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  • Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows' milk.
    Nutrition journal. 2016;:35

    Plain language summary

    Cows’ milk contains two types of beta-casein, A1 and A2, and the A1 type is thought to cause the adverse gastrointestinal side effects related to lactose intolerance. The aim of this crossover study was to compare the effects of milk consumption with differing beta-casein types in subjects with self-reported lactose intolerance. Forty-five participants were randomised to receive milk containing either both types of casein or only the A2 type, and inflammatory markers, symptoms of digestive discomfort and cognitive processing were assessed. This study demonstrated that consumption of milk containing A1 beta-casein was associated with increased inflammation, worsening of digestive discomfort, delayed transit and decreased cognitive functioning. The findings of this study suggest that some symptoms of lactose intolerance may be attenuated by consuming milk containing only the A2 type of beta-casein.

    Abstract

    BACKGROUND Cows' milk generally contains two types of β-casein, A1 and A2 types. Digestion of A1 type can yield the peptide β-casomorphin-7, which is implicated in adverse gastrointestinal effects of milk consumption, some of which resemble those in lactose intolerance. This study aimed to compare the effects of milk containing A1 β-casein with those of milk containing only A2 β-casein on inflammation, symptoms of post-dairy digestive discomfort (PD3), and cognitive processing in subjects with self-reported lactose intolerance. METHODS Forty-five Han Chinese subjects participated in this double-blind, randomized, 2 × 2 crossover trial and consumed milk containing both β-casein types or milk containing only A2 β-casein. Each treatment period was 14 days with a 14-day washout period at baseline and between treatment periods. Outcomes included PD3, gastrointestinal function (measured by smart pill), Subtle Cognitive Impairment Test (SCIT), serum/fecal laboratory biomarkers, and adverse events. RESULTS Compared with milk containing only A2 β-casein, the consumption of milk containing both β-casein types was associated with significantly greater PD3 symptoms; higher concentrations of inflammation-related biomarkers and β-casomorphin-7; longer gastrointestinal transit times and lower levels of short-chain fatty acids; and increased response time and error rate on the SCIT. Consumption of milk containing both β-casein types was associated with worsening of PD3 symptoms relative to baseline in lactose tolerant and lactose intolerant subjects. Consumption of milk containing only A2 β-casein did not aggravate PD3 symptoms relative to baseline (i.e., after washout of dairy products) in lactose tolerant and intolerant subjects. CONCLUSIONS Consumption of milk containing A1 β-casein was associated with increased gastrointestinal inflammation, worsening of PD3 symptoms, delayed transit, and decreased cognitive processing speed and accuracy. Because elimination of A1 β-casein attenuated these effects, some symptoms of lactose intolerance may stem from inflammation it triggers, and can be avoided by consuming milk containing only the A2 type of beta casein. TRIAL REGISTRATION ClinicalTrials.gov/NCT02406469.
  • Feasibility outcomes of a presurgical randomized controlled trial exploring the impact of caloric restriction and increased physical activity versus a wait-list control on tumor characteristics and circulating biomarkers in men electing prostatectomy for prostate cancer.
    BMC cancer. 2016;:61

    Plain language summary

    There is a strong body of evidence associating between obesity and increased risk for more aggressive and progressive cancer. This paper aims to assess the feasibility of a presurgical diet and exercise weight loss intervention in men with newly-diagnosed prostate cancer who elected prostatectomy. It also aims to explore the intervention’s effects on tumour proliferation rates and other biomarkers. The 3-weeks randomised controlled study included 40 overweight or obese men newly-diagnosed with prostate cancer. Participants in experimental arm were assigned to a healthy energy-restricted diet versus wait-list control arm. Primary endpoints were feasibility measures: accrual, retention, adherence, and safety. Exploratory outcomes were the intervention’s effect on: • Tumour proliferation marker (Ki-67). • Other tumour markers such as activated caspase-3 and nuclear factor kappa-light- chain-enhancer of activated B cells (NFκB). • Serum biomarkers such as testosterone and sex hormone binding globulin (SHBG). • Lymphocytic gene expression. • Cellular bioenergetics in neutrophils. • Gut microbiome. All feasibility endpoints were achieved with accrual completed within 2 years, retention of 85%, adherence of 95% and no adverse events. Biologic outcomes were not included in this paper, as biological testing was still ongoing. Authors concluded that this study’s methods and data on feasibility could provide useful framework for the design of future trials. They also highlighted the importance of presurgical trials as a feasible and safe means to assess the impacts of diet and exercise on tumour tissue.

