Real-world data suggest effectiveness of the allogeneic mesenchymal stromal cells preparation MSC-FFM in ruxolitinib-refractory acute graft-versus-host disease.

BACKGROUND: Patients with steroid-refractory acute graft-versus-host disease (aGvHD) not tolerating/responding to ruxolitinib (RR-aGvHD) have a dismal prognosis. METHODS: We retrospectively assessed real-world outcomes of RR-aGvHD treated with the random-donor allogeneic MSC preparation MSC-FFM, available via Hospital Exemption in Germany. MSC-FFM is provided as frozen cell dispersion for administration as i.v. infusion immediately after thawing, at a recommended dose of 1-2 million MSCs/kg body weight in 4 once-weekly doses. 156 patients, 33 thereof children, received MSC-FFM; 5% had Grade II, 40% had Grade III, and 54% had Grade IV aGvHD. Median (range) number of prior therapies was 4 (1-10) in adults and 7 (2-11) in children. RESULTS: The safety profile of MSC-FFM was consistent with previous reports for MSC therapies in general and MSC-FFM specifically. The overall response rate at Day 28 was 46% (95% confidence interval [CI] 36-55%) in adults and 64% (45-80%) in children; most responses were durable. Probability of overall survival at 6, 12 and 24 months was 47% (38-56%), 35% (27-44%) and 30% (22-39%) for adults, and 59% (40-74%), 42% (24-58%) and 35% (19-53%) for children, respectively (whole cohort: median OS 5.8 months). CONCLUSION: A recent real-world analysis of outcomes for 64 adult RR-aGvHD patients not treated with MSCs reports survival of 20%, 16% and 10% beyond 6, 12 and 24 months, respectively (median 28 days). Our data thus suggest effectiveness of MSC-FFM in RR-aGvHD.

Assessing the impact of non-nutritive sweeteners on anthropometric indices and leptin levels in adults: A GRADE-assessed systematic review, meta-analysis, and meta-regression of randomized clinical trials.

In today's world, non-nutritive sweeteners (NNSs) are recognized as substitutes for sugar or other high-calorie sweeteners, and their consumption is increasing dramatically. However, there is ongoing debate regarding the impact of NNSs on anthropometric indices. To fill this gap in knowledge, the current GRADE-assessed systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effects of artificial- and stevia-based sweeteners consumption on anthropometric indices and serum leptin level which is known as an appetite-regulating hormone. A comprehensive search was conducted on the Scopus, PubMed, and Embase databases up to November 2022 to identify randomized controlled trials (RCTs) investigating the effects of NNSs on anthropometric indices and serum leptin levels. Data extraction from qualified studies was performed independently by two researchers. A random- or fixed-effects model was used to estimate weighted mean differences (WMDs) and 95% confidence intervals (CIs) for anthropometric indices such as body weight (BW), body mass index (BMI), fat mass (FM), fat-free mass (FFM), waist circumference (WC) and serum leptin level. Heterogeneity between studies was assessed using Cochran's Q test and quantified using the I2 statistic. From a pool of 3212 studies initially identified, 20 studies with a total sample size of 2158 subjects were included in the analysis. Results of the pooled analysis showed that NNSs consumption had a significant reducing effect on BW (WMD: -1.02, 95% CI: -1.57, -0.46 Kg), FM (WMD: -1.09, 95% CI: -1.90, -0.29), and FFM (WMD: -0.83, 95% CI: -1.42, -0.23), but did not have any significant effect on BMI (WMD: -0.16, 95% CI: -0.35, 0.02), WC (WMD: -1.03, 95% CI: -2.77, 0.72), or serum leptin level (WMD: -2.17, 95% CI: -4.98, 0.65). The findings of this study indicate that the consumption of artificial- and stevia-based sweeteners may lead to a reduction in body weight, fat mass, and free fat mass.

Common genetic and environmental bases of the mental disorders and personality traits: Special focus on the hierarchical model of psychopathology and NEO-PI-R facets.

OBJECTIVE: This study examined whether phenotypic correlations between psychopathological dimensions and personality traits of different hierarchical levels originate from common genetic and environmental sources of variance. METHOD: Participants were 386 monozygotic and 204 dizygotic twins. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) was applied along with the Revised NEO Personality Inventory (NEO-PI-R). The results of the CFA confirmed the hypothesis of the internalizing and externalizing dimensions underlying PDSQ scales. RESULTS: The results indicated a significantly greater role of genetic compared to environmental factors in the relationship between internalizing psychopathology and personality traits. Facets of neuroticism showed positive genetic links with internalizing disorders, while negative genetic links were shown for all facets of extraversion except excitement-seeking, competence, self-discipline, achievement striving, actions, and trust. Lower-order personality traits were shown to be associated with internalizing disorders more intensively than the broader domains to which they belong, both at the phenotypic and genetic levels. CONCLUSIONS: High neuroticism, together with several facets from the domain of extraversion and conscientiousness seems to represent an increased genetic susceptibility to the disorders from the internalizing spectrum. Results also suggest that specific environmental factors which are not shared with personality traits contribute to the internalizing symptoms.

