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Is reducing appetite beneficial for body weight management in the context of overweight and obesity? A systematic review and meta-analysis from clinical trials assessing body weight management after exposure to satiety enhancing and/or hunger reducing products.
Hansen, TT, Andersen, SV, Astrup, A, Blundell, J, Sjödin, A
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(7):983-997
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Abstract
This review aims to investigate whether interventions that enhance satiety and/or reduce hunger lead to beneficial effects on body weight management in the context of overweight and obesity. A comprehensive review protocol was prepared before conducting a systematic search in PubMed identifying 517 papers with 12 meeting the inclusion criteria. A thorough risk of bias assessment was performed based on the Cochrane collaboration's tool for assessing risk of bias. Based on a meta-analysis, the average of 75 subjects exposed to satiety enhancing and/or hunger reducing foods during more than 8 weeks coincidently reduced their body weight by 3.60 (1.05; 6.15) kg (mean (95% confidence interval)) more compared with controls. Two studies analysed whether individual reductions in appetite were associated with body weight. Decreased ad libitum energy intake after exposure to the satiety enhancing and/or hunger reducing interventions explained 58% (P < 0.001) and 23% (P < 0.001) of the variations in the subsequent weight losses over 12 and 8 weeks, respectively. Robust acute effects on appetite were found equally likely to be linked to improved body weight management as sustained effects. Satiety enhancing and/or hunger reducing interventions are supported to improve body weight management, but studies specifically designed to demonstrate a causal link remain needed.
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Protein supplements after weight loss do not improve weight maintenance compared with recommended dietary protein intake despite beneficial effects on appetite sensation and energy expenditure: a randomized, controlled, double-blinded trial.
Kjølbæk, L, Sørensen, LB, Søndertoft, NB, Rasmussen, CK, Lorenzen, JK, Serena, A, Astrup, A, Larsen, LH
The American journal of clinical nutrition. 2017;(2):684-697
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Abstract
Background: High-protein diets increase weight loss (WL) during energy restriction; therefore, it has been suggested that additional protein intake may improve weight maintenance (WM) after WL.Objective: We investigated the effect of protein supplements from either whey with or without calcium or soy on WM success after WL compared with that of a control.Design: In a randomized, controlled, double-blinded trial, 220 participants aged 18-60 y with body mass index (in kg/m2) from 27.6 to 40.4 were included. The study was initiated with an 8-wk WL period followed by a 24-wk WM period. During WM, participants consumed the following isocaloric supplements (45-48 g/d): whey and calcium (whey+), whey, soy, or maltodextrin (control). Data were collected at baseline, before WM, and after WM (weeks 0, 8, and 32, respectively) and included body composition, blood biochemistry, and blood pressure. Meal tests were performed to investigate diet-induced-thermogenesis (DIT) and appetite sensation. Compliance was tested by 24-h urinary nitrogen excretion.Results: A total of 151 participants completed the WM period. The control and 3 protein supplements did not result in different mean ± SD weight regains (whey+: 2.19 ± 4.6 kg; whey: 2.01 ± 4.6 kg; soy: 1.76 ± 4.7 kg; and control: 2.23 ± 3.8 kg; P = 0.96), fat mass regains (whey+: 0.46 ± 4.5 kg; whey: 0.11 ± 4.1 kg; soy: 0.15 ± 4.1 kg; and control: 0.54 ± 3.3 kg; P = 0.96), or improvements in lean body mass (whey+: 1.87 ± 1.7 kg; whey: 1.94 ± 1.3 kg; soy: 1.58 ± 1.4 kg; and control: 1.74 ± 1.4 kg; P = 0.50) during WM. Changes in blood pressure and blood biochemistry were not different between groups. Compared with the control, protein supplementation resulted in higher DIT (∼30 kJ/2.5 h) and resting energy expenditure (243 kJ/d) and an anorexigenic appetite-sensation profile.Conclusion: Protein supplementation does not result in improved WM success, or blood biochemistry after WL compared with the effects of normal dietary protein intake (0.8-1.0 g · kg-1 · d-1). This trial was registered at clinicaltrials.gov as NCT01561131.
