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The impact of Dietary Weight loss, Aerobic Exercise, and Daylong Movement on Social Cognitive Mediators of Long-term Weight loss.
Fanning, J, Nicklas, B, Furlipa, J, Rejeski, WJ
Journal of behavioral medicine. 2023;46(3):499-508
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Obesity in older adults predisposes individuals to physical disability, a host of chronic diseases, and premature mortality. A strong body of evidence indicates that well-designed structured exercise interventions increase older adults’ self-efficacy and satisfaction with their physical functioning, and these are important social cognitive outcomes closely linked with quality of life and health behaviour change. The main aim of this study was to investigate changes in walking self-efficacy and satisfaction after the 6-month intensive phase of the intervention. This study was a secondary analysis of the Empowered with Movement to Prevent Obesity and Weight Regain (EMPOWER) study, which was an 18-month, three-group, single-blind randomised trial. A total of 183 participants were randomly assigned to one of the three treatment arms: weight loss + structured exercise (WL+EX), WL+ sitting less and moving more across the day (SL), or WL+EX+SL. Results showed that: - participants demonstrated improvements in self-efficacy and satisfaction following the 6-month intervention weight loss and physical activity intervention. - participants who received an exercise intervention focused on sustained walking demonstrated significantly better self-efficacy for walking relative to those who did not (WL+SL). - both WL+EX and WL+EX+SL regressed to baseline levels of self-efficacy for walking by month 18, only WL+SL did not significantly decrease self-efficacy scores, sustaining a significant increase over baseline. Authors conclude that programs focused on daylong movement may contribute to improved self-efficacy and satisfaction. Thus, health promotion professionals should demonstrate flexibility in the ways in which physical activity is prescribed for older adults since not everyone resonates with traditional structured exercise.
Abstract
This report contrasts the impact of a dietary weight loss intervention (WL) paired with aerobic exercise (EX) and/or sitting less and moving throughout the day (SL) on self-efficacy for walking (hereafter walking self-efficacy) and satisfaction with physical functioning (hereafter satisfaction). Additional analyses examined dose-response associations between change in weight and changes in these key outcomes. Older adults (N = 112; age = 70.21[Formula: see text]4.43) were randomized to 6 months of WL+EX, WL+SL, or WL+EX+SL followed by a 12-month maintenance period. All groups reported increases in walking self-efficacy at month 6 with greater improvements in WL+EX and WL + EX+SL. Only WL+SL demonstrated improved walking self-efficacy at month 18. All conditions demonstrated improved satisfaction scores at both time points. Changes in walking self-efficacy and satisfaction were negatively associated with change in weight over the 6-month intervention and after the maintenance period. These results support the utility of WL + SL for improving key social cognitive outcomes in aging.
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More Than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis.
Lopez-Leon, S, Wegman-Ostrosky, T, Perelman, C, Sepulveda, R, Rebolledo, P, Cuapio, A, Villapol, S
Research square. 2021
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Symptoms, signs, or abnormal clinical parameters persisting two or more weeks after COVID-19 onset that do not return to a healthy baseline can potentially be considered long-term effects of the disease. The aim of this study was to estimate the incidence of all the symptoms, signs, or abnormal laboratory parameters extending beyond the acute phase of COVID-19 reported to date. This study is a systematic review and meta-analysis of 15 peer-reviewed studies that reported symptoms, signs, or laboratory parameters of patients at a post-COVID-19 stage (assessed two weeks or more after initial symptoms) in cohorts of COVID-19 patients. Results indicate that 80% (95% CI 65–92) of individuals with a confirmed COVID-19 diagnosis continued to have at least one overall effect beyond two weeks following acute infection. In total, 55 effects, including symptoms, signs, and laboratory parameters, were identified, with fatigue, anosmia [partial or complete loss of the sense of smell], lung dysfunction, abnormal chest X-ray/CT scan, and neurological disorders being the most common. Authors conclude that physicians should be aware of the symptoms, signs, and biomarkers present in patients previously affected by COVID-19 to promptly assess, identify and halt long COVID-19 progression, minimize the risk of chronic effects and help re-establish pre-COVID-19 health.
Abstract
Background. COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. Methods . LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1 st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I 2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. Results. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). Conclusions . In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, the severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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Long-term effects of a three-component lifestyle intervention on emotional well-being in women with Polycystic Ovary Syndrome (PCOS): A secondary analysis of a randomized controlled trial.
