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Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting.
Anton, SD, Moehl, K, Donahoo, WT, Marosi, K, Lee, SA, Mainous, AG, Leeuwenburgh, C, Mattson, MP
Obesity (Silver Spring, Md.). 2018;(2):254-268
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Abstract
OBJECTIVE Intermittent fasting (IF) is a term used to describe a variety of eating patterns in which no or few calories are consumed for time periods that can range from 12 hours to several days, on a recurring basis. This review is focused on the physiological responses of major organ systems, including the musculoskeletal system, to the onset of the metabolic switch: the point of negative energy balance at which liver glycogen stores are depleted and fatty acids are mobilized (typically beyond 12 hours after cessation of food intake). RESULTS AND CONCLUSIONS Emerging findings suggest that the metabolic switch from glucose to fatty acid-derived ketones represents an evolutionarily conserved trigger point that shifts metabolism from lipid/cholesterol synthesis and fat storage to mobilization of fat through fatty acid oxidation and fatty acid-derived ketones, which serve to preserve muscle mass and function. Thus, IF regimens that induce the metabolic switch have the potential to improve body composition in overweight individuals. Moreover, IF regimens also induce the coordinated activation of signaling pathways that optimize physiological function, enhance performance, and slow aging and disease processes. Future randomized controlled IF trials should use biomarkers of the metabolic switch (e.g., plasma ketone levels) as a measure of compliance and of the magnitude of negative energy balance during the fasting period.
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Acute effects of salt on blood pressure are mediated by serum osmolality.
Kanbay, M, Aslan, G, Afsar, B, Dagel, T, Siriopol, D, Kuwabara, M, Incir, S, Camkiran, V, Rodriguez-Iturbe, B, Lanaspa, MA, et al
Journal of clinical hypertension (Greenwich, Conn.). 2018;(10):1447-1454
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Abstract
It is classically thought that it is the amount of salt that is critical for driving acute blood pressure responses. However, recent studies suggest that blood pressure responses, at least acutely, may relate to changes in serum osmolality. Here, we test the hypothesis that acute blood pressure responses to salt can be altered by concomitant water loading. Ten healthy patients free of any disease and medication underwent 4 interventions each a week apart in which they took 300 mL of lentil soup with no salt (visit 1), lentil soup with 3 g salt (visit 2), or lentil soup with 3 g salt and 500 mL water (visit 3) or 750 mL water (visit 4). At each visit, hourly blood measurements and blood pressure measurements (baseline, 1st, 2nd, 3rd, and 4th hour) were performed and plasma osmolarity, sodium and copeptin levels were measured. Patients receiving the 3 g salt showed a 6 mOsm/L change in osmolality with a 2.5 mmol/L change in plasma sodium and 10 mm Hg rise in systolic blood pressure at 2 hours. When the same patients drank salty soup with water, the changes in plasma osmolarity, plasma sodium, and blood pressure were prevented. The ability to raise blood pressure acutely with salt appears dependent on changes in plasma osmolality rather than the amount of salt. Our findings suggest that concurrent intake of water must be considered when evaluating the role of salt in blood pressure.
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The effect of mindful eating on subsequent intake of a high calorie snack.
Seguias, L, Tapper, K
Appetite. 2018;:93-100
Abstract
This study examined the effects of applying a mindful eating strategy during lunch on subsequent intake of a palatable snack. It also looked at whether this effect occurred due to improved memory for lunch and whether effects varied with participant gender, level of interoceptive awareness or sensitivity to reward. Participants (n = 51) completed a heartbeat perception task to assess interoceptive awareness. They were then provided with a lunch of 825 calories. Participants in the experimental group ate lunch while listening to an audio clip encouraging them to focus on the sensory properties of the food (e.g. its smell, look, texture). Those in the control group ate lunch in silence. Two hours later participants were offered a snack. They then completed a questionnaire assessing sensitivity to reward as well as other measures assessing various aspects of their memory for lunch. The results showed no significant difference in lunch intake between the two groups but participants in the experimental group consumed significantly less snack than those in the control group; mean = 112.30 calories (SD = 70.24) versus mean = 203.20 calories (SD = 88.05) respectively, Cohen's d = 1.14. This effect occurred regardless of participant gender or level of interoceptive awareness. There was also no significant moderation by sensitivity to reward although one aspect, reward interest, showed a trend towards significance. There was no evidence to indicate that the mindful eating strategy enhanced participants' memory for their lunch. Further research is needed to assess the long-term effects of this strategy, as well as establish the underlying mechanisms. Future work on the relationship between sensitivity to reward and the effects of mindful eating may also benefit from larger sample sizes.
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Evaluation of a New Noninvasive Glucose Monitoring Device by Means of Standardized Meal Experiments.