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Effects of RYGB on energy expenditure, appetite and glycaemic control: a randomized controlled clinical trial.
Schmidt, JB, Pedersen, SD, Gregersen, NT, Vestergaard, L, Nielsen, MS, Ritz, C, Madsbad, S, Worm, D, Hansen, DL, Clausen, TR, et al
International journal of obesity (2005). 2016;(2):281-90
Abstract
OBJECTIVES Increased energy expenditure (EE) has been proposed as an important mechanism for weight loss following Roux-en-Y gastric bypass (RYGB). However, this has never been investigated in a controlled setting independent of changes in energy balance. Similarly, only few studies have investigated the effect of RYGB on glycaemic control per se. Here, we investigated the effect of RYGB on EE, appetite, glycaemic control and specific signalling molecules compared with a control group in comparable negative energy balance. SUBJECTS/METHODS Obese normal glucose-tolerant participants were randomized to receive RYGB after 8 (n=14) or 12 weeks (n=14). The protocol included a visit at week 0 and three visits (weeks 7, 11 and 78) where 24-h EE, appetite and blood parameters were assessed. Participants followed a low-calorie diet from weeks 0-11, with those operated at week 12 serving as a control group for those operated at week 8. RESULTS Compared with controls, RYGB-operated participants had lower body composition-adjusted 24-h EE and basal EE 3 weeks postoperatively (both P<0.05) but EE parameters at week 78 were not different from preoperative values (week 7). Surgery changed the postprandial response of glucagon-like peptide-1 (GLP-1), peptide YY3-36 (PYY), ghrelin, cholecystokinin, fibroblast growth factor-19 and bile acids (all P<0.05). Particularly, increases in GLP-1, PYY and decreases in ghrelin were associated with decreased appetite. None of HOMA-IR (homeostasis model assessment-estimated insulin resistance), Matsuda index, the insulinogenic index, the disposition index and fasting hepatic insulin clearance were different between the groups, but RYGB operated had lower fasting glucose (P<0.05) and the postprandial glucose profile was shifted to the left (P<0.01). CONCLUSIONS Our data do not support that EE is increased after RYGB. More likely, RYGB promotes weight loss by reducing appetite, partly mediated by changes in gastrointestinal hormone secretion. Furthermore, we found that the early changes in glycaemic control after RYGB is to a large extent mediated by caloric restriction.
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Sucrose compared with artificial sweeteners: a clinical intervention study of effects on energy intake, appetite, and energy expenditure after 10 wk of supplementation in overweight subjects.
Sørensen, LB, Vasilaras, TH, Astrup, A, Raben, A
The American journal of clinical nutrition. 2014;(1):36-45
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BACKGROUND There is a lack of appetite studies in free-living subjects supplying the habitual diet with either sucrose or artificially sweetened beverages and foods. Furthermore, the focus of artificial sweeteners has only been on the energy intake (EI) side of the energy-balance equation. The data are from a subgroup from a 10-wk study, which was previously published. OBJECTIVE The objective was to investigate changes in EI and energy expenditure (EE) as possible reasons for the changes in body weight during 10 wk of supplementation of either sucrose or artificial sweeteners in overweight subjects. DESIGN Supplements of sucrose-sweetened beverages and foods (2 g/kg body weight; n = 12) or similar amounts containing artificial sweeteners (n = 10) were given single-blind in a 10-wk parallel design. Beverages accounted for 80% and solid foods for 20% by weight of the supplements. The rest of the diet was free choice. Indirect 24-h whole-body calorimetry was performed at weeks 0 and 10. At week 0 the diet was a weight-maintaining standardized diet. At week 10 the diet consisted of the supplements and ad libitum choice of foods. Visual analog scales were used to record appetite. RESULTS Body weight increased in the sucrose group and decreased in the sweetener group during the intervention. The sucrose group had a 3.3-MJ higher EI but felt less full and had higher ratings of prospective food consumption than did the sweetener group at week 10. Basal metabolic rate was increased in the sucrose group, whereas 24-h EE was increased in both groups at week 10. Energy balance in the sucrose group was more positive than in the sweetener group at the stay at week 10. CONCLUSION The changes in body weight in the 2 groups during the 10-wk intervention seem to be attributable to changes in EI rather than to changes in EE.
