbohydrate), 2) meal frequency (3 meals or meals and snacks), and 3) activity focus (daily or weekly goal); they experimented with different 3-part prescriptions, in random order and combination, for the first 4 weeks then picked their 3 goals to follow for weeks 5-12.

Results

Study retention (100%) and satisfaction were high. Mean 3-month weight loss (kg) was greater in PBWL (-7.08 (0.74)) than BWL (-3.79 (0.84), P = 0.03); 74% of PBWL and 63% of BWL participants were "optimizers" who achieved a 5% weight loss at 3 months. PBWL optimizers lost more weight (-8.66 (0.66)) than BWL optimizers (-4.76 (0.43), p < 0.001).

Conclusions

Experimentally-derived personalized prescriptions supported greater 12-week weight loss than standard recommendations. Trial Registration: ClinicalTrials.gov NCT04639076.

Beneficial Effects of a Moderately High-Protein Diet on Telomere Length in Subjects with Overweight or Obesity

BACKGROUND AND AIM

Telomere length (TL) is a key biomarker of cellular aging, with shorter telomeres associated with age-related diseases. Lifestyle interventions mitigating telomere shortening are essential for preventing such conditions. This study aimed to examine the effects of two weight loss dietary strategies, based on a moderately high-protein (MHP) diet and a low-fat (LF) diet on TL in individuals with overweight or obesity.

METHODS AND RESULTS

A total of 164 participants, aged 18-65 years from the OBEKIT trial received the MHP (n = 83) or the LF diet (n = 81) for 4 months and had TL data for analyses. TL was measured at baseline and after 4 months of the intervention using monochrome multiplex quantitative polymerase chain reaction (MMqPCR). Both groups experienced significant improvements in anthropometric and biochemical parameters after the dietary intervention (p < 0.001). The MHP group showed an increase in TL (+0.16 ± 0.13) compared to the LF group (-0.05 ± 0.13) in multiple-adjusted models (p = 0.016). An interaction was observed between the sex and dietary group, where women in the MHP group had increased TL (+0.23 ± 0.16) after 4 months compared to women in the LF group (-0.13 ± 0.15; p = 0.001); no differences between dietary groups were found in men. This increase in TL for women was associated with an increase in protein intake (p = 0.006), measured through dietary questionnaires.

CONCLUSION

This study shows that a MHP diet may have a protective effect on TL during weight loss, particularly in women, potentially contributing to healthier aging. These results highlight the importance of considering macronutrient composition in dietary interventions aimed at preserving TL.

The role of nutrition-related clinical trials in informing dietary recommendations for health and treatment of diseases

BACKGROUND

Dietary guidance is based on a robust evidence base including high-quality clinical trials, of which some have been designed to establish causal relationships between dietary interventions and atherosclerotic cardiovascular disease (ASCVD) risk reduction. However, the complexity associated with conducting these studies has resulted in criticism of nutrition and dietary recommendations because the strength and quality of evidence falls short of that for some pharmaceutical interventions.

SOURCES OF MATERIAL

In this paper, we aim to promote greater awareness of the nutrition-related clinical trials that have been conducted showing ASCVD benefits and how this evidence has contributed to dietary recommendations.

ABSTRACT OF FINDINGS

Compared to clinical trials of pharmaceutical agents, nutrition-related clinical trials have several unique considerations, including complexities of intervention design, challenges related to the blinding of participants to treatment, modest effect magnitudes, variability in baseline dietary exposures, absence of objective dietary adherence biomarkers, achieving sustained participant adherence, and the significant timeline for endpoint responses. Evidence-based dietary recommendations are made based on multiple lines of evidence including that from randomized controlled trials, epidemiological studies, as well as animal and in vitro studies.

CONCLUSION

This research has provided foundational evidence for the role of diet in prevention, management, and treatment of ASCVD. Based on the clinical trials that have been conducted, a strong consensus has evolved regarding the key elements of healthy dietary patterns that decrease ASCVD risk. Going forward, implementation research is needed to identify effective translation approaches to increase adherence to evidence-based dietary recommendations.

Effect of an intensive nutrition intervention of a high protein and low glycemic load diet on weight of kidney transplant recipients: a randomized clinical trial

PURPOSE

The purpose of this study is to evaluate the effect of a high protein and low glycemic load diet in preventing weight gain after kidney transplantation.

METHODS

We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3-1.4 g/kg/day) and low glycemic load diet versus a conventional diet (0.8-1.0 g/kg/day of protein and no recommendations on glycemic load) in preventing weight gain (ClinicalTrials.gov identifier: NCT02883777). A total of 120 patients were evaluated. Patients were followed for 12 months, and the primary outcome was weight maintenance or weight gain lower than 5%.

RESULTS

There were no differences in total energy intake, carbohydrates, and total fats between groups. Intervention group (IG) increased protein intake to 1.38 ± 0.56 g/kg/day and decreased the glycemic load to 87.27 ± 4.54 g/day, while control group (CG) had a dietary protein intake of 1.19 ± 0.43 g/kg/day and a glycemic load of 115.60 ± 7.01 g/day. Total fiber intake was greater and trans-fat was lower in IG. Dietetic cholesterol increased in IG over time and was significantly different between groups. Overall, patients had an increase in body weight over time, with a mean increment of 4.1 ± 5.5 kg (5.75%). The percentage of patients who achieved the primary outcome was 50% of sample size, without differences between groups. The glomerular filtration rate improved over time in both groups. Considering 24-h proteinuria and albuminuria, a similar rise was observed in both groups.