Pfützner, A, Strobl, S, Demircik, F, Redert, L, Pfützner, J, Pfützner, AH, Lier, A
Journal of diabetes science and technology. 2018;(6):1178-1183
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Abstract
BACKGROUND Frequent blood glucose readings are the most cumbersome aspect of diabetes treatment for many patients. The noninvasive TensorTip Combo Glucometer (CoG) component employs dedicated mathematical algorithms to analyze the collected signal and to predict tissue glucose at the fingertip. This study presents the performance of the CoG (the invasive and the noninvasive components) during a standardized meal experiment. METHODS Each of the 36 participants (18 females and males each, age: 49 ± 18 years, 14 healthy subjects, 6 type 1 and 16 type 2 patients) received a device for conducting calibration at home. Thereafter, they ingested a standardized meal. Blood glucose was assessed from capillary blood samples by means of the (non)invasive device, YSI Stat 2300 plus, Contour Next at time points -30, 0, 15, 30, 45, 60, 75, 90, 120, 150, and 180 minutes. Statistical analysis was performed by consensus error grid (CEG) and calculation of mean absolute relative difference (MARD) in comparison to YSI. RESULTS For the noninvasive (NI) CoG technology, 100% of the data pairs were found in CEG zones A (96.6%) and B (3.4%); 100% were seen in zone A for the invasive component and Contour Next. MARD was calculated to be 4.2% for Contour Next, 9.2% for the invasive component, and 14.4% for the NI component. CONCLUSIONS After appropriate individual calibration of the NI technology, both the NI and the invasive CoG components reliably tracked tissue and blood glucose values, respectively. This may enable patients with diabetes to monitor their glucose levels frequently, reliably, and most of all pain-free.
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Reinforcement sensitivity and restrained eating: the moderating role of executive control.
Jonker, NC, Bennik, EC, de Jong, PJ
Eating and weight disorders : EWD. 2018;(3):321-329
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Abstract
PURPOSE As the prevalence of overweight and obesity are still increasing, it is important to help individuals who encounter difficulty with losing weight. The current study was set out to further investigate characteristics of individuals who are highly motivated to restrict their food intake to lose weight, but fail to do so (i.e., restrained eaters). The motivation to lose weight might stem from high punishment sensitivity, whereas the failure to succeed in restricting food intake might be the result of high reward sensitivity. Thus, it was examined whether restrained eaters are characterized by both high reward sensitivity and high punishment sensitivity. Additionally, this is the first study to examine executive control as a potential moderator of this relationship. METHODS Female undergraduates (N = 60) performed a behavioral measure of executive control, and completed the Restraint Scale to index level of restrained eating as well as two questionnaires on reinforcement sensitivity; the Behavioral Inhibition Scale/Behavioral Activation Scale, and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire. RESULTS There was a positive relationship between restrained eating and punishment sensitivity as indexed by both questionnaires. Reward sensitivity as measured by both indices was not directly related to restrained eating. Executive control moderated the relation between reward responsivity (but not reward-drive) and restrained eating; specifically in women with relatively weak executive control there was a positive relationship between reward responsivity and restrained eating behavior. CONCLUSION In women with low executive control, restrained eating is associated with both heightened sensitivity to punishment and heightened responsivity to reward.
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Oral Feeding Difficulties in Children With Short Bowel Syndrome: A Narrative Review.
Hopkins, J, Cermak, SA, Merritt, RJ
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2018;(1):99-106
Abstract
Children with short bowel syndrome (SBS) with associated intestinal failure may be unable to absorb sufficient nutrients to sustain life. Improvements in the medical management of SBS, including use of parenteral nutrition, has significantly increased life expectancy. Independence from parenteral nutrition further improves quality of life. However, children living with SBS often develop oral aversions and feeding difficulties. There is limited research and information on which to base interventions that will preserve and develop oral motor and feeding skills. The aims of this article are to explore what is known about children with SBS who exhibit oral aversion/feeding difficulties and to suggest research for possible future interventions that could help these children overcome oral aversion, eat orally, and increase participation and satisfaction in mealtimes. This review explores the complexity of feeding children with SBS. Three underlying themes emerged: physical, developmental, and social aspects of eating and mealtimes. Interdisciplinary teams are needed to effectively address these complex oral feeding problems. Accurate identification the underlying issues will allow healthcare providers to develop interventions to improve feeding outcomes for children with SBS. Future research should focus on evaluating the effectiveness of interventions that address each of the underlying issues.
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Computer training of attention and inhibition for youngsters with obesity: A pilot study.
