Effects of a Stimulant-Free Dietary Supplement on Body Weight and Fat Loss in Obese Adults: A Six-Week Exploratory Study

Background: Obesity is a well-established risk factor for cardiovascular disease, diabetes, hyperlipidemia, hypertension, osteoarthritis, and stroke. Stimulants, such as ephedrine and caffeine and their herbal counterparts, have proved effective in facilitating body weight loss, but their use is controversial due to their undesired effects. Other nutraceuticals have shown moderate success in reducing body weight, whereas several other compounds have demonstrated little or no effect. Therefore, a tolerable and effective nutraceutical that can increase energy expenditure and/or decrease caloric intake is desirable for body weight reduction.Objective: The primary purpose of this study was to assess the tolerability and effectiveness of a novel, stimulant-free, dietary supplement containing glucomannan, chitosan, fenugreek, Gymnema sylvestre, and vitamin C on body weight and fat loss and change in body composition in obese adults.Methods: In this single-center, prospective, randomized, double-blind, placebo-controlled study conducted at the University of Guelph (Guelph, Ontario, Canada), obese adults (aged 20-50 years; body mass index [BMI], ≥30 kg/m²) were randomized to the treatment or placebo group. The treatment group received 6 capsules of a dietary supplement containing a proprietary blend of glucomannan, chitosan, fenugreek, G sylvestre, and vitamin C daily for 6 weeks, and the placebo group received 6 capsules of rice flour daily for 6 weeks. Body weight; percentage of body fat; absolute fat mass; lean body mass; BMI; upper abdominal, waist, and hip circumference; and anthropometric measurements were recorded at baseline and at study end. Patients completed daily dietary intake records on days 1 to 3 and days 40 to 42. They also completed weekly activity logs throughout the study.Results: Twenty-four subjects (mean [SD] age, 37.0 [8.2] years [range, 21-48years]; mean [SD] BMI, 35.7 [6.2] kg/m² [range, 28.9-50.9 kg/m²]) were assigned to the treatment group (8 women, 4 men) or the placebo group (9 women,3 men). Two subjects (8.3%; 1 patient [8.3%] from each group) dropped out for personal reasons unrelated to the study. No significant changes in the consumption of total calories; the percentage of calories ingested as carbohydrates, fat, or protein; or activity levels were found in either group throughout the study. Compared with the placebo group, the treatment group lost significantly more body weight (−2.3 kg vs 0.0 kg; P<0.01), percentage of body fat (−1.1% vs 0.2%; P<0.05), and absolute fat mass (−2.0 kg vs 0.2 kg; P<0.001). The treatment group also experienced a significantly greater reduction in upper abdominal circumference (−4.5 cm vs −0.7 cm), waist circumference (−4.1 cm vs 0.1 cm), and hip circumference (−2.9 cm vs 0.6 cm) compared with the placebo group (P<0.05 for all). No significant changes in heart rate or blood pressure were found in either group. Both the treatment and the placebo were well tolerated.Conclusion: Within the context of this study, the novel combination of glucomannan, chitosan, fenugreek, G sylvestre, and vitamin C results in significant body weight and fat loss in obese adults.Disclosure: Derek E. Woodgate, MSc, is president and owner of NxCare Inc., which produces the dietary supplement containing glucomannan, chitosan, fenugreek, Gymnema sylvestre, and vitamin C (trade name Calorie-Care™).     

女性体重、体脂含量、下肢肌力与骨密度的关系

目的：分析妇女体重、体重指数、体脂含量、下肢肌力与骨密度的关系，从生物力学角度探讨骨量的影响因素。方法：以在本中心进行保健的1109例女性为研究对象，分别测量身高、体重，计算体重指数（BMI），用肌肉功能分析仪测定体脂含量（FAT％）、下肢最大肌力（MLF），用双能X线吸收法（DEXA）测定股骨颈骨密度（FBMD）。结果：股骨颈骨密度与体重、体重指数、体脂含量、下肢肌力呈显著正相关，相关系数分别为0．145（P〈0．001）、0．182（P〈0.001）、0．189（P〈0.001）、0．074（P〈0.05）。结论：体重、体重指数、体脂含量、下肢肌力是骨密度的影响因素，适宜体重和运动有益于骨质疏松的防治。     

