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Nutrition and Exercise Interventions to Improve Body Composition for Persons with Overweight or Obesity Near Retirement Age: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
Eglseer, D, Traxler, M, Embacher, S, Reiter, L, Schoufour, JD, Weijs, PJM, Voortman, T, Boirie, Y, Cruz-Jentoft, A, Bauer, S
Advances in nutrition (Bethesda, Md.). 2023;14(3):516-538
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Obesity is characterised by excessive fat accumulation that often occurs during the process of aging. Aging is accompanied not only by a gradual increase in body fat stores but also a decrease in muscle mass, muscle function, and water retention. The aim of this study was to assess which nutrition and exercise interventions are most effective for improving the body composition (fat mass and muscle mass), body mass index, and waist circumference in persons with overweight or obesity near retirement age (55 to 70 years of age). This study was a systematic review and network meta-analysis (NMA) of randomised controlled trials of sixty-six studies. Results of the NMA showed that the most effective strategy to improve body composition, i.e., losing fat without increasing risk of sarcopenia in persons with obesity around retirement age, was combining energy restriction with resistance training or with mixed exercise (resistance combined with aerobic exercise) and/or high-protein intake. In fact, without training, an energy-restricted diet with or without added protein helped individuals lose fat mass but also tended to result in losses of muscle mass. Authors conclude that an energy-restricted diet alone probably contributes to the development of sarcopenic obesity in persons of retirement age. Thus, to simultaneously lose weight and maintain muscle mass, authors recommend a combination of energy restriction and resistance training.
Abstract
The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI), and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70 y). We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials, searching 4 databases from their inception up to July 12, 2022. The NMA was based on a random effects model, pooled mean differences, standardized mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. Ninety-two studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e., 500-1000 kcal), energy restriction plus high-protein intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training, aerobic training, high protein plus resistance training, energy restriction plus high protein plus exercise, energy restriction plus resistance training, energy restriction plus aerobic training, and energy restriction plus mixed exercise. Intervention durations ranged from 8 wk to 6 mo. Body fat was reduced with energy restriction plus any exercise or plus high-protein intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with mixed exercise. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except aerobic training/resistance training alone or resistance training plus high protein. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with resistance training or mixed exercise and high protein. Health care professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/ as CRD42021276465.
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Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-analysis.
Rousham, EK, Goudet, S, Markey, O, Griffiths, P, Boxer, B, Carroll, C, Petherick, ES, Pradeilles, R
Advances in nutrition (Bethesda, Md.). 2022
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Infants and children are consuming increasing amounts of foods with added sugars, high in salt, and high in saturated or trans fats. Commercially prepared foods are more likely to be high in energy, low in nutrients (energy dense, nutrient-poor), and ultra-processed. The aim of this study was to examine, in children aged ≤10.9 y, the risks of greater consumption of unhealthy foods and beverages compared with no or low consumption on overweight and obesity. This study is a systematic review and meta-analysis which included the summarized characterises of 71 articles from 60 included studies. Results indicate that in children aged ≤10.9 years, consumption of sugar-sweetened beverages and unhealthy foods may increase body mass index, percentage body fat, or the odds of overweight/obesity (low to very-low certainty). Furthermore, there was little or no difference to body mass index, percentage body fat, or overweight/obesity outcomes (low certainty) after consumption of artificially sweetened beverages and 100% fruit juices. Authors conclude that policy recommendations are needed to address the growing burden of overweight and obesity that children are experiencing worldwide.
Abstract
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs); non-RCTs; cohort studies and pre/post studies with control; 2) participants ≤ 10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages vs. no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥ 1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I and RoB2 tools for non-randomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using GRADE. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSB) and unhealthy foods in childhood may increase body mass index (BMI)/BMI z-score, % body fat or odds of overweight/obesity (low certainty of evidence). Artificially-sweetened beverages and 100% fruit juice consumption may make little/no difference to BMI, % body fat or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and % body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.
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A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms.
Marino, M, Puppo, F, Del Bo', C, Vinelli, V, Riso, P, Porrini, M, Martini, D
Nutrients. 2021;13(8)
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The demand for food items with longer shelf-life and improved palatability has led to other natural or artificial ingredients being added to processed foods, which may, to some extent, impact the nutritional quality of these foods, which are often characterized by high sugar, fat, and salt contents. The aim of this study was to investigate the actual level of consumption of ultra-processed food (UPF) across countries and target populations to determine the impact in real contexts. This study is a review of 99 unique studies with a total of 1,378,454 subjects. Results showed high levels of UPF consumption, especially in some countries and in specific target groups (i.e., children and adolescents). Even though several studies reported a positive association between UPF and obesity and cardiometabolic health, findings do not show such a clear-cut association. Authors conclude that since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status.