    Abstract

    BACKGROUND Obesity is associated with tumor aggressiveness and disease-specific mortality for more than 15 defined malignancies, including prostate cancer. Preclinical studies suggest that weight loss from caloric restriction and increased physical activity may suppress hormonal, energy-sensing, and inflammatory factors that drive neoplastic progression; however, exact mechanisms are yet to be determined, and experiments in humans are limited. METHODS We conducted a randomized controlled trial among 40 overweight or obese, newly-diagnosed prostate cancer patients who elected prostatectomy to explore feasibility of a presurgical weight loss intervention that promoted a weight loss of roughly one kg. week(-1) via caloric restriction and physical activity, as well as to assess effects on tumor biology and circulating biomarkers. Measures of feasibility (accrual, retention, adherence, and safety) were primary endpoints. Exploratory aims were directed at the intervention's effect on tumor proliferation (Ki-67) and other tumor markers (activated caspase-3, insulin and androgen receptors, VEGF, TNFβ, NFκB, and 4E-BP1), circulating biomarkers (PSA, insulin, glucose, VEGF, TNFβ, leptin, SHBG, and testosterone), lymphocytic gene expression of corresponding factors and cellular bioenergetics in neutrophils, and effects on the gut microbiome. Consenting patients were randomized in a 1:1 ratio to either: 1) weight loss via a healthful, guidelines-based diet and exercise regimen; or 2) a wait-list control. While biological testing is currently ongoing, this paper details our methods and feasibility outcomes. RESULTS The accrual target was met after screening 101 cases (enrollment rate: 39.6%). Other outcomes included a retention rate of 85%, excellent adherence (95%), and no serious reported adverse events. No significant differences by age, race, or weight status were noted between enrollees vs. non-enrollees. The most common reasons for non-participation were "too busy" (30%), medical exclusions (21%), and "distance" (16%). CONCLUSIONS Presurgical trials offer a means to study the impact of diet and exercise interventions directly on tumor tissue, and other host factors that are feasible and safe, though modifications are needed to conduct trials within an abbreviated period of time and via distance medicine-based approaches. Pre-surgical trials are critical to elucidate the impact of lifestyle interventions on specific mechanisms that mediate carcinogenesis and which can be used subsequently as therapeutic targets. TRIAL REGISTRATION NCT01886677.
  • The effect of green tea extract supplementation on exercise-induced oxidative stress parameters in male sprinters.
    European journal of nutrition. 2015;(5):783-91

    Plain language summary

    High intensity exercise or anaerobic exercise may generate Reactive oxygen species (ROS) that may induce oxidative stress and cellular damage. Oxidative stress may occur when production of ROS exceeds the capacity of the antioxidants system in the body that are unable to make ROS inactive anymore. However, some research state that, ROS generated during intense exercise helps with recovery and cellular damage and supplementation of antioxidants may hinder with this process but, none of these have been researched in details Aims : To evaluate the effects of Green tea extract (GTE) antioxidants supplementation on oxidative stress in male sprinters Method: To evaluate the effect of GTE on blood markers of oxidative stress, total antioxidant capacity (TAC) and other markers were measured. The study included 16 male sprinters for this double blind randomised trial. Result & Conclusion: No significant difference was noted in the two groups but increased polyphenols were observed in the GTE group at rest period in comparison to the placebo group. Supplementation with GTE may prevent with oxidative stress however, it showed no protective effect on muscle damage during or post exercise, neither any improvement in exercise performance was noted.