Verbeken, S, Braet, C, Naets, T, Houben, K, Boendermaker, W, ,
Appetite. 2018;:439-447
Abstract
Obesity is a widespread problem that starts from an early age. Previous studies suggest that obese youngsters have an attentional bias and an automatic approach tendency towards high-calorie food and display difficulties inhibiting impulses, which may result in a higher intake of (high-calorie) food. An interesting idea for improvement of the current obesity treatment is adding a program that enables to train their difficulties. Subjects were 36 youngsters aged 9-15 years old from an inpatient treatment program for obesity, randomized over a training group and an active control group. The training consisted of six training sessions with cognitive tasks aimed at enhancing inhibition towards unhealthy food items (with a go/no-go task), as well as decreasing a food approach bias (using an approach/avoidance task) and a food attentional bias (using a dot-probe task). The current study evaluated the feasibility, acceptability and initial effectiveness of the training and explores if these characteristics helps obese youngsters to maintain weight-loss once they return home at the end of their inpatient treatment program. Results on the cognitive performances were investigated during two measurement sessions, spread over 5 weeks while weight evolution was followed over 13 weeks. Results showed that the training program was feasible and acceptable to the majority of participants and clinicians. Furthermore, the preliminary findings suggest that the training tasks used were ineffective in this group of obese children. Lessons learned and suggestions for future research are discussed.
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A Review of the Evidence Surrounding the Effects of Breakfast Consumption on Mechanisms of Weight Management.
Gwin, JA, Leidy, HJ
Advances in nutrition (Bethesda, Md.). 2018;(6):717-725
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Abstract
The recommendation to eat breakfast has received scrutiny due to insufficient causal evidence for improvements in weight management. Despite the limited number of randomized controlled trials examining the effects of breakfast consumption compared with skipping breakfast on weight loss, an increasing number of studies target the hormonal and behavioral mechanisms underlying weight management. This review provides a comprehensive examination of the intervention-based clinical trials that test whether breakfast consumption improves appetite control and satiety as well as energy expenditure compared with skipping breakfast. Several factors were considered when interpreting the body of evidence. These include, but were not limited to, the following: the composition of breakfast, with a specific focus on dietary protein; meal size and form; and habitual breakfast behaviors. The evidence within this review shows positive to neutral support for the inclusion of breakfast for improvements in appetite control, satiety, and postprandial energy expenditure. The protein content, energy content, and form of the meal (i.e., beverages compared with foods) are key modulating factors for ingestive behavior and energy expenditure mechanisms. Specifically, breakfast meals containing a larger amount of protein (≥30 g protein/meal) and energy (≥350 kcal/meal) and provided as solid foods increased the magnitude of the appetite and satiety response compared with breakfast skipping. Longer-term randomized controlled trials including the measurement of ingestive behavior and weight management are needed to identify the role of breakfast for health promotion.
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Energy expenditure in the etiology of human obesity: spendthrift and thrifty metabolic phenotypes and energy-sensing mechanisms.
Piaggi, P, Vinales, KL, Basolo, A, Santini, F, Krakoff, J
Journal of endocrinological investigation. 2018;(1):83-89
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Abstract
The pathogenesis of human obesity is the result of dysregulation of the reciprocal relationship between food intake and energy expenditure (EE), which influences daily energy balance and ultimately leads to weight gain. According to principles of energy homeostasis, a relatively lower EE in a setting of energy balance may lead to weight gain; however, results from different study groups are contradictory and indicate a complex interaction between EE and food intake which may differentially influence weight change in humans. Recently, studies evaluating the adaptive response of one component to perturbations of the other component of energy balance have revealed both the existence of differing metabolic phenotypes ("spendthrift" and "thrifty") resulting from overeating or underfeeding, as well as energy-sensing mechanisms linking EE to food intake, which might explain the propensity of an individual to weight gain. The purpose of this review is to debate the role that human EE plays on body weight regulation and to discuss the physiologic mechanisms linking EE and food intake. An increased understanding of the complex interplay between human metabolism and food consumption may provide insight into pathophysiologic mechanisms underlying weight gain, which may eventually lead to prevention and better treatment of human obesity.
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The portion size effect: Women demonstrate an awareness of eating more than intended when served larger than normal portions.
Keenan, GS, Childs, L, Rogers, PJ, Hetherington, MM, Brunstrom, JM
Appetite. 2018;:54-60
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Abstract
Large portion sizes lead to increased intake. Some studies suggest that individuals are unaware that they consume more when served larger portions. In a between-subjects design we asked female participants (N = 48) how much pasta and tomato sauce they intended to consume for lunch prior to eating. We then provided a smaller or a larger portion of the same food and invited participants to self-serve a portion into a second bowl (same size in both conditions). After eating until comfortably full, participants were shown an image of the amount they had selected at the beginning of the meal. They were then asked whether they perceived having eaten more or less than this amount, and by how much more or less they had eaten. In total 46 responses were analysed. Of the participants who received the large portion and who ate more than intended, 77% (p = .029) correctly identified eating more. However, when participants were asked to indicate by how much they had eaten above or below their intended amount, those who ate more after receiving a larger portion underestimated their intake by 25% (p = .003). These findings suggest that greater intake from a larger portion is associated with an awareness of having eaten a large quantity combined with a failure to register the actual amount consumed (in the direction of underestimation). The latter might be attributed to an error associated with the visual estimation of volume.