Ethnic Differences in Weight Loss and Diabetes Remission After Bariatric Surgery: A meta-analysis

OBJECTIVE It has been postulated that the effectiveness of bariatric surgery varies between ethnic groups. However, data regarding this topic are inconclusive, as most studies included few patients from minority groups. We conducted a meta-analysis to determine the difference in percentage of excess weight loss (%EWL) 1-2 years after bariatric surgery in people of African and Caucasian descent. We also studied differences in diabetes mellitus (DM) remission. RESEARCH DESIGN AND METHODS We performed a MEDLINE and EMBASE search for studies reporting %EWL and/or DM remission after bariatric surgery and including both African Americans and Caucasians. The 613 publications obtained were reviewed. We included 14 studies (1,087 African Americans and 2,714 Caucasians); all provided data on %EWL and 3 on DM remission. We extracted surgery type, %EWL, and DM remission 1-2 years after surgery. After analyzing %EWL for any surgery type, we performed subanalyses for malabsorptive and restrictive surgery. RESULTS The overall absolute mean %EWL difference between African Americans and Caucasians was -8.36% (95% CI -10.79 to -5.93) significantly in favor of Caucasians. Results were similar for malabsorptive (-8.39% [-11.38 to -5.40]) and restrictive (-8.46% [-12.95 to -3.97]) surgery. The remission of DM was somewhat more frequent in African American patients than in Caucasian patients (1.41 [0.56-3.52]). However, this was not statistically significant. CONCLUSIONS In %EWL terms, bariatric surgery is more effective in Caucasians than in African Americans, regardless of procedure type. Further studies are needed to investigate the exact mechanisms behind these disparities and to determine whether ethnic differences exist in the remission of comorbidities after bariatric surgery.     

Cerebellar Tonsillar Herniation After Weight Loss in a Patient With Idiopathic Intracranial Hypertension

( Headache 2010;50:146-148)
Acquired cerebellar tonsillar herniation is a known complication of lumboperitoneal shunt (LPS) for any indication, including idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri. ¹ While the underlying pathophysiology of IIH remains unknown, increasing body mass index is a clear risk factor for the development of IIH. We describe an obese patient with IIH unresponsive to LPS who developed symptoms of intracranial hypotension and cerebellar tonsillar herniation after bariatric surgery and a 50-kg weight loss.     

孕妇腹壁脂肪厚度对胎儿体重估计的影响

为了较准确地估计胎儿体重 ,对 2 70例孕妇的腹壁脂肪厚度用皮褶计进行了测量 ,并总结出胎儿体重估计的改良公式 :胎儿体重(g) =(宫高 -腹脂厚度 )×(腹围 -腹脂厚度 ) 2 0 0 ,经与常用的公式 :胎儿体重(g) =宫高×腹围 2 0 0比较 ,结果显示 :孕妇的腹脂厚度≥ 3cm时 ,运用改良公式估计胎儿体重符合率为6 3 .9% ,两组相比差异显著(P <0 .0 1)。孕妇的腹脂厚度 <3cm时 ,运用两公式估计胎儿体重无差异 (P <0 .5 )。提出 :对于腹脂厚度≥ 3cm的孕妇 ,应采用改良公式估计胎儿体重     

The Influence of Body Weight and Cell Size on Lipogenesis and Lipolysis of Isolated Rat Fat Cells*

Abstract. A method for fractionating isolated fat cells is described. After fixation with osmium tetroxide, the cells are passed through a series of polyamide filters of decreasing mesh width and the number of cells on each filter is counted. – Isolated fat cells from ad libitum fed rats weighing 85–580 g were incubated with [U-¹⁴C]-glucose (0.55 mM), fixed with osmium tetroxide and fractionated according to size. When the cells were obtained from one animal the conversion of glucose to neutral lipids per cell increased with increasing cell size just as well in the absence of insulin as in the presence of insulin (10 mU/ml). The following results were obtained from comparisons between animals of different weight: in the absence of insulin, the lipogenesis for cells of the same size remained constant irrespective of the rat weight, whereas in the presence of insulin the lipogenesis for cells of the same size decreased markedly when the rat weight exceeded about 300 g. It is concluded that factors other than the cell size per st (e.g. age, degree of obesity) determine the responsiveness to insulin. – The hormone-stimulated lipolysis was studied on unfractionated cell samples from ad libitum fed rats of different weights and the following was found: the glycerol release per 10⁵ cells induced by ACTH and norepinephrine in maximally stimulating concentrations increased with increasing mean cell size or rat weight. In contrast, the glucagon-induced lipolysis of cells from rats weighing 300–400 g was smaller than that of cells from rats weighing 100–120 g.     