Jiskoot, G, Dietz de Loos, A, Beerthuizen, A, Timman, R, Busschbach, J, Laven, J
PloS one. 2020;15(6):e0233876
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Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women in their reproductive years. The condition is often associated with higher rates of depression and anxiety, particularly with a Body Mass Index (BMI) of >30. As weight-loss has shown to improve a host of symptoms experienced in PCOS, the authors sought to investigate whether weight-loss would also lead to a reduction in depressive symptoms. This secondary analysis of a longitudinal, randomised trial of 155 women, compared a combined lifestyle intervention of diet advice, eating behaviour, exercise and standardised Cognitive Behaviour Therapy (CBT) to standard advice for weight reduction. Over a 12-months the chosen lifestyle interventions demonstrated a sustained improvement in self-assessed depression scores, though independent of weight-loss. However, weight-loss itself was closely linked with improved body image and self-esteem. Additional monitoring of hormones (androgens, insulin, cortisol) and calculations for insulin sensitivity (HOMA-IR ) did not show any direct link with depressive scores. This study affirms the benefit of integrative lifestyle approaches on emotional well-being in women with PCOS. Practitioners might find it of interest that improvements in emotional well-being can occur independent of weight loss in individuals experiencing depressive symptoms with PCOS.
Abstract
Many women with Polycystic Ovary Syndrome (PCOS) report high depression rates. The relationship between PCOS and these high depression rates is unclear. Two-component lifestyle interventions have revealed short-term effects on depression scores in this group of women. In general, 3-component interventions including diet, exercise, and cognitive behavioral therapy (CBT) are more effective in the long-term to improve emotional well-being. This has not yet been studied in women with PCOS. This study examined the effect of 20 CBT lifestyle (LS) sessions combined with a healthy diet and physical therapy with or without 9 months additional feedback through Short Message Service (SMS) via mobile phone, compared to care as usual (CAU, involving advice to lose weight). In this secondary analysis, 155 women with PCOS and a BMI above 25 kg/m2 were eligible. Depression scores decreased significantly in the LS programme compared to CAU (P = 0.045). In both the LS programme without SMS (P = 0.036) and the LS programme with SMS (P = 0.011) depression scores decreased while no change was observed in CAU (P = 0.875). Self-esteem scores improved significantly in the LS programme compared to CAU (P = 0.027). No differences in body image scores were observed in LS participants compared to CAU (P = 0.087), although body image improved significantly in both the LS without SMS (P = 0.001) and with SMS (P = 0.008) study arms. We found no significant mediating role by androgens in the relationship between LS participants and emotional well-being. Only weight-loss mediated the relationship between LS and self-esteem. To conclude, a three-component lifestyle intervention programme with or without additional SMS resulted in significant improvements in depression and self-esteem compared to CAU, in women with PCOS, obesity, and a wish to achieve a pregnancy. Testosterone, androstenedione, DHEA, insulin, HOMA-IR, and cortisol did not mediate this effect. Weight loss mediated the effects on self-esteem but not on depression and body-image. This suggests that lifestyle treatment independent of weight loss can reduce depression and body-image, but both lifestyle treatment and weight loss can improve self-esteem. Thus, a three-component lifestyle intervention based on CBT could prove successful in improving mood in women with PCOS who are overweight or obese and attempting to become pregnant.
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Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study.
Dambha-Miller, H, Day, AJ, Strelitz, J, Irving, G, Griffin, SJ
Diabetic medicine : a journal of the British Diabetic Association. 2020;37(4):681-688
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Type 2 Diabetes is considered a lifelong condition, but calorie restriction or weight loss can lead to complete remission. Patients newly diagnosed with Type 2 Diabetic may benefit from behavioural change over the long run. When Type 2 Diabetes is diagnosed early in the disease trajectory, it may increase the patient's motivation and make them more receptive to weight-loss interventions. This prospective cohort study included 865 newly diagnosed Type 2 diabetic patients from the ADDICTION Cambridge Trial, a pragmatic, parallel-group cluster randomised controlled trial. The study assessed the relationship between behaviour change and weight loss and the prospect of type 2 diabetes remission in the first year, following four years and after five years without intense dietary or lifestyle intervention in patients. 30% of the patients achieved diabetes remission at 5-year follow-up, with a significant likelihood of remission among those who achieved ≥ 10% weight loss in the first year of diagnosis. A self-reported change in intake of alcohol units was found to be the only consistent association between behaviour change and remission in this study. The role of behaviour change in the remission of diabetes requires further robust research. This study will help healthcare professionals understand the association between weight loss and remission in diabetic patients.