Abstract
A debate is ongoing on the significance and appropriateness of the NOVA classification as a tool for categorizing foods based on their degree of processing. As such, the role of ultra-processed food (UPF) on human health is still not completely understood. With this review, we aimed to investigate the actual level of consumption of UPF across countries and target populations to determine the impact in real contexts. Suitable articles published up to March 2021 were sourced through the PubMed and SCOPUS databases. Overall, 99 studies providing data on the level of UPF consumption expressed as the percentage of total energy intake were identified, for a total of 1,378,454 participants. Most of them were published in Brazil (n = 38) and the United States (n = 15), and the 24 h recall was the most-used tool (n = 63). Analysis of the results revealed that the United States and the United Kingdom were the countries with the highest percent energy intake from UPF (generally >50%), whereas Italy had the lowest levels (about 10%); the latter was inversely associated with adherence to the Mediterranean diet. High variability was also observed based on sex, age, and body mass index, with men, young people, and overweight/obese subjects generally having higher levels of consumption compared to older subjects. Overall, our findings underline the large differences in UPF intake. Since most of the observations derived from studies conducted with food questionnaires are not specifically validated for UPF, further efforts are essential to confirm the results previously obtained and to investigate further the association between UPF consumption and health status, also considering the actual contribution within different dietary patterns, which has been less investigated to date.
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Nutrition in Menopausal Women: A Narrative Review.
Silva, TR, Oppermann, K, Reis, FM, Spritzer, PM
Nutrients. 2021;13(7)
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Menopause is the permanent cessation of menstrual cycles following the loss of ovarian follicular activity. It is associated with increased prevalence of obesity, metabolic syndrome, cardiovascular disease, and osteoporosis. The aim of this narrative review was to discuss the current evidence on the association between dietary patterns and clinical endpoints in postmenopausal women (body composition, bone mass, and risk markers for cardiovascular disease), and thereby providing novel insight into the establishment of optimal dietary guidelines for healthy postmenopausal period. Research shows that: - the changes in weight and fat distribution in women are associated with aging and mainly with the decrease in oestradiol levels during peri- and post-menopause. - calcium, vitamin D, vitamin K, selenium, magnesium, and beta-carotene adequate intake could be linked with better BMD in postmenopausal women. - diet is a major modifiable risk factor for cardiovascular disease and could be a powerful intervention to reduce cardiovascular risks in postmenopausal women. - the Mediterranean diet is composed of healthy foods that have anti-inflammatory and antioxidant properties. Authors indicate that future studies evaluating the effects of low-fat, plant-based diets on fat mass in post-menopausal women are needed.
Abstract
Among the various aspects of health promotion and lifestyle adaptation to the postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life. In this narrative review, we discuss the current evidence on the association between dietary patterns and clinical endpoints in postmenopausal women, such as body composition, bone mass, and risk markers for cardiovascular disease. Current evidence suggests that low-fat, plant-based diets are associated with beneficial effects on body composition, but further studies are needed to confirm these results in postmenopausal women. The Mediterranean diet pattern along with other healthy habits may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period. It consists on the use of healthy foods that have anti-inflammatory and antioxidant properties, and is associated with a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels. These effects remain to be evaluated over a longer period of time, with the assessment of hard outcomes such as bone fractures, diabetes, and coronary ischemia.
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Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations.
Zamir, A, Ben-Zeev, T, Hoffman, JR
Nutrients. 2021;13(10)
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Androgens, like testosterone, are steroid hormones commonly associated with reproduction. However, they also govern metabolic functions, body composition and growth. Higher levels of circulating androgens enhance athletic performance by supporting metabolic activities such as protein production, regeneration and growth and by inhibiting breakdown processes. Manipulating testosterone to enhance athletic performance without the use of anabolic steroids hormones has been of much interest. As macro-and micronutrients can influence androgen hormones, this review examined whether specific energy and nutrient intake can ‘naturally’ manipulate testosterone levels. The authors describe the metabolic functions of testosterone before exploring the current evidence on selected plant extracts and nutrients and their impact on aromatase activity. Inhibiting aromatase can prevent androgens from being converted into oestrogen and thus may help to raise circulating androgens. Discussed are a range of plant-derived compounds, flavonoids, macronutrients and micronutrients (Vitamin D, Zinc and Magnesium) and their impact on testosterone levels. The authors conclude that the nutrients discussed have some supportive evidence, yet overall findings are inconclusive due to limited studies. Regarding macronutrients more research is available, and the evidence supports that low energy intake negatively impacts testosterone levels and performance. Whereby supplementation of vitamins crucial to testosterone production seems to provide value in cases of deficiency further research is required. This article yields an overview of plant compounds, macro-and micronutrients and their potential impact on circulating testosterone levels. While low energy intake and nutrient deficiencies appears to be unfavourable, the absence of clear evidence on other compounds would warrant further case-specific investigations.