CONCLUSION

The present dietary intervention was safe, but had no effect on weight gain in kidney transplant subjects. Our findings suggest that other strategies, including alternative dietary and/or pharmacological and psychological interventions might be tested in randomized control trials in order to improve patients' body weight outcomes after transplant.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Eichorst B, Ekhlaspour L, Garg R, Hassanein M, Khunti K, Lal R, Lingvay I, Matfin G, Middelbeek RJ, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Tanenbaum ML, Urbanski P, Bannuru RR. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The association of SLC16A1 (MCT1) gene polymorphism with body composition changes during weight loss interventions: A randomized trial with sex-dependent analysis

Monocarboxylates, transported by monocarboxylate transporters (MCTs), have been proposed to influence energy homeostasis and exhibit altered metabolism during exercise. This study investigated the association between the Asp490Glu (T1470A) (rs1049434) polymorphism of the SLC16A1 (MCT1) gene and changes in body composition in males and females with overweight or obesity. The 173 participants (56.6% females) completed a 6-month randomized controlled trial, being assigned to the Supervised Exercise group (strength, endurance, or strength plus endurance training) or the Physical Activity (PA) Recommendations group. Participants were genotypically categorized as Asp/Asp (TT), Asp/Glu (TA), or Glu/Glu (AA). ANCOVA analysis showed main effects for genotype and interaction genotype × group (p < 0.05) for several variables, especially in females. Asp/Asp (TT) females showed greater reductions in total fat mass (-29.30 ± 8.75% change), percentage of body fat (-17.50 ± 8.06% change), and body weight (-13.90 ± 2.62% change) compared with Glu/Glu (AA) (p ≤ 0.020; d ≥ 0.18) and Asp/Glu (TA) (p ≤ 0.050; d ≥ 0.16) females, but only within the PA Recommendations group. Data indicated higher decreases in lean body mass of the Asp/Asp (TT) compared to Glu/Glu (AA) in females (p = 0.067, η2 p = 0.067) and to Asp/Glu (TA) in males (p = 0.026; η2 p = 0.101). Our investigation suggests an association of the single-nucleotide polymorphism with body composition changes especially in females following exercise recommendations, highlighting the importance of supervised training to offset genetic predisposition for different weight loss. Differences in males only appeared for lean body mass, suggesting sex differences for this genetic association. The study underscores the potential influence of MCT1 functionality on human adaptations to weight loss interventions. ClinicalTrials.gov information: registry name, Nutrition and Physical Activity for Obesity (PRONAF); registration number, NCT01116856.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Garg R, Khunti K, Kushner RF, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Bannuru RR. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Improvement in obesity-related comorbidities 5 years after endoscopic sleeve gastroplasty: a prospective cohort study

BACKGROUND AND AIMS

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure of the gastric cavity to facilitate weight loss. We aimed to evaluate the long-term effects of ESG as a monotherapy on obesity-related comorbidities over 5 years.

METHODS

This prospective study analyzed data from 404 consecutive patients (aged 45 ± 11.9 years, 76% women) who underwent ESG from August 2013 through June 2024. All patients had body mass indices ≥30 or ≥27 kg/m2 with comorbidities. Patients receiving adjuvant therapy were excluded to assess ESG as a monotherapy. All procedures were performed with a flexible endoscopic suturing system to facilitate restriction of the stomach. Patients were evaluated after 12 months (n = 336), 36 months (n = 210), and 60 months (n = 196) for anthropometric features, clinical parameters, metabolic panels, and liver function tests. Primary outcomes were the effects of ESG on obesity-related comorbidities and metabolic biomarkers. Secondary outcomes were total body weight loss (TBWL) and safety.

RESULTS

At 5 years after ESG, patients had significant reductions in levels of hemoglobin A1c (Δ .42%, P = .0007), systolic blood pressure (Δ 4.1 mm Hg, P = .0071), and alanine aminotransferase (Δ 7.4 U/L, P = .002). Body mass indices before the procedure were 37.5 ± 5.8 and 33.8 ± 6.7 kg/m2 at 60 months (P < .001). TBWL was 13.4% at 12 months (84.5% follow-up), 9.9% at 36 months (63.3% follow-up), and 11.8% at 60 months (74.8% follow-up), with 3 moderate adverse events (.7%).

CONCLUSIONS

ESG is an effective, noninvasive monotherapy that improved markers of hypertension, diabetes, and metabolic dysfunction-associated steatotic liver disease and led to a TBWL of 11.8% at 5 years after the procedure. (Clinical trial registration number: NCT04494048.).

Food Preference Assessed by the Newly Developed Nutrition-Based Japan Food Preference Questionnaire and Its Association with Dietary Intake in Abdominal-Obese Subjects

BACKGROUND/OBJECTIVES

Understanding food preferences is important for weight management. However, methods for assessing food preferences are not well established, especially in Japan. This study aimed to examine detailed food preferences and their associations with actual food intake in non-obese and abdominal-obese subjects using a newly developed questionnaire tailored for the Japanese population.