Abstract
AIM: To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5-year follow-up. METHOD We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40-69 years from the ADDITION-Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self-report), and alcohol consumption (self-report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1-5 years, as well as remission at 5-year follow-up. RESULTS Diabetes remission was achieved in 257 participants (30%) at 5-year follow-up. Compared with people who maintained the same weight, those who achieved ≥ 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission [risk ratio 1.77 (95% CI 1.32 to 2.38; p<0.01)]. In the subsequent 1-5 years, achieving ≥10% weight loss was also associated with remission [risk ratio 2.43 (95% CI 1.78 to 3.31); p<0.01]. CONCLUSION In a population-based sample of adults with screen-detected Type 2 diabetes, weight loss of ≥10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.
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PROFAST: A Randomized Trial Assessing the Effects of Intermittent Fasting and Lacticaseibacillus rhamnosus Probiotic among People with Prediabetes.
Tay, A, Pringle, H, Penning, E, Plank, LD, Murphy, R
Nutrients. 2020;12(11)
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The prevalence of diabetes is increasing worldwide, and with it, the risk of cardiovascular disease is also increasing. Intermittent fasting has been shown to reduce weight and improve glycaemic control. Weight control and glycaemic control were also improved with probiotic Lacticaseibacillus rhamnosus HN001 supplementation. This pilot, 12-week, double-blinded, two-armed, randomized 1:1 study aimed to investigate the combined effects of intermittent fasting with daily probiotic Lacticaseibacillus rhamnosus HN001 supplementation on glycaemic management in participants with prediabetes. For two days, participants restricted their calorie intake to 600-650 kcal, followed by five days of ad libitum consumption (5:2). Intermittent fasting for 12 weeks improved glycaemic control (reduced HbA1c) and reduced body weight by 5%. The supplementation with Lacticaseibacillus rhamnosus HN001 did not significantly improve these outcomes. Probiotic supplementation significantly improved mental health and social functioning in participants. There is a need for further large, robust studies to assess the effects of intermittent fasting alone and when it is combined with different exercise forms and different prebiotic and probiotic supplements on cardiometabolic markers and mental health. The findings of this study may be useful to healthcare professionals in understanding the effects of fasting on metabolism as well as the psychological benefits of Lacticaseibacillus rhamnosus HN001 supplementation.
Abstract
Both intermittent fasting and specific probiotics have shown promise in improving glucose tolerance with a potential for synergistic effects through alterations to gut microbiota. In this randomized, double-blinded, two-arm feasibility study, we investigated whether intermittent fasting, supplemented with Lacticaseibacillus rhamnosus HN001 probiotic, reduces HbA1c in individuals with prediabetes. All participants with HbA1c 40-50 mmol/mol commenced intermittent fasting (2 days per week of calorie restriction to 600-650 kcal/day) and were randomized 1:1 to either daily probiotic (Lacticaseibacillus rhamnosus HN001) or placebo for 12 weeks. The primary outcome was a change in HbA1c. Secondary outcomes included changes in anthropometry, body composition, glucoregulatory markers, lipids, hunger hormones, liver enzymes, inflammatory markers, gut hormones, calorie and macronutrient intake, quality of life, hunger, mood and eating behavior. Of 33 participants who commenced the trial, 26 participants (mean age 52 years, body mass index (BMI) 34.7 kg/m2) completed the intervention (n = 11 placebo, n = 15 probiotic). HbA1c decreased from 43 ± 2.7 mmol/mol to 41 ± 2.3 mmol/mol, p < 0.001, with average of 5% weight loss. No significant between-group differences were seen in primary or secondary outcomes except for social functioning (p = 0.050) and mental health (p = 0.007) scores as improvements were seen in the probiotic group, but not in the placebo group. This study shows additional psychological benefits of probiotic supplementation during intermittent fasting to achieve weight loss and glycemic improvement in prediabetes.
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Daily Ingestion of Eggplant Powder Improves Blood Pressure and Psychological State in Stressed Individuals: A Randomized Placebo-Controlled Study.
Nishimura, M, Suzuki, M, Takahashi, R, Yamaguchi, S, Tsubaki, K, Fujita, T, Nishihira, J, Nakamura, K
Nutrients. 2019;11(11)
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Prevention and management of hypertension are major public health challenges worldwide. Psychosocial factors are related to blood pressure and may lead to hypertension. The aim of this study was to examine the long-term antihypertensive, anti-stress, and psychological state-improving effects of eggplant in human participants with normal-high blood pressure and grade 1 hypertension. The study is a randomized, double-blind, placebo-controlled, parallel-group comparative study. The participants were randomized into one of two intervention groups; placebo group or eggplant group. The participants ingested four eggplant powder capsules, or four placebo capsules every day for 12 weeks. Results indicate that continuous intake of eggplant powder improved blood pressure in participants with normal-high blood pressure and grade 1 hypertension. Additionally, eggplant intake improved positive and negative psychosocial states. Authors conclude that eggplant should be utilised as a safe treatment for blood pressure and mental health.
