Increased consumption of dairy foods and protein during diet- and exercise-induced weight loss promotes fat mass loss and lean mass gain in overweight and obese premenopausal women

The effects of protein supplementation on body composition after bariatric surgery: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

We aimed to explore the effect of protein supplementation on anthropometric measures and body composition in patients after metabolic bariatric surgery (MBS).

METHODS

We performed a systematic search up to January 2024 including randomized controlled trials investigating the effects of protein or amino acid supplementation on the body composition of patients who underwent MBS. The overall effect was presented as the weighted mean difference (WMD) at a 95% CI.

RESULTS

Ten trials were included in this meta-analysis. Our results indicate that there was a statistically greater change in weight (WMD, -1.31 kg, 95% CI: -1.93 to -0.69, p < 0.001; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] = moderate), muscle mass (WMD, 1.33 kg, 95% CI: 0.1 to 2.57, p = 0.035; GRADE = low), fat-free mass (WMD, 1.74 kg, 95% CI: 0.46 to 3.01, p = 0.01; GRADE = low), and fat mass (WMD, -3.91 kg, 95% CI: -4.10 to -0.59, p = 0.01; GRADE = low) in the protein group compared to the control group. However, protein supplementation did not significantly change BMI and lean body mass.

CONCLUSIONS

Based on moderate- to low-certainty evidence, our findings suggest that although protein supplementation may improve weight and some body composition metrics, it does not influence overall BMI and lean body mass. More research is needed to recommend protein supplementation after MBS.

Proteomic associations with fluctuation and long-term changes in BMI: A 40-year follow-up study

Introduction

While some studies have explored associations between weight change and blood proteins, most have been intervention-based, offering limited insight into proteomic associations with long-term weight gain. It remains unclear whether plasma proteins are related to BMI fluctuation over time. This study investigates associations of long-term BMI changes and fluctuations with over 1,000 plasma proteins involved in cardiometabolic and inflammation functions.

Data and Methods

The study included 304 Finnish adult twins (117 men) born before 1958 from the Older Finnish Twin Cohort, with BMI data spanning five time points (1975, 1981, 1990, 2011, and 2012-2014). Proteomic data were derived from blood samples collected at the last BMI measurement. Linear mixed-effects models analyzed individual BMI trajectories, producing intercepts (baseline BMI) and slopes (BMI change rates). BMI fluctuation was calculated as the average squared deviation from expected BMI across time points. Associations between BMI changes/fluctuation and (i) 1,231 plasma proteins related to cardiometabolic and inflammatory functions and (ii) polygenic risk scores for BMI (PRSBMI), as well as interaction effects between PRSBMI and baseline BMI on protein-BMI relationships were studied. Within-pair analyses using monozygotic twins were conducted to account for shared confounding factors.

Results

A total of 135 proteins were associated with changes in BMI over 40 years, while 17 proteins were linked to fluctuation in BMI: 12 associations (10 with BMI changes and 2 with fluctuation) remained significant in within-twin pair analyses. PRSBMI associated with BMI changes but not with fluctuations. PRSBMI-protein interactions explaining BMI changes or fluctuation was found, though a single interaction between the CD72 protein and baseline BMI was observed.

Conclusion

This study highlights significant associations between plasma proteins and long-term BMI changes and fluctuations, with no evidence of PRSBMI-protein interactions influencing BMI trends. These findings underscore the substantial role of environmental factors in shaping proteome-BMI associations over adulthood.

No effects of high- v. low-protein breakfast on body composition and cardiometabolic health in young women with overweight: the NewStart randomised trial

The aim of this randomised controlled trial was to investigate the effects of breakfast high or low in protein on body composition and cardiometabolic markers in young women with overweight. In total, fifty-six women aged 18-30 years consumed a breakfast containing either high protein (34 g protein, n 26) or low protein (6 g protein, n 30) for 12 weeks. Measurements of body composition by dual-energy X-ray absorptiometry, waist circumference, glucose tolerance, fasting glucose, insulin and lipid profile were performed before and after this period. The primary outcome was fat mass. Satiety and hunger were evaluated by self-reported Visual Analogue Scale (VAS) scores. Dietary intake was estimated by 4-d dietary records, and calcium intake was estimated by FFQ. At baseline, relative daily protein intake was 15·2 ± 2·8 E%, which increased to 19·3 ± 3·4 E% in high protein but was unchanged in low protein (P < 0·001 between groups). High protein reported higher satiety compared with low protein (P = 0·02). Yet, no group differences were observed in changes in energy intake, body composition, blood lipid profile or measures of glucose tolerance (all P > 0·10). However, bone mineral content tended to increase in high protein (P = 0·05) and decrease in low protein (P = 0·07, interaction effect: P = 0·01). Conclusively, a high v. low content of protein in breakfast increased satiety but did not affect body composition or cardiometabolic markers in young women with overweight. This study adds to the sparse evidence on the effects of breakfast with different macronutrient compositions on health parameters in women with overweight. Registered at clinicaltrials.gov: NCT04518605.

Adaptive changes in multiple aspects of emotion regulation in the offspring of pregnant persons receiving a diet-and-exercise intervention relative to usual pregnancy care: a randomized controlled trial

BACKGROUND

Human studies examining the influence of prenatal diet and/or exercise interventions on offspring neurodevelopment are mixed. Interventions that include the provision of whole foods, nutritional counseling, address exercise behaviors, and that utilize multimethod assessments of offspring emotion regulation (ER) may better reveal the impact of these interventions on neurodevelopment.

OBJECTIVES

To explore whether the Be Healthy in Pregnancy (BHIP) prenatal diet-and-exercise intervention improves ER in 22-mo-old offspring.

METHODS

Pregnant persons (>18 y, singleton pregnancy) were recruited between 12 and 17 wk gestation and randomly assigned to the intervention [high protein energy-controlled diet via the provision of cottage cheese, Greek yogurt, low-fat milk, individualized biweekly nutritional counseling, a controlled walking program, and usual pregnancy care (UPC)] or control (UPC alone) groups. ER in offspring [mage = 22.2 (SD = 4.04); 50.9% female; intervention: n = 29, control: n = 28] was assessed using reports from pregnant persons and their partners on the Child Behavior Checklist, and the Behavior Rating Inventory of Executive Function-Preschool Version, laboratory observational tasks examining inhibitory control, attention, and empathy, and high-frequency heart rate variability (HF-HRV).

RESULTS

Children exposed to the BHIP intervention exhibited medium to large effect size reductions in pregnant person and partner reported externalizing [effect size ƞ2pmother = 0.08, 95% confidence interval of the difference (0.05, 7.14); ƞ2ppartner = 0.17 (1.68, 9.65)], internalizing [ƞ2pmother = 0.08 (0.09, 5.32); ƞ2ppartner = 0.13 (0.84, 8.88)], and total behavior problems [ƞ2pmother = 0.09 (0.72, 11.87); ƞ2ppartner = 0.17 (3.17, 17.88)] relative to control participants' children. Pregnant persons, but not partners, reported fewer problems with inhibitory control [ƞ2p = 0.13 (1.40, 8.55)], cognitive flexibility [ƞ2p = 0.08 (0.18, 4.85)], emergent metacognition [ƞ2p = 0.14 (2.00, 11.59)], and global executive function [ƞ2p = 0.14 (3.37, 20.12)]. Intervention children displayed fewer impulsive behaviors [ƞ2p = 0.11 (0.16, 1.77)] and a longer attention span [ƞ2p = 0.08 (0.30, 13.34)]. Finally, intervention children exhibited greater baseline HF-HRV [ƞ2p = 0.10 (0.16, 2.01)], and adaptive HF-HRV reactivity during the impulsivity [ƞ2p = 0.12 (0.20, 2.19)], and attention tasks [ƞ2p = 0.21 (0.74, 2.77)].

CONCLUSIONS

This intervention was associated with medium/large effect size improvements in offspring ER. Larger trials are needed to confirm the potential of these interventions on offspring neurodevelopment.

TRIAL REGISTRATION NUMBER

This trial was registered at www.

CLINICALTRIALS

gov as NCT01689961 (21 September, 2012).

Effect of meal replacements formula on lipid profiles: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Although some evidence shows the beneficial effects of meal replacements (MRs) on dyslipidaemias, it is not completely clear. Therefore, we investigate the possible effects of total and partial MRs on lipid profiles.

METHODS

For this systematic review and meta-analysis, we searched MEDLINE, Web of Science, SCOPUS, and Embase. We included randomized controlled trials (RCTs) that evaluated the effect of MRs on lipid profiles. A random-effects meta-analysis model was used to combine studies and calculate weighted mean difference and 95 % confidence intervals (95 % CI). Subgroup analysis was realized using intervention type, duration and average participant age.