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Effects of PYY3-36 and GLP-1 on energy intake, energy expenditure, and appetite in overweight men.
Schmidt, JB, Gregersen, NT, Pedersen, SD, Arentoft, JL, Ritz, C, Schwartz, TW, Holst, JJ, Astrup, A, Sjödin, A
American journal of physiology. Endocrinology and metabolism. 2014;(11):E1248-56
Abstract
Our aim was to examine the effects of GLP-1 and PYY3-36, separately and in combination, on energy intake, energy expenditure, appetite sensations, glucose and fat metabolism, ghrelin, and vital signs in healthy overweight men. Twenty-five healthy male subjects participated in this randomized, double-blinded, placebo-controlled, four-arm crossover study (BMI 29 ± 3 kg/m(2), age 33 ± 9 yr). On separate days they received a 150-min intravenous infusion of 1) 0.8 pmol·kg(-1)·min(-1) PYY3-36, 2) 1.0 pmol·kg(-1)·min(-1) GLP-1, 3) GLP-1 + PYY3-36, or 4) placebo. Ad libitum energy intake was assessed during the final 30 min. Measurements of appetite sensations, energy expenditure and fat oxidation, vital signs, and blood variables were collected throughout the infusion period. No effect on energy intake was found after monoinfusions of PYY3-36 (-4.2 ± 4.8%, P = 0.8) or GLP-1 (-3.0 ± 4.5%, P = 0.9). However, the coinfusion reduced energy intake compared with placebo (-30.4 ± 6.5%, P < 0.0001) and more than the sum of the monoinfusions (P < 0.001), demonstrating a synergistic effect. Coinfusion slightly increased sensation of nausea (P < 0.05), but this effect could not explain the effect on energy intake. A decrease in plasma ghrelin was found after all treatments compared with placebo (all P < 0.05); however, infusions of GLP-1 + PYY3-36 resulted in an additional decrease compared with the monoinfusions (both P < 0.01). We conclude that coinfusion of GLP-1 and PYY3-36 exerted a synergistic effect on energy intake. The satiating effect of the meal was enhanced by GLP-1 and PYY3-36 in combination compared with placebo. Coinfusion was accompanied by slightly increased nausea and a decrease in plasma ghrelin, but neither of these factors could explain the reduction in energy intake.
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Contribution of gastroenteropancreatic appetite hormones to protein-induced satiety.
Belza, A, Ritz, C, Sørensen, MQ, Holst, JJ, Rehfeld, JF, Astrup, A
The American journal of clinical nutrition. 2013;(5):980-9
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Abstract
BACKGROUND Effects of protein intake on appetite-regulating hormones and their dynamics are unclear. OBJECTIVES We investigated the satiating effects of meals with varying protein contents and whether there was an effect of dose on appetite-regulating hormones and appetite ratings. DESIGN Twenty-five men [mean ± SD age: 30.0 ± 8.7 y; body mass index (BMI; in kg/m(2)): 25.9 ± 4.7] participated in the 3-way, randomized, double-blind crossover study. Test meals were isocaloric with 30% of energy from fat and protein content adjusted at the expense of carbohydrate. Test meals were normal protein (NP; 14% of energy from protein), medium-high protein (MHP; 25% of energy from protein), and high protein (HP, 50% of energy from protein). Appetite ratings and blood samples were assessed every 0.5 h for 4 h. An ad libitum lunch was served 4 h after the meal. RESULTS Protein increased dose-dependently glucagon-like peptide-1 (GLP-1), peptide YY (PYY) 3-36, and glucagon; MHP produced 10%, 7%, and 47% greater responses, respectively; and HP produced 20%, 14%, and 116% greater responses, respectively, than did NP (P < 0.03). Compared with NP, HP increased insulin and cholecystokinin and decreased ghrelin and glucose-dependent insulinotropic polypeptide (P < 0.05). Satiety and fullness dose-dependently increased by 7% and 6% for MHP and 16% and 19% for HP compared with NP (P < 0.001). Hunger and prospective consumption dose-dependently decreased by 15% and 13% for MHP and by 25% and 26% for HP compared with NP (P < 0.0003). There was a combined effect of GLP-1 and PYY 3-36 (P = 0.03) next to the additive effect of GLP-1 (P = 0.006) on the composite appetite score. No difference was shown in ad libitum energy intake. CONCLUSION Protein dose-dependently increased satiety and GLP-1, PYY 3-36, and glucagon, which may, at least in part, be responsible for the satiety-stimulating effect of protein. This trial was registered at clinicaltrials.gov as NCT01561235.