METHODS

We developed the Japan Food Preference Questionnaire (JFPQ) to evaluate food preferences across four nutrient groups based on nutritional evidence: carbohydrate, fat, protein, and dietary fiber. A total of 38 non-obese and 30 abdominal-obese participants completed both the JFPQ and the Food Frequency Questionnaire (FFQ). Food preferences for each nutrient were compared between the two groups, and correlations between food preferences (assessed by the JFPQ) and food intake (assessed by the FFQ) were analyzed.

RESULTS

Compared with the non-obese group, the abdominal-obese group showed significantly greater preferences for carbohydrates, fat, and protein, with no significant difference in dietary fiber after adjusting for age and sex. Furthermore, in the abdominal-obese group, positive correlations were found between actual intake and preference for high-fat and high-carbohydrate foods.

CONCLUSIONS

Our findings from this pilot study demonstrated that abdominal-obese individuals had greater preferences for fat and carbohydrates, which were linked to actual fat and carbohydrate intake and possibly contributed to the development of obesity.

Body Composition Changes and Factors Influencing the Total Weight Loss Rate After Laparoscopic Sleeve Gastrectomy

Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve gastrectomy (LSG). Methods: This prospective observational cohort included patients who underwent LSG at a single academic health center between January 2017 and June 2022. We examined their body composition using InBody 720 or 770 and analyzed the factors associated with the percentage of total weight loss (%TWL) for 24 months. Results: The median body mass index (BMI) was 38.8 (interquartile range [IQR]: 35.6-46.7) preoperatively, 32.7 kg/m2 (IQR: 28.2-38.7) at 12 months postoperatively, and 33.9 kg/m2 (IQR: 29.1-40.1) at 24 months postoperatively. The lowest BMI was observed at 12 months (p < 0.001 vs. preoperative), followed by a significant increase at 24 months (p = 0.003). However, BMI remained significantly lower at 24 months than preoperatively (p < 0.001). The skeletal muscle mass to fat mass ratio (SMM/FM) was 0.59 (IQR: 0.50-0.71) preoperatively, 0.79 (IQR: 0.58-1.26) at 12 months, and 0.70 (IQR: 0.54-1.05) at 24 months, peaking at 12 months (p < 0.001 vs. preoperative) and decreasing significantly by 24 months (p < 0.001). Nevertheless, the SMM/FM ratio at 24 months remained higher than preoperative values (p < 0.001). Median body weight and %TWL were 86.0 kg and 15.6%, respectively, at 24 months after LSG. The SMM/FM ratio at 12 months was positively correlated with %TWL at 24 months after adjusting for age and sex. Conclusions: The effects of LSG persisted for up to 24 months postoperatively. The SMM/FM ratio 12 months after LSG was associated with the rate of weight loss at 24 months.

Mexican Clinical Practice Guidelines for Adult Overweight and Obesity Management

PURPOSE

To develop Mexico's first methodologically rigorous clinical practice guideline for the management of adult overweight and obesity. The target audiences are interdisciplinary healthcare professionals across healthcare systems who are the first point of contact for patients with obesity in Mexico, patients, and health system decision makers.

RECENT FINDINGS

A review of recent international obesity clinical practice guidelines and an expert consensus process identified: i) common recommendations appropriate for implementation in Mexico and ii) knowledge gaps requiring the formulation of new recommendations. In all, 20 new recommendations and 20 good practice statements were developed using the GRADE Evidence-to-Decision Framework and expert consensus. Overweight and obesity negatively impact the health and well-being of individuals and populations in Mexico. This guideline aims to establish a new evidence-based, patient-centered, non-stigmatizing, and practical treatment and management framework, based on the fundamental principles of chronic disease prevention and management.

Exploring Biases of the Healthy Eating Index and Alternative Healthy Eating Index When Scoring Low-Carbohydrate and Low-Fat Diets

BACKGROUND

The Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010) are commonly used to measure dietary quality in research settings. Neither index is designed specifically to compare diet quality between low-carbohydrate (LC) and low-fat (LF) diets. It is unknown whether biases exist in making these comparisons.

OBJECTIVE

The aim was to determine whether HEI-2010 and AHEI-2010 contain biases when scoring LC and LF diets.

DESIGN

Secondary analyses of the Diet Intervention Examining the Factors Interacting With Treatment Success (DIETFITS) weight loss trial were conducted. The trial was conducted in the San Francisco Bay Area of California between January 2013 and May 2016. Three approaches were used to investigate whether biases existed for HEI-2010 and AHEI-2010 when scoring LC and LF diets.

PARTICIPANTS/SETTING

DIETFITS participants were assigned to follow healthy LC or healthy LF diets for 12 months (n = 609).

MAIN OUTCOMES MEASURES

Mean diet quality index scores for each diet were measured.

