个性化营养干预对改善学龄儿童消瘦肥胖的效果评估

探讨肥胖、消瘦儿童的个性化营养干预模式效果,为推广适宜学生群体的营养改善方案提供理论依据.方法 选取上海市某小学44名肥胖学生和43名消瘦学生随机分为干预组(42人)和对照组(45人),对干预组学生及其家长进行9个月的个性化营养干预,营养干预措施包括有针对性的营养教育、跟踪随访、三餐的干预、微文推送及在线营养咨询等,并在干预前后分别进行学生、家长的营养知信行问卷调查和学生体质测量.结果 干预后,干预组学生营养知识、态度和行为得分较对照组均有提升,分别提高了0.66,0.96和1.66分(Z值分别为-2.274,-2.850,-2.120,P值均<0.05).干预前后比较,干预组学生BMI和体脂率有一定的改变,但差异无统计学意义(P值均>0.05);干预组肥胖学生肱三头肌皮褶厚度、肩胛下皮褶厚度下降(t值分别为2.491,2.149,P值均<0.05),而消瘦学生增加(t值分别为-2.674,-2.752,P值均<0.05).干预组学生的家长营养态度、行为得分干预后也有提升,分别提高了0.88,0.54分(Z值分别为-2.874,-2.902,P值均<0.05).结论 个性化营养干预对肥胖、消瘦的学生有一定效果,该模式可进一步研究和推广.     

A role for fruit content in energy-restricted diets in improving antioxidant status in obese women during weight loss

OBJECTIVE: The aim of the present work was to estimate the ability of two hypocaloric diets with different fruit contents to improve antioxidant biomarkers related to lipid peroxidation in obese women. METHODS: Fifteen obese women (age 32 +/- 6 y, body mass index 34.9 +/- 2.9 kg/m2) were assigned to two different dietary treatments for 8 wk. The subjects received a hypocaloric diet (600 kcal/d restriction from the measured individual energy expenditure) containing 5% (n = 8) or 15% (n = 7) energy supplied by fructose from fruits. Anthropometric measurements, blood lipid profile, plasma oxidative markers, total antioxidant capacity, and malondialdehyde (MDA) were evaluated before and after the nutritional intervention in addition to some relations among them. RESULTS: No differences in weight loss were observed between diets (5% energy from fructose in the low fruit diet -6.9 +/- 2% versus 15% energy from fructose in the high fruit diet -6.6 +/- 2%; P = 0.781). Low-density lipoprotein cholesterol levels significantly decreased (P = 0.048) in obese women who followed the high fruit diet, which was accompanied by a statistical (P = 0.046) diet-related decrease (-30%) in the ratio of MDA to antioxidant capacity. There was a positive association between MDA diet-related change and low-density lipoprotein cholesterol (r = 0.665, P = 0.003), with antioxidant capacity directly proportional to the fiber plus fructose content associated with fruit consumption (r = 0.697, P = 0.025). CONCLUSION: A fruit-enriched hypocaloric diet appears to be more effective against oxidative stress. Consumption of antioxidant substances contained in fruit could be a useful strategy in the design of hypocaloric diets that, with the weight reduction, could increase the improvement of cardiovascular risk factors related to obesity.     

Plasma and urinary carnitine of obese subjects on very-low-calorie diets

We evaluated the differential effects of feeding two very-low-calorie diets upon the fractions of plasma and urinary carnitine in obese females. Ten subjects received either diet D1, a 420 kcal/day formula diet, or diet D2, a 500-600 kcal/day meat/fish/poultry diet. Plasma and urinary carnitine levels were determined at the start of the study. After 1 month, plasma carnitine levels were obtained; at 2 months, both plasma and urinary carnitine levels were obtained. Subjects receiving diet D2 showed significantly higher levels of plasma total carnitine over the course of the study (p less than 0.05). Plasma short-chain acylcarnitine esters increased and free carnitine declined significantly in both groups during the study period. Subjects receiving D1 excreted significantly less urinary carnitine than those receiving D2. We conclude that long-term ingestion of very-low-calorie diets causes alterations in plasma carnitine metabolism.     