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Flaxseed dietary fibers suppress postprandial lipemia and appetite sensation in young men.
Kristensen, M, Savorani, F, Christensen, S, Engelsen, SB, Bügel, S, Toubro, S, Tetens, I, Astrup, A
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2013;(2):136-43
Abstract
BACKGROUND AND AIM Dietary fibers (DF) are linked to a reduced risk of life-style diseases, which relate to their physiological effects in the gastrointestinal tract. The aim was to examine whether flaxseed DF-enriched meals suppress postprandial lipemia and reduce appetite. METHODS AND RESULTS Four different iso-caloric meals were tested in 18 young men in a double-blind randomized crossover design. Test meals were served after an overnight fast. DF content and source were: control (C): 1.4 g/MJ; whole flaxseed (WF): 2.4 g/MJ from whole flaxseeds; low-mucilage dose (LM): 2.4 g/MJ from flaxseed DF; high-mucilage dose (HM): 3.4 g/MJ from flaxseed DF. During the 7 h test day, subjective appetite sensation was assessed using visual analogue scales and appetite-regulating hormones, and lipemia and glycemia were measured, after which ad libitum energy intake was recorded. There was a significant time × meal effect on triacylglycerols (TG) (p = 0.02) and an 18% smaller area under the curve (AUC) for TG after meal HM compared to meal C was observed (p < 0.01). AUC for insulin was smaller after both LM and HM meals compared to C and WF meals. Higher mean ratings of satiety (p < 0.01) and fullness (p = 0.03) was seen following the HM meal compared to meal C. AUC for ghrelin, CCK and GLP-1 and ad libitum energy intake did not differ between meals, but ghrelin response exhibited a different response pattern after the mucilage-containing meals. CONCLUSION These findings suggest that flaxseed DF may suppress postprandial lipemia and appetite although subsequent energy intake was not affected.
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Flaxseed dietary fiber supplements for suppression of appetite and food intake.
Ibrügger, S, Kristensen, M, Mikkelsen, MS, Astrup, A
Appetite. 2012;(2):490-5
Abstract
UNLABELLED We conducted two single-blinded randomized crossover acute studies with 24 and 20 subjects, respectively, to compare (I) CONTROL vs. Flax drink; and (II) Flax drink vs. Flax tablets. The subjects were exposed to one of the treatments after an overnight fast, and rated appetite sensation for 120 min using visual analog scales (VAS). Hereafter they consumed an ad libitum early lunch to assess energy intake. The treatments were iso-caloric and iso-volumeric: CONTROL 300 mL drink; Flax drink: CONTROL drink with addition flax fiber extract (2.5 g of soluble fibers); and Flax tablet: CONTROL drink with flax fiber tablets (2.5 g of soluble fibers). Flax drink increased sensation of satiety and fullness compared to CONTROL and a significant decrease in subsequent energy intake was observed after the Flax drink compared to CONTROL (2937 vs. 3214 kJ). Appetite ratings were similar for Flax tablets and Flax drink as they did not differ by more than 1-4%. Subsequent energy intake was similar after the two treatments (3370 vs. 3379 kJ). A small dose of flaxseed fiber significantly suppresses appetite and energy intake. Furthermore, flaxseed fibers administered as drinks or tablets produce similar responses.