RESULTS

Fifty-one studies were included. The pooled findings showed that total and partial MRs significantly reduced triglycerides (TG) (WMD: -12.20 mg/dl, 95 % CI -17.46 to -6.93) and increased high-density lipoprotein (HDL) (WMD: 1.06 mg/dl, 95 % CI 0.35-1.77) compared to controls. However, total cholesterol (TC) (WMD: -1.40 mg/dl, 95 % CI: -3.90-1.10) and low-density lipoprotein (LDL) (WMD: -0.85 mg/dl, 95 % CI: -3.05-1.35) were not significant. In addition, the subgroup analysis shows a greater effect on TG reduction and HDL increase in the type of intervention with total MRs compared to partial MRs and during the intervention >24 weeks compared to ≤24 weeks.

CONCLUSIONS

MRs lead to significant improvements in TG and HDL levels. These results may help strengthen programs for dyslipidaemias prevention/management.

Antioxidative, Glucose Management, and Muscle Protein Synthesis Properties of Fish Protein Hydrolysates and Peptides

The marine environment is an excellent source for many physiologically active compounds due to its extensive biodiversity. Among these, fish proteins stand out for their unique qualities, making them valuable in a variety of applications due to their diverse compositional and functional properties. Utilizing fish and fish coproducts for the production of protein hydrolysates and bioactive peptides not only enhances their economic value but also reduces their potential environmental harm, if left unutilized. Fish protein hydrolysates (FPHs), known for their excellent nutritional value, favorable amino acid profiles, and beneficial biological activities, have generated significant interest for their potential health benefits. These hydrolysates contain bioactive peptides which are peptide sequences known for their beneficial physiological effects. These biologically active peptides play a role in metabolic regulation/modulation and are increasingly seen as promising ingredients in functional foods, nutraceuticals and pharmaceuticals, with potential to improve human health and prevent disease. This review aims to summarize the current in vitro, cell model (in situ) and in vivo research on the antioxidant, glycaemic management and muscle health enhancement properties of FPHs and their peptides.

Differential effects of milk, yogurt, and cheese on energy homeostasis and brown adipose tissue phenotype in high-fat diet-induced obese mice

Aim: We hypothesized that milk, yogurt, and cheese have differential impacts on energy expenditure (EE) and obesity in mice fed a high-fat diet (HFD). Methods: C57BL/6 mice (n = 16 per group) were fed a HFD or a HFD supplemented with fat-free milk (MILK), fat-free plain yogurt (YOG), or reduced-fat cheddar cheese (CHE; 19 kcal% fat), each provided at 10% of the daily energy intake, for 8 weeks. EE was quantified using a metabolic chamber. Metabolic pathways related to BAT mitochondrial function and uncoupling protein 1 (UCP1) abundance were assessed. Serum lipidomic profiles were analyzed to identify potential mediators of the observed effects. Results: MILK supplementation lowered weight gain and fat accumulation and enhanced EE and BAT thermogenesis, perhaps via the SIRT1-AMPK-PGC1α axis in BAT. This led to elevated UCP1 abundance and enhanced the abundance of hormone-sensitive lipase (HSL). MILK also altered serum lipid species, indicating enhanced energy use, and promoted BAT thermogenesis and mitochondrial function pathways. YOG exhibited a similar pattern but a lower magnitude of effects than MILK on reducing weight gain and fat mass, increasing EE, and BAT thermogenic proteins, including AMPK-PGC1α-UCP1. Both MILK and YOG showed a relative increase in serum PC 15:0_15:0 and LPC 15:0. In contrast, CHE reduced weight gain and increased EE without impacting BAT thermogenesis proteins or serum lipid species. Conclusion: Our study showed that MILK, YOG, and CHE reduced weight gain in mice on a HFD by increasing EE. MILK and YOG also up-regulated BAT thermogenesis, while both additionally altered lipids involved in fat metabolism and inflammation. CHE did not affect BAT thermogenesis and lipid species compared to HFD.

Evidence for Simultaneous Muscle Atrophy and Hypertrophy in Response to Resistance Training in Humans

PURPOSE

Human skeletal muscle has the profound ability to hypertrophy in response to resistance training (RT). However, this has a high energy and protein cost and is presumably mainly restricted to recruited muscles. It remains largely unknown what happens with nonrecruited muscles during RT. This study investigated the volume changes of 17 recruited and 13 nonrecruited muscles during a 10-wk single-joint RT program targeting upper arm and upper leg musculature.

METHODS

Muscle volume changes were measured by manual or automatic 3D segmentation in 21 RT novices. Subjects ate ad libitum during the study and energy and protein intake were assessed by self-reported diaries.

RESULTS

Posttraining, all recruited muscles increased in volume (range: +2.2% to +17.7%, P < 0.05), whereas the nonrecruited adductor magnus (mean: -1.5% ± 3.1%, P = 0.038) and soleus (-2.4% ± 2.3%, P = 0.0004) decreased in volume. Net muscle growth ( r = 0.453, P = 0.045) and changes in adductor magnus volume ( r = 0.450, P = 0.047) were positively associated with protein intake. Changes in total nonrecruited muscle volume ( r = 0.469, P = 0.037), adductor magnus ( r = 0.640, P = 0.002), adductor longus ( r = 0.465, P = 0.039), and soleus muscle volume ( r = 0.481, P = 0.032) were positively related to energy intake. When subjects were divided into a HIGH or LOW energy intake group, overall nonrecruited muscle volume (-1.7% ± 2.0%), adductor longus (-5.6% ± 3.7%), adductor magnus (-2.8% ± 2.4%), and soleus volume (-3.7% ± 1.8%) decreased significantly ( P < 0.05) in the LOW but not the HIGH group.

CONCLUSIONS

To our knowledge, this is the first study documenting that some nonrecruited muscles significantly atrophy during a period of RT. Our data therefore suggest muscle mass reallocation, that is, that hypertrophy in recruited muscles takes place at the expense of atrophy in nonrecruited muscles, especially when energy and protein availability are limited.

Opportunities to optimize lifestyle interventions in combination with glucagon-like peptide-1-based therapy

Obesity is a chronic multi-system disease and major driver of type 2 diabetes and cardiometabolic disease. Nutritional interventions form the cornerstone of obesity and type 2 diabetes management. Some interventions such as Mediterranean diet can reduce incident cardiovascular disease, probably independently of weight loss. Weight loss of 5% or greater can improve many adiposity-related comorbidities. Although this can be achieved with lifestyle intervention, it is often difficult to sustain in the longer term due to adaptive endocrine changes. In recent years glucagon-like-peptide-1 receptor agonists (GLP-1RAs) have emerged as effective treatments for both type 2 diabetes and obesity. Newer GLP-1RAs can achieve average weight loss of 15% or greater and improve cardiometabolic health. There is heterogeneity in the weight loss response to GLP-1RAs, with a substantial number of patients unable to achieve 5% or greater weight. Weight loss, on average, is lower in older adults, male patients and people with type 2 diabetes. Mechanistic studies are needed to understand the aetiology of this variable response. Gastrointestinal side effects leading to medication discontinuation are a concern with GLP-1RA treatment, based on real-world data. With weight loss of 20% or higher with newer GLP-1RAs, nutritional deficiency and sarcopenia are also potential concerns. Lifestyle interventions that may potentially mitigate the side effects of GLP-1RA treatment and enhance weight loss are discussed here. The efficacy of such interventions awaits confirmation with well-designed randomized controlled trials.

Sarcopenic obesity in patients awaiting liver transplant: Unique challenges for nutritional recommendations

Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period. Nutrition recommendations for individuals with sarcopenia differ from recommendations for patients with obesity or sarcopenic obesity. While these nutrition guidelines have been established in non-cirrhotic patients, established guidelines for liver transplant candidates with sarcopenic obesity are lacking. In this paper, we review existing literature on sarcopenic obesity in patients with chronic liver disease and address opportunities to improve nutritional counseling in patients awaiting liver transplantation.

Milk protein concentrate supplementation improved appetite, metabolic parameters, adipocytokines, and body composition in dieting women with obesity: a randomized controlled trial

BACKGROUND

Dairy consumption is associated with many health benefits. However, to our knowledge, no clinical trials examined the effects of milk protein concentrate (MPC) on metabolic health in overweight and obese adults. This study investigated the effect of supplementation with MPC on glycaemic status, lipid profile, biomarkers of inflammation, and anthropometric measurements in women with obesity under a weight loss diet.

METHODS

This is a single-blind, open-labelled, parallel-group, randomized trial. Forty-four healthy women with obesity were randomized into a control (n = 22) or MPC (n = 22) group. Participants in the MPC group were supplemented with 30 g of MPC per day for 8 weeks. Both groups were on a calorie-restricted diet plan with 800 Kcal lower intakes than their needs. Blood samples, dietary intake, and body composition were assessed before and after the intervention.

