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Weidlinger S, Winterberger K, Pape J, Weidlinger M, Janka H, von Wolff M, Stute P. Impact of estrogens on resting energy expenditure: A systematic review. Obes Rev 2023; 24:e13605. [PMID: 37544655 DOI: 10.1111/obr.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
The fear of weight gain is one of the main reasons for women not to initiate or to early discontinue hormonal contraception or menopausal hormone therapy. Resting energy expenditure is by far the largest component and the most important determinant of total energy expenditure. Given that low resting energy expenditure is a confirmed predictive factor for weight gain and consecutively for the development of obesity, research into the influence of sex steroids on resting energy expenditure is a particularly exciting area. The objective of this systematic review was to evaluate the effects of medication with natural and synthetic estrogens on resting energy expenditure in healthy normal weight and overweight women. Through complex systematic literature searches, a total of 10 studies were identified that investigated the effects of medication with estrogens on resting energy expenditure. Our results demonstrate that estrogen administration increases resting energy expenditure by up to +208 kcal per day in the context of contraception and by up to +222 kcal per day in the context of menopausal hormone therapy, suggesting a preventive effect of circulating estrogen levels and estrogen administration on weight gain and obesity development.
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Affiliation(s)
- Susanna Weidlinger
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Katja Winterberger
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Janna Pape
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | | | - Heidrun Janka
- Medical Library, University Library Bern, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
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2
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Prentice RL, Aragaki AK, Manson JE, Schoeller DA, Tinker LF, Mossavar-Rahmani Y, Wallace RB, LaMonte MJ, Tooze JA, Johnson KC, Lampe JW, Neuhouser ML. Total energy expenditure as assessed by doubly labeled water and all-cause mortality in a cohort of postmenopausal women. Am J Clin Nutr 2023; 117:955-963. [PMID: 36889672 PMCID: PMC10273089 DOI: 10.1016/j.ajcnut.2023.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The association of TEE with all-cause mortality is uncertain, as is the dependence of this association on age. OBJECTIVES To examine the association between TEE and all-cause mortality, and its age interaction, in a Women's Health Initiative (WHI) cohort of postmenopausal United States women (1992-present). METHODS A cohort of 1131 WHI participants having DLW TEE assessment of ∼10.0 y (median) following WHI enrollment with ∼13.7 y (median) of subsequent follow-up, was used to study the EE associations with all-cause mortality. To enhance the comparability of TEE and total EI, key analyses excluded participants having >5% weight change between WHI enrollment and DLW assessment. The influence of participant age on mortality associations was examined, as was the ability of concurrent and earlier weight and height measurements to explain the results. RESULTS There were 308 deaths following the TEE assessment through 2021. TEE was unrelated to overall mortality (P = 0.83) in this cohort of generally healthy, older (mean 71 y at TEE assessment) United States women. However, this potential association varied with age (P = 0.003). Higher TEE was associated with a higher mortality rate at the age of 60 y and a lower mortality rate at the age of 80 y. Within the weight-stable subset (532 participants, 129 deaths), TEE was weakly positively related to overall mortality (P = 0.08). This association also varied with age (P = 0.03), with mortality HRs (95% CIs) for a 20% increment in TEE of 2.33 (1.24, 4.36) at the age of 60 y, 1.49 (1.10, 2.02) at 70 y of age, and 0.96 (0.66, 1.38) at 80 y of age. This pattern remained, although was somewhat attenuated, following control for baseline weight and weight changes between WHI enrollment and TEE assessment. CONCLUSIONS Higher EE is associated with higher all-cause mortality among younger postmenopausal women, only partially explained by weight and weight change. This study is registered with clinicaltrials.gov identifier: NCT00000611.
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Affiliation(s)
- Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States.
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison, WI, United States
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert B Wallace
- College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Michael J LaMonte
- Department of Epidemiology and Public Health, University at Buffalo-SUNY, Buffalo, NY, United States
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Center, Memphis, TN, United States
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
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3
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Abstract
Brown adipose tissue (BAT) displays the unique capacity to generate heat through uncoupled oxidative phosphorylation that makes it a very attractive therapeutic target for cardiometabolic diseases. Here, we review BAT cellular metabolism, its regulation by the central nervous and endocrine systems and circulating metabolites, the plausible roles of this tissue in human thermoregulation, energy balance, and cardiometabolic disorders, and the current knowledge on its pharmacological stimulation in humans. The current definition and measurement of BAT in human studies relies almost exclusively on BAT glucose uptake from positron emission tomography with 18F-fluorodeoxiglucose, which can be dissociated from BAT thermogenic activity, as for example in insulin-resistant states. The most important energy substrate for BAT thermogenesis is its intracellular fatty acid content mobilized from sympathetic stimulation of intracellular triglyceride lipolysis. This lipolytic BAT response is intertwined with that of white adipose (WAT) and other metabolic tissues, and cannot be independently stimulated with the drugs tested thus far. BAT is an interesting and biologically plausible target that has yet to be fully and selectively activated to increase the body's thermogenic response and shift energy balance. The field of human BAT research is in need of methods able to directly, specifically, and reliably measure BAT thermogenic capacity while also tracking the related thermogenic responses in WAT and other tissues. Until this is achieved, uncertainty will remain about the role played by this fascinating tissue in human cardiometabolic diseases.
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Affiliation(s)
- André C Carpentier
- Correspondence: André C. Carpentier, MD, Division of Endocrinology, Faculty of Medicine, University of Sherbrooke, 3001, 12th Ave N, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Denis P Blondin
- Division of Neurology, Department of Medicine, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada
| | | | - Denis Richard
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, G1V 4G5, Canada
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Corbin KD, Carnero EA, Allerton TD, Tillner J, Bock CP, Luyet PP, Göbel B, Hall KD, Parsons SA, Ravussin E, Smith SR. Glucagon-like peptide-1/glucagon receptor agonism associates with reduced metabolic adaptation and higher fat oxidation: A randomized trial. Obesity (Silver Spring) 2023; 31:350-362. [PMID: 36695055 PMCID: PMC9881753 DOI: 10.1002/oby.23633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/16/2022] [Accepted: 10/02/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study tested the hypothesis that treatment with the glucagon-like peptide-1/glucagon receptor agonist SAR425899 would lead to a smaller decrease in sleeping metabolic rate (SMR; kilocalories/day) than expected from the loss of lean and fat mass (metabolic adaptation). METHODS This Phase 1b, double-blind, randomized, placebo-controlled study was conducted at two centers in inpatient metabolic wards. Thirty-five healthy males and females with overweight and obesity (age = 36.5 ± 7.1 years) were randomized to a calorie-reduced diet (-1000 kcal/d) and escalating doses (0.06-0.2 mg/d) of SAR425899 (n = 17) or placebo (n = 18) for 19 days. SMR was measured by whole-room calorimetry. RESULTS Both groups lost weight (-3.68 ± 1.37 kg placebo; -4.83 ± 1.44 kg SAR425899). Those treated with SAR425899 lost more weight, fat mass, and fat free mass (p < 0.05) owing to a greater achieved energy deficit than planned. The SAR425899 group had a smaller reduction in body composition-adjusted SMR (p = 0.002) as compared with placebo, but not 24-hour energy expenditure. Fat oxidation and ketogenesis increased in both groups, with significantly greater increases with SAR425899 (p < 0.05). CONCLUSIONS SAR425899 led to reduced selective metabolic adaptation and increased lipid oxidation, which are believed to be beneficial for weight loss and weight-loss maintenance.
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Affiliation(s)
- Karen D Corbin
- AdventHealth Translational Research Institute, Orlando, Florida, USA
| | - Elvis A Carnero
- AdventHealth Translational Research Institute, Orlando, Florida, USA
| | | | | | | | | | | | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | | | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Steven R Smith
- AdventHealth Translational Research Institute, Orlando, Florida, USA
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Dakin C, Beaulieu K, Hopkins M, Gibbons C, Finlayson G, Stubbs RJ. Do eating behavior traits predict energy intake and body mass index? A systematic review and meta-analysis. Obes Rev 2023; 24:e13515. [PMID: 36305739 PMCID: PMC10078190 DOI: 10.1111/obr.13515] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/05/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022]
Abstract
At present, it is unclear whether eating behavior traits (EBT) predict objectively measured short-term energy intake (EI) and longer-term energy balance as estimated by body mass index (BMI). This systematic review examined the impact of EBT on BMI and laboratory-based measures of EI in adults ( ≥ 18 years) in any BMI category, excluding self-report measures of EI. Articles were searched up until 28th October 2021 using MEDLINE, PsycINFO, EMBASE and Web of Science. Sixteen EBT were identified and the association between 10 EBT, EI and BMI were assessed using a random-effects meta-analysis. Other EBT outcomes were synthesized qualitatively. Risk of bias was assessed with the mixed methods appraisal tool. A total of 83 studies were included (mean BMI = 25.20 kg/m2 , mean age = 27 years and mean sample size = 70). Study quality was rated moderately high overall, with some concerns in sampling strategy and statistical analyses. Susceptibility to hunger (n = 6) and binge eating (n = 7) were the strongest predictors of EI. Disinhibition (n = 8) was the strongest predictor of BMI. Overall, EBT may be useful as phenotypic markers of susceptibility to overconsume or develop obesity (PROSPERO: CRD42021288694).
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Affiliation(s)
- Clarissa Dakin
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kristine Beaulieu
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mark Hopkins
- School of Food Science & Nutrition, University of Leeds, Leeds, UK
| | - Catherine Gibbons
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Graham Finlayson
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - R James Stubbs
- Appetite Control and Energy Balance Research Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Gerving C, Lasater R, Starling J, Ostendorf DM, Redman LM, Estabrooks C, Cummiskey K, Antonetti V, Thomas DM. Predicting energy intake in adults who are dieting and exercising. Int J Obes (Lond) 2022; 46:2095-2101. [PMID: 35987955 PMCID: PMC9691568 DOI: 10.1038/s41366-022-01205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND When a lifestyle intervention combines caloric restriction and increased physical activity energy expenditure (PAEE), there are two components of energy balance, energy intake (EI) and physical activity energy expenditure (PAEE), that are routinely misreported and expensive to measure. Energy balance models have successfully predicted EI if PAEE is known. Estimating EI from an energy balance model when PAEE is not known remains an open question. OBJECTIVE The objective was to evaluate the performance of an energy balance differential equation model to predict EI in an intervention that includes both calorie restriction and increases in PAEE. DESIGN The Antonetti energy balance model that predicts body weight trajectories during weight loss was solved and inverted to estimate EI during weight loss. Using data from a calorie restriction study that included interventions with and without prescribed PAEE, we tested the validity of the Antonetti weight predictions against measured weight and the Antonetti EI model against measured EI using the intake-balance method at 168 days. We then evaluated the predicted EI from the model against measured EI in a study that prescribed both calorie restriction and increased PAEE. RESULTS Compared with measured body weight at 168 days, the mean (±SD) model error was 1.30 ± 3.58 kg. Compared with measured EI at 168 days, the mean EI (±SD) model error in the intervention that prescribed calorie restriction and did not prescribe increased PAEE, was -84.9 ± 227.4 kcal/d. In the intervention that prescribed calorie restriction combined with increased PAEE, the mean (±SD) EI model error was -155.70 ± 205.70 kcal/d. CONCLUSION The validity of the newly developed EI model was supported by experimental observations and can be used to determine EI during weight loss.