    Abstract

    BACKGROUND Although research suggests that antioxidant supplementation can protect against exercise-induced muscle damage and oxidative stress, also delayed post-exercise muscle recovery and hindered adaptation to training were reported in the supplemented athletes. PURPOSE The purpose of the study was to evaluate the effects of green tea extract (GTE) supplementation on selected blood markers of oxidative stress and muscle damage in sprinters during preparatory phase of their training cycle. METHODS Sixteen sprinters participated in a double-blind, randomized, placebo (PL)-controlled crossover study, including two 4-week treatment periods with PL and GTE (980 mg polyphenols daily). The sprinters performed two repeated cycle sprint tests (RST; 4 × 15 s, with 1-min rest intervals), after PL and GTE supplementation. Blood was sampled before (at rest), 5 min after RST, and after the 24-h recovery. The activities of superoxide dismutase (SOD) and glutathione peroxidase were measured in erythrocytes, and total polyphenols, total antioxidant capacity (TAC), uric acid (UA), albumin (AL), malondialdehyde (MDA), and creatine kinase (CK) were determined in blood plasma. RESULTS Repeated cycle sprint test performed after PL induced an increase in MDA, TAC, and SOD. Moreover, an increase in UA, AL, and CK was observed after RST irrespective of experimental conditions (PL, GTE). Supplementation with GTE caused an increase in total polyphenols and TAC at rest, and a decrease in MDA and SOD after RST. No significant changes in sprint performance were noted after GTE, as compared to PL. CONCLUSIONS Supplementation with GTE prevents oxidative stress induced by RST in sprinters. Furthermore, GTE supplementation does not seem to hinder training adaptation in antioxidant enzyme system. On the other hand, neither prevention of exercise-induced muscle damage, nor an improvement in sprint performance is noted after GTE administration.
  • The Mediterranean diet and micronutrient levels in depressive patients.
    Nutricion hospitalaria. 2014;(3):1171-5

    Plain language summary

    The incidence of major depressive disorder is increasing and much of this is due to changes in lifestyle factors, including diet. The traditional Mediterranean diet contains a high amount of selenium, zinc, magnesium, folic acid and vitamin B12, and these micronutrients that have been inversely associated with an increased risk of depression. The aim of this study was to assess the impact of dietary recommendations on micronutrient levels in patients with depression. Of the 77 patients enrolled, 51 completed the study after being enrolled and randomised to either receive dietary recommendations aligned with the Mediterranean diet or to the control group to receive recommendations based on what the participant thought best. This study demonstrated that there was no significant difference in the examined micronutrient levels between the group receiving dietary and lifestyle advice compared with the control group. The authors conclude that this result was likely due to a lack of adherence and suggest that the impact of dietary recommendations on serum micronutrient level of depressed patients be further explored.

    Abstract

    INTRODUCTION An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. OBJECTIVE To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. METHODS 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. RESULTS Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. CONCLUSION Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription.
  • A decline in inflammation is associated with less depressive symptoms after a dietary intervention in metabolic syndrome patients: a longitudinal study.
    Nutrition journal. 2014;:36