STATISTICAL ANALYSIS

Approach 1 examined both diet quality indices' scoring criteria. Approach 2 compared scores garnered by exemplary quality LC and LF menus created by registered dietitian nutritionists. Approach 3 used 2-sided t tests to compare the HEI-2010 and AHEI-2010 scores calculated from 24-hour dietary recalls of DIETFITS trial participants (n = 608).

RESULTS

Scoring criteria for both HEI-2010 (100 possible points) and AHEI-2010 (110 possible points) were estimated to favor an LF diet by 10 points. Mean scores for exemplary quality LF menus were higher than for LC menus using both HEI-2010 (91.8 vs 76.8) and AHEI-2010 (71.7 vs 64.4, adjusted to 100 possible points). DIETFITS participants assigned to a healthy LF diet scored significantly higher on HEI and AHEI than those assigned to a healthy LC diet at 3, 6, and 12 months (all, P < .001). Mean baseline scores were lower than mean scores at all follow-up time points regardless of diet assignment or diet quality index used.

CONCLUSIONS

Commonly used diet quality indices, HEI-2010 and AHEI-2010, showed biases toward LF vs LC diets. However, both indices detected expected changes in diet quality within each diet, with HEI-2010 yielding greater variation in scores. Findings support the use of these indices in measuring diet quality differences within, but not between, LC and LF diets.

Review of the Relationships Between Human Gut Microbiome, Diet, and Obesity

Obesity is a complex disease that increases the risk of other pathologies. Its prevention and long-term weight loss maintenance are problematic. Gut microbiome is considered a potential obesity modulator. The objective of the present study was to summarize recent findings regarding the relationships between obesity, gut microbiota, and diet (vegetable/animal proteins, high-fat diets, restriction of carbohydrates), with an emphasis on dietary fiber and resistant starch. The composition of the human gut microbiome and the methods of its quantification are described. Products of the gut microbiome metabolism, such as short-chain fatty acids and secondary bile acids, and their effects on the gut microbiota, intestinal barrier function and immune homeostasis are discussed in the context of obesity. The importance of dietary fiber and resistant starch is emphasized as far as effects of the host diet on the composition and function of the gut microbiome are concerned. The complex relationships between human gut microbiome and obesity are finally summarized.

Dietary Patterns of Healthy Underweight Individuals Compared to Normal-BMI Individuals Using Photographic Food Diaries

BACKGROUND

Previously, we found that healthy underweight (HU) subjects, with BMI < 18.5, eat about 12% less food (by calories) each day. It is presently unclear whether this lower intake is associated with them making food choices that provide high satiation and satiety.

METHODS

Using 7-day photographic records of food intake, we analyzed 52 HU and 50 normal-weight participants.

RESULTS

We included 52 HU and 50 normal-weight participants in the final analysis. HU individuals ate 25% fewer calories than normal-weight individuals. Their intake included a higher % of rice (p = 0.0013) and vegetables (p = 0.0006) and a lower % of livestock meat (p = 0.0007), poultry meat (p < 0.0001), and starchy roots (p = 0.0015), compared with the normal-weight population. The percent energy from carbohydrates was significantly higher (p = 0.0234), and the % energy from fat was significantly lower (p < 0.0001) in the HU group, with no difference in the % energy from protein. HU individuals sourced more of their protein from plants. Dietary patterns were grouped into three clusters, with 24 individuals grouped into cluster 1 (87.5% normal-weight population), 28 individuals into cluster 2 (64.3% normal-weight group), and 50 individuals into cluster 3 (78% HU group).

CONCLUSIONS

The HU group ate less overall and had proportionally more rice and vegetables and less poultry and livestock meat, starchy roots, and drinks. With respect to macronutrients, they also ate a greater % carbohydrates and less % fat, and they sourced more of their protein intake from plant sources. HU individuals did not follow a low-carbohydrate lifestyle.

Lifestyle Therapy for Obesity

Lifestyle management of obesity includes nutritional therapy, physical activity, and several intermittent fasting therapies. Effective nutrition therapies include optimized low-fat diets, high-quality ketogenic diets, and energy-restricted diets. Adherence to dietary change remains the most substantial barrier to success; therefore, patients engaging in lifestyle changes require intensive support and resources. Physical activity is shown to have benefits to body composition and disease risk beyond the effects on weight loss. Patients should be guided toward a regimen that is appropriate for their capacity for movement. Multiple intermittent fasting strategies have now been shown to cause substantial weight loss and metabolic health improvement.

The Effect of High Protein-High Fat and High Protein-High Carbohydrate Meals on Resting Metabolic Rate and Metabolic Factors in Overweight and Obese Adults: The Study Protocol for a Randomized Crossover Clinical Trial

Background

The macronutrient composition of daily meals plays a crucial role in influencing the body's metabolic responses during the postprandial phase. However, existing research on the effects of macronutrients, particularly fats and carbohydrates, has produced inconsistent findings.

Objectives

This study aims to evaluate the postprandial effects of two high-protein meals-one low in fat and high in carbohydrates (HP-LF-HC) and the other high in fat and low in carbohydrates (HP-HF-LC)-on energy metabolism, appetite response, and blood markers in overweight and obese men and women without underlying health conditions.