Dairy-rich diets augment fat loss on an energy-restricted diet: a multicenter trial

A 12-week randomized controlled multi-center clinical trial was conducted in 106 overweight and obese adults. Diets were designed to produce a 2,093 kJ/day energy deficit with either low calcium (LC; ~600 mg/day), high calcium (HC; ~1,400 mg/day), or high dairy (HD; three dairy servings, diet totaling ~1,400 mg/day). Ninety-three subjects completed the trial, and 68 met all a priori weekly compliance criteria. Both HC and HD contained comparable levels of calcium, but HC was only ~30% as effective as HD in suppressing 1,25-(OH)(2)D and exerted no significant effects on weight loss or body composition compared to LC. In the group that met compliance criteria, HD resulted in ~two-fold augmentation of fat loss compared to LC and HC (HD: -4.43 ± 0.53 kg; LC: -2.69 ± 0.0.53 kg; HC: -2.23 ± 0.73 kg, p < 0.025); assessment of all completers and an intent-to-treat analysis produced similar trends. HD augmentated central (trunk) fat loss (HD: -2.38 ± 0.30 kg; HC: -1.42 ± 0.30 kg; LC: -1.36 ± 0.42 kg, p < 0.05) and waist circumference (HD: -7.65 ± 0.75 cm; LC: -4.92 ± 0.74 cm; LC: -4.95 ± 1.05 cm, p < 0.025). Similar effects were noted among all subjects completing the study and in an intent-to-treat analysis. These data indicate that dairy-rich diets augment weight loss by targeting the fat compartment during energy restriction.     

Serum ghrelin levels in response to glucose load in obese subjects post-gastric bypass surgery

OBJECTIVE: We sought to elucidate further the mechanisms leading to weight loss after gastric bypass (GBP) surgery in morbidly obese individuals. Ghrelin is a gastroenteric appetite-stimulating peptide hormone, fasting levels of which decrease with increasing adiposity and increase with diet-induced weight loss. In addition, ghrelin levels rapidly decline postprandially. RESEARCH METHODS AND PROCEDURES: We measured serum ghrelin responses to a 75-g oral glucose tolerance test (OGTT) in 6 subjects who had undergone GBP surgery 1.5 +/- 0.7 years before testing and compared these responses with 6 obese subjects about to undergo GBP surgery, 6 obese nonsurgical subjects (matched for BMI to the post-GBP surgical group), and 5 lean subjects. RESULTS: Despite weight loss induced by the GBP surgery, fasting serum ghrelin levels were significantly lower in the post-GBP surgery group than in the lean subject (by 57%) or pre-GBP surgery (by 45%) group. Serum ghrelin levels during the OGTT were significantly lower in postoperative than in lean, obese pre-GBP surgical, or obese nonsurgical subjects. The magnitude of the decline in serum ghrelin levels between 0 and 120 minutes post-OGTT was significantly smaller in postoperative (by 62%), obese pre-GBP surgical (by 80%), or obese nonsurgical (by 69%) subjects in comparison with lean subjects. DISCUSSION: Serum ghrelin levels in response to OGTT are lower in subjects post-GBP surgery than in either lean or obese subjects. Tonically low serum ghrelin levels may be involved in the mechanisms inducing sustained weight loss after GBP surgery.     

Differences in glycaemic status do not predict weight loss in response to hypocaloric diets in obese patients

OBJECTIVE: The aim of our study was to detect differences in weigth loss with a hypocaloric diet in obese patients depending on their glycaemic status. SUBJECTS AND METHODS: A population of 76 obesity outpatients was analysed in a prospective way. The following variables were specifically recorded at basal time and after 3 months of hypocaloric diet (1200 kcal/day): weight, blood pressure, body mass index (BMI), waist circumference, and waist-hip ratio. Basal glucose, insulin, fibrinogen, cortisol, c-reactive protein, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides blood levels were measured. HOMA was calculated. An indirect calorimetry, tetrapolar electrical bioimpedance and a serial assessment of nutritional intake with 3 days written food records were performed. RESULTS: The mean age was 46.9 +/- 17.1 years and the mean BMI 34.6 +/- 5.3. All subjects were weight stable during the 2 weeks period preceding the study (body weight change, 0.3 +/- 0.1 kg). Anthropometric measurements showed an average waist circumference (108.7 +/- 15.7 cm), waist-to-hip ratio (0.93 +/- 0.11), and average weight (88.7 +/- 16.9 kg). Bipolar body electrical bioimpedance showed a fat mass of 37 +/- 12.3 kg. Indirect calorimetry showed a resting metabolic rate (RMR) (1674.3 +/- 392 kcal/day). Patients were divided in to two groups by glycaemic status (group I: normal glycaemic metabolism, fasting glucose levels <109 mg/dl; n = 50) and (group II: impaired glycaemic metabolism, fasting glucose levels >110 mg/dl, n = 26). Waist circumference (I: 108 +/- 17.1cm vs. 104.6 +/- 16.7 cm; P < 0.05) and (II: 113.6 +/- 9.8 cm vs. 110.9 +/- 8.9 cm; P < 0.05), weight (I: 90.6 +/- 19.2 kg vs. 86.3 +/- 18.6 kg:P < 0.05) and (II: 89.2 +/- 11.3 kg vs. 86.4 +/- 11.6 kg: P < 0.05) and BMI (I: 34.2 +/- 5.6 vs. 33.7 +/- 5.5; P < 0.05) and (II: 34.8 +/- 4.2 vs. 34.2 +/- 4.6; P < 0.05) improved in both groups with hypocaloric diet. Blood systolic pressure, total cholesterol and LDL cholesterol improved in both groups, without statistical differences. In group II improved glucose levels and HOMA index, too. Patients of group II had higher systolic blood pressure, glucose, total cholesterol, LDL cholesterol, triglycerides, lipoprotein (a), RCP levels and HOMA index than patients in group I. ANOVA analysis did not show differences among weight loss in tertiles of HOMA and glucose. CONCLUSION: Ability to lose weight on a hypocaloric diet over a 3-month time period does not vary in obese patients as a function of glycaemic status. Improvement in cardiovascular risk factors is not related with glycaemic status, too.     