Abstract
Elevations in the circulating concentration of androgens are thought to have a positive effect on the anabolic processes leading to improved athletic performance. Anabolic-androgenic steroids have often been used by competitive athletes to augment this effect. Although there has been concerted effort on examining how manipulating training variables (e.g., intensity and volume of training) can influence the androgen response to exercise, there has been much less effort directed at understanding how changes in both macronutrient and micronutrient intake can impact the androgen response. Thus, the focus of this review is to examine the effect that manipulating energy and nutrient intake has on circulating concentrations of testosterone and what the potential mechanism is governing these changes.
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Personalised nutrition advice reduces intake of discretionary foods and beverages: findings from the Food4Me randomised controlled trial.
Livingstone, KM, Celis-Morales, C, Navas-Carretero, S, San-Cristobal, R, Forster, H, Woolhead, C, O'Donovan, CB, Moschonis, G, Manios, Y, Traczyk, I, et al
The international journal of behavioral nutrition and physical activity. 2021;18(1):70
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Food4Me is an internet-based personalised nutrition study that evaluates the effectiveness of personalized dietary advice in avoiding discretionary foods compared to conventional advice. In different countries, discretionary foods are classified differently. Therefore, this study included two measures of discretionary foods identified by the Food4Me Food Frequency Questionnaire, which covered 22 discretionary foods classified by Food Standards Scotland and 59 discretionary foods identified by Australian Dietary Guidelines. For six months, 1607 participants from seven European countries were randomly assigned to receive generalised dietary advice or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Personalised nutrition advice was found to be effective in reducing discretionary foods when categorisation included foods high in fat, added sugar and salt. There was a greater reduction in energy, sugar, salt, and saturated fat intakes in people who received personalised nutrition advice [L1-3] as compared to generalised dietary advice after six months. Results of this study can be used by healthcare professionals to support personalised nutrition strategies in the general population targeting discretionary foods to increase compliance with personalised nutrition strategies and achieve better health outcomes.
Abstract
BACKGROUND The effect of personalised nutrition advice on discretionary foods intake is unknown. To date, two national classifications for discretionary foods have been derived. This study examined changes in intake of discretionary foods and beverages following a personalised nutrition intervention using these two classifications. METHODS Participants were recruited into a 6-month RCT across seven European countries (Food4Me) and were randomised to receive generalised dietary advice (control) or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Dietary intake was derived from an FFQ. An analysis of covariance was used to determine intervention effects at month 6 between personalised nutrition (overall and by levels) and control on i) percentage energy from discretionary items and ii) percentage contribution of total fat, SFA, total sugars and salt to discretionary intake, defined by Food Standards Scotland (FSS) and Australian Dietary Guidelines (ADG) classifications. RESULTS Of the 1607 adults at baseline, n = 1270 (57% female) completed the intervention. Percentage sugars from FSS discretionary items was lower in personalised nutrition vs control (19.0 ± 0.37 vs 21.1 ± 0.65; P = 0.005). Percentage energy (31.2 ± 0.59 vs 32.7 ± 0.59; P = 0.031), percentage total fat (31.5 ± 0.37 vs 33.3 ± 0.65; P = 0.021), SFA (36.0 ± 0.43 vs 37.8 ± 0.75; P = 0.034) and sugars (31.7 ± 0.44 vs 34.7 ± 0.78; P < 0.001) from ADG discretionary items were lower in personalised nutrition vs control. There were greater reductions in ADG percentage energy and percentage total fat, SFA and salt for those randomised to L3 vs L2. CONCLUSIONS Compared with generalised dietary advice, personalised nutrition advice achieved greater reductions in discretionary foods intake when the classification included all foods high in fat, added sugars and salt. Future personalised nutrition approaches may be used to target intake of discretionary foods. TRIAL REGISTRATION Clinicaltrials.gov NCT01530139 . Registered 9 February 2012.