    Plain language summary

    Metabolic syndrome (defined as a cluster of cardiovascular risk factors including central obesity, glucose intolerance, hypertension and lipid disorders) is rising rapidly worldwide. Certain features of metabolic syndrome including adiposity, glucose intolerance and lipid disorders have also been linked to depression, another burden on healthcare worldwide. The exact pathways linking these diseases are unclear but appear to be bidirectional and dependent on biological and behaviour factors. This study hypothesises that hypo caloric treatment may have a positive impact on both metabolic syndrome and depression, and explores the possible mechanisms for this effect. The sample included 60 subjects with a BMI of at least 36.1 and aged over 50 years. These were a subsample of the RESMENA-S study which involved a 6 month weight loss intervention (either RESMANA-S or a control both with the same energy restrictions). This study found a reduction in depressive symptoms, alongside a reduction in CRP and leptin following the diet. Previous research has found a relationship between weight loss and reduced depression, but this study specifically found the decrease in CRP and leptin with a reduction of depression. The precise mechanism between CRP and depression remains unclear but the authors suggest that inflammation may be responsible. Theoretically, the association between leptin and depression may be related to its metabolic properties and neurobiological activity (it may relate to mood and cognition).

    Abstract

    BACKGROUND Metabolic syndrome (MetS) and depression have become two prevalent diseases worldwide, whose interaction needs further investigation. Dietary treatment for weight loss in patients with MetS may improve depressive manifestations, however, the precise interactive pathways remain uncertain. Therefore, the aim of this study was to examine the effects of a hypocaloric diet designed to reduce MetS features on self-perceived depression and the possible underlying factors. METHODS Sixty subjects (Age: 50 ± 1 y; BMI: 36.1 ± 0.6 kg/m(2)) with MetS were selected from the RESMENA study (control and intervention) after they completed the 6-months hypocaloric treatment and rated for depressive symptoms using the Beck Depression Inventory (BDI). Anthropometric and biochemical measurements including leptin, C-reactive protein (CRP) and insulin levels were evaluated. RESULTS Depressive symptoms decreased during the weight loss intervention, with no differences between both dietary groups (control group -4.2 ± 0.8 vs RESMENA group -3.2 ± 0.6, P = 0.490). The number of criteria of the MetS was higher among subjects with more somatic-related depressive symptoms at baseline (B = 1.032, P-trend = 0.017). After six months of dietary treatment, body weight decreased in all subjects (-8.7%; confidence interval (95% CI) = 7.0-9.7) and also self-perceived depression (-37.9%; 95% CI = 2.7-4.9), as well as circulating leptin (-20.1%; 95% CI = 1.8-6.8), CRP (-42.8%; 95% CI = 0.6-3.0) and insulin (-37.7%; 95% CI = 4.1-7.2) concentrations. The decrease in BDI was significantly associated with declines in body fat mass (B = 0.34, 95% CI = 0.11-0.56) and also with the decrease in leptin (B = 0.16, 95% CI = 0.04-0.28) and CRP (B = 0.24, 95% CI = 0.01-0.46) concentrations. CONCLUSIONS The decrease in depressive manifestations after a weight loss intervention was related with adiposity, CRP and leptin in subjects with MetS. TRIAL REGISTRATION ClinicalTrials.gov: NCT01087086.
  • No effect of caloric restriction on salivary cortisol levels in overweight men and women.
    Metabolism: clinical and experimental. 2014;(2):194-8

    Plain language summary

    Alterations in normal cortisol patterns have been observed in people who are obese. The effect of weight loss on cortisol levels, a measure of hypothalamic pituitary adrenal (HPA) activity, in overweight individuals is not known. The aim of this study was to test the hypothesis that 6 months of moderate caloric restriction would alter morning and diurnal salivary cortisol levels. Thirty-five overweight adults (average BMI 27.8 kg/m2) took part in this randomised control trial. Participants were assigned to either calorie restriction (CR: 25% reduction in energy intake), calorie restriction+exercise (CR+EX: 12.5% reduction in energy intake+12.5% increase in exercise energy expenditure) or control (healthy weight-maintenance diet) for 6 months. Salivary cortisol was measured at 8:00, 8:30, 11:00, 11:30, 12:30, 13:00, 16:00 and 16:30. Morning cortisol was defined as the mean cortisol concentration at 08:00 and 08:30. Diurnal cortisol was calculated as the mean of the 8 cortisol measures across the day. Across all groups, higher morning and diurnal cortisol levels were associated with impaired insulin sensitivity. There was no significant effect of group, time or sex on morning or diurnal cortisol levels. The authors concluded that a 10% weight loss with a 25% CR diet alone or with exercise did not impact morning or diurnal salivary cortisol levels in overweight individuals. Their findings suggest that prolonged restriction of energy intake is not perceived by the body as a stressor, and therefore CR may present a viable intervention.