Genetic polymorphisms of the renin-angiotensin system and obesity-related metabolic changes in response to low-energy diets in obese women

Objective

Genetic polymorphisms of the renin-angiotensin system have been implicated in cardiovascular and metabolic diseases. The purpose of this study was to investigate whether the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene and 3123C/A polymorphism of the angiotensin II type 2 receptor (AT₂R) gene affect blood pressure and other obesity-related metabolic changes in response to low-energy diets using meal replacement shakes for weight loss.

Methods

Clinical, metabolic, and biochemical profiles were measured before and after a 2-mo intervention in 32 obese women (age 49.9 ± 8.4 [SD] y; BMI 28.4 ± 3.3 kg/m²) restricted to 1200 kcal/d (5021 kJ/d). The polymorphisms were determined with an intercalater-mediated FRET probe assay system.

Results

Although weight loss and nutrient intake levels did not differ among the genotypes, the reduction in body fat after weight loss was significantly less in the ACE deletion/deletion (D/D) genotype than insertion/insertion (I/I) plus I/D genotype (−2.25 ± 1.40% versus −0.80 ± 1.57%, P < 0.05). The AT₂R A/A group had significantly less improved levels of systolic blood pressure (−7.23 ± 8.50 versus 2.50 ± 12.6 mmHg, P < 0.05), low-density lipoprotein-cholesterol (−0.36 ± 0.29 versus −0.09 ± 0.25 mmol/L, P < 0.05), carbohydrate (−54.4 ± 27.2 versus −31.8 ± 16.3 mg/min, P < 0.05) and fat oxidation (8.31 ± 11.86 versus 0.05 ± 9.99 mg/min, P < 0.05) than the C/C plus C/A genotypes.

Conclusion

The present findings suggest that the homozygous form of the ACE gene may hinder the improvement of body fat and that the homozygous form of the AT₂R gene may make improving systolic blood pressure and some obesity-related metabolic parameters through a dietary intervention difficult among obese women.     

营养健康教育对单纯性肥胖儿童营养知识-态度-行为的研究

目的:了解和提高肥胖儿童营养知识水平,培养肥胖儿童良好的饮食习惯。方法:将840例肥胖儿童分为扑克牌组和对照组各420例,扑克牌组根据研究制订的营养健康教育模型进行健康教育,对照组采用传统营养教育方法。结果:营养健康教育后,肥胖儿童营养知识得到提高,食物选择及饮食行为趋于合理。扑克牌组的营养知识明显高于对照组(P<0.05)。结论:对肥胖儿童进行扑克牌营养健康教育寓教于乐,有助于增加其营养知识,改善其营养态度及饮食行为,最终达到减少儿童肥胖症的目的,值得推广和普及。     