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Affiliation(s)
- Corey Gerving
- Department of Physics and Nuclear Engineering, United States Military Academy, West Point, NY, 10996, USA
| | - Robert Lasater
- Department of Mathematical Sciences, United States Military Academy, West Point, NY, US
| | - James Starling
- Department of Mathematical Sciences, United States Military Academy, West Point, NY, US
| | - Danielle M Ostendorf
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Kevin Cummiskey
- Department of Mathematical Sciences, United States Military Academy, West Point, NY, US
| | - Vincent Antonetti
- Department of Mechanical Engineering, Manhattan College, New York City, NY, USA
| | - Diana M Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, NY, US.
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7
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Abstract
Adipose tissue is a complex dynamic organ with whole-body immunometabolic influence. Much of the work into understanding the role of immune cells in adipose tissue has been in the context of obesity. These investigations have also uncovered a range of typical (immune) and non-typical functions exerted by adipose tissue leukocytes. Here we provide an overview of the adipose tissue immune system, including its role as an immune reservoir in the whole-body response to infection and as a site of parasitic and viral infections. We also describe the functional roles of specialized immunological structures found within adipose tissue. However, our main focus is on the recently discovered 'non-immune' functions of adipose tissue immune cells, which include the regulation of adipocyte homeostasis, as well as responses to changing nutrient status and body temperature. In doing so, we outline the therapeutic potential of the adipose tissue immune system in health and disease.
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8
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Shook RP, Yeh HW, Welk GJ, Davis AM, Ries D. Commercial Devices Provide Estimates of Energy Balance with Varying Degrees of Validity in Free-Living Adults. J Nutr 2022; 152:630-638. [PMID: 34642741 DOI: 10.1093/jn/nxab317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 08/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The challenges of accurate estimation of energy intake (EI) are well-documented, with self-reported values 12%-20% below expected values. New approaches rely on gold-standard assessments of the other components of energy balance, energy expenditure (EE) and energy storage (ES), to estimate EI. OBJECTIVES The purpose of this study was to evaluate the validity, repeatability, and measurement error of consumer devices when estimating energy balance in a free-living population. METHODS Twenty-four healthy adults (14 women, 10 men; mean ± SD age: 30.7 ± 8.2 y) completed two 14-d assessment periods, including assessments of EE and ES using gold-standard [doubly labeled water (DLW) and DXA] and commercial devices [Fitbit Alta HR activity monitor (Alta) and Fitbit Aria wireless body composition scale (Aria)], and of EI by dietician-administered recalls. Accuracy and validity were assessed using Spearman correlation, interclass correlation, mean absolute percentage error, and equivalency testing. We also applied linear measurement error modeling including error in gold-standard devices and within-subject repeated-measures design to calibrate consumer devices and quantify error. RESULTS There was moderate to strong agreement for EE between the Fitbit Alta and DLW at each time point (rs = 0.82 and 0.66 for Times 1 and 2, respectively). There was weak agreement for ES between the Fitbit Aria and DXA (rs = 0.15 and 0.49 for Times 1 and 2, respectively). Correlations between methods to assess EI ranged from weak to strong, with agreement between the DXA/DLW-calculated EI and dietary recalls being the highest (rs = 0.63 for Time 1 and 0.73 for Time 2). Only EE from the Fitbit Alta at Time 1 was equivalent to the DLW value using equivalency testing. CONCLUSIONS Commercial devices provide estimates of energy balance in free-living adults with varying degrees of validity compared to gold-standard techniques. EE estimates were the most robust overall, whereas ES estimates were generally poor.
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Affiliation(s)
- Robin P Shook
- Department of Pediatrics, Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Hung-Wen Yeh
- Department of Pediatrics, Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Gregory J Welk
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Ann M Davis
- Department of Pediatrics, Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Daniel Ries
- Sandia National Laboratories, Albuquerque, NM, USA
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9
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Martin CK, Höchsmann C, Dorling JL, Bhapkar M, Pieper CF, Racette SB, Das SK, Redman LM, Kraus WE, Ravussin E. Challenges in defining successful adherence to calorie restriction goals in humans: Results from CALERIE™ 2. Exp Gerontol 2022; 162:111757. [DOI: 10.1016/j.exger.2022.111757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/04/2022]
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10
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"I didn't want to do it on my own": A qualitative study of women's perceptions of facilitating and risk factors for weight control on a UK commercial community program. Appetite 2021; 165:105308. [PMID: 34010725 DOI: 10.1016/j.appet.2021.105308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Abstract
Overweight and obesity remain serious public health concerns. Outcomes from community based commercial weight management programmes vary, relapse is common and drop out is high. Outcomes could be improved by better understanding experiences on these programmes. The aim of our study was to generate accounts of people's experience on a commercial weight-management program to identify what experiences were perceived as facilitating, and what posed risks, to programme effectiveness and compliance. We conducted individual, semi-structured interviews with eighteen Caucasian women (mean age 45.4y) who were members of nation-wide UK commercial, fee-paying, community weight management programme. Interview data was analysed via framework analysis. Participants' experiences indicated that the programme helped by triggering several intra- and interpersonal processes that catalysed change across psychological, physiological, dietary and behavioural areas of their life. Risks to program adherence and effectiveness spanned well-known risks such as self-regulation fatigue and the difficulty of recovering from negative self-criticism, as well as new factors such as the confusing nature of weight change, the relatively powerful impact of everyday events, and the difficulty in getting the balance right between personalised support vs. intrusion. The complexity of reported experiences challenges the linear, predictive pathways of change proposed by many health behaviour models of weight management. To improve effectiveness, programmes need to go well beyond behavioural and dietary support. It is recommended that community, commercial programmes educate people about the physiological and psychological tensions they will encounter, why people lose weight at different rates, the likelihood of weight relapse and strategies to manage these, including evidence-based support for managing self-criticism.
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11
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Dorling JL, van Vliet S, Huffman KM, Kraus WE, Bhapkar M, Pieper CF, Stewart T, Das SK, Racette SB, Roberts SB, Ravussin E, Redman LM, Martin CK. Effects of caloric restriction on human physiological, psychological, and behavioral outcomes: highlights from CALERIE phase 2. Nutr Rev 2021; 79:98-113. [PMID: 32940695 DOI: 10.1093/nutrit/nuaa085] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/01/2020] [Indexed: 02/04/2023] Open
Abstract
Caloric restriction (CR) is a strategy that attenuates aging in multiple nonhuman species. The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trials are part of a research program aiming to test the effects of CR on aging and longevity biomarkers in humans. Building on CALERIE phase 1, CALERIE phase 2 (CALERIE 2) was the largest study to date to assess sustained CR in healthy humans without obesity. In a 24-month randomized controlled trial comprising 218 participants at baseline, CALERIE 2 showed that moderate CR, 11.9% on average, induced improvements in aging-related biomarkers without adversely affecting psychological or behavioral outcomes. The objectives of this report are to summarize and review the highlights of CALERIE 2 and report previously unpublished results on eating disorder symptoms and cognitive function. This article specifically summarizes the physiological, psychological, aging, behavioral, and safety results of the trial. Also provided are research directions beyond CALERIE 2 that highlight important opportunities to investigate the role of CR in aging, longevity, and health span in humans.
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Affiliation(s)
- James L Dorling
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Kim M Huffman
- Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Kraus
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carl F Pieper
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Tiffany Stewart
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sai Krupa Das
- US Department of Agriculture, Jean Mayer Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Susan B Racette
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan B Roberts
- US Department of Agriculture, Jean Mayer Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Stubbs RJ, Duarte C, Palmeira AL, Sniehotta FF, Horgan G, Larsen SC, Marques MM, Evans EH, Ermes M, Harjumaa M, Turicchi J, O'Driscoll R, Scott SE, Pearson B, Ramsey L, Mattila E, Matos M, Sacher P, Woodward E, Mikkelsen ML, Sainsbury K, Santos I, Encantado J, Stalker C, Teixeira PJ, Heitmann BL. Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project. Obes Facts 2021; 14:320-333. [PMID: 33915534 PMCID: PMC8255638 DOI: 10.1159/000515663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. IMPACT The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.
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Affiliation(s)
- R. James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - António L. Palmeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Graham Horgan
- Biomathematics and Statistics Scotland (James Hutton Institute), Aberdeen, United Kingdom
| | - Sofus C. Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Marta M. Marques
- Trinity Centre for Practice and Healthcare Innovation and ADAPT Centre, Trinity College Dublin, Dublin, Ireland
| | - Elizabeth H. Evans
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Miikka Ermes
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ruari O'Driscoll
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Sarah E. Scott
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Beth Pearson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Lauren Ramsey
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Elina Mattila
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Paul Sacher
- Childhood Nutrition Research Centre, University College London, London, United Kingdom
| | - Euan Woodward
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Marie-Louise Mikkelsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Inês Santos
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jorge Encantado
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Carol Stalker
- College of Life and Natural Sciences, University of Derby, Derby, United Kingdom
| | - Pedro J. Teixeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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13
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An objective measure of energy intake using the principle of energy balance. Int J Obes (Lond) 2021; 45:725-732. [PMID: 33479453 DOI: 10.1038/s41366-021-00738-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/30/2020] [Accepted: 01/04/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND The measurement of energy intake is central to the understanding of energy balance and predicting changes in body weight. Until recently, the most commonly used methods of assessing intake were self-reported diet recalls, diet diaries, or food-frequency questionnaires. These methods, however, are subject to systematic biases and are often inaccurate. AIM Review the validations and applications of an expenditure/balance method for measuring energy intake. METHODS Review the literature regarding the theory and practice of objectively measuring energy intake based on the principle of energy balance i.e., energy intake is calculated from the measured total energy expenditure plus the change in body energy stores (ES). The attainable precision is modeled and compared with the accuracy and precision of validations against known energy intake. RESULTS Measurement of energy intake, calculated in this way, is accurate to within 2% and has a precision of 4-37% depending on the expenditure and body composition methods used and the time interval between measures. Applications of this expenditure/balance (EB) method have provided novel data on the compliance to dietary restriction and its association with physical activity interventions, and the effects of bariatric surgery on energy intake and weight gain. Practical limitations to this method, however, include cost and limited access to the analyses required by the DLW method. CONCLUSION The EB method of objectively measuring energy intake is objective, accurate, and reasonably precise. It is practical for moderate-sized studies.