    Abstract

    OBJECTIVE The effect of weight loss by diet or diet and exercise on salivary cortisol levels, a measure of hypothalamic pituitary adrenal activity, in overweight individuals is not known. The objective was to test the hypothesis that 24 weeks of moderate caloric restriction (CR) (25%) by diet or diet and aerobic exercise would alter morning and diurnal salivary cortisol levels. DESIGN AND SETTING Randomized control trial in an institutional research center. PARTICIPANTS Thirty-five overweight (BMI: 27.8±0.7 kg/m(2)) but otherwise healthy participants (16 M/19 F). INTERVENTION Participants were randomized to either calorie restriction (CR: 25% reduction in energy intake, n=12), calorie restriction+exercise (CR+EX: 12.5% reduction in energy intake+12.5% increase in exercise energy expenditure, n=12) or control (healthy weight-maintenance diet, n=11) for 6 months. MAIN OUTCOME MEASURE Salivary cortisol measured at 8:00, 8:30, 11:00, 11:30, 12:30, 13:00, 16:00 and 16:30. Morning cortisol was defined as the mean cortisol concentration at 08:00 and 08:30. Diurnal cortisol was calculated as the mean of the 8 cortisol measures across the day. RESULTS In the whole cohort, higher morning and diurnal cortisol levels were associated with impaired insulin sensitivity (morning: P=0.004, r(2)=0.24; diurnal: P=0.02, r(2)=0.15). Using mixed model analysis, there was no significant effect of group, time or sex on morning or diurnal cortisol levels. CONCLUSION A 10% weight loss with a 25% CR diet alone or with exercise did not impact morning or diurnal salivary cortisol levels.
  • Timed-daily ingestion of whey protein and exercise training reduces visceral adipose tissue mass and improves insulin resistance: the PRISE study.
    Journal of applied physiology (Bethesda, Md. : 1985). 2014;(1):1-10

    Plain language summary

    High-protein diets may promote weight loss and improved body composition via a number of mechanisms such as increasing satiety and promoting muscle synthesis. The aim of this study was to examine the effects of timed ingestion of whey protein on body weight, fat distribution, insulin resistance and hunger. A secondary aim was to assess the effect of different exercise regimes on the same outcomes. Participants were sedentary and overweight or obese, but otherwise healthy, adults. For 16 weeks, all participants consumed three 20g servings of whey protein per day; within 1 hour of waking, mid-afternoon or within 30 minutes of exercise, and within 2 hours of going to bed (P). Some participants were also assigned to an exercise regime consisting of either resistance and sprint training (RT) or a mixed regime of resistance training, interval training, stretching and endurance (RISE). All participants continued to consume their usual diets. All three groups saw improvements in markers of their body composition and cardiometabolic health, regardless of whether they exercised or not. However, the combined effects of whey protein and exercise resulted in additional improvements in visceral fat, adipokines and insulin sensitivity. Whey protein plus the mixed exercise regime (RISE) was associated with the greatest improvements and the authors concluded that this is an effective lifestyle intervention for overweight and obese adults.

