USE OF INTESTINAL BYPASS TO TREAT MORBID OBESITY

Follow-up data are reported on weight loss, medical complications and other changes in 75 obese patients who underwent jejunoileal bypass operations.     

The Gut Microbiota during a Behavioral Weight Loss Intervention

Altered gut microbiota has been linked to obesity and may influence weight loss. We are conducting an ongoing weight loss trial, comparing daily caloric restriction (DCR) to intermittent fasting (IMF) in adults who are overweight or obese. We report here an ancillary study of the gut microbiota and selected obesity-related parameters at the baseline and after the first three months of interventions. During this time, participants experienced significant improvements in clinical health measures, along with altered composition and diversity of fecal microbiota. We observed significant associations between the gut microbiota features and clinical measures, including weight and waist circumference, as well as changes in these clinical measures over time. Analysis by intervention group found between-group differences in the relative abundance of Akkermansia in response to the interventions. Our results provide insight into the impact of baseline gut microbiota on weight loss responsiveness as well as the early effects of DCR and IMF on gut microbiota.     

Is Probiotic Supplementation Useful for the Management of Body Weight and Other Anthropometric Measures in Adults Affected by Overweight and Obesity with Metabolic Related Diseases? A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis is to assess the effectiveness of probiotics in inducing body weight loss in patients with overweight or obesity with related metabolic diseases. The research was carried out on PubMed and Scopus, focusing on studies reporting the effect on anthropometric measures (weight, body mass Index (BMI), waist circumference (WC), and hip circumference (HC) after administration of various probiotic strains compared to placebo. Twenty randomized controlled trials, that included 1411 patients, were considered. The meta-analyzed mean differences (MD) for random effects showed no significant decrease in body weight after probiotic supplementation (−0.26 kg [−075, 0.23], p = 0.30), while a significant BMI decrease was found (−0.73 kg/m² [−1.31, −0.16], p = 0.01). For WC and HC, the meta-analyzed MD for random effects showed a significant decrease (WC: −0.71 cm [−1.24; −0.19], p = 0.008 and HC: −0.73 cm [−1.16; −0.30], p = 0.0008). The risk of bias was also evaluated considering a high risk and a low risk according to PRISMA criteria. In conclusion, the results of this meta-analysis highlight a positive trend of probiotics supplementation on the amelioration of anthropometric measures of overweight and obese patients with related metabolic diseases. However, further research is needed before recommending the use of probiotics as a therapeutic strategy for these patients. The focus of the future research should be to evaluate the efficacy of different probiotic strains, the quantities to be administered, and the duration of the intervention.     

重复性“饥饿/再投喂”对高脂饮食诱导肥胖大鼠的作用及其机制研究

目的探究重复性"饥饿/再投喂"饲喂方式处理对高脂饮食诱导肥胖大鼠的作用及其机制。方法设计"重复性饥饿1 d/再投喂1 d,持续6 w"的方式(基础饲料)饲喂模型动物,6 w末实验组(RFR)大鼠改为每天喂以高脂饲料(RFR-CF/HF),并将对照组随机分为两组,一组饲喂高脂饲料(HF),另一组饲喂基础饲料(CF)至第12 w。分别于实验第6 w和第12 w末处死动物,比较各组大鼠体重、Lee’s指数和脂体比的差异,检测血脂、血清中生长激素、甲状腺素、瘦素、胰岛素、血浆促肾上腺皮质激素及下丘脑匀浆神经肽Y(NPY)含量,应用RT-PCR法检测下丘脑NPY、阿片黑皮素原(POMC)mRNA的表达水平。结果 RFR-LF/HF组Lee’s指数、脂体比、血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、瘦素和胰岛素水平均显著低于HF组而高于CF组,下丘脑匀浆NPY含量和NPY mRNA表达水平显著高于HF组和CF组,POMC mRNA表达水平显著低于HF组和CF组。结论重复性"饥饿/再投喂"饲喂处理可降低高脂饮食诱导的肥胖程度,减轻外周血的瘦素抵抗和胰岛素抵抗,但可能会引起中枢神经内分泌肽表达的极度紊乱。     

THE NATURE OF WEIGHT LOSS DURING SHORT TERM DIETING

Weight loss on an 800 kcal ketogenic diet is faster than that on a mixed diet, due to extra water loss. In each regimen fat loss is equal and similar to that during total starvation in which much greater protein losses occur.     