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14
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Stubbs RJ, Turicchi J. From famine to therapeutic weight loss: Hunger, psychological responses, and energy balance-related behaviors. Obes Rev 2021; 22 Suppl 2:e13191. [PMID: 33527688 DOI: 10.1111/obr.13191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
Understanding physiological and behavioral responses to energy imbalances is important for the management of overweight/obesity and undernutrition. Changes in body composition and physiological functions associated with energy imbalances provide the structural and functional context in which to consider psychological and behavioral responses. Compensatory changes in physiology and behavior are more pronounced in response to negative than positive energy balances. The physiological and psychological impact of weight loss (WL) occur on a continuum determined by (i) the degree of energy deficit (ED), (ii) its duration, (iii) body composition at the onset of the energy deficit, and (iv) the psychosocial environment in which it occurs. Therapeutic WL and famine/semistarvation both involve prolonged EDs, which are sometimes similar in magnitude. The key differences are that (i) the body mass index (BMI) of most famine victims is lower at the onset of the ED, (ii) therapeutic WL is intentional and (iii) famines are typically longer in duration (partly due to the voluntary nature of therapeutic WL and disengagement with WL interventions). The changes in psychological outcomes, motivation to eat, and energy intake in therapeutic WL are often modest (bearing in mind the nature of the measures used) and can be difficult to detect but are quantitatively significant over time. As WL progresses, these changes become more marked. It appears that extensive WL beyond 10%-20% in lean individuals has profound effects on body composition and physiological function. At this level of WL, there is a marked erosion of psychological functioning, which appears to run in parallel to WL. Psychological resources dwindle and become increasingly focused on alleviating escalating hunger and food seeking behavior. Functional changes in fat-free mass, characterized by catabolism of skeletal muscle and organs may be involved in the drive to eat associated with semistarvation. Higher levels of body fat mass may act as a buffer to protect fat-free mass, functional integrity and limit compensatory changes in energy balance behaviors. The increase in appetite that accompanies therapeutic WL appears to be very different to the intense and all-consuming drive to eat that occurs during prolonged semistarvation. The mechanisms may also differ but are not well understood, and longitudinal comparisons of the relationship between body structure, function, and behavior in response to differing EDs in those with higher and lower BMIs are currently lacking.
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Affiliation(s)
- R James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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15
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Saraiva Leão Borges LP, Ries DC, Sousa AG, Da Costa THM. Comparison and calibration of 24-hour physical activity recall in adult population. Eur J Sport Sci 2021; 22:289-296. [PMID: 33327887 DOI: 10.1080/17461391.2020.1866077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThis study compared and calibrated metabolic equivalents (METs) per day from 24-hour physical activity recall (24hPAR) with accelerometry. A sub-sample of 74 adults of both sexes, residents of Brasília, Brazil, from a larger study had same day measurements of accelerometry and 24hPAR data. METs values were assessed by accelerometry (7 consecutive days of use) and by 24hPAR (minimum of one and maximum of 2 per person). A script was written in the R statistical software to analyse the recall and accelerometer data. The script ran a simple linear regression to visualize the relationship between total METs/day for the two methods and to execute the recall measurement error correction. Most of participants were female (54.1%), with at least university graduate (94.6%) and mean age of 34.8 years (±11.83). The correlation coefficient obtained between 24hPAR and accelerometer was r = 0.55, considered moderate and significant (p < 0.001). A majority of the participants (77%) underestimated METs values compared to accelerometry when answering the questionnaire. Calibration of 24hPAR allowed us to approximate MET values to the accelerometer. The calibration equation to correct total METs/day for measurement error is (total 24hPAR METs/day - 10.6)/0.619. The 24hPAR is a decent tool to assess PA level in large adults' samples. However, compared with accelerometer, it underestimates METs values, which can be corrected with the use of the calibration equation provided in this study.
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Affiliation(s)
- Lara P Saraiva Leão Borges
- Human Nutrition Graduate Course, Faculty of Health Science, University of Brasilia, Brasilia, Brazil.,Department of Nutrition, School of Health Science, University of Brasilia, Brasilia, Brazil
| | - Daniel C Ries
- Statistical Sciences Group, Sandia National Laboratories, Albuquerque, NM, USA
| | - Alessandra Gaspar Sousa
- Human Nutrition Graduate Course, Faculty of Health Science, University of Brasilia, Brasilia, Brazil
| | - Teresa Helena Macedo Da Costa
- Department of Nutrition, School of Health Science, University of Brasilia, Brasilia, Brazil.,University of Oxford, Oxford, UK.,Medical Research Council, Human Nutrition Research, Cambridge, UK.,Sabbatical at Iowa State University, Ames, IA, USA
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16
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Chao AM, Quigley KM, Wadden TA. Dietary interventions for obesity: clinical and mechanistic findings. J Clin Invest 2021; 131:140065. [PMID: 33393504 DOI: 10.1172/jci140065] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dietary modification is central to obesity treatment. Weight loss diets are available that include various permutations of energy restriction, macronutrients, foods, and dietary intake patterns. Caloric restriction is the common pathway for weight reduction, but different diets may induce weight loss by varied additional mechanisms, including by facilitating dietary adherence. This narrative Review of meta-analyses and select clinical trials found that lower-calorie diets, compared with higher-calorie regimens, reliably induced larger short-term (<6 months) weight losses, with deterioration of this benefit over the long term (>12 months). Few significant long-term differences in weight loss were observed for diets of varying macronutrient composition, although some regimens were found to have short-term advantages (e.g., low carbohydrate versus low fat). Progress in improving dietary adherence, which is critical to both short- and long-term weight loss, could result from greater efforts to identify behavioral and metabolic phenotypes among dieters.
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Affiliation(s)
- Ariana M Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kerry M Quigley
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Stubbs RJ, Duarte C, O'Driscoll R, Turicchi J, Kwasnicka D, Sniehotta FF, Marques MM, Horgan G, Larsen S, Palmeira A, Santos I, Teixeira PJ, Halford J, Heitmann BL. The H2020 "NoHoW Project": A Position Statement on Behavioural Approaches to Longer-Term Weight Management. Obes Facts 2021; 14:246-258. [PMID: 33662958 PMCID: PMC8138206 DOI: 10.1159/000513042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022] Open
Abstract
There is substantial evidence documenting the effects of behavioural interventions on weight loss (WL). However, behavioural approaches to initial WL are followed by some degree of longer-term weight regain, and large trials focusing on evidence-based approaches to weight loss maintenance (WLM) have generally only demonstrated small beneficial effects. The current state-of-the-art in behavioural interventions for WL and WLM raises questions of (i) how we define the relationship between WL and WLM, (ii) how energy balance (EB) systems respond to WL and influence behaviours that primarily drive weight regain, (iii) how intervention content, mode of delivery and intensity should be targeted to keep weight off, (iv) which mechanisms of action in complex interventions may prevent weight regain and (v) how to design studies and interventions to maximise effective longer-term weight management. In considering these issues a writing team within the NoHoW Consortium was convened to elaborate a position statement, and behaviour change and obesity experts were invited to discuss these positions and to refine them. At present the evidence suggests that developing the skills to self-manage EB behaviours leads to more effective WLM. However, the effects of behaviour change interventions for WL and WLM are still relatively modest and our understanding of the factors that disrupt and undermine self-management of eating and physical activity is limited. These factors include physiological resistance to weight loss, gradual compensatory changes in eating and physical activity and reactive processes related to stress, emotions, rewards and desires that meet psychological needs. Better matching of evidence-based intervention content to quantitatively tracked EB behaviours and the specific needs of individuals may improve outcomes. Improving objective longitudinal tracking of energy intake and energy expenditure over time would provide a quantitative framework in which to understand the dynamics of behaviour change, mechanisms of action of behaviour change interventions and user engagement with intervention components to potentially improve weight management intervention design and evaluation.
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Affiliation(s)
- R James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom,
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ruairi O'Driscoll
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
- Digital Health, NHMRC Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, University of Melbourne, Melbourne, Virgin Islands, Australia
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Marta M Marques
- Trinity Centre for Practice and Healthcare Innovation and ADAPT Centre, Trinity College Dublin, Dublin, Ireland
| | - Graham Horgan
- Biomathematics and Statistics Scotland (James Hutton Institute), Aberdeen, United Kingdom
| | - Sofus Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - António Palmeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Santos
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro J Teixeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Jason Halford
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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18
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Lowe DA, Wu N, Rohdin-Bibby L, Moore AH, Kelly N, Liu YE, Philip E, Vittinghoff E, Heymsfield SB, Olgin JE, Shepherd JA, Weiss EJ. Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity: The TREAT Randomized Clinical Trial. JAMA Intern Med 2020; 180:1491-1499. [PMID: 32986097 PMCID: PMC7522780 DOI: 10.1001/jamainternmed.2020.4153] [Citation(s) in RCA: 252] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE The efficacy and safety of time-restricted eating have not been explored in large randomized clinical trials. OBJECTIVE To determine the effect of 16:8-hour time-restricted eating on weight loss and metabolic risk markers. INTERVENTIONS Participants were randomized such that the consistent meal timing (CMT) group was instructed to eat 3 structured meals per day, and the time-restricted eating (TRE) group was instructed to eat ad libitum from 12:00 pm until 8:00 pm and completely abstain from caloric intake from 8:00 pm until 12:00 pm the following day. DESIGN, SETTING, AND PARTICIPANTS This 12-week randomized clinical trial including men and women aged 18 to 64 years with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 to 43 was conducted on a custom mobile study application. Participants received a Bluetooth scale. Participants lived anywhere in the United States, with a subset of 50 participants living near San Francisco, California, who underwent in-person testing. MAIN OUTCOMES AND MEASURES The primary outcome was weight loss. Secondary outcomes from the in-person cohort included changes in weight, fat mass, lean mass, fasting insulin, fasting glucose, hemoglobin A1c levels, estimated energy intake, total energy expenditure, and resting energy expenditure. RESULTS Overall, 116 participants (mean [SD] age, 46.5 [10.5] years; 70 [60.3%] men) were included in the study. There was a significant decrease in weight in the TRE (-0.94 kg; 95% CI, -1.68 to -0.20; P = .01), but no significant change in the CMT group (-0.68 kg; 95% CI, -1.41 to 0.05, P = .07) or between groups (-0.26 kg; 95% CI, -1.30 to 0.78; P = .63). In the in-person cohort (n = 25 TRE, n = 25 CMT), there was a significant within-group decrease in weight in the TRE group (-1.70 kg; 95% CI, -2.56 to -0.83; P < .001). There was also a significant difference in appendicular lean mass index between groups (-0.16 kg/m2; 95% CI, -0.27 to -0.05; P = .005). There were no significant changes in any of the other secondary outcomes within or between groups. There were no differences in estimated energy intake between groups. CONCLUSIONS AND RELEVANCE Time-restricted eating, in the absence of other interventions, is not more effective in weight loss than eating throughout the day. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT03393195 and NCT03637855.