    Abstract

    The present study examined the effects of timed ingestion of supplemental protein (20-g servings of whey protein, 3×/day), added to the habitual diet of free-living overweight/obese adults and subsequently randomized to either whey protein only (P; n = 24), whey protein and resistance exercise (P + RT; n = 27), or a whey protein and multimode exercise training program [protein and resistance exercise, intervals, stretching/yoga/Pilates, endurance exercise (PRISE); n = 28]. Total and regional body composition and visceral adipose tissue (VAT) mass (dual-energy X-ray absorptiometry), insulin sensitivity [homeostasis model assessment-estimated insulin resistance (HOMA-IR)], plasma lipids and adipokines, and feelings of hunger and satiety (visual analog scales) were measured before and after the 16-wk intervention. All groups lost body weight, fat mass (FM), and abdominal fat; however, PRISE lost significantly (P < 0.01) more body weight (3.3 ± 0.7 vs. 1.1 ± 0.7 kg, P + RT) and FM (2.8 ± 0.7 vs. 0.9 ± 0.5 kg, P + RT) and gained (P < 0.05) a greater percentage of lean body mass (2 ± 0.5 vs. 0.9 ± 0.3 and 0.6 ± 0.4%, P + RT and P, respectively). Only P + RT (0.1 ± 0.04 kg) and PRISE (0.21 ± 0.07 kg) lost VAT mass (P < 0.05). Fasting glucose decreased only in P + RT (5.1 ± 2.5 mg/dl) and PRISE (15.3 ± 2.1 mg/dl), with the greatest decline occurring in PRISE (P < 0.05). Similarly, HOMA-IR improved (0.6 ± 0.3, 0.6 ± 0.4 units), and leptin decreased (4.7 ± 2.2, 4.7 ± 3.1 ng/dl), and adiponectin increased (3.8 ± 1.1, 2.4 ± 1.1 μg/ml) only in P + RT and PRISE, respectively, with no change in P. In conclusion, we find evidence to support exercise training and timed ingestion of whey protein added to the habitual diet of free-living overweight/obese adults, independent of caloric restriction on total and regional body fat distribution, insulin resistance, and adipokines.
  • Comprehensive Approach to Lower Blood Pressure (CALM-BP): a randomized controlled trial of a multifactorial lifestyle intervention.
    Journal of human hypertension. 2013;(10):594-600

    Plain language summary

    Blood pressure (BP) is influenced by nutritional, physical and psychosocial factors. The aim of this study was to compare the effect of a Comprehensive Approach to Lower Blood Pressure (CALM-BP) with the standard recommended Dietary Approach to Stop Hypertension (DASH) diet plus exercise on BP, medication use and cardiovascular risk factors. Study participants were adults with high BP being treated with at least one BP-lowering drug. Measures given to the CALM-BP group included a low-fat diet based on wholegrain rice, walking, yoga, relaxation and stress management. Those in the DASH group received a diet in line with that promoted by the US Department of Health and Human Services, plus walking. The interventions lasted for 16 weeks, and this was followed by a 6-month maintenance period. Normal BP readings were achieved by 71% of participants in the CALM-BP group compared with 33% in the DASH group. Medication was reduced in 70% of the CALM-BP group and 31% of the DASH group. Participants in the CALM-BP group reduced their BP by an average of 4.33/3.07 mm Hg compared with 4.0/1.9 mm Hg in the DASH group. After 6 months, only patients in the CALM-BP group had reduced their BMI and cholesterol and improved their quality of life scores. The authors concluded that lifestyle and diet modifications are highly effective with respect to BP control, medication use and cardiovascular risk factors.

    Abstract

    Complementary medicine advocates the use of a multifactorial approach to address the varied aspects of hypertension. The aim of this study was to compare the blood pressure (BP) effect and medication use of a novel Comprehensive Approach to Lowering Measured Blood Pressure (CALM-BP), based on complementary medicine principles, with the standard recommended Dietary Approach to Stop Hypertension (DASH). A total of 113 patients treated with antihypertensive drugs were randomly assigned to either CALM-BP treatment (consisting of rice diet, walks, yoga, relaxation and stress management) or to a DASH+exercise control group (consisting of DASH and walks). Ambulatory 24-h and home BP were monitored over a 16-week programme, followed by 6 months of maintenance period. Medications were reduced if systolic BP dropped below 110 mm Hg accompanied by symptoms. In addition to BP reduction, medications were reduced because of symptomatic hypotension in 70.7% of the CALM-BP group compared with 32.7% in the DASH group, P<0.0001. After 6 months, medication status was not altered in the majority of individuals. Significant reductions in body mass index, cholesterol and improved quality-of-life scores were observed only in the CALM-BP group. Lifestyle and diet modifications based on complementary medicine principles are highly effective with respect to BP control, medication use and cardiovascular risk factors.
  • Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
    The New England journal of medicine. 2013;(2):145-54