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Effects of oral nutrition supplements in persons with dementia: A systematic review.
Tangvik, RJ, Bruvik, FK, Drageset, J, Kyte, K, Hunskår, I
Geriatric nursing (New York, N.Y.). 2021;42(1):117-123
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Dementia is a chronic condition characterised as a decline in cognitive functioning that leads to dependence in the performance of daily activities, including nutritional sufficiency. As the dis-ease progresses, eating and drinking may become more difficult. The aim of this study was to investigate the effects of oral nutrition supplements (ONS) on nutritional intake and clinical outcomes in older persons with dementia. This study is a systemic review which included ten studies of which 9 where experimental studies (n=6 RCTs; n=3 non RCTs) based on patients with dementia who were undernourished. Results indicate that ONS improved daily intake of energy and protein, compliance was high, and more persons met the recommended nutrition intake. In fact, intervention with ONS improved nutritional status; however, no effects on cognitive or functional outcomes were reported. Authors conclude that there is the need for a more comprehensive intervention plan for people with cognitive impairments that addresses the individual nutritional challenges in order to systematically meet nutritional needs.
Abstract
OBJECTIVE Persons with dementia are at risk of malnutrition, evidenced by low dietary intake, which has consequences for nutritional status, activity of daily living and disease progression. The effects of oral nutrition supplements (ONS) on nutritional intake, nutritional status, and cognitive and physical outcomes in older persons with dementia were evaluated. METHODS PubMed, Medline, Embase, CINAHL and the Cochrane Central Register of Controlled Trials were searched in December 2017, and this was repeated in May 2019. The Preferred Reporting Items for Systematic Reviews and Analysis (PRISMA) checklist was used. Papers were considered if they presented experimental clinical trials using oral nutritional supplements to persons diagnosed with dementia, including Alzheimer's disease and mild cognitive impairment, and conducted in hospitals, nursing homes or homes. RESULTS We included ten articles reporting nine clinical trials. A total of 407 persons with dementia were included, of whom 228 used ONS for 7 to 180 days. Nutritional intake improved by 201 to 600 kcal/day. Energy intake from ordinary foods was not affected, thus ONS improved the persons daily intake of energy and protein. Body weight, muscle mass, and nutritional biomarkers in blood improved in the intervention groups compared with the control groups. No effects on cognition or physical outcomes were observed. CONCLUSION ONS increases the intake of energy and protein and improves nutritional status in persons with dementia; however, RCTs with longer intervention periods are needed to investigate the impact on cognitive and functional outcomes.
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Vegetarian and Vegan Diet in Fibromyalgia: A Systematic Review.
Nadal-Nicolás, Y, Miralles-Amorós, L, Martínez-Olcina, M, Sánchez-Ortega, M, Mora, J, Martínez-Rodríguez, A
International journal of environmental research and public health. 2021;18(9)
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Fibromyalgia (FM) is a chronic non-degenerative disease of unknown etiology without effective medical treatment that mostly affects women. The aim of this study was to evaluate the efficacy of mainly plant-based diets in patients with FM compared to omnivorous diets. A secondary aim was to examine the main effects of these diets on patients’ symptoms and the improvement in their quality of life. This study is a systemic review of six studies (n = 4 clinical trials and n = 2 observational cohort studies). The selected studies included 157 FM patients in both the intervention and control groups, and more than 117 were women. Results indicate that a mainly plant-based diet improves biochemical parameters and body inflammation; body weight, sleep quality, quality of life, pain at rest as well as other symptoms of FM and their impact on health. Authors conclude that even though their findings are promising further well-designed clinical trials are needed to consolidate these dietary recommendations in FM patient.
Abstract
Fibromyalgia (FM) is a chronic non-degenerative disease characterized by the presence of multiple symptoms such as chronic pain, which negatively influence the quality of life of sufferers, most of whom are women. Currently, there is no effective treatment to limit the impact of these symptoms. The aim of this research is to review the scientific evidence on the effect of following a vegetarian or vegan diet on fibromyalgia patients. A systematic review included the original articles that answered the research question. These articles were in 2021 in the PubMed, Web of Science and Scopus databases. The research used the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. No time restriction was applied, and grey literature was not included. The evaluation of the methodological quality of the articles was carried out using the following different scales: STROBE (strengthening the reporting of observational studies in epidemiology), PEDro (Physiotherapy Evidence Database), and MMAT (Mixed Methods Appraisal Tool) scales. A total of 88 studies were analyzed, of which 6 investigations were included in this systematic review (n = 4 clinical trials and n = 2 cohort studies). These investigations show significant improvements in biochemical parameters, quality of life, quality of sleep, pain at rest and general health status when following mainly plant-based dietary patterns. In conclusion, these findings are promising but interpretation of the findings is limited due to the methodological quality of the studies. Well-designed clinical trials are needed to consolidate these dietary recommendations in FM patients.