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Affiliation(s)
- Dylan A Lowe
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco
| | - Nancy Wu
- Cardiology Division, University of California, San Francisco, San Francisco.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco
| | | | - A Holliston Moore
- Cardiology Division, University of California, San Francisco, San Francisco.,Clovis Oncology Inc, Boulder, Colorado
| | - Nisa Kelly
- University of Hawai'i Cancer Center, Honolulu
| | - Yong En Liu
- University of Hawai'i Cancer Center, Honolulu
| | - Errol Philip
- University of California School of Medicine, San Francisco
| | - Eric Vittinghoff
- Cardiology Division, University of California, San Francisco, San Francisco
| | | | - Jeffrey E Olgin
- Cardiology Division, University of California, San Francisco, San Francisco
| | | | - Ethan J Weiss
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco.,Cardiology Division, University of California, San Francisco, San Francisco
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19
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Developing evidence-based behavioural strategies to overcome physiological resistance to weight loss in the general population. Proc Nutr Soc 2020; 78:576-589. [PMID: 31670628 DOI: 10.1017/s0029665119001083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Physiological and behavioural systems are tolerant of excess energy intake and responsive to energy deficits. Weight loss (WL) changes body structure, physiological function and energy balance (EB) behaviours, which resist further WL and promote subsequent weight regain. Measuring and understanding the response of EB systems to energy deficits is important for developing evidence-based behaviour change interventions for longer-term weight management. Currently, behaviour change approaches for longer-term WL show modest effect sizes. Self-regulation of EB behaviours (e.g. goal setting, action plans, self-monitoring, relapse prevention plans) and aspects of motivation are important for WL maintenance. Stress management, emotion regulation and food hedonics may also be important for relapse prevention, but the evidence is less concrete. Although much is known about the effects of WL on physiological and psychological function, little is known about the way these dynamic changes affect human EB behaviours. Key areas of future importance include (i) improved methods for detailed tracking of energy expenditure, balance and by subtraction intake, using digital technologies, (ii) how WL impacts body structure, function and subsequent EB behaviours, (iii) how behaviour change approaches can overcome physiological resistance to WL and (iv) who is likely to maintain WL or relapse. Modelling physiological and psychological moderators and mediators of EB-related behaviours is central to understanding and improving longer-term weight and health outcomes in the general population.
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20
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O’Driscoll R, Turicchi J, Hopkins M, Horgan GW, Finlayson G, Stubbs JR. Improving energy expenditure estimates from wearable devices: A machine learning approach. J Sports Sci 2020; 38:1496-1505. [DOI: 10.1080/02640414.2020.1746088] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ruairi O’Driscoll
- Appetite Control and Energy Balance Group, School of Psychology, University of Leeds, Leeds, UK
| | - Jake Turicchi
- Appetite Control and Energy Balance Group, School of Psychology, University of Leeds, Leeds, UK
| | - Mark Hopkins
- School of Food Science and Nutrition, Faculty of Mathematics and Physical Sciences, University of Leeds, Leeds, UK
| | | | - Graham Finlayson
- Appetite Control and Energy Balance Group, School of Psychology, University of Leeds, Leeds, UK
| | - James. R. Stubbs
- Appetite Control and Energy Balance Group, School of Psychology, University of Leeds, Leeds, UK
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21
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O’Driscoll R, Turicchi J, Hopkins M, Gibbons C, Larsen SC, Palmeira AL, Heitmann BL, Horgan GW, Finlayson G, Stubbs RJ. The validity of two widely used commercial and research-grade activity monitors, during resting, household and activity behaviours. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00392-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AbstractWearable devices are increasingly prevalent in research environments for the estimation of energy expenditure (EE) and heart rate (HR). The aim of this study was to validate the HR and EE estimates of the Fitbit charge 2 (FC2), and the EE estimates of the Sensewear armband mini (SWA). We recruited 59 healthy adults to participate in walking, running, cycling, sedentary and household tasks. Estimates of HR from the FC2 were compared to a HR chest strap (Polar) and EE to a stationary metabolic cart (Vyntus CPX). The SWA overestimated overall EE by 0.03 kcal/min−1 and was statistically equivalent to the criterion measure, with a mean absolute percentage error (MAPE) of 29%. In contrast, the FC2 was not equivalent overall (MAPE = 44%). In household tasks, MAPE values of 93% and 83% were observed for the FC2 and SWA, respectively. The FC2 HR estimates were equivalent to the criterion measure overall. The SWA is more accurate than the commercial-grade FC2. Neither device is consistently accurate across the range of activities used in this study. The HR data obtained from the FC2 is more accurate than its EE estimates and future research may focus more on this variable.
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22
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Control-theory models of body-weight regulation and body-weight-regulatory appetite. Appetite 2019; 144:104440. [PMID: 31494154 DOI: 10.1016/j.appet.2019.104440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/08/2019] [Accepted: 09/02/2019] [Indexed: 12/24/2022]
Abstract
Human body weight (BW), or some variable related to it, is physiologically regulated. That is, negative feedback from changes in BW elicits compensatory influences on appetite, which may be called BW-regulatory appetite, and a component of energy expenditure (EE) called adaptive thermogenesis (AdEE). BW-regulatory appetite is of general significance because it appears to be related to a variety of aspects of human appetite beyond just energy intake. BW regulation, BW-regulatory appetite and AdEE are frequently discussed using concepts derived from control theory, which is the mathematical description of dynamic systems involving negative feedback. The aim of this review is to critically assess these discussions. Two general types of negative-feedback control have been invoked to describe BW regulation, set-point control and simple negative-feedback control, often called settling-point control in the BW literature. The distinguishing feature of set-point systems is the existence of an externally controlled target level of regulation, the set point. The performance of almost any negative-feedback regulatory system, however, can be modeled on the basis of feedback gain without including a set point. In both set-point and simple negative-feedback models of BW regulation, the precision of regulation is usually determined mainly by feedback gain, which refers to the transformations of feedback into compensatory changes in BW-regulatory appetite and AdEE. Stable BW most probably represents equilibria shaped by feedback gain and tonic open-loop challenges, especially obesogenic environments. Data indicate that simple negative-feedback control accurately models human BW regulation and that the set-point concept is superfluous unless its neuroendocrine representation is found in the brain. Additional research aimed at testing control-theory models in humans and non-human animals is warranted.
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23
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Foster E, Lee C, Imamura F, Hollidge SE, Westgate KL, Venables MC, Poliakov I, Rowland MK, Osadchiy T, Bradley JC, Simpson EL, Adamson AJ, Olivier P, Wareham N, Forouhi NG, Brage S. Validity and reliability of an online self-report 24-h dietary recall method (Intake24): a doubly labelled water study and repeated-measures analysis. J Nutr Sci 2019; 8:e29. [PMID: 31501691 PMCID: PMC6722486 DOI: 10.1017/jns.2019.20] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 12/24/2022] Open
Abstract
Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40-65 years). Accuracy and precision of EI were assessed using correlation and Bland-Altman analysis. Test-retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11-88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement -73 % to +68 %) in the first recall, 22 % (-61 % to +41 %) for average of first two, and 25 % (-60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.
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Affiliation(s)
- Emma Foster
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Clement Lee
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, UK
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | | | | | - Ivan Poliakov
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Maisie K. Rowland
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Timur Osadchiy
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer C. Bradley
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Emma L. Simpson
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J. Adamson
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick Olivier
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nita G. Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Soren Brage
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
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24
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Brown E, Wilding JPH, Barber TM, Alam U, Cuthbertson DJ. Weight loss variability with SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes mellitus and obesity: Mechanistic possibilities. Obes Rev 2019; 20:816-828. [PMID: 30972878 DOI: 10.1111/obr.12841] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 12/31/2022]
Abstract
We are facing a global epidemic of obesity and type 2 diabetes. Weight loss, in the context of obesity and type 2 diabetes, may improve glycaemic control and weight-related comorbidities, and in some cases, induce diabetes remission. Although lifestyle-based weight loss strategies may be initially successful, most are not effective long-term. There is an increasing need to consider pharmacological approaches to assist weight loss in diabetes-obesity. Older glucose-lowering agents may cause weight gain, whereas the newer drug classes, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP-1 RAs), concomitantly target weight loss and glycaemic control. Clinical trial data suggest that both SGLT2i and GLP1 RAs cause a mean weight loss of approximately 2 to 3 kg but real-world evidence and clinical experience suggests a significant heterogeneity in the magnitude of the weight loss (GLP-1 RAs) or the magnitude of the actual weight loss is significantly less than anticipated (SGLT2i). Why do some individuals lose more weight than others in response to these pharmacological treatments? This review will first explore mechanisms by which body weight is regulated through control of energy balance and its dysregulation in obesity, and then consider how these mechanisms may be modulated therapeutically with SGLT2i and GLP1 RAs.
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Affiliation(s)
- Emily Brown
- Metabolism and Nutrition Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Metabolism and Nutrition Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Thomas M Barber
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, UK
| | - Uazman Alam
- Metabolism and Nutrition Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Metabolism and Nutrition Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Richard MA, Blondin DP, Noll C, Lebel R, Lepage M, Carpentier AC. Determination of a pharmacokinetic model for [ 11C]-acetate in brown adipose tissue. EJNMMI Res 2019; 9:31. [PMID: 30919091 PMCID: PMC6437247 DOI: 10.1186/s13550-019-0497-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/11/2019] [Indexed: 12/28/2022] Open
Abstract
Background [11C]-acetate positron emission tomography is used to assess oxidative metabolism in various tissues including the heart, tumor, and brown adipose tissue. For brown adipose tissue, a monoexponential decay model is commonly employed. However, no systematic assessment of kinetic models has been performed to validate this model or others. The monoexponential decay model and various compartmental models were applied to data obtained before and during brown adipose tissue activation by cold exposure in healthy men. Quality of fit was assessed visually and by analysis of residuals, including the Akaike information criterion. Stability and accuracy of compartmental models were further assessed through simulations, along with sensitivity and identifiability of kinetic parameters. Results Differences were noted in the arterial input function between the warm and cold conditions. These differences are not taken into account by the monoexponential decay model. They are accounted for by compartmental models, but most models proved too complex to be stable. Two and three-tissue models with no more than four distinct kinetic parameters, including blood volume fraction, provided the best compromise between fit quality and stability/accuracy. Conclusion For healthy men, a three-tissue model with four kinetic parameters, similar to a heart [11C]-palmitate model seems the most appropriate based on model stability and its ability to describe the main [11C]-acetate pathways in BAT cells. Further studies are required to validate this model in women and people with metabolic disorders. Electronic supplementary material The online version of this article (10.1186/s13550-019-0497-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Anne Richard
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Denis P Blondin
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Christophe Noll
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Réjean Lebel
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Martin Lepage
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
| | - André C Carpentier
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
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Guo J, Robinson JL, Gardner C, Hall KD. Objective versus Self-Reported Energy Intake Changes During Low-Carbohydrate and Low-Fat Diets. Obesity (Silver Spring) 2019; 27:420-426. [PMID: 30672127 PMCID: PMC6392435 DOI: 10.1002/oby.22389] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/09/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to compare self-reported with objective measurements of energy intake changes (∆EI) during a 1-year weight-loss intervention with subjects randomized to low-carbohydrate versus low-fat diets. METHODS Repeated body weight measurements were used as inputs to an objective mathematical model to calculate ∆EIModel and to compare with self-reported energy intake changes assessed by repeated 24-hour recalls (∆EIRecall ). RESULTS ∆EIRecall indicated a relatively persistent state of calorie restriction of ~500 to 600 kcal/d at 3, 6, and 12 months with no significant differences between the diets. ∆EIModel demonstrated large early decreases in calorie intake > 800 kcal/d followed by an exponential return to ~100 kcal/d below baseline at the end of the year. Accounting for self-reported physical activities did not materially affect the results. Discrepancies between ∆EIModel and ∆EIRecall became progressively greater over time. The low-carbohydrate diet resulted in ∆EIModel that was 162 ± 53 kcal/d lower than the low-fat diet over the first 3 months (P = 0.002), but no significant diet differences were found thereafter. CONCLUSIONS Self-reported ∆EI measurements were inaccurate. Model-based calculations of ∆EI found that instructions to follow the low-carbohydrate diet resulted in greater calorie restriction than the low-fat diet in the early phases of the intervention, but these diet differences were not sustained.