RESULTS

MPC group had a significantly lower body mass index (P = 0.009), waist circumference (P = 0.013), fat mass (P = 0.021), appetite score (P = 0.002), fasting blood sugar (P < 0.001), insulin (P = 0.027), low-density lipoprotein cholesterol (P = 0.025), and leptin (P = 0.014) levels and higher high-density lipoprotein cholesterol (P = 0.001) and adiponectin (P = 0.032) compared to the control group after supplementation. Lean body mass, total cholesterol, and triglyceride did not differ significantly (P > 0.05).

CONCLUSION

Daily intake of 30 g of MPC for 8 weeks may improve several anthropometric and metabolic markers in women with obesity under a hypocaloric diet.

Nutritional Fuelling for Microgravity Environment of Space Missions

Abstract:

Since the beginning of space missions, the food systems have undergone a sea change with prolonged manned missions and permanent space habitats. We have a better understanding of physiological changes which happen in humans in space and help in adaptation to the space environment. Yet, much remains underexplored and warrants further research.

:

Space missions today involve a considerable number of individuals operating in a microgravity environment for both short and long periods. The provision of food for such missions and managing the physio-pathological changes that affect nutritional requirements continue to be challenging. Food systems (food and beverages) used during every program to date have been shelf‐stable and were composed primarily of rehydratable or thermostabilized food items. Such foods usually have a lower hedonic value than fresh or frozen foods. Consequently, a reliable food system must provide a wide range of palatable and attractive foods as well as the tools to prepare them (through rehydration, heating, and cooling) to enhance the taste sensation of the crew. Adequate nutrition with easily accessible food is essential to this effort. To deliver nutritional recommendations to crew members for long-duration space missions, it is important to understand how nutritional status and general physiology are linked and affected by microgravity exposure. In view of this, it has been pointed out that nutritional countermeasures could rectify the physiological and behavioural anomalies during microgravity exposure. In this comprehensive narrative review, we have provided an overview of a few recent advances such as silkworm protein, good mood-vegan diet, 3-D food printing, and space garden’s produce for onboard support to food systems. It has also been found that exercise could be an addition to nutritional interventions. Areas of space exploration that require more in-depth research using ground-based bed rest models, as well as inflight microgravity conditions, are highlighted.

The OPTIFAST total and partial meal replacement programme reduces cardiometabolic risk in adults with obesity: Secondary and exploratory analysis of the OPTIWIN study

AIM

The effects of weight loss with a partial or total meal replacement programme (MRP) on atherosclerotic cardiovascular disease (ASCVD) risk factors are not fully understood, in particular in people at higher CV risk. In the 52-week randomized controlled OPTIWIN study in men and women with obesity, meal replacement programme (total for first 26 weeks, partial for the ensuing 26 weeks) with OPTIFAST (OP) resulted in significantly greater weight loss compared with a low-calorie food-based (FB) dietary plan, both as part of a comprehensive lifestyle intervention [OP (n = 135)/FB (n = 138) week 26: -12.4%/-6.0%, p < .001; week 52: -10.5%/-5.5%, p < .001]. Here, we examined effects on ASCVD risk factors and 10-year ASCVD risk.

MATERIALS AND METHODS

Participants with body mass index 30-55 kg/m2 and age 18-70 years, and not on anti-obesity medications, were recruited. The effects on systolic and diastolic blood pressure (SBP, DBP), lipid parameters and 10-year ASCVD risk were analysed as changes over time using linear mixed models. Subgroup analyses were conducted for changes in SBP, DBP and ASCVD risk by categories of age (<40, 40-59, ≥60 years), baseline SBP (

RESULTS

Baseline characteristics were well balanced (OP/FB females 86%/79%, mean age 47/47 years, body mass index 38.4/39.2 kg/m2 , 10-year ASCVD risk <5% 87%/74%, dysglycaemia 52%/50%). At week 26, SBP/DBP were significantly reduced with OP versus FB, and a greater proportion achieved BP ≤130/80 mmHg [odds ratio 2.11 (95% confidence interval 1.10, 4.03), p = .024]. All lipid parameters as well as 10-year ASCVD risk were significantly improved with OP versus FB. A similar, but slightly attenuated pattern was observed at 52 weeks. Across subgroups, greater reductions for SBP, DBP and ASCVD risk were generally seen with OP versus FB with quantitatively higher baseline SBP and age, and in men.

CONCLUSIONS

In people with obesity at low ASCVD risk, OP significantly reduced cardiovascular risk factors and 10-year predicted risk for ASCVD.

Collapse

Key Words

• blood pressure
• body weight
• caloric restriction
• clinical trial
• heart disease risk factors
• obesity management

Collapse

MESH Headings

• Adult
• Male
• Humans
• Female
• Middle Aged
• Adolescent
• Young Adult
• Aged
• Obesity/complications
• Obesity/epidemiology
• Blood Pressure
• Risk Factors
• Weight Loss
• Atherosclerosis
• Lipids
• Hypertension/drug therapy

Collapse

Grants

• Nestlé Health Science

Collapse

Affiliation(s)

Jamy D Ard Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
Ian J Neeland Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Amy E Rothberg University of Michigan, Ann Arbor, Michigan, USA
Robert J Chilton University of Texas Health Science Center, San Antonio, Texas, USA
Daniel de Luis Center of Investigation of Endocrinlogy and Nutrition, University of Valladolid, Hospital clínico Universitario de Valladolid, Valladolid, Spain
Sarah S Cohen EpidStrategies, A Division of Tox Strategies Inc., Katy, Texas, USA
Odd Erik Johansen Nestlé Health Science, Lausanne, Switzerland

Collapse

Collaborators Collapse

D-galactose might mediate some of the skeletal muscle hypertrophy-promoting effects of milk-A nutrient to consider for sarcopenia?

Sarcopenia is a process of progressive aging-associated loss of skeletal muscle mass (SMM) recognized as a serious global health issue contributing to frailty and increased all-cause mortality. Exercise and nutritional interventions (particularly intake of dairy products and milk) demonstrate good efficacy, safety, and broad applicability. Here, we propose that at least some of the well-documented favorable effects of milk and milk-derived protein supplements on SMM might be mediated by D-galactose, a monosaccharide present in large quantities in milk in the form of disaccharide lactose (milk sugar). We suggest that ingestion of dairy products results in exposure to D-galactose in concentrations metabolized primarily via the Leloir pathway with the potential to (i) promote anabolic signaling via maintenance of growth factor (e.g., insulin-like growth factor 1 [IGF-1]) receptor mature glycosylation patterns; and (ii) provide extracellular (liver glycogen) and intracellular substrates for short (muscle glycolysis) and long-term (muscle glycogen, intramyocellular lipids) energy availability. Additionally, D-galactose might optimize the metabolic function of skeletal muscles by increasing mitochondrial content and stimulating glucose and fatty acid utilization. The proposed potential of D-galactose to promote the accretion of SMM is discussed in the context of its therapeutic potential in sarcopenia.

Effects of manual resistance versus weight resistance training on body composition and strength in young adults after a 14-week intervention

Manual Resistance Training (MRT) is an alternative training modality where the external resistance is provided by a spotter.

PURPOSE

The purpose of this study was to observe changes in body composition and muscular fitness after a 14-week MRT intervention compared to changes elicited by a Weight Resistance Training (WRT) intervention.

METHODS

Eighty-four young adults were randomly assigned to either the MRT (n = 53, height 170.1 ± 8.1 cm, body mass 73.9 ± 16.0 kg, and body fat 24.6 ± 8.7%) or WRT (n = 31, mean ± SD: height 169.6 ± 10.1 cm, body mass 75.0 ± 17.4 kg, and body fat 24.7 ± 8.5%) group. Body composition was assessed by Dual-energy X-ray Absorptiometry (DEXA), muscular strength and muscular endurance were tested before and after the intervention.

RESULTS

Findings indicated that trunk, arm, leg, and total lean mass increased in both groups after the intervention (p < 0.05). Moreover, total fat mass significantly decreased compared to baseline in both groups (p < 0.05). However, no statistically significant changes were observed in Bone Mineral Density and Bone Mineral Content in response to the intervention. Both MRT and WRT programs were successful at significantly increasing muscular strength and endurance (p < 0.05).

CONCLUSION

The changes in body composition after a 14-week MRT program were similar to those of the WRT intervention. Hence, an MRT program may be effectively used to increase lean mass and decrease fat mass.