The Long-Term Dietitian and Psychological Support of Obese Patients Who Have Reduced Their Weight Allows Them to Maintain the Effects

The role of post-therapeutic support after weight loss in obesity treatment is not fully understood. Therefore, weight maintenance after a successful weight loss intervention is not very common, especially in obese individuals. This randomized controlled study was conducted to explore the efficacy of following dietary and psychological support in a group of 36 obese individuals. Participants (22 women, 14 men aged 35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m²) who completed a 12-month weight loss phase (balanced energy-restricted diet) were randomly allocated to receive 18-month support (SG) or no additional care (CG). The support phase included some elements of Ten Top Tips (TTT), cognitive behavioral therapy (CBT), motivational interviewing (MI) in combination with nutritional education and assessment of the level of physical activity. The primary outcome was the maintenance of anthropometric parameters at an 18-month follow-up. The secondary outcomes included evaluation of biochemical parameters and single nucleotide polymorphisms (SNPs) in genes connected with obesity. A comparison of SG vs. CG after a 30-month period of the study revealed significant differences in weight changes (−3.83 ± 6.09 vs. 2.48 ± 6.24 kg), Body Mass Index (−1.27 ± 2.02 vs. 0.72 ± 2.12 kg/m²), visceral adipose tissue (−0.58 ± 0.63 vs. 0.45 ± 0.74 L), and waist circumference (−4.83 ± 4.05 vs. 1.83 ± 5.97 cm). Analysis of SNPs (rs9939609 FTO, rs987237 TFAP2B, and rs894160 PLIN1) provided further insight into the potential modulating effect of certain genotypes on weight loss and maintenance and extended the knowledge of the potential benefits of personalized medicine. Post-therapeutical support in current clinical practice may increase the chances of long-term weight loss maintenance in obesity treatment even in patients with a genetic predisposition to excessive weight.     

5+2轻断食减重法在某医大附属医院员工减重中的应用

目的:肥胖是一种代谢性疾病,其严重危害人类的健康.5+2轻断食膳食模式是《中国超重/肥胖医学营养治疗专家共识(2016年版)》推荐的科学减重方法之一,近年来受到关注.但是,其在团体体重管理中少有报道.本研究利用轻断食膳食模式对某医科大学附属医院的员工进行减重管理,并评价其效果.方法:对报名参加某医科大学附属医院减重的工...     

Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study

To retrospectively review the efficacy of intermittent fasting 5:2 plus program (30% of energy requirements on fast days and 70% of energy requirements on nonfasting days) in Chinese patients with overweight or obesity. This retrospective cohort study evaluated weight loss outcomes of patients treated with 12 weeks weight loss program in clinic. Adults with overweight or obesity participated in intermittent fasting 5:2 plus, daily calorie restriction (70% of energy requirements every day) or daily calorie restriction with meal replacement (70% of energy requirements every day, partly provided with high-protein meal replacement) programs for 12 weeks. The primary objective was to compare the weight loss of three groups. The primary outcome measure was the change in the % total weight loss. A total of 131 patients (35.3 ± 10.1 years; 81.7% female) were included, and the mean weight loss was 7.8 ± 4.4% after 12 weeks. The intermittent fasting 5:2 plus group (n = 42) achieved 9.0 ± 5.3% weight loss, compared with 5.7 ± 3.7% in the daily calorie restriction group (n = 41) (p < 0.001) and 8.6 ± 3.5% in the meal replacement group (n = 48) (p = 0.650). A total of 85.7% of patients in the intermittent fasting 5:2 plus group lost more than 5% body weight, vs. 58.5% in the daily calorie restriction group (p = 0.008), and 45.2% lost more than 10% body weight, vs. 14.6% in the daily calorie restriction group (p = 0.005). No serious adverse events were reported in the three groups. The intermittent fasting 5:2 plus program more effectively led to weight loss than daily calorie restriction in the short-term in Chinese patients with overweight or obesity. A longer-term prospective randomized controlled trial is needed.     

Intermittent Fasting: Potential Bridge of Obesity and Diabetes to Health?

Obesity has been an escalating worldwide health problem for decades, and it is likely a risk factor of prediabetes and diabetes. Correlated with obesity, the number of diabetic patients is also remarkable. A modest weight loss (5–10%) is critical to alleviate the risk of any other metabolic disease. Reduced energy intake has been an essential factor for weight loss reduction. As a new behavior intervention to lose weight, intermittent fasting (IF) attracts considerable attention and has become a popular strategy among young people. IF is a diet pattern that cycles between periods of fasting and eating on a regular schedule, involving various types, mainly Intermittent Energy Restriction and Time-Restricted Fasting. Accumulating evidence shows that short-term IF has a greatly positive effect in animal studies and contributes favorable benefits in human trials as well. Nevertheless, as an emerging, diverse, and relatively premature behavior intervention, there are still limited studies considering patients with obesity and type 2 diabetes mellitus. It is also a controversial intervention for the treatment of metabolic disease and cancer. The risks and challenges appear consequently. Additionally, whether intermittent fasting can be applied to long-term clinical treatment, and whether it has side effects during the long-term period or not, demands more large-scale and long-term experiments.     