'Personality and bipolar disorder: personality profiles of patients with remitted bipolar disorder and matched controls in a Danish sample'.

BACKGROUND: The aim of the study was to investigate whether patients with bipolar disorder (BD) in remission differ in personality traits compared with a healthy control group. METHODS: A sample of patients with BD (n = 44) was compared with an individually matched control group (n = 44) using the Danish version of the Revised NEO Personality Inventory (NEO PI-R). Paired t-tests were used to analyze differences between the two groups and multiple regression models to evaluate predictors of NEO scores in the patient group. RESULTS: Patients with BD reported significantly higher scores on both Neuroticism and Openness to Experience and lower scores on Conscientiousness. No differences were found on Extraversion and Agreeableness. The effect size for Neuroticism and its facets had a range from 0.77 to 1.45 SD.Statistically significant group differences were seen on 15 of 30 lower-level traits within all five high-order dimensions. There were large effect sizes for Trust (0.77) and Self-discipline (0.85), while the other statistically significant group differences were smaller with effect sizes in the range from 0.43 to 0.74 SD.However, patients with BD showed a profile with high-order dimensions and lower-level traits within one standard deviation from the mean score except for the lower-level trait Depression. CONCLUSIONS: Our findings suggest that patients with BD differ from healthy control persons with respect to higher levels of Neuroticism, Openness to Experience and lower scores on Agreeableness and on Conscientiousness, but prospective studies are needed to evaluate the implications of this finding.

The effect of 6-week consumption of bakery products on changes in selected anthropometric parameters in women.

Background: The changes in consumers' eating habits are one of the most important factors affecting the consumption of selected foods. The most important factors for bakery products consumers are freshness, taste, price, durability, composition, and country of origin. Objective: The aim of this study was to monitor changes in selected anthropometric characteristics in women from the general population in Slovakia, after 6 weeks of bakery products consumption. Material and Methods: The study was conducted on healthy adult women from the general population (n=78), who were divided into four subgroups ("gluten" group, "gluten-free" group, "whole-grain" group and "control" group). The intervention dose consisted of a different combination of several types of bakery products (bread, pastries, soft pastries) within the individual weeks of consumption, while the intervention lasted 6 weeks, women consumed 150-200 grams per day. Anthropometric characteristics were measured by body composition analyser InBody 720 (Biospace Co. Ltd., Seoul, Republic of Korea), which works on the principle of bioelectrical impedance analysis. We also used the Lookin´Body 3.0 software to process the results. The collected data from these measurements were evaluated statistically and graphically in Microsoft Office Excel 2010 (Los Angeles, CA, USA). The levels of statistical significance were set at P<0.05 (*); P<0.01 (**); P<0.001 (***). Differences among subgroups of probands were tested with Pared Student t-test. Results: The amount of fat mass (FM) in the participants changed along a similar curve as their body weight. After the 6-week intervention, there was a slight decrease in FM with statistical significance (P<0.01). In the third measurement, i.e., two months after the intervention, there was an increase in the amount of FM, but without statistical significance. Fat free mass (FFM) values in women increased very slightly after 6 weeks of consumption and remained approximately at the same level two months after the intervention (without statistical significance). We noted the most significant changes in the visceral fat area (VFA) parameter, which had a steadily increasing tendency. Changes in VFA values were statistically significant after the 6-week intervention (P<0.01) and also after two months of the intervention (P<0.05). Conclusions: Changes in body composition in women were noted already after 6 weeks of bakery products consumption, especially in the FM, FFM, VFA and partially BMI parameters, but no changes were recorded in the WHR parameters during the entire duration of the study. One of the most significant results is the finding that there was an increase in VFA when consuming all types of bakery products (gluten, gluten-free and whole grain).

Personality characteristics of empathy profiles - practical implications for education of medicine students.