Leveraging genetic diversity to identify small molecules that reverse mouse skeletal muscle insulin resistance

Systems genetics has begun to tackle the complexity of insulin resistance by capitalising on computational advances to study high-diversity populations. 'Diversity Outbred in Australia (DOz)' is a population of genetically unique mice with profound metabolic heterogeneity. We leveraged this variance to explore skeletal muscle's contribution to whole-body insulin action through metabolic phenotyping and skeletal muscle proteomics of 215 DOz mice. Linear modelling identified 553 proteins that associated with whole-body insulin sensitivity (Matsuda Index) including regulators of endocytosis and muscle proteostasis. To enrich for causality, we refined this network by focusing on negatively associated, genetically regulated proteins, resulting in a 76-protein fingerprint of insulin resistance. We sought to perturb this network and restore insulin action with small molecules by integrating the Broad Institute Connectivity Map platform and in vitro assays of insulin action using the Prestwick chemical library. These complementary approaches identified the antibiotic thiostrepton as an insulin resistance reversal agent. Subsequent validation in ex vivo insulin-resistant mouse muscle and palmitate-induced insulin-resistant myotubes demonstrated potent insulin action restoration, potentially via upregulation of glycolysis. This work demonstrates the value of a drug-centric framework to validate systems-level analysis by identifying potential therapeutics for insulin resistance.

Effects of a High-Protein Diet on Kidney Injury under Conditions of Non-CKD or CKD in Mice

Considering the prevalence of obesity and global aging, the consumption of a high-protein diet (HPD) may be advantageous. However, an HPD aggravates kidney dysfunction in patients with chronic kidney disease (CKD). Moreover, the effects of an HPD on kidney function in healthy individuals are controversial. In this study, we employed a remnant kidney mouse model as a CKD model and aimed to evaluate the effects of an HPD on kidney injury under conditions of non-CKD and CKD. Mice were divided into four groups: a sham surgery (sham) + normal diet (ND) group, a sham + HPD group, a 5/6 nephrectomy (Nx) + ND group and a 5/6 Nx + HPD group. Blood pressure, kidney function and kidney tissue injury were compared after 12 weeks of diet loading among the four groups. The 5/6 Nx groups displayed blood pressure elevation, kidney function decline, glomerular injury and tubular injury compared with the sham groups. Furthermore, an HPD exacerbated glomerular injury only in the 5/6 Nx group; however, an HPD did not cause kidney injury in the sham group. Clinical application of these results suggests that patients with CKD should follow a protein-restricted diet to prevent the exacerbation of kidney injury, while healthy individuals can maintain an HPD without worrying about the adverse effects.

Efficacy of progressive versus severe energy restriction on body composition and strength in concurrent trained women

PURPOSE

This study evaluated the concurrent training (CT) effect in combination with either progressive energy restriction (PER) or severe energy restriction (SER) on body composition and strength-related variables in resistance-trained women.

METHODS

Fourteen women (29.5 ± 3.8 years; 23.8 ± 2.8 kg·m^-2) were randomly assigned to a PER (n = 7) or SER (n = 7) group. Participants performed an 8-week CT program. Pre- and post-intervention measures of fat mass (FM) and fat-free mass (FFM) were assessed by dual-energy X-ray absorptiometry and strength-related variables were assessed through 1-repetition maximum (in the squat and bench press) and countermovement jump.

RESULTS

Significant reductions in FM were observed in PER and SER (Δ = - 1.7 ± 0.4 kg; P =  < 0.001; ES = - 0.39 and Δ = - 1.2 ± 0.6 kg; P = 0.002; ES = - 0.20, respectively). After correcting FFM for fat-free adipose tissue (FFAT), no significant differences for this variable were found either in PER (Δ = - 0.3 ± 0.1; P = 0.071; ES = - 0.06) or in SER (Δ = - 0.2 ± 0.1; P = 0.578; ES = - 0.04). There were no significant changes in the strength-related variables. No between-group differences were found in any of the variables.

CONCLUSION

A PER has similar effects to a SER on body composition and strength in resistance-trained women performing a CT program. Given that PER is more flexible and thus may enhance dietary adherence, it might be a better alternative for FM reduction compared to SER.

Effects of whey protein supplementation on adiposity, body weight, and glycemic parameters: A synthesis of evidence

AIMS

The aim of this review was to analyze the evidence of whey protein supplementation on body weight, fat mass, lean mass and glycemic parameters in subjects with overweight or type 2 diabetes mellitus (T2DM) undergoing calorie restriction or with ad libitum intake.

DATA SYNTHESIS

Overweight and obesity are considered risk factors for the development of chronic noncommunicable diseases such as T2DM. Calorie restriction is a dietary therapy that reduces weight and fat mass, promotes the improvement of glycemic parameters, and decreases muscle mass. The maintenance of muscle mass during weight loss is necessary in view of its implication in preventing chronic diseases and improving functional capacity and quality of life. The effects of increased protein consumption on attenuating muscle loss and reducing body fat during calorie restriction or ad libitum intake in overweight individuals are discussed. Some studies have demonstrated the positive effects of whey protein supplementation on improving satiety and postprandial glycemic control in short term; however, it remains unclear whether long-term whey protein supplementation can positively affect glycemic parameters.

CONCLUSIONS

Although whey protein is considered to have a high nutritional quality, its effects in the treatment of overweight, obese individuals and those with T2DM undergoing calorie restriction or ad libitum intake are still inconclusive.

Effect of increased protein intake and exogenous ketosis on body composition, energy expenditure and exercise capacity during a hypocaloric diet in recreational female athletes

Introduction: Since low body weight is an important determinant of success in many sports such as gymnastics, martial arts and figure skating, athletes can benefit from effective weight loss strategies that preserve muscle mass and athletic performance. The present study investigates the effects of increased protein intake and exogenous ketosis on body composition, energy expenditure, exercise capacity, and perceptions of appetite and well-being during a hypocaloric diet in females. Methods: Thirty-two female recreational athletes (age: 22.2 ± .5 years; body weight: 58.3 ± .8 kg; BMI: 20.8 ± .2 kg·m^-2) underwent 4 weeks of 30% caloric restriction and were randomized to receive either an increased daily amount of dietary protein (PROT, ∼2.0-2.2 g protein·kg^-1·day^-1), 3 × 20 g·day^-1 of a ketone ester (KE), or an isocaloric placebo (PLA). Body composition was measured by DXA, resting energy expenditure (REE) by indirect calorimetry, exercise capacity during a VO₂max test, appetite hormones were measured in serum, and perceptions of general well-being were evaluated via questionnaires. Results: The hypocaloric diet reduced body weight by 3.8 ± .3 kg in PLA, 3.2 ± .3 kg in KE and 2.4 ± .2 kg in PROT (P_time<.0001). The drop in fat mass was similar between treatments (average: 2.6 ± .1 kg, P_time<.0001), while muscle mass was only reduced in PLA and KE (average: .8 ± .2 kg, P_time<.05), and remained preserved in PROT (P_interaction<.01). REE [adjusted for lean mass] was reduced after caloric restriction in PLA (pre: 32.7 ± .5, post: 28.5 ± .6 kcal·day^-1·kg^-1) and PROT (pre: 32.9 ± 1.0, post: 28.4 ± 1.0 kcal·day^-1·kg^-1), but not in KE (pre: 31.8 ± .9, post: 30.4 ± .8 kcal·day^-1·kg^-1) (P_interaction<.005). Furthermore, time to exhaustion during the VO₂max test decreased in PLA (by 2.5 ± .7%, p < .05) but not in KE and PROT (P_interaction<.05). Lastly, the perception of overall stress increased in PLA and PROT (p < .05), but not in KE (P_interaction<.05). Conclusion: Increased protein intake effectively prevented muscle wasting and maintained exercise capacity during a period of caloric restriction in female recreational athletes. Furthermore, exogenous ketosis did not affect body composition, but showed its potential in weight management by preserving a drop in exercise capacity and REE and by improving overall stress parameters during a period of caloric restriction.

The Influence of Increased Dairy Product Consumption, as Part of a Lifestyle Modification Intervention, on Diet Quality and Eating Patterns in Female Adolescents with Overweight/Obesity

Our study examined how increased dairy consumption versus habitually low dairy consumption, against a background of healthy eating (and exercise), influenced diet quality, nutrient intake, and snacking in Canadian female adolescents (14.8 ± 2.2 years) with overweight/obesity (OW/OB). We also explored dairy consumption patterns in the group consuming dairy products. Participants were randomized into two groups: higher/recommended dairy (RDa; 4 svg/d; n = 24) or low dairy (LDa; 0−2 svg/d; n = 23). Both groups participated in a 12-week, eucaloric, lifestyle modification intervention consisting of exercise training and nutritional counseling. The intervention increased the total Canadian Healthy Eating Index score (p < 0.001) with no differences between groups. The “other food” sub-score improved more in RDa than LDa (p = 0.02), and the “saturated fat” sub-score increased more in LDa than RDa (p = 0.02). The intervention significantly increased the consumption of dairy-related nutrients more in RDa than LDa (p < 0.05). The intervention also decreased snack size in both groups (p = 0.01) and improved percentage of healthy snack energy intake more in RDa than LDa (p = 0.04). More servings of dairy products were consumed as snacks than at breakfast, lunch, or dinner (p < 0.05). Thus, our study improved diet quality, and dairy product consumption improved intakes of key related nutrients and snack consumption in adolescents with OW/OB.