Methods

This study was conducted as an acute randomized crossover clinical trial at the Health Monitoring Center of Mashhad University of Medical Sciences (MUMS) within Imam Reza Hospital, Mashhad, Iran. A total of 30 overweight and obese men and women, meeting the eligibility criteria and free of underlying diseases, were recruited through a public call. Participants were randomly assigned to receive both intervention meals, with a washout period of at least one week between each trial.

Results

The primary outcomes focused on the acute effects of the two dietary interventions on energy metabolism, particularly resting metabolic rate (RMR), and appetite response. Secondary outcomes included changes in lipid profiles, insulin, blood glucose levels, thyroid hormones, and epinephrine.

Conclusions

This study aims to identify which macronutrient composition most effectively enhances resting energy expenditure. The findings could provide valuable insights for dietitians in developing more efficient dietary plans, helping overweight and obese individuals maintain an ideal weight or achieve weight loss by modifying food composition without altering meal volume.

Comparative Analysis of Dietary Habits and Obesity Prediction: Body Mass Index versus Body Fat Percentage Classification Using Bioelectrical Impedance Analysis

Background: Obesity remains a widely debated issue, often criticized for the limitations in its identification and classification. This study aims to compare two distinct systems for classifying obesity: body mass index (BMI) and body fat percentage (BFP) as assessed by bioelectrical impedance analysis (BIA). By examining these measures, the study seeks to clarify how different metrics of body composition influence the identification of obesity-related risk factors. Methods: The study enrolled 1255 adults, comprising 471 males and 784 females, with a mean age of 36 ± 12 years. Participants exhibited varying degrees of weight status, including optimal weight, overweight, and obesity. Body composition analysis was conducted using the TANITA Body Composition Analyzer BC-418 MA III device (T5896, Tokyo, Japan), evaluating the following parameters: current weight, basal metabolic rate (BMR), adipose tissue (%), muscle mass (%), and hydration status (%). Results: Age and psychological factors like cravings, fatigue, stress, and compulsive eating were significant predictors of obesity in the BMI model but not in the BFP model. Additionally, having a family history of diabetes was protective in the BMI model (OR: 0.33, 0.11-0.87) but increased risk in the BFP model (OR: 1.66, 1.01-2.76). The BMI model demonstrates exceptional predictive ability (AUC = 0.998). In contrast, the BFP model, while still performing well, exhibits a lower AUC (0.975), indicating slightly reduced discriminative power compared to the BMI model. Conclusions: BMI classification demonstrates superior predictive accuracy, specificity, and sensitivity. This suggests that BMI remains a more reliable measure for identifying obesity-related risk factors compared to the BFP model.

COL6A6 Peptide Vaccine Alleviates Atherosclerosis through Inducing Immune Response and Regulating Lipid Metabolism in Apoe-/- Mice

Atherosclerosis is an autoimmune disease characterized by lipid imbalances and chronic inflammation within blood vessels, with limited preventive and treatment options currently available. In this study, a vaccine prepared with COL6A6 peptide (named the Pep_A6 vaccine) was administered to immunize Apoe-/- mice, and the immune mechanism of the Pep_A6 vaccine against atherosclerosis was first investigated. The results of arterial oil red O staining demonstrated that the Pep_A6 vaccine significantly reduced the atherosclerotic plaque area in Apoe-/- mice fed with a high-fat diet for 20 weeks. A flow cytometry analysis revealed that the Pep_A6 vaccine inhibited Th1 cell differentiation and increased the proportion of Treg cells. Furthermore, there was a significant increase in Ly6Clow monocytes observed in the vaccinated group. The ELISA results showed that the Pep_A6 vaccine induced a significant expression of Pep_A6-specific antibody IgG and IgG1 in mouse serum. Additionally, we found that the Pep_A6 vaccine significantly decreased serum LDL-C content and regulated the expression of genes related to liver lipid metabolism. Together, our findings suggest that the Pep_A6 vaccine alleviates atherosclerosis by inducing a positive immune response and regulating lipid metabolism, providing new insights into potential prevention strategies for atherosclerosis as an innovative vaccine.

Obesity in adults

Obesity has increased in prevalence worldwide and WHO has declared it a global epidemic. Population-level preventive interventions have been insufficient to slow down this trajectory. Obesity is a complex, heterogeneous, chronic, and progressive disease, which substantially affects health, quality of life, and mortality. Lifestyle and behavioural interventions are key components of obesity management; however, when used alone, they provide substantial and durable response in a minority of people. Bariatric (metabolic) surgery remains the most effective and durable treatment, with proven benefits beyond weight loss, including for cardiovascular and renal health, and decreased rates of obesity-related cancers and mortality. Considerable progress has been made in the development of pharmacological agents that approach the weight loss efficacy of metabolic surgery, and relevant outcome data related to these agents' use are accumulating. However, all treatment approaches to obesity have been vastly underutilised.

2024 KSoLA consensus on secondary dyslipidemia

Elevated blood cholesterol and triglyceride levels induced by secondary causes are frequently observed. The identification and appropriate handling of these causes are essential for secondary dyslipidemia treatment. Major secondary causes of hypercholesterolemia and hypertriglyceridemia include an unhealthy diet, diseases and metabolic conditions affecting lipid levels, and therapeutic side effects. It is imperative to correct secondary causes prior to initiating conventional lipid-lowering therapy. Guideline-based lipid therapy can then be administered based on the subsequent lipid levels.