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Reproducibility and power of ad libitum energy intake assessed by repeated single meals.
Gregersen, NT, Flint, A, Bitz, C, Blundell, JE, Raben, A, Astrup, A
The American journal of clinical nutrition. 2008;(5):1277-81
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BACKGROUND The reproducibility of the measurement of ad libitum energy intake (EI) is not well known. Furthermore, it is not known whether standardized conditions before the test day influence this measure. OBJECTIVE The objective was to examine the reproducibility and power of the measurement of ad libitum EI with and without prior diet standardization. DESIGN Fifty-five healthy, normal-weight men were tested in 2 groups, one with (D, n = 32) and one without (ND, n = 23) prior diet standardization, on 2 different identical occasions. They were given a standardized energy-fixed breakfast and then an ad libitum lunch 4.5 h later. Reproducibility was assessed by the coefficient of repeatability. RESULTS No effect of prior diet standardization was seen on the reproducibility of ad libitum EI (P = 0.56), but diet standardization increased ad libitum EI significantly (P < 0.001). The correlation between ad libitum EI on the 2 test days was r = 0.861 (R(2) = 0.742, P < 0.0001) and r = 0.654 (R(2) = 0.428, P < 0.001) in the D and ND groups, respectively. The coefficient of repeatability and CV were 1478 kJ and 8.9% compared with 1831 kJ and 14.5% in the D and ND groups, respectively. A paired design with a study power of 0.8 requires 17 and 26 subjects, with and without prior diet standardization, respectively, to detect a difference of 500 kJ in EI. CONCLUSIONS The ad libitum test meal used to measure spontaneous EI is reproducible, and the reproducibility does not seem to be influenced by prior standardization. However, prior diet standardization exerts a significant effect on ad libitum EI.
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The effect of salatrim, a low-calorie modified triacylglycerol, on appetite and energy intake.
Sørensen, LB, Cueto, HT, Andersen, MT, Bitz, C, Holst, JJ, Rehfeld, JF, Astrup, A
The American journal of clinical nutrition. 2008;(5):1163-9
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BACKGROUND Salatrim is modified triacylglycerol that is rich in short-chain fatty acids and stearic acid. It is used as a lower-calorie fat replacer. In addition, it has been hypothesized that salatrim's reduced absorption in the small intestine may lead to greater amounts of fat in the gastrointestinal tract, which may decrease appetite and energy intake through the release of appetite-regulating gastrointestinal hormones. OBJECTIVE We aimed to compare the effects of salatrim and traditional fat on appetite, ad libitum energy intake, and gastrointestinal hormones. DESIGN Twenty-two healthy, young, normal-weight men participated in a randomized, double-blind, crossover study. Test meals were a traditional fat meal and a salatrim meal with a mixture of traditional fat and salatrim. Visual analogue scales were used to record appetite and well-being every 30 min, and blood was sampled frequently. An ad libitum lunch was served 4.5 h after the test meal. RESULTS The salatrim meal increased fullness (P = 0.04) and decreased hunger (P = 0.06) significantly more than did the traditional fat meal. The traditional fat meal increased well-being (P = 0.02). There was no significant difference in ad libitum energy intake or overall energy intake between the 2 test days. No significant differences in blood glucose, insulin, triacylglycerol, ghrelin, cholecystokinin, glucagon-like peptide-1, or peptide YY concentrations were found. A significantly (P = 0.01) smaller increase in free fatty acids was observed after the salatrim meal than after the traditional fat meal. CONCLUSIONS Salatrim had a modestly more suppressive effect on appetite than did a traditional fat. Gastrointestinal hormones did not seem to be involved.