Implication of diet and exercise on the management of age‐related sarcopenic obesity in Asians

The incidence of sarcopenic obesity among adults aged ≥65 years is rising worldwide. Sarcopenic obesity is a high‐risk geriatric syndrome defined as a gain in the amount of adipose tissue along with the age‐related loss of muscle mass and strength or physical performance. Sarcopenic obesity is associated with increased risks of falls, physical limitations, cardiovascular diseases, metabolic diseases, and/or mortality. Thus, the identification of preventive and treatment strategies against sarcopenic obesity is important for healthy aging. Diet and exercise are the reasons for the development of sarcopenic obesity and are key targets in its prevention and treatment. Regarding weight reduction alone, it is most effective to maintain a negative energy balance with dietary calorie restriction and aerobic exercise. However, it is important to preserve skeletal muscle mass while reducing fat mass. Resistance exercise and appropriate protein supply are the main ways of preserving skeletal muscle mass, as well as muscle function. Therefore, in order to improve sarcopenic obesity, a complex treatment strategy is needed to limit energy ingestion with proper nutrition and to increase multimodal exercises. In this review, we focus on recently updated interventions for diet and exercise and potential future management strategies for Asian individuals with aging‐related sarcopenic obesity. Geriatr Gerontol Int 2022; 22: 695–704.

Sarcopenia in Menopausal Women: Current Perspectives

Menopause is associated with hormonal changes, which could accelerate or lead to sarcopenia. Functional impairment and physical disability are the major consequences of sarcopenia. In order to hamper these negative health outcomes, it appears necessary to prevent and even treat sarcopenia, through healthy lifestyle changes including diet and regular physical activity or through hormonal replacement therapy when appropriate. Therefore, the purpose of this narrative review will be 1) to present the prevalence of sarcopenia in postmenopausal women; 2) to address the risk factors related to sarcopenia in this specific population; and 3) to discuss how to manage sarcopenia among postmenopausal women.

Effects of Increased Physical Activity/Exercise on Long-Term Losses in Weight and Waist Circumference: Serial Mediation from Changes in Exercise-Related to Eating-Related Self-Regulation

BACKGROUND

Behavioral obesity treatments have generally been unsuccessful at facilitating long-term weight reductions. Increased physical activity/exercise is a strong predictor of maintained weight loss. It has been proposed this is more linked to increases in exercise-related self-regulation carrying-over to eating-related self-regulation than through direct energy expenditures.

METHODS

Women with obesity participated in 10-month community-based behavioral treatments that had theory-based foci on either self-regulation skills building (n = 59) or knowledge of weight loss methods (n = 54). Physical activity/exercise, exercise-related self-regulation, and eating-related self-regulation were assessed at baseline and months 3, 6, and 12 in the prediction of weight and waist circumference changes over 24 months.

RESULTS

Significant overall improvements on all measures were found, which were significantly greater in the self-regulation-focused group than the knowledge-focused group. Mean reductions in waist circumference/weight were - 4.64 cm/ - 5.17 kg (- 5.5% of baseline weight) and - 0.66 cm/ - 1.19 kg (- 1.2% of baseline weight), respectively. Aggregated data indicated that early increase in physical activity/exercise significantly predicted 24-month reductions in both weight and waist circumference. Serial mediation analyses indicated that a sequential path from exercise-related self-regulation (baseline-month 3) → eating-related self-regulation (baseline-month 6) → eating-related self-regulation (baseline-month 12) fully mediated the physical activity/exercise-weight/waist circumference change relationships. Energy expenditures from physical activity/exercise accounted for 21% of lost weight.

CONCLUSIONS

Findings of this field research supported benefits of progressively building self-regulation skills, first for physical activity/exercise then controlled eating, through accordingly focused behavioral treatments. Opportunities for tailoring large-scale community-based interventions grounded in theory were enhanced.

Moderate and Higher Protein Intakes Promote Superior Body Recomposition in Older Women Performing Resistance Training

PURPOSE

Resistance training (RT) combined with appropriate dietary intake can promote a concomitant increase in skeletal muscle mass (SMM) and reduction in fat mass, a condition termed body recomposition. This study's primary purpose was to explore the effects of protein ingestion on body recomposition after 24 wk of RT in older women.

METHODS

Data from 130 untrained older women (68.7 ± 5.6 yr, 66.5 ± 11.5 kg, 155.5 ± 6.0 cm, and 27.4 ± 4.0 kg·m-2) across six studies were retrospectively analyzed. The participants were divided into tertiles according to their customary protein intake (g·kg-1·d-1): lower (LP; n = 45), moderate (MP; n = 42), and higher (HP; n = 43) protein intake. Participants performed a whole-body RT program carried out over 24 wk (eight exercises, three sets, 8-15 repetitions, three sessions a week). SMM and fat mass were determined by dual-energy x-ray absorptiometry.

RESULTS

All groups increased SMM from baseline (P < 0.05), with the HP and MP groups showing greater increases than the LP group (LP, 2.3%; MP, 5.4%; and HP, 5.1%; P < 0.05). Reductions in fat mass were similar for all three groups (LP, 1.7%; MP, 3.7%; and HP, 3.1%; P > 0.05). The composite z-score of the percentage changes from pretraining to posttraining indicated greater positive body recomposition values for HP and MP compared with LP (P < 0.05).

CONCLUSIONS

Results suggest that protein intake is a moderating variable for body recomposition in older women undergoing RT, with a low protein intake having a less favorable effect on body recomposition.

Acute Effects of Milk vs. Carbohydrate on Bone Turnover Biomarkers Following Loading Exercise in Young Adult Females

Dairy products and impact exercise have previously been identified to be independently beneficial for bone mineral properties, however, it is unknown how the combination of these two osteogenic interventions may alter acute bone turnover. Using a randomized crossover design, we compared the acute effects of consuming milk vs. an isoenergetic carbohydrate control beverage on bone biomarkers following loading exercise. Thirteen healthy female participants (Age = 20.3 ± 2.3y; BMI = 21.0 ± 1.1 kg/m2) consumed either 550 mL of 0% skim white milk (MILK) or 52.7 g of maltodextrin in 550 mL of water (CHO), both 5 min and 1 h following completion of a combined plyometric (198 impacts) and resistance exercise (3-4 sets/exercise, 8-12 reps/set, ∼75% 1-RM) bout. Venous blood samples were obtained pre-exercise, and 15 min, 75 min, 24 h and 48 h post-exercise to assess serum concentrations of bone resorption biomarkers, specifically carboxyl-terminal crosslinking telopeptide of type I collagen (CTX), receptor activator nuclear factor kappa-β ligand (RANKL), and sclerostin (SOST), as well as bone formation biomarkers, specifically osteoprotegerin (OPG) and osteocalcin (OC). When absolute biomarker concentrations were examined, there were no interaction or group effects for any biomarker, however, there were main time effects (p < 0.05) for RANKL, SOST, and OC, which were lower, and the OPG: OPG/RANKL ratio, which was higher at 75 min post-exercise compared with baseline in both conditions. In addition to assessing absolute biomarker concentrations at specific timepoints, we also evaluated the relative (% change) cumulative post-exercise response (75 min to 48 h) using an area under the curve (AUC) analysis. This analysis showed that the relative post-exercise CTX response was significantly lower in the MILK compared to the CHO condition (p = 0.03), with no differences observed in the other biomarkers. These results show that while milk does not appear to alter absolute concentrations of bone biomarkers compared to CHO, it may attenuate relative post-exercise bone resorption (i.e., blunt the usual catabolic response to exercise).

Official position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry: part I (technical aspects)—general concepts, indications, acquisition, and analysis

Objective

To review the technical aspects of body composition assessment by dual-energy X-ray absorptiometry (DXA) and other methods based on the most recent scientific evidence.

Materials and methods

This Official Position is a result of efforts by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and health care professionals with expertise in body composition assessment who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications. In this first part of the Official Position, the authors discuss the different methods and parameters used for body composition assessment, general principles of DXA, and aspects of the acquisition and analysis of DXA scans.

Conclusion

Considering aspects of accuracy, precision, cost, duration, and ability to evaluate all three compartments, DXA is considered the gold-standard method for body composition assessment, particularly for the evaluation of fat mass. In order to ensure reliable, adequate, and reproducible DXA reports, great attention is required regarding quality control procedures, preparation, removal of external artifacts, imaging acquisition, and data analysis and interpretation.