Caloric Restriction and Weight Loss Are Primary Factors in the Early Tissue-Specific Metabolic Changes After Bariatric Surgery

OBJECTIVETo evaluate changes in insulin sensitivity, hormone secretion, and hepatic steatosis immediately after caloric restriction, vertical sleeve gastrectomy (VSG), and Roux-en-Y gastric bypass (RYGB).RESEARCH DESIGN AND METHODSObese subjects were assessed for 1) insulin sensitivity with hyperinsulinemic-euglycemic clamp with glucose tracer infusion, 2) adipokine concentrations with serum and subcutaneous adipose interstitial fluid sampling, and 3) hepatic fat content with MRI before and 7–10 days after VSG, RYGB, or supervised caloric restriction.RESULTSEach group exhibited an ∼5% total body weight loss, accompanied by similar improvements in hepatic glucose production and hepatic, skeletal muscle, and adipose tissue insulin sensitivity. Leptin concentrations in plasma and adipose interstitial fluid were equally decreased, and reductions in hepatic fat were similar.CONCLUSIONSThe improvements in insulin sensitivity and adipokine secretion observed early after bariatric surgery are replicated by equivalent caloric restriction and weight loss.     

Gut Microbial Carbohydrate Metabolism Hinders Weight Loss in Overweight Adults Undergoing Lifestyle Intervention With a Volumetric Diet

The rising incidence of obesity requires the reevaluation of our current therapeutic strategies to optimize patient outcomes. The objective of this study was to determine whether compositional and functional characteristics of the gut microbiota in adults predict responses to a comprehensive lifestyle intervention program in overweight and obese adults. We recruited 26 participants from the Mayo Clinic Obesity Treatment Research Program between August 6, 2013, and September 12, 2013, to participate in a lifestyle intervention program for weight loss. Adults aged 18 to 65 years with a body mass index of 27 to 39.9 kg/m² and able to provide informed consent were included in the study. Fecal stool samples were obtained at baseline and after 3 months. Loss of at least 5% of baseline weight after 3 months was defined as success. Clinical characteristics and gut microbial composition and function were compared between those who achieved at least 5% and those who achieved less than 5% weight loss. After 3 months, 9 of 26 participants lost at least 5% of their weight. The mean weight loss was 7.89 kg (95% CI, 6.46-9.32 kg) in the success group and 1.51 kg (95% CI, 0.52-2.49 kg) in the less than 5% weight loss group. An increased abundance of Phascolarctobacterium was associated with success. In contrast, an increased abundance of Dialister and of genes encoding gut microbial carbohydrate-active enzymes was associated with failure to lose 5% body weight. A gut microbiota with increased capability for carbohydrate metabolism appears to be associated with decreased weight loss in overweight and obese patients undergoing a lifestyle intervention program.     

Increased Skeletal Muscle Capillarization After Aerobic Exercise Training and Weight Loss Improves Insulin Sensitivity in Adults With IGT

OBJECTIVE

Transcapillary transport of insulin is one determinant of glucose uptake by skeletal muscle; thus, a reduction in capillary density (CD) may worsen insulin sensitivity. Skeletal muscle CD is lower in older adults with impaired glucose tolerance (IGT) compared with those with normal glucose tolerance and may be modifiable through aerobic exercise training and weight loss (AEX+WL). We tested the hypothesis that 6-month AEX+WL would increase CD to improve insulin sensitivity and glucose tolerance in older adults with IGT.