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Affiliation(s)
- Juen Guo
- National Institute of Diabetes and Digestive and Kidney
Diseases
| | | | | | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney
Diseases
- To whom correspondence should be addressed:
Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive &
Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892,
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27
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Gonzalez JT. Using misleading online media articles to teach critical assessment of scientific findings about weight loss. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:500-506. [PMID: 30035631 DOI: 10.1152/advan.00065.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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28
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Ries D, Carriquiry A, Shook R. Modeling energy balance while correcting for measurement error via free knot splines. PLoS One 2018; 13:e0201892. [PMID: 30161152 PMCID: PMC6116982 DOI: 10.1371/journal.pone.0201892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/26/2018] [Indexed: 11/18/2022] Open
Abstract
Measurements of energy balance components (energy intake, energy expenditure, changes in energy stores) are often plagued with measurement error. Doubly-labeled water can measure energy intake (EI) with negligible error, but is expensive and cumbersome. An alternative approach that is gaining popularity is to use the energy balance principle, by measuring energy expenditure (EE) and change in energy stores (ES) and then back-calculate EI. Gold standard methods for EE and ES exist and are known to give accurate measurements, albeit at a high cost. We propose a joint statistical model to assess the measurement error in cheaper, non-intrusive measures of EE and ES. We let the unknown true EE and ES for individuals be latent variables, and model them using a bivariate distribution. We try both a bivariate Normal as well as a Dirichlet Process Mixture Model, and compare the results via simulation. Our approach, is the first to account for the dependencies that exist in individuals' daily EE and ES. We employ semiparametric regression with free knot splines for measurements with error, and linear components for error free covariates. We adopt a Bayesian approach to estimation and inference and use Reversible Jump Markov Chain Monte Carlo to generate draws from the posterior distribution. Based on the semiparameteric regression, we develop a calibration equation that adjusts a cheaper, less reliable estimate, closer to the true value. Along with this calibrated value, our method also gives credible intervals to assess uncertainty. A simulation study shows our calibration helps produce a more accurate estimate. Our approach compares favorably in terms of prediction to other commonly used models.
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Affiliation(s)
- Daniel Ries
- Statistical Sciences Department, Sandia National Laboratories, Albuquerque, NM, United States of America
- Department of Statistics, Iowa State University, Ames, IA, United States of America
- * E-mail:
| | - Alicia Carriquiry
- Department of Statistics, Iowa State University, Ames, IA, United States of America
| | - Robin Shook
- Center for Children’s Healthy Lifestyles & Nutrition, Children’s Mercy, Kansas City, MO, United States of America
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Narrative Review of New Methods for Assessing Food and Energy Intake. Nutrients 2018; 10:nu10081064. [PMID: 30103401 PMCID: PMC6116053 DOI: 10.3390/nu10081064] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022] Open
Abstract
Dietary self-report instruments are essential to nutritional analysis in dietetics practice and their use in research settings has facilitated numerous important discoveries related to nutrition, health and chronic diseases. An important example is obesity, for which measuring changes in energy intake is critical for assessing efficacy of dietary interventions. However, current methods, including counting calories, estimating portion size and using food labels to estimate human energy intake have considerable constraints; consequently, research on new methodologies/technologies has been encouraged to mitigate the present weaknesses. The use of technologies has prompted innovation in dietary analysis. In this review, the strengths and limitations of new approaches have been analyzed based on ease of use, practical limitations, and statistical evaluation of reliability and validity. Their utility is discussed through the lens of the 4Ms of Obesity Assessment and Management, which has been used to evaluate root causes of obesity and help select treatment options.
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30
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Carpentier AC, Blondin DP, Virtanen KA, Richard D, Haman F, Turcotte ÉE. Brown Adipose Tissue Energy Metabolism in Humans. Front Endocrinol (Lausanne) 2018; 9:447. [PMID: 30131768 PMCID: PMC6090055 DOI: 10.3389/fendo.2018.00447] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/20/2018] [Indexed: 12/16/2022] Open
Abstract
The demonstration of metabolically active brown adipose tissue (BAT) in humans primarily using positron emission tomography coupled to computed tomography (PET/CT) with the glucose tracer 18-fluorodeoxyglucose (18FDG) has renewed the interest of the scientific and medical community in the possible role of BAT as a target for the prevention and treatment of obesity and type 2 diabetes (T2D). Here, we offer a comprehensive review of BAT energy metabolism in humans. Considerable advances in methods to measure BAT energy metabolism, including nonesterified fatty acids (NEFA), chylomicron-triglycerides (TG), oxygen, Krebs cycle rate, and intracellular TG have led to very good quantification of energy substrate metabolism per volume of active BAT in vivo. These studies have also shown that intracellular TG are likely the primary energy source of BAT upon activation by cold. Current estimates of BAT's contribution to energy expenditure range at the lower end of what would be potentially clinically relevant if chronically sustained. Yet, 18FDG PET/CT remains the gold-standard defining method to quantify total BAT volume of activity, used to calculate BAT's total energy expenditure. Unfortunately, BAT glucose metabolism better reflects BAT's insulin sensitivity and blood flow. It is now clear that most glucose taken up by BAT does not fuel mitochondrial oxidative metabolism and that BAT glucose uptake can therefore be disconnected from thermogenesis. Furthermore, BAT thermogenesis is efficiently recruited upon repeated cold exposure, doubling to tripling its total oxidative capacity, with reciprocal reduction of muscle thermogenesis. Recent data suggest that total BAT volume may be much larger than the typically observed 50-150 ml with 18FDG PET/CT. Therefore, the current estimates of total BAT thermogenesis, largely relying on total BAT volume using 18FDG PET/CT, may underestimate the true contribution of BAT to total energy expenditure. Quantification of the contribution of BAT to energy expenditure begs for the development of more integrated whole body in vivo methods.
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Affiliation(s)
- André C. Carpentier
- Division of Endocrinology, Department of Medicine, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Kirsi A. Virtanen
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland (UEF), Kuopio, Finland
| | - Denis Richard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
| | - François Haman
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Éric E. Turcotte
- Department of Nuclear Medicine and Radiobiology, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
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Abstract
PURPOSE OF REVIEW Summarize the physiological effects of low-carbohydrate diets as they relate to weight loss, glycemic control, and metabolic health. RECENT FINDINGS Low-carbohydrate diets are at least as effective for weight loss as other diets, but claims about increased energy expenditure and preferential loss of body fat are unsubstantiated. Glycemic control and hyperinsulinemia are improved by low-carbohydrate diets, but insulin sensitivity and glucose-stimulated insulin secretion may be impaired, especially in the absence of weight loss. Fasting lipid parameters are generally improved, but such improvements may depend on the quality of dietary fat and the carbohydrates they replaced. Postprandial hyperlipemia is a potential concern given the high fat content typical of low-carbohydrate diets. SUMMARY Low-carbohydrate diets have several potential benefits for treatment of obesity and type 2 diabetes, but more research is required to better understand their long-term consequences as well as the variable effects on the endocrine control of glucose, lipids, and metabolism.
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Affiliation(s)
| | - Stephanie T Chung
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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32
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Symons Downs D, Savage JS, Rivera DE, Smyth JM, Rolls BJ, Hohman EE, McNitt KM, Kunselman AR, Stetter C, Pauley AM, Leonard KS, Guo P. Individually Tailored, Adaptive Intervention to Manage Gestational Weight Gain: Protocol for a Randomized Controlled Trial in Women With Overweight and Obesity. JMIR Res Protoc 2018; 7:e150. [PMID: 29884603 PMCID: PMC6015270 DOI: 10.2196/resprot.9220] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/16/2018] [Accepted: 04/06/2018] [Indexed: 12/25/2022] Open
Abstract
Background High gestational weight gain is a major public health concern as it independently predicts adverse maternal and infant outcomes. Past interventions have had only limited success in effectively managing pregnancy weight gain, especially among women with overweight and obesity. Well-designed interventions are needed that take an individualized approach and target unique barriers to promote healthy weight gain. Objective The primary aim of the study is to describe the study protocol for Healthy Mom Zone, an individually tailored, adaptive intervention for managing weight in pregnant women with overweight and obesity. Methods The Healthy Mom Zone Intervention, based on theories of planned behavior and self-regulation and a model of energy balance, includes components (eg, education, self-monitoring, physical activity/healthy eating behaviors) that are adapted over the intervention (ie, increase in intensity) to better regulate weight gain. Decision rules inform when to adapt the intervention. In this randomized controlled trial, women are randomized to the intervention or standard care control group. The intervention is delivered from approximately 8-36 weeks gestation and includes step-ups in dosages (ie, Step-up 1 = education + physical activity + healthy eating active learning [cooking/recipes]; Step-up 2 = Step-up 1 + portion size, physical activity; Step-up 3 = Step-up 1 + 2 + grocery store feedback, physical activity); 5 maximum adaptations. Study measures are obtained at pre- and postintervention as well as daily (eg, weight), weekly (eg, energy intake/expenditure), and monthly (eg, psychological) over the study period. Analyses will include linear mixed-effects models, generalized estimating equations, and dynamical modeling to understand between-group and within-individual effects of the intervention on weight gain. Results Recruitment of 31 pregnant women with overweight and obesity has occurred from January 2016 through July 2017. Baseline data have been collected for all participants. To date, 24 participants have completed the intervention and postintervention follow-up assessments, 3 are currently in progress, 1 dropped out, and 3 women had early miscarriages and are no longer active in the study. Of the 24 participants, 13 women have completed the intervention to date, of which 1 (8%, 1/13) received only the baseline intervention, 3 (23%, 3/13) received baseline + step-up 1, 6 (46%, 6/13) received baseline + step-up 1 + step-up 2, and 3 (23%, 3/13) received baseline + step-up 1 + step-up 2 +step-up 3. Data analysis is still ongoing through spring 2018. Conclusions This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy. Results from this study will be useful in designing a larger randomized trial to examine efficacy of this intervention and developing strategies for clinical application. Registered Report Identifier RR1-10.2196/9220
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Affiliation(s)
- Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States.,Department of Obstetrics and Gynecology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Daniel E Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, United States
| | - Joshua M Smyth
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Barbara J Rolls
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Emily E Hohman
- Center for Childhood Obesity Research, Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Katherine M McNitt
- Center for Childhood Obesity Research, Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Allen R Kunselman
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christy Stetter
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Penghong Guo
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, United States
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Rosenbaum M, Agurs-Collins T, Bray MS, Hall KD, Hopkins M, Laughlin M, MacLean PS, Maruvada P, Savage CR, Small DM, Stoeckel L. Accumulating Data to Optimally Predict Obesity Treatment (ADOPT): Recommendations from the Biological Domain. Obesity (Silver Spring) 2018; 26 Suppl 2:S25-S34. [PMID: 29575784 PMCID: PMC6945498 DOI: 10.1002/oby.22156] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The responses to behavioral, pharmacological, or surgical obesity treatments are highly individualized. The Accumulating Data to Optimally Predict obesity Treatment (ADOPT) project provides a framework for how obesity researchers, working collectively, can generate the evidence base needed to guide the development of tailored, and potentially more effective, strategies for obesity treatment. OBJECTIVES The objective of the ADOPT biological domain subgroup is to create a list of high-priority biological measures for weight-loss studies that will advance the understanding of individual variability in response to adult obesity treatments. This list includes measures of body composition, energy homeostasis (energy intake and output), brain structure and function, and biomarkers, as well as biobanking procedures, which could feasibly be included in most, if not all, studies of obesity treatment. The recommended high-priority measures are selected to balance needs for sensitivity, specificity, and/or comprehensiveness with feasibility to achieve a commonality of usage and increase the breadth and impact of obesity research. SIGNIFICANCE The accumulation of data on key biological factors, along with behavioral, psychosocial, and environmental factors, can generate a more precise description of the interplay and synergy among them and their impact on treatment responses, which can ultimately inform the design and delivery of effective, tailored obesity treatments.