Be Healthy in Pregnancy (BHIP): A Randomized Controlled Trial of Nutrition and Exercise Intervention from Early Pregnancy to Achieve Recommended Gestational Weight Gain

A randomized two-arm prospective superiority trial tested the efficacy of a novel structured and monitored nutrition (bi-weekly counselling for individualized energy and high dairy protein diet) and exercise program (walking goal of 10,000 steps/day) (intervention) compared to usual care (control) in pregnant women to achieve gestational weight gain (GWG) within current recommendations. Women recruited in communities in southern Ontario, Canada were randomized at 12–17 weeks gestation with stratification by site and pre-pregnancy BMI to intervention (n = 119) or control (n = 122). The primary outcome was the proportion of women who achieved GWG within the Institute of Medicine recommendations. Although the intervention compared to control group was more likely to achieve GWG within recommendations (OR = 1.51; 95% CI (0.81, 2.80)) and total GWG was lower by 1.45 kg (95% CI: (−11.9, 8.88)) neither reached statistical significance. The intervention group achieved significantly higher protein intake at 26–28 week (mean difference (MD); 15.0 g/day; 95% CI (8.1, 21.9)) and 36–38 week gestation (MD = 15.2 g/day; 95% CI (9.4, 21.1)) and higher healthy diet scores (22.5 ± 6.9 vs. 18.7 ± 8.5, p < 0.005) but step counts were similar averaging 6335 steps/day. Pregnancy and infant birth outcomes were similar between groups. While the structured and monitored nutrition with counselling improved diet quality and protein intake and may have benefited GWG, the exercise goal of 10,000 steps/day was unachievable. The results can inform future recommendations for diet and physical activity in pregnancy.

Effects of 8-week increment aerobic exercise program on bone metabolism and body composition in young non-athletes

PURPOSE

The effects of aerobic exercise on bone metabolism are still unclear. Thus, the main goal of this study was to explore if there was an effect of the short-term aerobic exercise program on the bone remodeling process and if there were sex differences in the effect of the training program on bone metabolism.

METHODS

Twenty-one participants (men and women) aged 20-23 performed an 8-week aerobic exercise program three times per week in 1-h sessions with increases in the exercise load every 2 weeks. Bone density, bone mineral content and concentration of markers of bone metabolism: osteocalcin, C-terminal procollagen type I peptide, pyridinoline, parathyroid hormone, osteoprotegerin, and the receptor activator of nuclear kappa B ligand by ELISA were measured at the start and at the end of the study, while changes in body composition were assessed by a bioelectric impedance analysis method 6 times during the study.

RESULTS

The aerobic exercise program increased the concentration of osteocalcin (11.34 vs 14.24 ng/ml), pyridinoline (67.51 vs 73.99 nmol/l), and the receptor activator of nuclear kappa B ligand (95.122 vs 158.15 pg/ml). A statistically significant increase in bone density at neck mean (1.122 vs 1.176 g/cm³) and in bone mineral content at dual femur (33.485 vs 33.700 g) was found in women, while there was no statistically significant change at any site in men.

CONCLUSION

8 weeks of the aerobic exercise program with increment in intensity increased some of bone remodeling biomarkers and showed different effects for men and women.

Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk

BACKGROUND

Debates on effective and safe diets for managing obesity in adults are ongoing. Low-carbohydrate weight-reducing diets (also known as 'low-carb diets') continue to be widely promoted, marketed and commercialised as being more effective for weight loss, and healthier, than 'balanced'-carbohydrate weight-reducing diets.

OBJECTIVES

To compare the effects of low-carbohydrate weight-reducing diets to weight-reducing diets with balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults without and with type 2 diabetes mellitus (T2DM).

SEARCH METHODS

We searched MEDLINE (PubMed), Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 25 June 2021, and screened reference lists of included trials and relevant systematic reviews. Language or publication restrictions were not applied.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in adults (18 years+) who were overweight or living with obesity, without or with T2DM, and without or with cardiovascular conditions or risk factors. Trials had to compare low-carbohydrate weight-reducing diets to balanced-carbohydrate (45% to 65% of total energy (TE)) weight-reducing diets, have a weight-reducing phase of 2 weeks or longer and be explicitly implemented for the primary purpose of reducing weight, with or without advice to restrict energy intake.  DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts and full-text articles to determine eligibility; and independently extracted data, assessed risk of bias using RoB 2 and assessed the certainty of the evidence using GRADE. We stratified analyses by participants without and with T2DM, and by diets with weight-reducing phases only and those with weight-reducing phases followed by weight-maintenance phases. Primary outcomes were change in body weight (kg) and the number of participants per group with weight loss of at least 5%, assessed at short- (three months to < 12 months) and long-term (≥ 12 months) follow-up.

MAIN RESULTS

We included 61 parallel-arm RCTs that randomised 6925 participants to either low-carbohydrate or balanced-carbohydrate weight-reducing diets. All trials were conducted in high-income countries except for one in China. Most participants (n = 5118 randomised) did not have T2DM. Mean baseline weight across trials was 95 kg (range 66 to 132 kg). Participants with T2DM were older (mean 57 years, range 50 to 65) than those without T2DM (mean 45 years, range 22 to 62). Most trials included men and women (42/61; 3/19 men only; 16/19 women only), and people without baseline cardiovascular conditions, risk factors or events (36/61). Mean baseline diastolic blood pressure (DBP) and low-density lipoprotein (LDL) cholesterol across trials were within normal ranges. The longest weight-reducing phase of diets was two years in participants without and with T2DM. Evidence from studies with weight-reducing phases followed by weight-maintenance phases was limited. Most trials investigated low-carbohydrate diets (> 50 g to 150 g per day or < 45% of TE; n = 42), followed by very low (≤ 50 g per day or < 10% of TE; n = 14), and then incremental increases from very low to low (n = 5). The most common diets compared were low-carbohydrate, balanced-fat (20 to 35% of TE) and high-protein (> 20% of TE) treatment diets versus control diets balanced for the three macronutrients (24/61). In most trials (45/61) the energy prescription or approach used to restrict energy intake was similar in both groups. We assessed the overall risk of bias of outcomes across trials as predominantly high, mostly from bias due to missing outcome data. Using GRADE, we assessed the certainty of evidence as moderate to very low across outcomes.  Participants without and with T2DM lost weight when following weight-reducing phases of both diets at the short (range: 12.2 to 0.33 kg) and long term (range: 13.1 to 1.7 kg).  In overweight and obese participants without T2DM: low-carbohydrate weight-reducing diets compared to balanced-carbohydrate weight-reducing diets (weight-reducing phases only) probably result in little to no difference in change in body weight over three to 8.5 months (mean difference (MD) -1.07 kg, (95% confidence interval (CI) -1.55 to -0.59, I2 = 51%, 3286 participants, 37 RCTs, moderate-certainty evidence) and over one to two years (MD -0.93 kg, 95% CI -1.81 to -0.04, I2 = 40%, 1805 participants, 14 RCTs, moderate-certainty evidence); as well as change in DBP and LDL cholesterol over one to two years. The evidence is very uncertain about whether there is a difference in the number of participants per group with weight loss of at least 5% at one year (risk ratio (RR) 1.11, 95% CI 0.94 to 1.31, I2 = 17%, 137 participants, 2 RCTs, very low-certainty evidence).  In overweight and obese participants with T2DM: low-carbohydrate weight-reducing diets compared to balanced-carbohydrate weight-reducing diets (weight-reducing phases only) probably result in little to no difference in change in body weight over three to six months (MD -1.26 kg, 95% CI -2.44 to -0.09, I2 = 47%, 1114 participants, 14 RCTs, moderate-certainty evidence) and over one to two years (MD -0.33 kg, 95% CI -2.13 to 1.46, I2 = 10%, 813 participants, 7 RCTs, moderate-certainty evidence); as well in change in DBP, HbA1c and LDL cholesterol over 1 to 2 years. The evidence is very uncertain about whether there is a difference in the number of participants per group with weight loss of at least 5% at one to two years (RR 0.90, 95% CI 0.68 to 1.20, I2 = 0%, 106 participants, 2 RCTs, very low-certainty evidence).  Evidence on participant-reported adverse effects was limited, and we could not draw any conclusions about these.  AUTHORS' CONCLUSIONS: There is probably little to no difference in weight reduction and changes in cardiovascular risk factors up to two years' follow-up, when overweight and obese participants without and with T2DM are randomised to either low-carbohydrate or balanced-carbohydrate weight-reducing diets.