Abstract
Eggplant (Solanum melongena) is a globally popular vegetable and its significant health effect has not been reported in randomized controlled trials. Recently, we reported that eggplant was rich in choline esters, including acetylcholine (ACh), and had an antihypertensive effect in spontaneously hypertensive rats. Here, we evaluated the effects of a continuous intake of eggplant powder on blood pressure (BP), stress, and psychological state (PS) in 100 stressed participants with normal-high BP or grade 1 hypertension in a randomized, double-blind, placebo-controlled, parallel-group comparative study. The participants were randomly assigned to the eggplant or placebo group. Participants in the eggplant group ingested capsules containing eggplant powder (1.2 g/day; 2.3 mg of ACh/day) for 12 weeks, whereas participants in the placebo group ingested placebo capsules. The primary outcome assessed was hospital BP. Secondary outcomes were stress and PS. Eggplant powder intake significantly decreased the hospital diastolic blood pressure (DBP) at week 8 overall and in the normal-high BP group, and the systolic blood pressure (SBP) and DBP at week 12 overall and in the grade 1 hypertension group, compared to those of the placebo group. It also improved negative PSs at week 8 or 12 in the normal-high BP group. This is the first evidence of the BP- and PS-improving effects of eggplant intake in humans. The functional substance responsible for the effects was estimated to be eggplant-derived choline ester, namely ACh.
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Psychological, pharmacological, and combined treatments for binge eating disorder: a systematic review and meta-analysis.
Ghaderi, A, Odeberg, J, Gustafsson, S, Råstam, M, Brolund, A, Pettersson, A, Parling, T
PeerJ. 2018;6:e5113
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It is estimated that between 1% and 4% of the population suffer from binge eating disorder (BED), which is characterised by episodes of binge eating and a lack of control over eating. People with BED tend to have lower mental wellbeing and are more likely to be overweight or obese, leading to increased risk of related diseases such as type 2 diabetes. Treatments for BED include psychological treatments such as cognitive behavioural therapy (CBT), and medication such as selective serotonin re-update inhibitors (SSRIs) and weight-loss medication, as well as medications that are normally prescribed for attention deficit disorders, addictions and epilepsy. The aim of this review was to evaluate previous trials on the effectiveness of a range of psychological, pharmacological and combined treatments for BED. The authors looked at 45 trials which included over 4,000 participants. They found moderate support for the effectiveness of CBT and guided self-help for the treatment of BED in stopping or reducing the frequency of binge eating. Overall, there was a lack of long-term follow-ups, with no data on the long-term effect of medications. Interesting, the use of SSRIs did not have a significant impact on depressed mood in people with BED and lisdexamfetamine was the only intervention associated with a reduction in BMI (an expected finding as this medication is associated with some loss of appetite). There were very few studies that directly compared psychological treatments with medication, and a lack of evidence on the effectiveness of treatment in younger adults and teenagers. The authors concluded that more long-term studies are needed in the treatment of BED (included exploring quality of life), standardised assessments of BED and people from underrepresented populations (e.g. adolescents).
Abstract
OBJECTIVE To systematically review the efficacy of psychological, pharmacological, and combined treatments for binge eating disorder (BED). METHOD Systematic search and meta-analysis. RESULTS We found 45 unique studies with low/medium risk of bias, and moderate support for the efficacy of cognitive behavior therapy (CBT) and CBT guided self-help (with moderate quality of evidence), and modest support for interpersonal psychotherapy (IPT), selective serotonin reuptake inhibitors (SSRI), and lisdexamfetamine (with low quality of evidence) in the treatment of adults with BED in terms of cessation of or reduction in the frequency of binge eating. The results on weight loss were disappointing. Only lisdexamfetamine showed a very modest effect on weight loss (low quality of evidence). While there is limited support for the long-term effect of psychological treatments, we have currently no data to ascertain the long-term effect of drug treatments. Some undesired side effects are more common in drug treatment compared to placebo, while the side effects of psychological treatments are unknown. Direct comparisons between pharmaceutical and psychological treatments are lacking as well as data to generalize these results to adolescents. CONCLUSION We found moderate support for the efficacy of CBT and guided self-help for the treatment of BED. However, IPT, SSRI, and lisdexamfetamine received only modest support in terms of cessation of or reduction in the frequency of binge eating. The lack of long-term follow-ups is alarming, especially with regard to medication. Long-term follow-ups, standardized assessments including measures of quality of life, and the study of underrepresented populations should be a priority for future research.