RESEARCH DESIGN AND METHODS

Sixteen sedentary, overweight-obese (BMI 27–35 kg/m²), older (63 ± 2 years) men and women with IGT underwent hyperinsulinemic-euglycemic clamps to measure insulin sensitivity, oral glucose tolerance tests, exercise and body composition testing, and vastus lateralis muscle biopsies to determine CD before and after 6-month AEX+WL.

RESULTS

Insulin sensitivity (M) and 120-min postprandial glucose (G₁₂₀) correlated with CD at baseline (r = 0.58 and r = −0.60, respectively, P < 0.05). AEX+WL increased maximal oxygen consumption (VO_2max) 18% (P = 0.02) and reduced weight and fat mass 8% (P < 0.02). CD increased 15% (264 ± 11 vs. 304 ± 14 capillaries/mm², P = 0.01), M increased 21% (42.4 ± 4.0 vs. 51.4 ± 4.3 µmol/kg FFM/min, P < 0.05), and G₁₂₀ decreased 16% (9.35 ± 0.5 vs. 7.85 ± 0.5 mmol/L, P = 0.008) after AEX+WL. Regression analyses showed that the AEX+WL-induced increase in CD independently predicted the increase in M (r = 0.74, P < 0.01) as well as the decrease in G₁₂₀ (r = −0.55, P < 0.05).

CONCLUSIONS

Six-month AEX+WL increases skeletal muscle CD in older adults with IGT. This represents one mechanism by which AEX+WL improves insulin sensitivity in older adults with IGT.     

Improvement in the Spatial Distribution of Pain,Somatic Symptoms,and Depression After a Weight Loss Intervention

Weight loss is known to improve pain localized to weight-bearing joints but it is not known how weight loss affects the spatial distribution of pain and associated somatic symptoms like fatigue. We sought to determine if weight loss using a low-calorie diet improves pain, affect, and somatic symptoms commonly associated with chronic pain conditions in an observational study. We also documented changes in inflammatory markers in serum before and after weight loss. Participants were 123 obese individuals undergoing a 12- to 16-week calorie restriction weight loss intervention. The spatial distribution of pain, symptom severity (eg, fatigue, sleep difficulties), depression, and total fibromyalgia scale scores were measured before and after weight loss. Pain (P?=?. 022), symptom severity (P?=?.004), depression (P?<?.001), and fibromyalgia scores (P?=?.004) improved after weight loss; men showed greater improvement than women on somatic symptoms and fibromyalgia scores (both P?<?.01). Those who lost at least 10% of body weight showed greater improvement than those who lost <10%. Levels of the regulatory cytokine interleukin-10 increased after the intervention (P?=?.002). Weight loss may improve diffuse pain and comorbid symptoms commonly seen in chronic pain participants.

Effects of Dietary Polyunsaturated and Saturated Fat on the Properties of High Density Lipoproteins and the Metabolism of Apolipoprotein A-I

In this study we have investigated, in four normal males the effects of dietary saturated and polyunsaturated fat on the chemical composition and thermotropic properties of human high density lipoproteins (HDL) and have measured the influence of the diets on the metabolism of that fraction of HDL apolipoprotein A-I (apoA-I) that undergoes exchange in vitro and accounts for approximately two-thirds of the lipoprotein's apoA-I complement. When compared with the saturated fat diet, the polyunsaturated diet reduced plasma cholesterol (24%, P < 0.01) by affecting the cholesterol content in the very low density lipoprotein ( downward arrow25%, P < 0.02), low density lipoprotein ( downward arrow20%, P < 0.01), and high density lipoprotein fractions ( downward arrow33%, P < 0.01). Plasma triglyceride was also lowered (by 13%, P < 0.01). Furthermore, polyunsaturated fat ingestion caused a significant fall in the palmitate and stearate content of HDL triglyceride (41 and 37%, respectively), cholesteryl esters (29 and 35%), and phospholipids (17 and 9%) with a concomitant increase in the linoleate content of these moieties (157, 28, and 29%, respectively). The polyunsaturated diet also produced reciprocal changes in the percentage protein ( downward arrow9%, P < 0.02) and phospholipid ( downward arrow11.5%, P < 0.01) in HDl. These compositional changes were associated with an increase in the microscopic fluidity of the polyunsaturated HDL, although both diets had little effect on the fluidity parameters of HDL at body temperature. Rate zonal ultracentrifugation indicated that the HDL(2)/HDL(3) ratio fell by 28% (P < 0.05) on the polyunsaturated fat diet. In addition to the above, this diet reduced plasma apoA-I by 21% (P < 0.01). No change was seen in the fractional catabolic rate or the distribution of the apoprotein between intravascular and extravascular compartments on the two diets. However, when compared with the saturated diet, the synthetic rate of apoA-I was reduced by 26% during polyunsaturated fat feeding. The results show that polyunsaturated fat alters the chemical composition, thermotropic properties, and subfraction distribution of HDL without changing the fractional rate of catabolism of their major protein, apoA-I.These findings deserve careful consideration in determining the applicability and efficacy of polyunsaturated fat diet therapy in the prevention of atherosclerosis in man.     