2024 KSoLA Consensus on Secondary Dyslipidemia

Elevated blood cholesterol and triglyceride levels induced by secondary causes are frequently observed. The identification and appropriate handling of these causes are essential for secondary dyslipidemia treatment. Major secondary causes of hypercholesterolemia and hypertriglyceridemia include an unhealthy diet, diseases and metabolic conditions affecting lipid levels, and therapeutic side effects. It is imperative to correct secondary causes prior to initiating conventional lipid-lowering therapy. Guideline-based lipid therapy can then be administered based on the subsequent lipid levels.

A Higher-Protein, Energy Restriction Diet Containing 4 Servings of Fresh, Lean Beef per Day Does Not Negatively Influence Circulating miRNAs Associated with Cardiometabolic Disease Risk in Women with Overweight

This study examined the acute effects of 7-d energy restriction normal-protein (NP; ∼15% of daily intake as protein) compared with higher-protein (HP; ∼38% of daily intake as protein) diets varying in quantities of fresh, lean beef on circulating miRNA expression associated with cardiometabolic disease in 16 women with overweight (mean ± SD; age: 35 ± 8.7 y; body mass index: 28.5 ± 1.9 kg/m2). Fasting blood samples were collected at the end of each diet for miRNA expression, glucose, insulin, adiponectin, C-reactive protein (CRP), and IL-6. Of the 12 surveyed, 10 miRNAs (miR-320a-3p, miR-146a-5p, miR-150-5p, miR-423-5p, miR-122-5p, miR-223-3p, miR-199a-5p, miR-214-3p, miR-24-3p, and miR-126-3p) were detected. Several miRNAs were associated with fasting CRP (i.e., miR-150-5p, miR-24-3p, miR-423-5p; all P < 0.05). miR-423-5p was also associated with fasting glucose, IL-6, and homeostasis model assessment 2 %β cell function (all, P < 0.05). No differences in miRNA expression were identified between diets. These data suggest that fresh, lean beef in a short-term HP, energy restriction diet does not negatively influence circulating miRNAs associated with cardiometabolic disease in women. This trial was registered at clinicaltrials.gov as NCT02614729.

Weight reduction and the impact on apnea-hypopnea index: A systematic meta-analysis

Obstructive sleep apnea (OSA) is strongly associated with obesity. While the relationship between weight reduction and apnea-hypopnea index improvement has been documented, to our knowledge, it has not been quantified adequately. Therefore, this study aimed to quantify the relationship between weight reduction and AHI change.

METHODS

A systematic literature search was performed using meta-analyses (PRISMA) guidelines for studies reporting AHI and weight loss in people with obesity/overweight and OSA between 2000 and 2023. A linear and quadratic model (weighted by treatment arm sample size) predicted percent change from baseline AHI against mean percent change from baseline weight. The quadratic term was statistically significant (P < 0.05), so the quadratic model (with 95 % prediction interval) was used.

RESULTS

The literature search identified 27 studies/32 treatment arms: 15 using bariatric surgery and lifestyle intervention each and 2 using pharmacological interventions. Included studies were ≥3 months with weight intervention and participants had AHI ≥15/h. Weight reduction in people with OSA and obesity was associated with improvements in the severity of OSA. BMI reduction of 20 % was associated with AHI reduction of 57 %, while further weight reduction beyond 20 % in BMI was associated with a smaller effect on AHI. As the prediction intervals are relatively wide, a precise relationship could not be conclusively established.

CONCLUSION

The degree of AHI index improvement was associated with the magnitude of weight reduction. The model suggests that with progress in weight reduction beyond 20 %, the incremental decrease in BMI appeared to translate to a smaller additional effect on AHI.

Phenotypic age mediates effects of Life's Essential 8 on reduced mortality risk in US adults

Objective

This study aimed to find out whether phenotypic age could mediate the protective effects of a healthy lifestyle on mortality.

Methods

We included adult participants with available data for individual phenotypic age (PhenoAge) and Life's Essential 8 (LE8) scores from the National Health and Nutrition Examination Survey 2005-2010 (three cycles) and linked mortality records until 31 December 2019. Adjusted hazard ratios (HR) were estimated to evaluate the associations of PhenoAge and LE8 scores with all-cause and cardiovascular mortality risk. Mediation analyses were performed to estimate the proportional contribution of PhenoAge to the effect of LE8 on mortality risks.

Results

A 1-year increment in PhenoAge was associated with a higher risk of all-cause (HR = 1.04 [95% confidence interval, 1.04-1.05]) and cardiovascular (HR = 1.04 [95% confidence interval, 1.04-1.05]) mortality, independent of chronological age, demographic characteristics, and disease history. High level of LE8 (score: 80-100) was associated with a 3.30-year younger PhenoAge. PhenoAge was estimated to mediate 36 and 22% of the effect of LE8 on all-cause and cardiovascular mortality, respectively (all P < 0.001). As for single-metric scores of LE8, PhenoAge mediated 30%, 11%, 9%, and 7% of the effects of the healthy diet, smoking status, blood pressure, and physical activity on all-cause mortality risk, respectively (all P < 0.05).