NUTRITIONAL COMPLICATIONS OF THE SURGICAL TREATMENT OF MORBID OBESITY

The significance of the complications following jejunoileal bypass surgery is demonstrated by the increasing incidence of late reversal of the surgery and reconstitution of small bowel integrity. Alternative surgical procedures such as gastric plication are equally effective with fewer serious, long-term complications.     

L-Serine Supplementation Blunts Fasting-Induced Weight Regain by Increasing Brown Fat Thermogenesis

Weight regain after fasting, often exceeding the pre-fasting weight, is a common phenomenon and big problem for the treatment of obesity. Thus, novel interventions maintaining reduced body weight are critically important to prevent metabolic disease. Here we investigate the metabolic effects of dietary L-serine supplementation, known to modulate various organ functions. C57BL/6N-Rj male mice were supplemented with or without 1% L-serine in their drinking water and fed with a chow or high-fat diet. Mice were fed either ad libitum or subjected to repeated overnight fasting. Body weight, body composition, glucose tolerance and energy metabolism were assessed. This was combined with a detailed analysis of the liver and adipose tissues, including the use of primary brown adipocytes to study mitochondrial respiration and protein expression. We find that L-serine supplementation has little impact on systemic metabolism in ad libitum-fed mice. Conversely, L-serine supplementation blunted fasting-induced body weight regain, especially in diet-induced obese mice. This reduction in body weight regain is likely due to the increased energy expenditure, based on elevated brown adipose tissue activity. Thus, L-serine supplementation during and after weight-loss could reduce weight regain and thereby help tackle one of the major problems of current obesity therapies.     

Body image disturbance in obese outpatients before and after weight loss in relation to race, gender, binge eating, and age of onset of obesity

OBJECTIVE: To assess body image disturbance as a composite of three aspects (distortion, discrepancy, and dissatisfaction) in obese subjects before and after weight loss. Disturbance was then related to race, gender, binge eating behavior, and age of onset of obesity. METHODS: Eighty-two obese outpatients (24 males, 58 females) completed the Stunkard Figure Rating Scale (FRS). A Disturbance score was derived from the weighted sum of distortion, discrepancy, and dissatisfaction. The measures were repeated 4 weeks after starting a medically supervised liquid formula diet. RESULTS: Prior to weight loss, race (r =.28, p =.01) and gender (r =.25, p =.02) were each predictive of disturbance, with Caucasians and men having the most disturbance. Binge eaters exhibited more discrepancy (p =.03) and dissatisfaction (p =.005) than non-binge eaters. Early-onset subjects demonstrated more discrepancy than adult-onset subjects (p =.02). Following weight loss, disturbance scores decreased for all groups (p =.009). However, early-onset subjects still showed more discrepancy (p =.002) and more dissatisfaction (p =.005) than adult-onset subjects. DISCUSSION: Body image disturbance was viewed as a composite of three aspects. Prior to weight loss, the high disturbance score in Caucasians may be due to them experiencing greater cultural pressure to be thin. The men may have exaggerated their degree of obesity because of less denial of being overweight than women. Following weight loss, disturbance decreased for all groups but remained elevated for those with early onset, possibly because of a persistent self-image from adolescence.     

Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities

Background

The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi‐component weight management programme.

Methods

TAKE 5 is a 16‐week multi‐component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m^–2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty‐two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.

Results

There were no significant differences between the groups in the amount of weight loss (median: ?3.6 versus ?3.8 kg, respectively, P = 0.4), change in BMI (median: ?1.5 versus ?1.4 kg m^–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16‐week intervention.

Conclusions

A multi‐component weight loss intervention can be equally effective for adults with and without ID and obesity.

     

高原现场大鼠肝细胞的体外长期培养

[目的]在高原环境条件下初步建立体外肝细胞长期培养的一种方法。[方法]将体外分离的大鼠肝细胞以3×105/孔接种于用胶原包被的12孔塑料培养板内,总体培养时间为30 d,动态观察培养细胞形态、细胞数量及培养上清中总蛋白、白蛋白和尿素水平变化。[结果]细胞接种4 h开始贴壁,8 h开始增殖,6 d生长满瓶,形成均匀的单层;4 d细胞数量明显增多,8 d最多,达35.2×105/孔,然后细胞数量渐减少;14 d培养细胞胞浆内开始出现颗粒状物质和空泡,20 d培养细胞开始出现细胞脱壁现象,培养液中漂浮细胞增多;培养上清中总蛋白、白蛋白和尿素水平均呈现显著升高,其达峰值时间分别为10、8和10 d,然后渐降低,培养结束时仍然高于培养2 d时的水平。[结论]在高原环境条件下,体外长期培养肝细胞生长、增殖及其生物学功能良好,可以应用于高原肝脏生理及病理生理等相关方面的研究。