Effects of Weight Loss,Weight Cycling,and Weight Loss Maintenance on Diabetes Incidence and Change in Cardiometabolic Traits in the Diabetes Prevention Program

OBJECTIVE

This study examined specific measures of weight loss in relation to incident diabetes and improvement in cardiometabolic risk factors.

RESEARCH DESIGN AND METHODS

This prospective, observational study analyzed nine weight measures, characterizing baseline weight, short- versus long-term weight loss, short- versus long-term weight regain, and weight cycling, within the Diabetes Prevention Program (DPP) lifestyle intervention arm (n = 1,000) for predictors of incident diabetes and improvement in cardiometabolic risk factors over 2 years.

RESULTS

Although weight loss in the first 6 months was protective of diabetes (hazard ratio [HR] 0.94 per kg, 95% CI 0.90, 0.98; P < 0.01) and cardiometabolic risk factors (P < 0.01), weight loss from 0 to 2 years was the strongest predictor of reduced diabetes incidence (HR 0.90 per kg, 95% CI 0.87, 0.93; P < 0.01) and cardiometabolic risk factor improvement (e.g., fasting glucose: β = −0.57 mg/dL per kg, 95% CI −0.66, −0.48; P < 0.01). Weight cycling (defined as number of 5-lb [2.25-kg] weight cycles) ranged 0–6 times per participant and was positively associated with incident diabetes (HR 1.33, 95% CI 1.12, 1.58; P < 0.01), fasting glucose (β = 0.91 mg/dL per cycle; P = 0.02), HOMA-IR (β = 0.25 units per cycle; P = 0.04), and systolic blood pressure (β = 0.94 mmHg per cycle; P = 0.01). After adjustment for baseline weight, the effect of weight cycling remained statistically significant for diabetes risk (HR 1.22, 95% CI 1.02, 1.47; P = 0.03) but not for cardiometabolic traits.

CONCLUSIONS

Two-year weight loss was the strongest predictor of reduced diabetes risk and improvements in cardiometabolic traits.     

高脂肪食物的摄入和运动对于骨骼肌的脂类及糖类代谢的影响

目的探讨高脂肪食物的摄入和运动对骨骼肌的脂类及糖类代谢的影响特点。方法采用44只体重在60~80g的Wistar雄性小鼠为实验对象,将它们分为标准食物的对照组(N),食高脂肪食物组(F),非运动组(S)和运动组(T)四组。每组各11只小鼠,饲养五周,然后将解剖取出副睾丸脂肪组织,肝藏,比目鱼肌,外侧包括的肌肉,肌腱和血液。进行血液性状,脂肪分辨力,糖原含量,酶的活性进行测定。结果高脂肪食物的摄入和耐力运动训练对ep-itrochlearis肌肉中肌糖原的影响具有显著性(P<0·05,P<0·001)高脂肪食物和耐力训练对副睾丸脂肪组织的脂肪分解表现出显著性差异(P<0·001,P<0·001)。摄入高脂肪食物和耐力训练对epitrochlearis肌肉中氧化酶cs的活性也具有显著性影响(P<0·05,P<0·001);对脂肪酶氧化酶3-HAD活性的影响非常显著(P<0·001)。结论高脂肪食物摄入虽然使骨骼肌肉内糖原含量降低,但可使氧化酶的活性增强,运动训练可使脂肪酸氧化酶的活性显著提高。     