Popular diets: correlation to health, nutrition, and obesity

OBJECTIVE: To examine the association between a range of health and nutrition indicators and popular diets. DESIGN: The Continuing Survey of Food Intake by Individuals (CSFII) 1994-1996 data were used to examine the relationship between prototype popular diets and diet quality as measured by the healthy eating index (HEI), consumption patterns, and body mass index (BMI). The prototype diets included vegetarian (no meat, poultry, or fish on day of survey) and non-vegetarian. The nonvegetarian group was further subdivided into low carbohydrate (less than 30% of energy from carbohydrate), medium (30% to 55%), and high (greater than 55% of energy). Within the high carbohydrate group, participants were classified as having Pyramid or non-Pyramid eating patterns. The Pyramid group was defined as 30% or less of energy from fat and at least one serving from the five major food groups in the USDA Food Guide Pyramid. Finally, the non-Pyramid group was further subdivided into low fat (less than 15% of energy from fat) and moderate fat (15% to 30% of energy from fat). In addition, a review of the published scientific literature was conducted; all studies identified were included in the review. SUBJECTS: 10,014 adults, aged 19 years and older, from the 1994-1996 CSFII were included in the analyses of extant data. More than 200 individual studies were included in the review of the literature. RESULTS: Analyses of the CSFII indicate that diet quality as measured by HEI was highest for the high carbohydrate Pyramid group (82.9) and lowest for the low carbohydrate group (44.6). Energy intakes were low for the vegetarians (1,606 kcals) and high carbohydrate/low fat group (1360 kcals). BMIs were lowest for women in the vegetarian group (24.6) and the high carbohydrate/low fat group (24.4); for men, the lowest BMIs were observed for vegetarians (25.2) and the high carbohydrate Pyramid group (25.2). Review of the literature suggests that weight loss is independent of diet composition. Energy restriction is the key variable associated with weight reduction in the short term. CONCLUSIONS: Diets that are high in carbohydrate and low to moderate in fat tend to be lower in energy. The lowest energy intakes were observed for those on a vegetarian diet. The diet quality as measured by HEI was highest for the high carbohydrate groups and lowest for the low carbohydrate groups. The BMIs were significantly lower for men and women on the high carbohydrate diet; the highest BMIs were noted for those on a low carbohydrate diet.     

Using patient-reported measurement to pave the path towards personalized medicine

Objective

Given the potential and importance of personalized or individualized medicine for health care delivery and its effects on patients’ quality of life, a plenary session was devoted to personalized medicine during the 19th Annual Conference of the International Society for Quality of Life Research held in October 2012 in Budapest, Hungary. This paper summarizes the three presentations and discusses their implications for quality-of-life research.

Methods

Reviews of the literature and presentation of empirical studies.

Results

Personalized screening for breast cancer. To individualize screening and only target those women with an increased risk for breast cancer, researchers at the Karolinska Institutet in Stockholm perform a large population-based study to identify high-risk women based on lifestyle, genetics, mammographic morphology, and other markers as well as quality of life. Personalized support for treatment adherence. Inclusion of a simple, brief adherence measure into the clinical visit has demonstrated significant improvement in medication-taking behaviour and resultant improvement in health status. Personalized diagnosis of mental disorders. The DSM-5, the current manual for mental disorders, contains patient-based symptom and diagnosis severity measures that allow more individualized diagnosis than was hitherto possible.

Conclusions

Personalized medicine will continue to be increasingly applied and holds the potential to improve health outcomes including quality of life. At the same time, it will invite a host of new ethical, practical, and psychosocial questions. Further reflection and discussion of how our field can embrace and address these emerging challenges is needed.     

Very-low-calorie diets: Downsizing the hospitalised obese patient

The rising prevalence of obesity and its associated morbidity and mortality are placing significant strain on Australia's health‐care system. The present case study examines the weight loss attempts of a 60‐year‐old male patient weighing 218 kg (body mass index 69 kg/m²) in the setting of an acute hospital ward. The patient was confined to bed, secondary to a previous above knee amputation, and was unable to be transferred or fit safely into a wheelchair because of his weight. He was also unable to return home alone because of his current size. Because of the need for rapid weight reduction, a novel inpatient approach to weight loss was adopted, using a very‐low‐calorie diet (VLCD) and multidisciplinary team management. The VLCD intervention was prescribed in conjunction with medical management, regular physical therapy, behaviour therapy and dietary counselling. Serial anthropometric and biochemical measurements were obtained throughout the treatment period. The patient achieved an 80‐kg weight loss (37% initial body weight) over a six‐month hospitalisation. Improvements in obesity‐related comorbidities and the patient's functional and independence level were also observed, enabling discharge from hospital to residential care. Total weight loss at 24 months post hospital discharge was 103 kg (47% initial body weight). The use of a VLCD in a motivated individual in a controlled hospital environment, along with input from the multidisciplinary team, resulted in substantial and sustained weight loss with improved health outcomes.