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Patterns of Eating Disorder Pathology are Associated with Weight Change in Family-Based Behavioral Obesity Treatment.
Balantekin, KN, Hayes, JF, Sheinbein, DH, Kolko, RP, Stein, RI, Saelens, BE, Hurst, KT, Welch, RR, Perri, MG, Schechtman, KB, et al
Obesity (Silver Spring, Md.). 2017;25(12):2115-2122
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Children who are overweight or obese have higher rates of eating disorder pathology (extreme dietary restraint, loss of control eating and emotional eating) than their peers who are not overweight or obese, thus having an increased risk of developing a clinical eating disorder. The aim of the study is to classify overweight or obese children entering family-based treatment into groups with distinct patterns of eating disorder pathology and then examine eating disorder pattern differences in 3 categories. The study includes data from a multi-site randomised controlled trial. The analysis focused on data from the initial weight loss phase which included 241 obese or overweight children aged between 7 to 11 years. Results showed that eating disorders are more common among females than males, yet males also experience high levels of eating disorder pathology. Levels of eating disorder pathology decreased after family-based behavioural weight-loss treatment and so decreased the risk of the development of a clinical eating disorder. Authors conclude that eating disorder pathology is prevalent among children with overweight or obesity but has varying presentations.
Abstract
OBJECTIVE Children with overweight or obesity have elevated eating disorder (ED) pathology, which may increase their risk for clinical EDs. The current study identified patterns of ED pathology in children with overweight or obesity entering family-based behavioral weight loss treatment (FBT) and examined whether children with distinct patterns differed in their ED pathology and BMI z score (zBMI) change across FBT. METHODS Before participating in a 16-session FBT, children (N = 241) completed surveys or interviews assessing ED pathology (emotional eating, shape/weight/eating concerns, restraint, and loss of control [LOC]). Shape and weight concerns (SWC) and LOC were also assessed post treatment. Child height and weight were measured at baseline and post treatment. Latent class analysis identified patterns of ED pathology. Repeated-measures ANOVA examined changes in zBMI and ED pathology. RESULTS Four patterns of ED pathology were identified: low ED pathology, SWC, only loss of control, and high ED pathology. SWC decreased across treatment, with the highest decreases in patterns characterized by high SWC. All groups experienced significant decreases in zBMI; however, children with the highest ED pathology did not achieve clinically significant weight loss. CONCLUSIONS ED pathology decreased after FBT, decreasing ED risk. While all children achieved zBMI reductions, further research is needed to enhance outcomes for children with high ED pathology.
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Zinc supplementation in the treatment of anorexia nervosa.
Brazilian Association of Nutrology
Revista da Associacao Medica Brasileira (1992). 2013;59(4):321-4
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Anorexia nervosa (AN) is a disorder characterised by significant weight loss, restrictive diets, a search for thinness and a distortion of body image. Zinc is a key micronutrient that plays essential roles in the body including in gene transcription regulation and enzyme reactions. There is a similarity between symptoms of zinc deficiency and AN; namely weight loss, changes in appetite and sexual dysfunction. This review aims to provide healthcare professionals with insight into the nutritional recommendations for zinc in patients with AN. The review suggests that there are clinical studies demonstrating a strong association between AN and low levels of serum zinc and low levels of urinary zinc suggesting a micronutrient deficiency in these individuals. The severity of zinc deficiency is associated with greater weight deficits and longer AN duration. It is also associated with higher levels of anxiety and depression in AN individuals. Zinc is key in smell and taste perception and the brain regions associated with interpreting eating as pleasurable. Reduced food intake and practices like purging and low-zinc diets may exacerbate any low levels and impair zinc absorption. A controlled study showed that oral supplementation resulted in a higher rate of body mass index (BMI) increase and an improvement in neurotransmitters. The review recommends: 1. Check serum levels of zinc in AN patients as it may be low. Zinc status may contribute to eating behaviour including gaining pleasure from eating, smell and taste. 2. Zinc supplementation of 15mg/daily for preventative purposes and 15-20mg/daily if zinc deficiency is identified after testing. The review recommends supplementation for a minimum of 2 months.