Intermittent fasting and continuous energy restriction result in similar changes in body composition and muscle strength when combined with a 12 week resistance training program

Purpose

The objective of this study was to compare the effects of 12 weeks of resistance training combined with either 5:2 intermittent fasting or continuous energy restriction on body composition, muscle size and quality, and upper and lower body strength.

Methods

Untrained individuals undertook 12 weeks of resistance training plus either continuous energy restriction [20% daily energy restriction (CERT)] or 5:2 intermittent fasting [~ 70% energy restriction 2 days/week, euenergetic consumption 5 days/week (IFT)], with both groups prescribed a mean of ≥ 1.4 g of protein per kilogram of body weight per day. Participants completed 2 supervised resistance and 1 unsupervised aerobic/resistance training combination session per week. Changes in lean body mass (LBM), thigh muscle size and quality, strength and dietary intake were assessed.

Results

Thirty-four participants completed the study (CERT = 17, IFT = 17). LBM was significantly increased (+ 3.7%, p < 0.001) and body weight (− 4.6%, p < 0.001) and fat (− 24.1%, p < 0.001) were significantly reduced with no significant difference between groups, though results differed by sex. Both groups showed improvements in thigh muscle size and quality, and reduced intramuscular and subcutaneous fat assessed by ultrasonography and peripheral quantitative computed tomography (pQCT), respectively. The CERT group demonstrated a significant increase in muscle surface area assessed by pQCT compared to the IFT group. Similar gains in upper and lower body strength and muscular endurance were observed between groups.

Conclusion

When combined with resistance training and moderate protein intake, continuous energy restriction and 5:2 intermittent fasting resulted in similar improvements in body composition, muscle quality, and strength. ACTRN: ACTRN12620000920998, September 2020, retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-022-02804-3.

Effects of physical activity and dietary supplement on fat free mass and bone mass density during weight loss - a systematic review and meta-analysis

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Effects of exercise training and dietary supplement on fat free mass and bone mass density during weight loss - a systematic review and meta-analysis

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Effects of physical activity and dietary supplement on fat free mass and bone mass density during weight loss - a systematic review and meta-analysis

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Physical activity in management of persons with obesity

Physical activity and exercise have many benefits in persons with obesity, helping with weight loss, body fat loss, abdominal visceral fat loss and possibly with weight maintenance after weight loss. The effect of exercise training (endurance or endurance plus resistance or high-intensity interval training) alone on weight loss as outcome appears relatively modest, amounting to only a few kg. However, endurance training during weight loss has been shown to increase V̇O₂max and resistance training during weight loss leads to lower loss in lean body mass and increased muscle strength. In addition, higher physical activity levels improve cardiovascular risk, whatever weight variations. Specifically, physical activity or exercise is part of lifestyle measures for prevention of type 2 diabetes and substantially helps with metabolic control in patients with type 2 diabetes. The importance of physical activity counselling and exercise prescription in the management strategy will depend on specific treatment objectives as defined for a given patient, including weight loss, prevention of weigh regain, prevention of cardio-metabolic comorbidities, lean body mass preservation but also improvement in quality of life or development of social links. The 5 A's strategy consisting in: Ask, Assess, Advise, Agree, Assist (or Arrange) appears well adapted in this setting. Professionals need to be aware of the many barriers patients with obesity may meet on their way to increase habitual physical activity as specific solutions should be proposed. A major challenge is how to improve adherence to new physical activity habits over time.

Weight Loss Strategies and the Risk of Skeletal Muscle Mass Loss

With energy intake restriction and exercise remaining the key diet and lifestyle approaches to weight loss, this is not without potential negative implications for body composition, metabolic health, and quality and quantity of life. Ideally, weight loss should be derived almost exclusively from the fat mass compartment as this is the main driver of metabolic disease, however, several studies have shown that there is an accompanying loss of tissue from the fat-free compartment, especially skeletal muscle. Population groups including post-menopausal women, the elderly, those with metabolic disease and athletes may be particularly at risk of skeletal muscle loss when following a weight management programme. Research studies that have addressed this issue across a range of population groups are reviewed with a focus upon the contribution of resistance and endurance forms of exercise and a higher intake dietary protein above the current guideline of 0.8 g/kg body weight/day. While findings can be contradictory, overall, the consensus appears that fat-free and skeletal muscle masses can be preserved, albeit to varying degrees by including both forms of exercise (but especially resistance forms) in the weight management intervention. Equally, higher intakes of protein can protect loss of these body compartments, acting either separately or synergistically with exercise. Elderly individuals in particular may benefit most from this approach. Thus, the evidence supports the recommendations for intakes of protein above the current guidelines of 0.8 g/kg body weight/d for the healthy elderly population to also be incorporated into the dietary prescription for weight management in this age group.

Milk-Fat Intake and Differences in Abdominal Adiposity and BMI: Evidence Based on 13,544 Randomly-Selected Adults

The primary purpose of this investigation was to evaluate the relationship between milk-fat intake and obesity, particularly abdominal obesity, in 13,544 U.S. adults. A lesser objective was to measure the degree to which the association was influenced by multiple potential confounding variables. This cross-sectional study used data from the 2011-2016 National Health and Nutrition Examination Survey (NHANES). Quantity of milk-fat regularly consumed was the exposure variable. Sagittal abdominal diameter (SAD), a measure of abdominal obesity, and body mass index (BMI) were the outcome variables. Sagittal abdominal diameter is a strong predictor of visceral abdominal fat, when measured by computed tomography, and has been shown to predict cardiometabolic disorders better than BMI. After controlling for age, race, gender, physical activity, leisure computer use and gaming, alcohol habits, and cigarette use, significantly lower BMIs were associated with consistent non-fat and full-fat milk consumption (F = 4.1, p = 0.0063). A significantly lower SAD was associated only with regular consumption of non-fat milk (F = 5.0, p = 0.0019). No significant differences were detected between the other milk-fat groups or milk abstainers. In this nationally representative sample, only 19.6% of adults regularly consumed low-fat milk. In conclusion, consistent non-fat milk intake was predictive of lower levels of abdominal adiposity compared to consumption of higher levels of milk-fat.

Neutral Effect of Increased Dairy Product Intake, as Part of a Lifestyle Modification Program, on Cardiometabolic Health in Adolescent Girls With Overweight/Obesity: A Secondary Analysis From a Randomized Controlled Trial

Background: The presence of obesity and some cardiometabolic disease risk factors in childhood and adolescence track into adulthood. Intake of dairy products has been shown to be inversely related to adiposity and cardiometabolic variables in youth. However, limited research has examined cardiometabolic disease risk factors following increased dairy product consumption as part of a lifestyle modification intervention in youth with overweight/obesity. This secondary analysis aimed to determine whether 12 weeks of increased dairy consumption, as part of a lifestyle modification program, affects cardiometabolic variables in adolescent females (range: 10-18 years) with overweight/obesity (BMI > 85th centile). Methods: Participants were randomized into two groups: higher dairy intake (RDa; four servings/day [to reflect previous Canada's Food Guide recommendations]; n = 23) or low dairy intake (LDa; 0-2 servings/day; n = 23). Both RDa and LDa participated in a 12-week, eucaloric, lifestyle modification intervention consisting of exercise training, and nutritional counseling. Adiposity (percent body fat [%BF]), dietary intake, and measures of cardiometabolic health were measured pre- and post-intervention. Results: There were no significant changes over time within groups or differences over time between groups for triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), TC/HDL ratio, low-density lipoprotein cholesterol (LDL), glucose, insulin, homeostatic model assessment of insulin resistance, adiponectin, and tumor necrosis factor alpha (TNF-α) (main effects of time and interactions, p > 0.05). Leptin decreased over the 12-week lifestyle intervention in both groups (main effect of time, p = 0.02). After combining the groups (n = 46), significant correlations were found between change in %BF and change in some cardiometabolic variables (HDL [r = -0.40], TC/HDL ratio [r = 0.42], LDL [r = 0.36], and TNF-α [r = 0.35], p < 0.05). After controlling for change in dairy product intake, the correlations were unchanged. Conclusion: Our findings demonstrate that increased dairy product consumption, as part of a lifestyle modification, weight management intervention, had a neutral effect on cardiometabolic disease risk factors in adolescent females with overweight/obesity. Change in dairy product intake did not influence the relationships between change in adiposity and change in cardiometabolic variables. Future research designed to primarily assess the effect of increased dairy product consumption on cardiometabolic disease risk factors in this population is warranted. Clinical Trial Registration: Clinicaltrials.gov; NCT#02581813.