Unintentional Weight Loss and Bilirubinuria in an Adolescent Female

Exacerbations in Crohn’s disease may be accompanied by extraintestinal manifestations. Clinicians should be aware of possible extraintestinal organ involvement to aid in diagnosis and to rule out possible life-threatening manifestations. This case report presents a patient whose initial onset of Crohn’s disease had multiorgan involvement that expanded the differential diagnoses. Discussion includes assessment diagnostic criteria, possible extraintestinal manifestations of Crohn’s, and recommended treatment for severe initial presentation of disease.     

Bidirectional Relationships Between Weight Change and Sleep Apnea in a Behavioral Weight Loss Intervention

Objective

To examine the bidirectional relationship between weight change and obstructive sleep apnea (OSA) in the context of a behavioral weight loss intervention.

Association Between Body Image Dissatisfaction and Weight Loss Among Patients With Advanced Cancer and Their Caregivers: A Preliminary Report

ContextNo prospective studies have dealt with the impact of cachexia-related weight loss on patients' body image as well as the impact of patients' body image changes on the level of patient and family distress.ObjectivesOur aim was to examine associations between body mass index (BMI), weight loss, symptom distress, and body image for patients with advanced cancer and their caregivers.MethodsOutpatients with advanced cancer and different levels of BMI, along with their caregivers, were recruited. Patient assessments included BMI, precancer weight, Body Image Scale (BIS; 0–30), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and sexual interest and enjoyment as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck Cancer Module 35. Caregivers were asked to assess the patient's body image, using the BIS; rate their own quality of life, using the Caregiver Quality of Life Index-Cancer; and rate their overall distress and distress regarding the patient's weight, using the Distress Thermometer (DT).ResultsWe included 81 patients and 30 caregivers. Forty-eight patients (59%) experienced weight loss of at least 10%. The mean BIS score was 11.23 (SD = 7.24). Body image dissatisfaction was correlated with weight loss (r = 0.31, P = 0.006), anxiety (HADS-A; r = 0.39, P < 0.001), depression (HADS-D; r = 0.46, P < 0.001), decreased sexual interest (r = 0.37, P = 0.001), decreased sexual enjoyment (r = 0.33, P = 0.004), ESAS score for pain (r = 0.25, P = 0.026), fatigue (r = 0.28, P = 0.014), drowsiness (r = 0.28, P = 0.014), shortness of breath (r = 0.27, P = 0.016), sleep disorders (r = 0.24, P = 0.036), and well-being (r = 0.29, P = 0.011). We found a significant association between the caregivers' evaluation of patients' body image dissatisfaction and patients' BIS score (r = 0.37, P = 0.049) and caregivers' distress regarding the patients' weight (DT; r = 0.58; P = 0.001).ConclusionBody image dissatisfaction was strongly associated with patients' weight loss and with psychosocial distress among patients and their caregivers. More research is necessary to better understand the association between the severity of body image dissatisfaction and the severity of other problems in patients with cancer.     

秦皇岛市大学生体脂分布与丙氨酸氨基转移酶相关性研究

[目的]探讨大学生体脂分布与丙氨酸氨基转移酶（ALT）相关性.[方法]采用分层整群随机抽样的方法,选取秦皇岛市两所大学789名在校大学生（男性 369例,女性 420例）作为研究对象,测量身高、体重、腰围（WC）,计算体重指数（BMI）,检测血清丙氨酸氨基转移酶（ALT）.[结果]大学生ALT升高检出率为9.8%,男性检出率高于女性（16.3% vs 4.0%,P=0.000）.ALT升高组BMI和WC升高检出率均高于ALT正常组（P〈0.001）.Logistic回归分析显示,单纯BMI升高者ALT升高检出率是BMI和WC均正常者的 4.252倍,而单纯WC升高者达到 10.570倍,在BMI和WC均升高者达到最高14.141倍.[结论]秦皇岛市大学生ALT升高检出率较高.ALT升高与体脂分布密切相关.