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Affiliation(s)
- Michael Rosenbaum
- Columbia University, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Tanya Agurs-Collins
- National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Molly S Bray
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hopkins
- School of Food Science and Nutrition, University of Leeds, Leeds, England
| | - Maren Laughlin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul S MacLean
- School of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Padma Maruvada
- School of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cary R Savage
- Center for Brain, Biology and Behavior, Department of Psychology, University of Nebraska, Lincoln, Nebraska, USA
| | - Dana M Small
- Yale University Medical School, New Haven, Connecticut, USA
| | - Luke Stoeckel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Guo J, Brager DC, Hall KD. Simulating long-term human weight-loss dynamics in response to calorie restriction. Am J Clin Nutr 2018; 107:558-565. [PMID: 29635495 PMCID: PMC6248630 DOI: 10.1093/ajcn/nqx080] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/20/2017] [Indexed: 01/09/2023] Open
Abstract
Background Mathematical models have been developed to predict body weight (BW) and composition changes in response to lifestyle interventions, but these models have not been adequately validated over the long term. Objective We compared mathematical models of human BW dynamics underlying 2 popular web-based weight-loss prediction tools, the National Institutes of Health Body Weight Planner (NIH BWP) and the Pennington Biomedical Research Center Weight Loss Predictor (PBRC WLP), with data from the 2-year Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) study. Design Mathematical models were initialized using baseline CALERIE data, and changes in body weight (ΔBW), fat mass (ΔFM), and energy expenditure (ΔEE) were simulated in response to time-varying changes in energy intake (ΔEI) objectively measured using the intake-balance method. No model parameters were adjusted from their previously published values. Results The PBRC WLP model simulated an exaggerated early decrease in EE in response to calorie restriction, resulting in substantial underestimation of the observed mean (95% CI) BW losses by 3.8 (3.5, 4.2) kg. The NIH WLP simulations were much closer to the data, with an overall mean ΔBW bias of -0.47 (-0.92, -0.015) kg. Linearized model analysis revealed that the main reason for the PBRC WLP model bias was a parameter value defining how spontaneous physical activity expenditure decreased with caloric restriction. Both models exhibited substantial variability in their ability to simulate individual results in response to calorie restriction. Monte Carlo simulations demonstrated that ΔEI measurement uncertainties were a major contributor to the individual variability in NIH BWP model simulations. Conclusions The NIH BWP outperformed the PBRC WLP and accurately simulated average weight-loss and energy balance dynamics in response to long-term calorie restriction. However, the substantial variability in the NIH BWP model predictions at the individual level suggests cautious interpretation of individual-level simulations. This trial was registered at clinicaltrials.gov as NCT00427193.
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Affiliation(s)
- Juen Guo
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive
and Kidney Diseases, Bethesda, MD
| | - Danielle C Brager
- School of Mathematical and Statistical Sciences, Arizona State University,
Tempe, AZ
| | - Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive
and Kidney Diseases, Bethesda, MD,Address correspondence to KDH (e-mail: )
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35
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Barone Gibbs B, Davis KK. In Pursuit of the "Something" that Is Better than Nothing for Measuring Energy Intake. J Nutr 2018; 148:309-310. [PMID: 29546311 DOI: 10.1093/jn/nxy006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Kelliann K Davis
- Department of Health and Physical Activity, University of Pittsburgh, PA
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36
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Shook RP, Hand GA, O'Connor DP, Thomas DM, Hurley TG, Hébert JR, Drenowatz C, Welk GJ, Carriquiry AL, Blair SN. Energy Intake Derived from an Energy Balance Equation, Validated Activity Monitors, and Dual X-Ray Absorptiometry Can Provide Acceptable Caloric Intake Data among Young Adults. J Nutr 2018; 148:490-496. [PMID: 29546294 DOI: 10.1093/jn/nxx029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Assessments of energy intake (EI) are frequently affected by measurement error. Recently, a simple equation was developed and validated to estimate EI on the basis of the energy balance equation [EI = changed body energy stores + energy expenditure (EE)]. Objective The purpose of this study was to compare multiple estimates of EI, including 2 calculated from the energy balance equation by using doubly labeled water (DLW) or activity monitors, in free-living adults. Methods The body composition of participants (n = 195; mean age: 27.9 y; 46% women) was measured at the beginning and end of a 2-wk assessment period with the use of dual-energy X-ray absorptiometry. Resting metabolic rate (RMR) was calculated through indirect calorimetry. EE was assessed with the use of the DLW technique and an arm-based activity monitor [Sensewear Mini Armband (SWA); BodyMedia, Inc.]. Self-reported EI was calculated by using dietitian-administered 24-h dietary recalls. Two estimates of EI were calculated with the use of a validated equation: quantity of energy stores estimated from the changes in fat mass and fat-free mass occurring over the assessment period plus EE from either DLW or the SWA. To compare estimates of EI, reporting bias (estimated EI/EE from DLW × 100) and Goldberg ratios (estimated EI/RMR) were calculated. Results Mean ± SD EEs from DLW and SWA were 2731 ± 494 and 2729 ± 559 kcal/d, respectively. Self-reported EI was 2113 ± 638 kcal/d, EI derived from DLW was 2723 ± 469 kcal/d, and EI derived from the SWA was 2720 ± 730 kcal/d. Reporting biases for self-reported EI, DLW-derived EI, and SWA-derived EI are as follows: -21.5% ± 22.2%, -0.7% ± 18.5%, and 0.2% ± 20.8%, respectively. Goldberg cutoffs for self-reported EI, DLW EI, and SWA EI are as follows: 1.39 ± 0.39, 1.77 ± 0.38, and 1.77 ± 0.38 kcal/d, respectively. Conclusions These results indicate that estimates of EI based on the energy balance equation can provide reasonable estimates of group mean EI in young adults. The findings suggest that, when EE derived from DLW is not feasible, an activity monitor that provides a valid estimate of EE can be substituted for EE from DLW.
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Affiliation(s)
- Robin P Shook
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Gregory A Hand
- School of Public Health, University of West Virginia, Morgantown, WV
| | - Daniel P O'Connor
- Department of Health and Human Performance, University of Houston, Houston, TX
| | - Diana M Thomas
- Department of Mathematics, US Military Academy, West Point, NY
| | - Thomas G Hurley
- South Carolina Statewide Cancer Prevention and Control Program and Departments of Epidemiology and Biostatistics and Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program and Departments of Epidemiology and Biostatistics and Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Departments of Epidemiology and Biostatistics and Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Gregory J Welk
- Departments of Kinesiology and Statistics, Iowa State University, Ames, IA
| | | | - Steven N Blair
- Departments of Epidemiology and Biostatistics and Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Departments of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Silva AM, Matias CN, Santos DA, Thomas D, Bosy-Westphal A, Müller MJ, Heymsfield SB, Sardinha LB. Energy Balance over One Athletic Season. Med Sci Sports Exerc 2018; 49:1724-1733. [PMID: 28514233 DOI: 10.1249/mss.0000000000001280] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Magnitude and variation in energy balance (EB) components over an athletic season are largely unknown. PURPOSE We investigated the longitudinal changes in EB over one season and explored the association between EB variation and change in the main fat-free mass (FFM) components in highly trained athletes. METHODS Eighty athletes (54 males; handball, volleyball, basketball, triathlete, and swimming) were evaluated from the beginning of the season to the main competition stage. Resting and total energy expenditure (REE and TEE, respectively) were assessed by indirect calorimetry and doubly labeled water, respectively. Physical activity energy expenditure was calculated as TEE - 0.1 TEE - REE. Fat mass (FM), FFM, and bone mineral were evaluated with dual-energy x-ray absorptiometry; changed body energy stores were calculated as 1.0(ΔFFM/Δtime) + 9.5(ΔFM/Δtime). Total-body water (TBW) and its compartments were assessed through dilution techniques, and total-body protein was calculated from a four-compartment model, with body volume assessed by air displacement plethysmography. RESULTS Although a negative EB of -17.4 ± 72.7 kcal·d was observed (P < 0.05), EB varied widely among sports and across sex groups resulting in a net weight increase (0.7 ± 2.3 kg) that is attributable to significant changes in FFM (1.2 ± 1.6 kg) and FM (-0.7 ± 1.5 kg) (P < 0.05). EB was related with TBW and intracellular water (r = 0.354, r = 0.257, P < 0.05, respectively), regardless of sex, sports, and age. CONCLUSIONS The mean negative EB observed over the season resulted from the rate of FM use and FFM accretion, but with a large variation by sex and sports. TBW, but not total-body protein or mineral balance, explained the magnitude of EB, which means that athletes under a positive or a negative EB showed a TBW expansion or shrinkage, respectively, specifically within the cells, over one athletic season.