Conclusion

Adherence to LE8 recommendations slows phenotypic aging. PhenoAge could mediate the effect of LE8 on mortality risk.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management

PURPOSE OF REVIEW

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies.

RECENT FINDINGS

Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

A Dietary Intervention in Adults with Overweight or Obesity Leads to Weight Loss Irrespective of Macronutrient Composition

Obesity is a critical public health issue, necessitating effective weight loss interventions. While various dietary regimens have been explored, individual responses to interventions often vary. This study involved a 3-month dietary intervention aiming at assessing the role of macronutrient composition and the potential role of genetic predisposition in weight loss among Greek adults. This randomized clinical trial followed the CONSORT principles, recruiting 202 participants overall; 94 received a hypocaloric, high-protein diet and 108 received a high-carbohydrate, hypocaloric diet. Genetic predispositions were assessed through 10 target variants known for their BMI associations. Participants' weight and BMI values were recorded at baseline and post-intervention (n = 202 at baseline, n = 84 post-intervention) and an imputation method was applied to account for the observed missing values. Participants experienced a statistically significant weight loss across all dietary regimens (p < 0.001). Genetic analyses did not display statistically significant effects on weight loss. No significant differences in weight loss were observed between macronutrient groups, aligning with the POUNDS Lost and DIETFITS studies. This study underscores the importance of dietary interventions for weight loss and the potential contributions of genetic makeup. These findings contribute to obesity management within the Greek population and support the need for further research in personalized interventions.

Effect of Low Protein Diet on Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis

Background

Low protein diet plays an important role in cardiovascular diseases. However, exact role is unclear so far. We aimed to find out the effect of low protein diet on patients with cardiovascular disease.

Methods

The PRISMA guidelines were followed throughout the research project until 10th Apr 2023. MeSH phrases and Boolean operators were used to search PubMed for suitable studies. The entire estimate was expressed as a 95% confidence interval around the mean difference. The model was picked because of the discrepancies found in the research. Choi's Q test and I2 statistics were used to determine the degree of variation between experiments. The funnel plot was used to qualitatively examine the publishing bias.

Results

Low-protein diets have a greater impact on waist circumference [-8.82 (-9.51, -8.13), P<0000.1] and high-density lipoprotein (HDL) [-0.05 (-0.07, -0.03), P<0000.1] alteration than non-LPD diets, as measured by the standard mean difference (SMD). Further, significant changes were observed in weight loss [1.51 (1.25, 1.77), P<0.00001], BMI, [0.46 (0.25, 0.67), P<0.0001], change systolic [2.48 (1.20, 3.77), P=0.0002] and diastolic blood pressure [1.49 (0.72, 2.26), P=0.0002], low density lipoprotein [0.09 (0.06, 0.12), P<0.00001], triglyceride [0.52 (0.49, 0.55), P<0.00001], in non-LPD group as compared to LPD group.

Conclusion

The results indicated the role of low protein diet on patients with cardiovascular disease.

Western diets and chronic diseases

'Westernization', which incorporates industrial, cultural and dietary trends, has paralleled the rise of noncommunicable diseases across the globe. Today, the Western-style diet emerges as a key stimulus for gut microbial vulnerability, chronic inflammation and chronic diseases, affecting mainly the cardiovascular system, systemic metabolism and the gut. Here we review the diet of modern times and evaluate the threat it poses for human health by summarizing recent epidemiological, translational and clinical studies. We discuss the links between diet and disease in the context of obesity and type 2 diabetes, cardiovascular diseases, gut and liver diseases and solid malignancies. We collectively interpret the evidence and its limitations and discuss future challenges and strategies to overcome these. We argue that healthcare professionals and societies must react today to the detrimental effects of the Western diet to bring about sustainable change and improved outcomes in the future.

Impacts of dietary animal and plant protein on weight and glycemic control in health, obesity and type 2 diabetes: friend or foe?

It is well established that high-protein diets (i.e. ~25-30% of energy intake from protein) provide benefits for achieving weight loss, and subsequent weight maintenance, in individuals with obesity, and improve glycemic control in type 2 diabetes (T2D). These effects may be attributable to the superior satiating property of protein, at least in part, through stimulation of both gastrointestinal (GI) mechanisms by protein, involving GI hormone release and slowing of gastric emptying, as well as post-absorptive mechanisms facilitated by circulating amino acids. In contrast, there is evidence that the beneficial effects of greater protein intake on body weight and glycemia may only be sustained for 6-12 months. While both suboptimal dietary compliance and metabolic adaptation, as well as substantial limitations in the design of longer-term studies are all likely to contribute to this contradiction, the source of dietary protein (i.e. animal vs. plant) has received inappropriately little attention. This issue has been highlighted by outcomes of recent epidemiological studies indicating that long-term consumption of animal-based protein may have adverse effects in relation to the development of obesity and T2D, while plant-based protein showed either protective or neutral effects. This review examines information relating to the effects of dietary protein on appetite, energy intake and postprandial glycemia, and the relevant GI functions, as reported in acute, intermediate- and long-term studies in humans. We also evaluate knowledge relating to the relevance of the dietary protein source, specifically animal or plant, to the prevention, and management, of obesity and T2D.

