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Effects of Morning Vs. Evening exercise on appetite, energy intake, performance and metabolism, in lean males and females.
Mode, WJA, Slater, T, Pinkney, MG, Hough, J, James, RM, Varley, I, James, LJ, Clayton, DJ
Appetite. 2023;182:106422
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Long-term weight management is notoriously difficult, with many people experiencing progressive weight gain throughout adult life. The aim of this study was to assess the acute effects of morning and evening cycling exercise on appetite, post-exercise ad-libitum energy intake, substrate metabolism, voluntary performance, and subjective responses to exercise, in young, healthy males and females. Sixteen healthy participants (eight males and eight females) were recruited to the study. Each participant completed two preliminary trials, followed by two experimental trials which involved exercising at 10:30 or 18:30. Results show that: - post-exercise energy intake was greater after acute cycling exercise performed in the evening compared to the morning, despite no post-exercise differences in subjective appetite. - there wasn’t any difference in exercise performance between morning and evening exercise. - exercise timing did not affect performance during a 15-min all-out performance test. Authors conclude that their findings demonstrate a disconnect between subjective appetite and ad-libitum energy intake but provide some evidence that exercise can offset circadian-related appetite profiles.
Abstract
Exercise is an important component of a weight management strategy. However, little is known about whether circadian variations in physiological and behavioural processes can influence the appetite and energy balance responses to exercise performed at different times of the day. This study compared the effects of morning and evening exercise on appetite, post-exercise energy intake, and voluntary performance. In randomised, counterbalanced order, 16 healthy males and females (n = 8 each) completed two trials, performing morning exercise at 10:30 (AMEx) or evening exercise at 18:30 (PMEx). Exercise consisted of 30 min steady-state cycling (60% V˙ O2peak), and a 15-min performance test. A standardised meal (543 ± 86 kcal) was consumed 2-h before exercise and ad-libitum energy intake was assessed 15 min after exercise, with subjective appetite measured throughout. Absolute ad-libitum energy intake was 152 ± 126 kcal greater during PMEx (P < 0.001), but there was no differences in subjective appetite between trials immediately pre-exercise, or immediately before the post-exercise meal (P ≥ 0.060). Resting energy expenditure (P < 0.01) and carbohydrate oxidation (P < 0.05) were greater during AMEx, but there were no differences in substrate oxidation or energy expenditure during exercise (P ≥ 0.155). Exercise performance was not different between trials (P = 0.628). In conclusion, acute morning and evening exercise prompt similar appetite responses, but post-exercise ad-libitum energy intake is greater following evening exercise. These findings demonstrate discordant responses between subjective appetite and ad-libitum energy intake but suggest that exercise might offset circadian variations in appetite. Longer-term studies are required to determine how exercise timing affects adherence and weight management outcomes to exercise interventions. TRIAL REGISTRATION NCT04742530, February 8, 2021.
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Effect of Targeted vs. Standard Fortification of Breast Milk on Growth and Development of Preterm Infants (≤32 Weeks): Results from an Interrupted Randomized Controlled Trial.
Seliga-Siwecka, J, Fiałkowska, J, Chmielewska, A
Nutrients. 2023;15(3)
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Preterm birth results in a high risk of mortality and is a cause of several morbidities, including extrauterine growth restriction. Despite numerous proven benefits, the concentration of some nutrients in human milk may be too low to meet the high nutritional needs of premature infants. Thus, to ensure optimal growth and development, human milk fortification is recommended for all very low birth weight babies. The primary aim of this study was to determine whether tailored compared to the standard fortification of enteral nutrition improved weight gain velocity in preterm infants born at ≤32 weeks of gestation. This study is a randomised observer- and patient-blinded controlled multicentre superiority trial, with two parallel groups with a 1:1 allocation ratio. Due to shortage of staff, two out of three centres failed to randomise patients. Patients were assigned to standard or tailored enteral nutrition fortification groups. Results show that there is no statistically significant difference in the velocity of weight gain during the supplementation period in infants born before 32 weeks of gestation who received targeted fortification compared to those who received standard fortification. Changes in length and head circumference did not differ between the groups. Authors conclude that targeted milk modification is a strategy that may allow for the optimisation of growth in premature infants; however, feasibility and poor tolerance of feeds may be important obstacles in introducing this strategy to neonatal intensive care unit clinical practice.