The Efficacy of Short-Term Weight Loss Programs and Consumption of Natural Probiotic Bryndza Cheese on Gut Microbiota Composition in Women

Weight loss interventions with probiotics have favourable effects on gut microbiota composition and derived metabolites. However, little is known about whether the consumption of natural probiotics, such as Bryndza cheeses, brings similar benefits. The purpose of the study was to find the effect of short-term weight loss programs and Bryndza cheese consumption on the structure of the gut microbiota, microbiota-derived metabolites and body composition in middle-aged women. We conducted a randomised controlled intervention study. Twenty-two female participants with a body fat percentage ≥25% underwent a short weight loss program (4 weeks). Subjects were randomised to either the control or intervention group according to diet. The intervention group comprised 13 participants, whose diet contained 30 g of “Bryndza” cheese daily (WLPB). The control group comprised nine participants without the regular consumption of Bryndza cheese (WLP) in their diet. Both interventions lead to a significant and favourable change of BMI, body fat, waist circumference and muscle mass. Moreover, the relative abundance of Erysipelotrichales significantly increased in both groups. However, the relative abundance of lactic acid bacteria (Lactobacillales, Streptococcaceae, Lactococcus and Streptococcus) significantly increased only in the WLPB group. Furthermore, short-chain fatty acid producers Phascolarctobacterium and Butyricimonas increased significantly in the WLPB group. A short-term weight loss program combined with Bryndza cheese consumption improves body composition and increases the abundance of lactic acid bacteria and short-chain fatty acid producers in middle-aged women.

Comparison of the effect of soya protein and whey protein on body composition: a meta-analysis of randomised clinical trials

Essential amino acids (EAA) promote the process of regulating muscle synthesis. Thus, whey protein that contains higher amounts of EAA can have a considerable effect on modifying muscle synthesis. However, there is insufficient evidence regarding the effect of soya and whey protein supplementation on body composition. Thus, we sought to perform a meta-analysis of published randomised clinical trials that examined the effect of whey protein supplementation and soya protein supplementation on body composition (lean body mass, fat mass, body mass and body fat percentage) in adults. We searched PubMed, Scopus and Google Scholar, up to August 2020, for all relevant published articles assessing soya protein supplementation and whey protein supplementation on body composition parameters. We included all randomised clinical trials that investigated the effect of whey protein supplementation and soya protein supplementation on body composition in adults. Pooled means and standard deviations were calculated using random effects models. Subgroup analysis was applied to discern possible sources of heterogeneity. After excluding non-relevant articles, ten studies, with 596 participants, remained in this study. We found a significant increase in lean body mass after whey protein supplementation (weighted mean difference (WMD: 0·91; 95 % CI 0·15, 1·67; P = 0·019). We observed no significant change between whey protein supplementation and body mass, fat mass and body fat percentage. We found no significant change between soya protein supplementation and body composition parameters. Whey protein supplementation significantly improved body composition via increases in lean body mass, without influencing fat mass, body mass and body fat percentage.

A comparison study of the influence of milk protein versus whey protein in high-protein diets on adiposity in rats

High-protein diets are known to reduce weight and fat deposition. However, there have been only a few studies on the efficacy of different types of high-protein diets in preventing obesity. Therefore, the emphasis of this study lies in comparing the efficacy of two high-protein diets (milk protein and whey protein) in preventing obesity and exploring specific mechanisms. Eighty Sprague Dawley rats were divided into two groups and fed with milk protein concentrate (MPC) and whey protein concentrate (WPC) for 12 weeks. Each group was divided into four levels: two low-fat regimens with either low or high protein content (L-14%, L-40%) and two high-fat regimens with either low or high protein content (H-14%, H-40%). The studies we have performed showed that rats treated with MPC at the 40% protein level had significantly reduced body weight, fat weight and fat ratio gain induced by a high-fat diet, while the protein level in the WPC group had no effect on body weight or body fat in rats fed with a high-fat diet. What is more, rats fed with MPC at the H-40% energy level showed a significant decrease in plasma triglyceride, total cholesterol and low-density lipoprotein cholesterol levels and a significant increase in plasma high-density lipoprotein cholesterol levels compared with the H-14% energy level group. In contrast, in the WPC groups, increasing the protein content in high-fat diets had no significant influence on plasma lipid levels. The results of the amino acid composition of the two proteins and plasma showed that the MPC diet of 40% protein level increased the transsulfuration pathway in rats, thereby increasing the level of H₂S. This research work has shown that not all types of high-protein diets can effectively prevent obesity induced by high-fat diets, as effectiveness depends on the amino acid composition of the protein.

Meta-analysis of randomized controlled trials on calcium supplements and dairy products for changes in body weight and obesity indices

This meta-analysis was performed to investigate whether calcium supplements and dairy products change obesity indices including fat mass. Original articles published in English between July 2009 and August 2019 were identified. Ten and 14 randomised controlled trials (RCTs) with ≥ 12 weeks interventions of calcium supplements and dairy products among overweight or obese adults aged ≥18 were critically reviewed. Mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) were obtained using a random effect meta-analysis. Dairy products significantly changed fat mass (SMD, 95% CI; -0.40 [-0.77, -0.02]) and BMI (MD, 95% CI: -0.46 kg/m2 [-0.67, -0.26]), and calcium supplements also showed changes in fat mass (SMD, 95% CI; -0.15[-0.28, -0.02]). However, in the analysis of RCTs with low risk of bias scores, the significant changes remained only in the dairy-products intervention. Our findings suggest that dairy products without distinction of fat percentage may help reduce fat mass and BMI, but calcium supplements may not.

Protein, lysine and vitamin D: critical role in muscle and bone health

Optimum body composition in terms of higher muscle and bone mass is crucial for balancing metabolic activities for sustainability of healthy human life. Individuals with lesser muscle mass respond poorly to stressed states such as traumatic injury, sepsis and advanced cancers. Most common diseases like obesity, heart disease, cancer and diabetes can be prevented by muscle mass modification. The nutrients like protein, lysine, calcium and vitamin D play a critical role in the maintenance of muscle mass and bone health. Poor dietary protein quality owing to high amounts of cereals and little animal foods have a marked negative impact on health in resource-limited settings. Lysine intake in developing countries is low mainly due to lesser food intake, consumption of cereals as staple diet and processing loss of lysine. Furthermore, lysine intakes have been shown to be marginal in low socio-economic groups which are of even greater concern. Cereal-based diets and cereal-based food subsidy programs offer low quality proteins and pose a risk of quality protein deficiency. Diets lacking in vitamin D contribute to vitamin D deficiency which is prevalent in epidemic proportions in large part of the world. Cereal-based vegetarian diets are responsible for lesser bioaccessibility of calcium as well. For obtaining optimal health, optimal muscle mass should be maintained at a younger age, which can be achieved by improving nutritional quality of diets. Dietary and medicinal supplementation of lysine, calcium and vitamin D may improve the body composition of young adult women in the form of proportionally more muscle mass, bone mass and lesser fat mass, which in turn, may prove helpful in improving general well-being, physical fitness as well as preventing metabolic diseases in developing countries.

Increased dairy product consumption as part of a diet and exercise weight management program improves body composition in adolescent females with overweight and obesity-A randomized controlled trial

BACKGROUND

Exercise can improve body composition in adolescents and adults with overweight/obesity. Consumption of dairy foods, as part of a healthy lifestyle program, can also promote favourable body composition changes in adults with overweight/obesity. However, the few studies examining these combined effects on body composition in adolescents are inconclusive.

OBJECTIVE

To determine whether increased dairy product consumption, as part of a lifestyle modification program featuring exercise training and dietary guidance promotes favourable body composition changes in adolescent females with overweight/obesity.

METHODS

Fifty-four participants (age: 14.8 ± 2.2y; BMI percentile: 95th ± 6) assigned to three groups completed the study. There were two experimental groups: recommended dairy (RDa; n = 24) and low dairy (LDa; n = 22), and a no-intervention control group (Con; n = 8). RDa and LDa participated in a 12-week, eucaloric, lifestyle modification intervention consisting of mixed-mode exercise (3x/week), and nutritional counselling. RDa was provided 4 servings/day of dairy foods, while LDa and Con maintained habitually low intakes (0-2 servings/day). Body weight/composition, waist/hip circumference, cardiovascular fitness and food intake were assessed at weeks 0 and 12.

RESULTS

Weight did not significantly change in any group. RDa significantly decreased fat mass (FM) and increased lean mass (LM) more than LDa and Con (FM: -1.3 ± 2.1 kg, -1.1 ± 2.0 kg, 0.8 ± 1.8 kg; LM: 1.5 ± 1.9 kg, 0.7 ± 1.6 kg, 0.5 ± 1.4 kg, respectively). LDa also significantly decreased FM and increased LM more than Con (P < .005; all interactions).

CONCLUSION

The inclusion of dairy foods in the diet of adolescent females with overweight/obesity, as part of a diet and exercise intervention, favourably improves body composition in the absence of weight loss.