Effects of Very Low-Calorie Diet versus Roux-en-Y Gastric Bypass Surgery on Body Composition in Patients with Obesity

Roux-en-Y gastric bypass (RYGB) is the most effective treatment for severe obesity. A very low-calorie diet (VLCD) is another effective dietary intervention to treat obesity. This study evaluated the effect of a VLCD versus RYGB on weight reduction, changes in body composition and the resolution of comorbidities during a 12-week period. Individuals with obesity at the obesity clinic, Ramathibodi Hospital, Mahidol University, Thailand with a body mass index (BMI) ≥ 37.5 kg/m2 or ≥32.5 kg/m2 with obesity-related complications were recruited. Treatment options, either RYGB or VLCD, were assigned depending on patients' preferences and physicians' judgment. The analysis included 16 participants in the RYGB group and 15 participants in the VLCD group. Baseline characteristics were similar between groups; nevertheless, the participants in the VLCD group were significantly younger than those in the RYGB group. The number of patients with type 2 diabetes (T2D) was slightly higher in the RYGB group (43.8% vs. 33.3%, p = 0.552). Additionally, patients in the RYGB group had a longer duration of T2D and were treated with anti-diabetic agents, while VLCD patients received only lifestyle modifications. At 12 weeks, total and percentage weight loss in the RYGB and VLCD groups, respectively, were as follows: -17.6 ± 6.0 kg vs. -15.6 ± 5.1 kg (p = 0.335) and -16.2% ± 4.3% vs. -14.1% ± 3.6% (p = 0.147). Changes in biochemical data and the resolution of comorbidities were similar between the groups at 12 weeks. A 12-week VLCD resulted in similar weight loss and metabolic improvement compared with RYGB. Large-scale studies with long follow-up periods are needed to elucidate whether VLCD is a viable alternative treatment to bariatric surgery.

Is There an Ideal Diet? Some Insights from the POUNDS Lost Study

Diets for weight loss have a long history but an ideal one has not yet been clearly identified. To compare low-fat and lower carbohydrate diets, we designed The Preventing Overweight by Novel Dietary Strategies (POUNDS) Lost study. This is a 2 × 2 factorial study with diets of 20% or 40% fat and 15% or 25% protein with a graded carbohydrate intake of 35, 45, 55 and 65%. Weight loss, overall, was modest at nearly 6% with all four diets, and no significant dietary difference. The variability in weight loss in each diet group was significant, ranging from greater than 20% to a small weight gain. Studies of genetic variations in relation to weight loss showed that the diet that was selected could significantly affect weight loss, emphasizing that there is no ideal diet and more than one diet can be used to treat obesity. Weight loss was also influenced by the level of baseline triiodothyronine or thyroxine, and baseline carbohydrate and insulin resistance. Achieving a stable Health Eating Food Diversity Index, eating more protein, eating more fiber, engaging in more physical activity, sleeping better and eating less ultra-processed foods were beneficial strategies for weight loss in this trial. Although there is no "ideal diet", both the DASH diet and the Mediterranean diet have clinical trials showing their significant benefit for cardiovascular risk factors. Finally, the lesson of the "Last Chance Diet", which recommended a diet with protein from gelatin, proved that some diets could be hazardous.

Isocaloric replacement of ultraprocessed foods was associated with greater weight loss in the POUNDS Lost trial

OBJECTIVE

Higher intake of ultraprocessed foods (UPFs) is associated with obesity. We examined whether replacing UPFs (NOVA 4) with minimally processed foods and culinary ingredients (NOVA 1 + 2) was associated with differential weight change in this secondary prospective analysis of the Preventing Overweight Using Novel Dietary Strategies (POUNDS) Lost trial.

METHODS

We estimated percent energy intake (%kcal) from the four NOVA groups using 24-h dietary recalls in a subset of 356 participants. Multivariable-adjusted substitution models examined whether replacing %kcal from UPFs with NOVA 1 + 2 was associated with greater weight, body fat percentage, trunk fat, and waist circumference reduction at 6 months; changes in parameters were compared among NOVA 1 + 2 tertiles (T).

RESULTS

Participants were on average 52.3 years of age, 85% White, 55% female, and 58.2% nonsmoking, with a mean BMI of 32.7 kg/m2. Replacing 10%kcal of UPFs with NOVA 1 + 2 was associated with greater 6-month weight (ß = 0.51, 95% CI: -0.93 to -0.09, p = 0.02), body fat percentage (ß = 2.7, 95% CI: -5.10 to -0.43, p = 0.02), and trunk fat reduction (ß = 3.9, 95% CI: -7.01 to -0.70, p = 0.02), but not waist circumference reduction. Participants in T3 (-8.33 kg) versus T1 (-5.32 kg) of NOVA 1 + 2 had greater weight loss (p < 0.001).

CONCLUSIONS

Isocaloric substitution of UPFs with NOVA 1 + 2 was associated with marginally greater weight loss under energy restriction. These modest findings support more research exploring the mechanisms linking UPFs with body weight regulation beyond energy intake.