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Affiliation(s)
- Analiza M Silva
- 1Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, PORTUGAL; 2Department of Mathematical Sciences, United States Military Academy West Point, NY; 3Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, GERMANY; 4Department of Human Nutrition and Food Science, Christian-Albrechts-University of Kiel, Kiel, GERMANY; and 5Pennington Biomedical Research Center, Baton Rouge, LA
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Cancello R, Soranna D, Brunani A, Scacchi M, Tagliaferri A, Mai S, Marzullo P, Zambon A, Invitti C. Analysis of Predictive Equations for Estimating Resting Energy Expenditure in a Large Cohort of Morbidly Obese Patients. Front Endocrinol (Lausanne) 2018; 9:367. [PMID: 30090085 PMCID: PMC6068274 DOI: 10.3389/fendo.2018.00367] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/18/2018] [Indexed: 01/10/2023] Open
Abstract
The treatment of obesity requires creating an energy deficit through caloric restriction and physical activity. Energy needs are estimated assessing the resting energy expenditure (REE) that in the clinical practice is estimated using predictive equations. In the present cross sectional study, we compared, in a large cohort of morbidly obese patients, the accuracy of REE predictive equations recommended by current obesity guidelines [Harris-Benedict, WHO/FAO/ONU and Mifflin-St Jeor (MJ)] and/or developed for obese patients (Muller, Muller BC, Lazzer, Lazzer BC), focusing on the effect of comorbidities on the accuracy of the equations. Data on REE measured by indirect calorimetry and body composition were collected in 4,247 obese patients (69% women, mean age 48 ± 19 years, mean BMI 44 ± 7 Kg/m2) admitted to the Istituto Auxologico Italiano from 1999 to 2014. The performance of the equations was assessed in the whole cohort, in 4 groups with 0, 1, 2, or ≥ 3 comorbidities and in a subgroup of 1,598 patients with 1 comorbidity (47.1% hypertension, 16.7% psychiatric disorders, 13.3% binge eating disorders, 6.1% endocrine disorders, 6.4% type 2 diabetes, 3.5% sleep apnoea, 3.1% dyslipidemia, 2.5% coronary disease). In the whole cohort of obese patients, as well as in each stratum of comorbidity number, the MJ equation had the highest performance for agreement measures and bias. The MJ equation had the best performance in obese patients with ≥3 comorbidities (accuracy of 61.1%, bias of -89.87) and in patients with type 2 diabetes and sleep apnoea (accuracy/bias 69%/-19.17 and 66%/-21.67 respectively), who also have the highest levels of measured REE. In conclusion, MJ equation should be preferred to other equations to estimate the energy needs of Caucasian morbidly obese patients when measurement of the REE cannot be performed. As even MJ equation does not precisely predict REE, it should be better to plan the diet intervention by measuring rather than estimating REE. Future studies focusing on the clinical differences that determine the high inter-individual variability of the precision of the REE predictive equations (e.g., on the organ-tissue metabolic rate), could help to develop predictive equations with a better performance.
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Affiliation(s)
- Raffaella Cancello
- Obesity Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Raffaella Cancello
| | | | - Amelia Brunani
- Division of Rehabilitation Medicine, IRCCS Istituto Auxologico Italiano, Piancavallo-Oggebbio, Italy
| | - Massimo Scacchi
- Division of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piancavallo-Oggebbio, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonella Tagliaferri
- Division of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piancavallo-Oggebbio, Italy
| | - Stefania Mai
- Laboratory of Metabolic Research, IRCCS Istituto Auxologico Italiano, Piancavallo-Oggebbio, Italy
| | - Paolo Marzullo
- Division of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piancavallo-Oggebbio, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Biostatistics, Epidemiology and Public Health, Milano-Bicocca University, Milan, Italy
| | - Cecilia Invitti
- Obesity Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Abstract
Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892, USA.
| | - Scott Kahan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; George Washington University School of Medicine, 1020 19th Street NW, Suite 450, Washington, DC 20036, USA
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Butler L, Popkin BM, Poti JM. Associations of Alcoholic Beverage Consumption with Dietary Intake, Waist Circumference, and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003-2012. J Acad Nutr Diet 2017; 118:409-420.e3. [PMID: 29276140 DOI: 10.1016/j.jand.2017.09.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Findings from studies of alcohol and obesity measures (eg, waist circumference [WC] and body mass index [BMI; calculated as kg/m2]) are conflicting. Residual confounding by dietary intake, inconsistent definitions of alcohol consumption across studies, and the inclusion of former drinkers in the nondrinking comparison group can contribute to the mixed literature. OBJECTIVE This study examines associations of alcoholic beverage consumption with dietary intake, WC, and BMI. DESIGN Cross-sectional data from the 2003-2012 National Health and Nutrition Examination Survey were analyzed. PARTICIPANTS/SETTING Adults 20 to 79 years of age (n=7,436 men; n=6,939 women) were studied. MAIN OUTCOME MEASURES Associations of alcoholic beverage consumption with energy (kcal), macronutrient and sugar intakes (% kcal), WC, and BMI were determined. STATISTICAL ANALYSES PERFORMED Multivariable linear regression models were used to determine associations of average daily volume and drinking quantity (ie, drinks per drinking day) with dietary intake and obesity measures. Former and never drinkers were analyzed as distinct categories; associations of drinking with WC and BMI were examined with and without adjustment for dietary intake variables. RESULTS Heavier-drinking men (≥3 drinks/day) and women (≥2 drinks/day) consumed less nonalcoholic energy (β -252 kcal/day, 95% CI -346 to -159 kcal/day and β -159 kcal/day, 95% CI -245 to -73 kcal/day, respectively) than moderate drinkers (1 to 2 drinks/day in men and 1 drink/day in women). By average daily drinking volume, differences in WC and BMI between former and moderate drinkers were +1.78 cm (95% CI 0.51 to 3.05 cm) and +0.65 (95% CI 0.12 to 1.18) in men and +4.67 cm (95% CI 2.95 to 6.39 cm) and +2.49 (95% CI 1.64 to 3.34) in women. Compared with moderate drinking, heavier drinking volume was not associated with WC or BMI among men or women. In men, drinking ≥5 drinks/drinking day was associated with higher WC (β 3.48 cm, 95% CI 1.97 to 5.00 cm) and BMI (β 1.39, 95% CI 0.79 to 2.00) compared with men who consumed 1 to 2 drinks/drinking day. In women, WC and BMI were not significantly different for women drinking ≥4 drinks/drinking day compared with 1 drink/drinking day. CONCLUSIONS Differences in dietary intake across drinking subgroups and separation of former drinkers from nondrinkers should be considered in studies of alcohol intake in relation to WC and BMI.
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Silva AM, Matias CN, Santos DA, Thomas D, Bosy-Westphal A, MüLLER MJ, Heymsfield SB, Sardinha LUB. Compensatory Changes in Energy Balance Regulation over One Athletic Season. Med Sci Sports Exerc 2017; 49:1229-1235. [PMID: 28121799 DOI: 10.1249/mss.0000000000001216] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Mechanisms in energy balance (EB) regulation may include compensatory changes in energy intake (EI) and metabolic adaption (MA), but information is unavailable in athletes who often change EB components. We aim to investigate EB regulation compensatory mechanisms over one athletic season. METHODS Fifty-seven athletes (39 males/18 females; handball, volleyball, basketball, triathlon, and swimming) were evaluated from the beginning to the competitive phase of the season. Resting and total energy expenditure (REE and TEE, respectively) were assessed by indirect calorimetry and doubly labeled water, respectively, and physical activity energy expenditure was determined as TEE - 0.1(TEE) - REE. Fat mass (FM) and fat-free mass (FFM) were evaluated by dual-energy x-ray absorptiometry and changed body energy stores was determined by 1.0(ΔFFM/Δtime) + 9.5(ΔFM/Δtime). EI was derived as TEE + EB. REE was predicted from baseline FFM, FM, sex, and sports. %MA was calculated as 100(measured REE/predicted REE-1) and MA (kcal) as %MA/100 multiplied by baseline measured REE. Average EI minus average physical activity energy expenditure was computed as a proxy of average energy availability, assuming that a constant nonexercise EE occurred over the season. RESULTS Body mass increased by 0.8 ± 2.5 kg (P < 0.05), but a large individual variability was found ranging from -6.1 to 5.2 kg. The TEE raise (16.8% ± 11.7%) was compensated by an increase EI change (16.3% ± 12.0%) for the whole group (P < 0.05). MA was found in triathletes, sparing 128 ± 168 kcal·d, and basketball players, dissipating 168 ± 205 kcal·d (P < 0.05). MA was associated (P < 0.05) with EB and energy availability (r = 0.356 and r = 0.0644, respectively). CONCLUSION TEE increased over the season without relevant mean changes in weight, suggesting that EI compensation likely occurred. The thrifty or spendthrift phenotypes observed among sports and the demanding workloads these athletes are exposed to highlight the need for sport-specific energy requirements.
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Affiliation(s)
- Analiza M Silva
- 1Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, PORTUGAL; 2Department of Mathematical Sciences, United States Military Academy, West Point, NY; 3Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, GERMANY; 4Department of Human Nutrition and Food Science, Christian-Albrechts-University of Kiel, Kiel, GERMANY; and 5Pennington Biomedical Research Center, Baton Rouge, LA
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Hall KD, Sanghvi A, Göbel B. Proportional Feedback Control of Energy Intake During Obesity Pharmacotherapy. Obesity (Silver Spring) 2017; 25:2088-2091. [PMID: 29071809 PMCID: PMC5757521 DOI: 10.1002/oby.21978] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/18/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Obesity pharmacotherapies result in an exponential time course for energy intake whereby large early decreases dissipate over time. This pattern of declining drug efficacy to decrease energy intake results in a weight loss plateau within approximately 1 year. This study aimed to elucidate the physiology underlying the exponential decay of drug effects on energy intake. METHODS Placebo-subtracted energy intake time courses were examined during long-term obesity pharmacotherapy trials for 14 different drugs or drug combinations within the theoretical framework of a proportional feedback control system regulating human body weight. RESULTS Assuming each obesity drug had a relatively constant effect on average energy intake and did not affect other model parameters, our model correctly predicted that long-term placebo-subtracted energy intake was linearly related to early reductions in energy intake according to a prespecified equation with no free parameters. The simple model explained about 70% of the variance between drug studies with respect to the long-term effects on energy intake, although a significant proportional bias was evident. CONCLUSIONS The exponential decay over time of obesity pharmacotherapies to suppress energy intake can be interpreted as a relatively constant effect of each drug superimposed on a physiological feedback control system regulating body weight.
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Affiliation(s)
- Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
- To whom correspondence should be addressed: Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive & Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892, , Phone: 301-402-8248, Fax: 301-402-0535
| | - Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Britta Göbel
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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Hall KD, Guo J. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology 2017; 152:1718-1727.e3. [PMID: 28193517 PMCID: PMC5568065 DOI: 10.1053/j.gastro.2017.01.052] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/14/2022]
Abstract
Weight changes are accompanied by imbalances between calorie intake and expenditure. This fact is often misinterpreted to suggest that obesity is caused by gluttony and sloth and can be treated by simply advising people to eat less and move more. Rather various components of energy balance are dynamically interrelated and weight loss is resisted by counterbalancing physiological processes. While low-carbohydrate diets have been suggested to partially subvert these processes by increasing energy expenditure and promoting fat loss, our meta-analysis of 32 controlled feeding studies with isocaloric substitution of carbohydrate for fat found that both energy expenditure (26 kcal/d; P <.0001) and fat loss (16 g/d; P <.0001) were greater with lower fat diets. We review the components of energy balance and the mechanisms acting to resist weight loss in the context of static, settling point, and set-point models of body weight regulation, with the set-point model being most commensurate with current data.