Abstract
Human milk is recommended for very low birth weight infants. Their nutritional needs are high, and the fortification of human milk is a standard procedure to optimize growth. Targeted fortification accounts for the variability in human milk composition. It has been a promising alternative to standard fixed-dose fortification, potentially improving short-term growth. In this trial, preterm infants (≤32 weeks of gestation) were randomized to receive human milk after standard fortification (HMF, Nutricia) or tailored fortification with modular components of proteins (Bebilon Bialko, Nutricia), carbohydrates (Polycal, Nutricia), and lipids (Calogen, Nutricia). The intervention started when preterms reached 80 mL/kg/day enteral feeds. Of the target number of 220 newborns, 39 were randomized. The trial was interrupted due to serious intolerance in five cases. There was no significant difference in velocity of weight gain during the supplementation period (primary outcome) in the tailored vs. standard fortification group: 27.01 ± 10.19 g/d vs. 25.84 ± 13.45 g/d, p = 0.0776. Length and head circumference were not significantly different between the groups. We found the feasibility of targeted fortification to be limited in neonatal intensive care unit practice. The trial was registered at clinicaltrials.gov NCT:03775785.
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The effect of a preconception and antenatal nutritional supplement on children's BMI and weight gain over the first 2 years of life: findings from the NiPPeR randomised controlled trial.
Lyons-Reid, J, Derraik, JGB, Kenealy, T, Albert, BB, Nieves, JMR, Monnard, CR, Titcombe, P, Nield, H, Barton, SJ, El-Heis, S, et al
The Lancet. Global health. 2023;11 Suppl 1:S11-S12
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Rapid weight gain in infancy is associated with future adverse metabolic health. Nutrition intervention before and during pregnancy may promote healthy weight gain in infants, however evidence is lacking. The purpose of this study was to see whether preconception and antenatal supplementation effects the size and growth of children from birth until 2 years of age. 1729 women were recruited for the study and divided into two groups. The intervention group took myo-inositol, probiotics and additional micronutrients, the control group took a standard micronutrient supplement. Measurements of weight and length were obtained from 576 children at multiple intervals during the first 2 years of life. Differences in age and sex standardised BMI at age 2 years (WHO standards) and the change in weight from birth were examined. The results show that the infants where the mother took the intervention supplement before and throughout pregnancy had a lower risk of rapid weight gain and high BMI at age 2 years. Long-term follow-up is required to assess the longevity of these benefits.
Abstract
BACKGROUND Nutritional intervention before and throughout pregnancy might promote healthy infant weight gain; however, clinical evidence is scarce. Therefore, we examined whether preconception and antenatal supplementation would affect the body size and growth of children in the first 2 years of life. METHODS Women were recruited from the community before conception in the UK, Singapore, and New Zealand, and randomly allocated to either the intervention (myo-inositol, probiotics, and additional micronutrients) or control group (standard micronutrient supplement) with stratification by site and ethnicity. Measurements of weight and length were obtained from 576 children at multiple timepoints in the first 2 years of life. Differences in age and sex standardised BMI at age 2 years (WHO standards) and the change in weight from birth were examined. Written informed consent was obtained from the mothers, and ethics approval was granted by local committees. The NiPPeR trial was registered with ClinicalTrials.gov (NCT02509988) on July 16, 2015 (Universal Trial Number U1111-1171-8056). FINDINGS 1729 women were recruited between Aug 3, 2015, and May 31, 2017. Of the women randomised, 586 had births at 24 weeks or more of gestation between April, 2016, and January, 2019. At age 2 years, adjusting for study site, infant sex, parity, maternal smoking, maternal prepregnancy BMI, and gestational age, fewer children of mothers who received the intervention had a BMI of more than the 95th percentile (22 [9%] of 239 vs 44 [18%] of 245, adjusted risk ratio 0·51, 95% CI 0·31-0·82, p=0·006). Longitudinal data revealed that the children of mothers who received the intervention had a 24% reduced risk of experiencing rapid weight gain of more than 0·67 SD in the first year of life (58 [21·9%] of 265 vs 80 [31·1%] of 257, adjusted risk ratio 0·76, 95% CI 0·58-1·00, p=0·047). Risk was likewise decreased for sustained weight gain of more than 1·34 SD in the first 2 years (19 [7·7%] of 246 vs 43 [17·1%] of 251, adjusted risk ratio 0·55, 95% CI 0·34-0·88, p=0·014). INTERPRETATION Rapid weight gain in infancy is associated with future adverse metabolic health. The intervention supplement taken before and throughout pregnancy was associated with lower risk of rapid weight gain and high BMI at age 2 years among children. Long-term follow-up is required to assess the longevity of these benefits. FUNDING National Institute for Health Research; New Zealand Ministry of Business, Innovation and Employment; Société Des Produits Nestlé; UK Medical Research Council; Singapore National Research Foundation; National University of Singapore and the Agency of Science, Technology and Research; and Gravida.
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Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial.