    Plain language summary

    Weight loss is recommended for overweight or obese patients with type 2 diabetes as it increases glycaemic control, reduces risk factors of cardiovascular disease and improves overall quality of life. These benefits, however, are based on short-term studies and the long-term effects of weight loss in this population have not been examined. The aim of this randomised trial was to elucidate whether an intensive lifestyle intervention of weight loss and increased physical activity would decrease cardiovascular morbidity and mortality in overweight or obese adults with type 2 diabetes. Participants were either assigned to an intervention group receiving diet and exercise counselling, or a control group receiving diabetes support and education. A total of 5145 patients were enrolled in the study and the median follow-up was nearly 10 years. The findings of this study showed that an intensive lifestyle intervention did not reduce the risk of cardiovascular morbidity and mortality, as compared with a control programme of diabetes support and education, among overweight and obese patients. While this primary outcome was not reduced, participants in the intervention group experienced various clinically beneficial outcomes throughout the follow-up period.

    Abstract

    BACKGROUND Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).
  • A comparative controlled trial comparing the effects of yoga and walking for overweight and obese adults.
    Medical science monitor : international medical journal of experimental and clinical research. 2014;:894-904

    Plain language summary

    Walking and yoga are types of exercise that may be useful for weight loss. The aim of this study was to compare the effects of yoga and walking on the biochemistry, body composition, balance and strength in overweight people. 68 Indian adults aged who were overweight or obese were allocated to either yoga or walking twice a day for 15 days. Both groups were given the same plant-based diet providing 1,650 kcal/day Both groups showed similar and significant decreases in body mass index (BMI), waist and hip circumference, lean mass, body water and total cholesterol over the 15 days. The yoga group increased serum leptin and decreased LDL cholesterol. The walking group decreased serum adiponectin and triglycerides. Since there was no control group, it was not possible to attribute the changes to the yoga or walking, rather than the diet. The authors concluded that both yoga and walking improved anthropometric variables and serum lipid profile in overweight and obese people, and that these interventions may be useful in treating obesity.

    Abstract

    BACKGROUND Walking and yoga have been independently evaluated for weight control; however, there are very few studies comparing the 2 with randomization. MATERIAL AND METHODS The present study compared the effects of 90 minutes/day for 15 days of supervised yoga or supervised walking on: (i) related biochemistry, (ii) anthropometric variables, (iii) body composition, (iv) postural stability, and (v) bilateral hand grip strength in overweight and obese persons. Sixty-eight participants, of whom 5 were overweight (BMI ≥25 kg/m2) and 63 were obese (BMI ≥30 kg/m2; group mean age ±S.D., 36.4±11.2 years; 35 females), were randomized as 2 groups - (i) a yoga group and (ii) a walking group - given the same diet. RESULTS All differences were pre-post changes within each group. Both groups showed a significant (p<0.05; repeated measures ANOVA, post-hoc analyses) decrease in: BMI, waist circumference, hip circumference, lean mass, body water, and total cholesterol. The yoga group increased serum leptin (p<0.01) and decreased LDL cholesterol (p<0.05). The walking group decreased serum adiponectin (p<0.05) and triglycerides (p<0.05). CONCLUSIONS Both yoga and walking improved anthropometric variables and serum lipid profile in overweight and obese persons. The possible implications are discussed.
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