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Müller MJ, Geisler C. From the past to future: from energy expenditure to energy intake to energy expenditure. Eur J Clin Nutr 2017; 71:358-364. [PMID: 27901032 PMCID: PMC5518173 DOI: 10.1038/ejcn.2016.231] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/11/2016] [Indexed: 12/26/2022]
Abstract
Although most recent research on energy balance focusses on energy intake (EI) there is still need to think about both sides of the energy balance. Current research on energy expenditure (EE) relates to metabolic adaptation to negative energy balance, mitochondrial metabolism associated with aging, obesity and type 2 diabetes mellitus, the role of EE in hunger and appetite control, non-shivering thermogenesis and brown adipose tissue activity, cellular bioenergetics as a target of obesity treatment and the evolutionary and ecological determinants of EE in humans and other primates. As far as regulation of energy balance is concerned there is recent evidence that EE rather than body weight is under tight control. Biologically, EE is maintained within a narrow physiological range. An EE-set point has been proposed as the width between the upper and lower boundaries of the individual EE range. Regulation of EE may fail in very obese patients with an EI above their upper boundary and after drastic weight loss when patients may go far below their lower EE boundary and thus are loosing control. In population studies, fat-free mass (FFM) and its composition (that is, the proportion of high to low metabolic rate organs) are major determinants of EE. It is tempting to speculate that tight biologic control of EE is related to brain energy need, which is preserved at the cost of peripheral metabolism. There is a moderate heritability of EE, which is independent of the heritability of FFM. In future, metabolic phenotyping should focus on the EE-FFM relationship rather than on EE-values alone.
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Affiliation(s)
- M J Müller
- Institut für Humanernährung und Lebensmittelkunde, Agrar- und Ernährungswissenschaftliche Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - C Geisler
- Institut für Humanernährung und Lebensmittelkunde, Agrar- und Ernährungswissenschaftliche Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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Polidori D, Sanghvi A, Seeley RJ, Hall KD. How Strongly Does Appetite Counter Weight Loss? Quantification of the Feedback Control of Human Energy Intake. Obesity (Silver Spring) 2016; 24:2289-2295. [PMID: 27804272 PMCID: PMC5108589 DOI: 10.1002/oby.21653] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/27/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To quantify the feedback control of energy intake in response to long-term covert manipulation of energy balance in free-living humans. METHODS A validated mathematical method was used to calculate energy intake changes during a 52-week placebo-controlled trial in 153 patients treated with canagliflozin, a sodium glucose co-transporter inhibitor that increases urinary glucose excretion, thereby resulting in weight loss without patients being directly aware of the energy deficit. The relationship between the body weight time course and the calculated energy intake changes was analyzed using principles from engineering control theory. RESULTS It was discovered that weight loss leads to a proportional increase in appetite resulting in eating above baseline by ∼100 kcal/day per kilogram of lost weight-an amount more than threefold larger than the corresponding energy expenditure adaptations. CONCLUSIONS While energy expenditure adaptations have often been considered the main reason for slowing of weight loss and subsequent regain, feedback control of energy intake plays an even larger role and helps explain why long-term maintenance of a reduced body weight is so difficult.
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Affiliation(s)
- David Polidori
- Janssen Research & Development, LLC, San Diego, California, USA
| | - Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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Abstract
Background Obesity is a consequence of chronic energy imbalance. We need accurate and precise measurements of energy intake and expenditure, as well as the related behaviors, to fully understand how energy homeostasis is regulated in order to develop interventions and evaluate their effectiveness to combat the global obesity epidemic. Scope of review We provide an in-depth review of the methodologies currently used to measure energy intake and expenditure in humans, including their principles, advantages, and limitations in the clinical research setting. The aim is to provide researchers with a comprehensive guide to conduct obesity research of the highest possible quality. Major conclusions An array of methodologies is available to measure various aspects of energy metabolism and none is perfect under all circumstances. The choice of methods should be specific to particular research questions with practicality and quality of data the priorities for consideration. A combination of complementary measurements may be preferable. There is an imperative need to develop new methodologies to improve the accuracy and precision of energy intake assessments. Image-based technology is a significant step to improve energy intake measurement. Physical activity informs patterns but not absolute energy expenditure. Combining complementary measurements overcomes shortfalls of individual methods.
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Affiliation(s)
| | - Kevin D Hall
- Integrative Physiology Section, Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA.
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Katan MB, de Ruyter JC, Kuijper LDJ, Chow CC, Hall KD, Olthof MR. Impact of Masked Replacement of Sugar-Sweetened with Sugar-Free Beverages on Body Weight Increases with Initial BMI: Secondary Analysis of Data from an 18 Month Double-Blind Trial in Children. PLoS One 2016; 11:e0159771. [PMID: 27447721 PMCID: PMC4957753 DOI: 10.1371/journal.pone.0159771] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/06/2016] [Indexed: 01/10/2023] Open
Abstract
Background Substituting sugar-free for sugar-sweetened beverages reduces weight gain. This effect may be more pronounced in children with a high body mass index (BMI) because their sensing of kilocalories might be compromised. We investigated the impact of sugar-free versus sugary drinks separately in children with a higher and a lower initial BMI z score, and predicted caloric intakes and degree of compensation in the two groups. Methods and Findings This is a secondary, explorative analysis of our double-blind randomized controlled trial (RCT) which showed that replacement of one 250-mL sugary drink per day by a sugar—free drink for 18 months significantly reduced weight gain. In the 477 children who completed the trial, mean initial weights were close to the Dutch average. Only 16% were overweight and 3% obese. Weight changes were expressed as BMI z-score, i.e. as standard deviations of the BMI distribution per age and sex group. We designated the 239 children with an initial BMI z-score below the median as ‘lower BMI’ and the 238 children above the median as ‘higher BMI’. The difference in caloric intake from experimental beverages between treatments was 86 kcal/day both in the lower and in the higher BMI group. We used a multiple linear regression and the coefficient of the interaction term (initial BMI group times treatment), indicated whether children with a lower BMI responded differently from children with a higher BMI. Statistical significance was defined as p ≤ 0.05. Relative to the sugar sweetened beverage, consumption of the sugar—free beverage for 18 months reduced the BMI z-score by 0.05 SD units within the lower BMI group and by 0.21 SD within the higher BMI group. Body weight gain was reduced by 0.62 kg in the lower BMI group and by 1.53 kg in the higher BMI group. Thus the treatment reduced the BMI z-score by 0.16 SD units more in the higher BMI group than in the lower BMI group (p = 0.04; 95% CI -0.31 to -0.01). The impact of the intervention on body weight gain differed by 0.90 kg between BMI groups (p = 0.09; 95% CI -1.95 to 0.14). In addition, we used a physiologically-based model of growth and energy balance to estimate the degree to which children had compensated for the covertly removed sugar kilocalories by increasing their intake of other foods. The model predicts that children with a lower BMI had compensated 65% (95% CI 28 to 102) of the covertly removed sugar kilocalories, whereas children with a higher BMI compensated only 13% (95% CI -37 to 63). Conclusions The children with a BMI above the median might have a reduced tendency to compensate for changes in caloric intake. Differences in these subconscious compensatory mechanisms may be an important cause of differences in the tendency to gain weight. If further research bears this out, cutting down on the intake of sugar-sweetened drinks may benefit a large proportion of children, especially those who show a tendency to become overweight. Trial Registration ClinicalTrials.gov NCT00893529
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Affiliation(s)
- Martijn B. Katan
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Janne C. de Ruyter
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Lothar D. J. Kuijper
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Carson C. Chow
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States of America
| | - Kevin D. Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States of America
| | - Margreet R. Olthof
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
- * E-mail:
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49
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Dhurandhar NV, Brown AW, Thomas D, Allison DB. We Agree That Self-Reported Energy Intake Should Not Be Used as a Basis for Conclusions about Energy Intake in Scientific Research. J Nutr 2016; 146:1141-2. [PMID: 27138889 PMCID: PMC4841923 DOI: 10.3945/jn.115.227017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nikhil V Dhurandhar
- From the Department of Nutritional Sciences, Texas Tech University, Lubbock, TX (NVD); the Nutrition Obesity Research Center (DBA, e-mail: ) and Office of Energetics (AWB), University of Alabama at Birmingham, Birmingham, AL; and the Department of Mathematical Sciences, Montclair State University, Montclair, NJ (DT)
| | - Andrew W Brown
- From the Department of Nutritional Sciences, Texas Tech University, Lubbock, TX (NVD); the Nutrition Obesity Research Center (DBA, e-mail: ) and Office of Energetics (AWB), University of Alabama at Birmingham, Birmingham, AL; and the Department of Mathematical Sciences, Montclair State University, Montclair, NJ (DT)
| | - Diana Thomas
- From the Department of Nutritional Sciences, Texas Tech University, Lubbock, TX (NVD); the Nutrition Obesity Research Center (DBA, e-mail: ) and Office of Energetics (AWB), University of Alabama at Birmingham, Birmingham, AL; and the Department of Mathematical Sciences, Montclair State University, Montclair, NJ (DT)
| | - David B Allison
- From the Department of Nutritional Sciences, Texas Tech University, Lubbock, TX (NVD); the Nutrition Obesity Research Center (DBA, e-mail: ) and Office of Energetics (AWB), University of Alabama at Birmingham, Birmingham, AL; and the Department of Mathematical Sciences, Montclair State University, Montclair, NJ (DT)
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Salley JN, Hoover AW, Wilson ML, Muth ER. Comparison between Human and Bite-Based Methods of Estimating Caloric Intake. J Acad Nutr Diet 2016; 116:1568-1577. [PMID: 27085871 DOI: 10.1016/j.jand.2016.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current methods of self-monitoring kilocalorie intake outside of laboratory/clinical settings suffer from a systematic underreporting bias. Recent efforts to make kilocalorie information available have improved these methods somewhat, but it may be possible to derive an objective and more accurate measure of kilocalorie intake from bite count. OBJECTIVE This study sought to develop and examine the accuracy of an individualized bite-based measure of kilocalorie intake and to compare that measure to participant estimates of kilocalorie intake. It was hypothesized that kilocalorie information would improve human estimates of kilocalorie intake over those with no information, but a bite-based estimate of kilocalorie intake would still outperform human estimates. PARTICIPANTS/SETTINGS Two-hundred eighty participants were allowed to eat ad libitum in a cafeteria setting. Their bite count and kilocalorie intake were measured. After completion of the meal, participants estimated how many kilocalories they consumed, some with the aid of a menu containing kilocalorie information and some without. Using a train and test method for predictive model development, participants were randomly divided into one of two groups: one for model development (training group) and one for model validation (test group). STATISTICAL ANALYSIS Multiple regression was used to determine whether height, weight, age, sex, and waist-to-hip ratio could predict an individual's mean kilocalories per bite for the training sample. The model was then validated with the test group, and the model-predicted kilocalorie intake was compared with human-estimated kilocalorie intake. RESULTS Only age and sex significantly predicted mean kilocalories per bite, but all variables were retained for the test group. The bite-based measure of kilocalorie intake outperformed human estimates with and without kilocalorie information. CONCLUSIONS Bite count might serve as an easily measured, objective proxy for kilocalorie intake. A tool that can monitor bite count may be a powerful assistant to self-monitoring.
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