Sartorelli, DS, Crivellenti, LC, Baroni, NF, de Andrade Miranda, DEG, da Silva Santos, I, Carvalho, MR, de Lima, MC, Carreira, NP, Chaves, AVL, Manochio-Pina, MG, et al
European journal of nutrition. 2023;62(1):443-454
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Excessive gestational weight gain exposes the woman and the child to a higher risk of harmful health outcomes in the short and long term. Dietary patterns based on the substitution of meals made with unprocessed or minimally processed foods for the consumption of ultra-processed items can be partly blamed for the exponential global growth in the incidence of obesity. The main aim of this study was to evaluate the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products. This study is a two-armed parallel randomised controlled trial conducted among overweight, pregnant women receiving prenatal care in seven primary health units. Participants (n=350) were randomly allocated into the intervention group (IG) or control group (CG). The women allocated into the IG, in addition to the usual prenatal care, were invited to participate in three individualised nutritional counselling sessions conducted by trained nutritionists. Results show that even though there were more women in the IG who had increased their daily intake of minimally processed foods and vegetables at lunch time when compared to the CG, this was not statistically significant. Additionally, there weren’t any differences between the groups in relation to physical activity. Authors conclude that their study was unprecedented in demonstrating that a nutritional counselling intervention based on the NOVA food classification system, together with the practice of physical activity, is effective in preventing excessive gestational weight gain in overweight pregnant women.
Abstract
PURPOSE This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women. METHODS This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed. RESULTS Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated. CONCLUSION The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women. TRIAL REGISTRATION Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).
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HOMEFOOD randomised trial - Six-month nutrition therapy improves quality of life, self-rated health, cognitive function, and depression in older adults after hospital discharge.
Blondal, BS, Geirsdottir, OG, Halldorsson, TI, Beck, AM, Jonsson, PV, Ramel, A
Clinical nutrition ESPEN. 2022;48:74-81
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It is well known that older people are at a higher risk for nutritional inadequacy which is accompanied by depression, impaired cognitive function, and poor overall health. In this secondary analysis of a randomised controlled assessor-blinded dietary intervention trial, the authors examined the effects of six months of nutritional therapy on quality of life, self-rated health, cognitive function, and depression in elderly patients aged 65 years and over. The participants in the intervention group received nutritional therapy (HOMEFOOD) education to overcome malnutrition, which included dietary recommendations to ensure an adequate nutritional intake of energy and protein through diet and additional supplemental protein and energy-rich foods. After six months of nutritional therapy, the intervention group showed improvement in cognitive function, self-rated health, depression score, and quality of life scores, as well as improvements in measures related to weight gain. Further studies need to be conducted in order to determine if nutritional therapy provides additional benefits to older people. However, healthcare professionals can use the results of this study to better understand how nutritional therapy can improve the quality of life and health of older people in comparison to standard care, so they can better advise their patients.
Abstract
BACKGROUND AND AIMS Malnutrition is common among older adults and is related to quality of life, cognitive function, and depression. To what extent nutrition interventions can improve these outcomes remains unclear. The aim of this study was to investigate the effect of nutrition therapy on health-related quality of life (EQ-5D), self-rated health, cognitive function, and depression in community dwelling older adults recently discharged from hospital. METHODS Participants (>65 years) were randomised into an intervention (n = 53) and a control group (n = 53). The intervention group received individualised nutrition therapy based on the nutrition care process including 5 home visits and 3 phone calls, in combination with freely delivered energy- and protein-rich foods and oral nutrition supplements for six months after hospital discharge. EQ-5D, self-rated health, Mini-Mental-State-Examination (MMSE), and the Centre for Epidemiologic Studies Depression - IOWA (CES-D) scale were measured at baseline and at endpoint. RESULTS Two subjects dropped out, one from each arm. The control group experienced an increase in depressive symptoms and a decrease in self-rated health during the study period, while the intervention group experienced increases in cognitive function, self-rated health, and EQ-5D resulting in significant endpoint differences between the groups: EQ-5D (0.102, P = 0.001); self-rated health: 15.876 (P < 0.001); MMSE 1.701 (P < 0.001); depressive symptoms: - 3.072 (P < 0.001); all in favour of the intervention group. Improvements during the intervention in MMSE, self-rated health, and CES-D were significantly related to body weight gain in a linear way. CONCLUSION Cognitive function and mental well-being worsen or stagnate in older adults who receive standard care after hospital discharge. However, a six-month nutrition therapy improves these outcomes leading to statistically and clinically significant endpoint differences between the groups. As improvements were related to body weight gain after hospital discharge, we conclude that the increase in dietary intake, with focus on energy and protein density, and changes in body weight might have contributed to better cognitive function and mental well-being in older adults after the intervention.