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Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial.
Cho, SMJ, Lee, JH, Shim, JS, Yeom, H, Lee, SJ, Jeon, YW, Kim, HC
Journal of medical Internet research. 2020;22(10):e17435
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Metabolic disorders are established precursors to cardiovascular disease. The aim of the study was to evaluate the longitudinal effect of smartphone-based health care app on metabolic parameters in a sample of the general population with moderate metabolic abnormalities. The study is a single-blind 3-arm parallel-design randomized controlled trial delivering a 6-month primary prevention program via mobile app. One hundred twenty-nine smartphone users, aged between 30-59 years with at least 2 metabolic abnormalities, have been recruited. Results showed that the simultaneous diet/exercise logging and lifestyle coaching yielded greater body weight reduction, specifically via body fat mass reduction. On the other hand, the systolic blood pressure did not change notably between the 3 groups at any follow-up examinations. Authors conclude that future studies focusing on comparative effectiveness using alternative study designs are needed to integrate these apps in everyday lives and clinic practice.
Abstract
BACKGROUND Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. OBJECTIVE We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. METHODS In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. RESULTS Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean -10.95, SD 2.09 mmHg; app only: mean -7.29, SD 1.83 mmHg; app with personalized coaching: mean -7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean -0.12, SD 0.30 kg; app only: mean -0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean -0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean -0.13, SD 0.34 kg; app only: mean -0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean -0.79, SD 0.38 kg; P=.08). CONCLUSIONS Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271.
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Body Composition Changes Following a Very-Low-Calorie Pre-Operative Diet in Patients Undergoing Bariatric Surgery.
Sivakumar, J, Chong, L, Ward, S, Sutherland, TR, Read, M, Hii, MW
Obesity surgery. 2020;30(1):119-126
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Surgery for the treatment of morbid obesity has become a very common intervention due to the increased prevalence of disease and relative ineffective comparative therapies. The aim of this study was to evaluate overall changes in body composition in bariatric surgery patients undergoing a very-low-calorie-diet (VLCD). The study is a prospective analysis on patients who underwent a 2-week period of VLCD prior to bariatric surgery. A total of 60 patients were enrolled. This study demonstrated that although VLCD appears to induce considerable weight loss in a short period of time, the majority of this is attributable to lean body mass (62.2%) rather than fat mass (37.6%). Another notable finding is that greater losses in weight occur largely at the expense of lean body mass rather than fat mass. Authors conclude that a 2-week VLCD is an effective tool for pre-operative weight reduction. However, a large amount of the total weight loss is attributed to a loss of lean body mass.
Abstract
BACKGROUND Fatty liver in obese patients increases the technical difficulty of bariatric surgery. Pre-operative weight loss with a very-low-calorie diet (VLCD) is commonly used to facilitate surgery. Few studies have quantified the systemic effect of rapid pre-operative weight loss on body composition. The objective of this study is to evaluate body composition changes in bariatric surgery patients undergoing a VLCD. METHODS Body composition assessments were performed between August 2017 and January 2019 using dual-energy X-ray absorptiometry immediately before and after a 2-week VLCD at St Vincent's Hospital Melbourne. Data collected prospectively pre- and post-VLCD included total body weight, excess body weight, body mass index (BMI), lean body mass (LBM), fat mass (FM) and bone mineral content (BMC). The pre- and post-operative results were compared. RESULTS Forty-four patients completed both the 2-week VLCD and body composition assessments. Following a 2-week VLCD, patients lost a mean of 4.5 kg (range - 0.3 to 9.5) in a total body weight and 8.8% (range - 0.9 to 17.1) of excess body weight, with a mean reduction in body mass index of 1.6 kg/m2 (range - 0.2 to 3.1). Loss of LBM was 2.8 kg and was significantly greater than loss of FM, 1.7 kg (p < 0.05). BMC changes were insignificant. CONCLUSION A VLCD is an effective tool for pre-operative weight reduction. In this cohort, a large amount of the total weight loss was attributed to a loss of lean body mass. The impact of significant lean body mass loss and its relationship to short- and long-term health outcomes warrants further assessment.