BACKGROUND: Empathy plays the key role in the doctor - patient relationship. The research of empathy determinants plays an important role in formulating practical guidelines for the education of medical students. The aim of this study was to analyse personality characteristics of empathy profiles among students of medicine, with consideration of chief personality factors and their subdimensions according to the FFM model. METHODS: During workshops in Clinical Psychological Skills, 153 students (M = 57, F = 96; mean age 23 years) analysed their psychological functioning styles by examining their personality profiles and empathy indicators. Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R) were applied for this purpose. The analyses of empathy indicators were presented by means of cluster analysis. Variance analysis with post hoc Tukey-b test was performed for differences between clusters and to differentiate between personality factors and their components in empathy clusters. This study was approved by the Jagiellonian University Bioethics Committee (approval number: 1072.6120.175.2018 date: 28.06.2018). RESULTS: The first cluster included students who presented high empathetic concern for others, understood their perspective and needs characterised by medium level of Neuroticism, high levels of other dimensions The second group included students who could understand others very well, yet with lower tendency to react emotionally to suffering, characterised by medium level of Neuroticism, Extraversion, Openness, high Conscientiousness and low Agreeableness. The third cluster included students who react strongly to painful and unpleasant reactions of others, characterised by high Neuroticism and Agreeableness, low Extraversion. CONCLUSIONS: Each empathy profile is manifested in relations with patients in a specific way. Medical education in empathy holds great potential to reduce anxiety, stress, and burnout associated with the medical profession. Discussion of individual results with students, gives an opportunity to talk about how their empathy and personality characteristics may influence their everyday medical practice.

Graphene Confers Ultralow Friction on Nanogear Cogs.

Friction-induced energy dissipation impedes the performance of nanomechanical devices. Nevertheless, the application of graphene is known to modulate frictional dissipation by inducing local strain. This work reports on the nanomechanics of graphene conformed on different textured silicon surfaces that mimic the cogs of a nanoscale gear. The variation in the pitch lengths regulates the strain induced in capped graphene revealed by scanning probe techniques, Raman spectroscopy, and molecular dynamics simulation. The atomistic visualization elucidates asymmetric straining of CC bonds over the corrugated architecture resulting in distinct friction dissipation with respect to the groove axis. Experimental results are reported for strain-dependent solid lubrication which can be regulated by the corrugation and leads to ultralow frictional forces. The results are applicable for graphene covered corrugated structures with movable components such as nanoelectromechanical systems, nanoscale gears, and robotics.

Different body parts' fat mass and corrected QT interval on the electrocardiogram: The Fasa PERSIAN Cohort Study.

BACKGROUND: Previous studies suggested that obesity and fat mass are associated with QT interval prolongation, but the role of different body parts' fat mass is unclear. The associations between total and regional fat mass (FM) and corrected QT interval (QTc) were investigated for the first time in this study. METHODS: In this sub-analysis of Fasa PERSIAN cohort Study data, 3217 subjects aged 35-70 entered our study. Body fat mass was assessed by bioelectrical impedance analysis and QTc interval calculated by the QT interval measured by Cardiax® software from ECGs and Bazett's formula. Uni- and multi-variable linear and logistic regression was performed in IBM SPSS Statistics v23. RESULTS: In males, the fat mass to fat-free mass (FM/FFM) ratio in the trunk, arms, total body, and legs were significantly higher in the prolonged QTc group (QTc > 450 ms). Trunk (B = 0.148), total (B = 0.137), arms (B = 0.124), legs (B = 0.107) fat mass index (FMI) showed significant positive relationship with continuous QTc (P-value < 0.001). Also, just the fat-free mass index of legs had significant positive associations with QTc interval (P-value < 0.05). Surprisingly, in females, the mean of FM/FFM ratio in trunk and legs in the normal QTc group had higher values than the prolonged QTc group (QTc > 470 ms). Also, none of the body composition variables had a significant correlation with continuous QTc. CONCLUSION: Our study suggested that FMI ratios in the trunk, total body, arms, and legs were positively associated with QTc interval in males, respectively, from a higher to a lower beta-coefficient. Such associations were not seen in females. Our study implies that body fat mass may be an independent risk factor for higher QTc interval and, consequently, more cardiovascular events that should be investigated.

The Circumplex of Personality Metatraits and the HEXACO model: Toward refinement and integration.

OBJECTIVE: There is a considerable body of evidence from the last 20 years, indicating the need for the reconceptualization of the highest level of the personality structure that the Big Five/Five-Factor Model (FFM) was assumed to occupy. The main goal of the presented study was to test the relationships between two models that have been developed in this respect: The Circumplex of Personality Metatraits (CPM), based on the higher-order factors of the Big Five, and the HEXACO model including a sixth basic personality dimension (Honesty-Humility). METHOD: The sample consisted of 500 respondents (56.8% females; Mage = 31.9, SDage  = 14.0), all of whom completed the CPM, HEXACO, and FFM measures. RESULTS: The results corroborated the expectation that the HEXACO model can be coherently located within the CPM model, despite the latter is rooted in the FFM research tradition. However, this substantial integration has been made possible by a relatively slight but crucial modification of the CPM, already suggested by previous research. CONCLUSION: After the modification, which concerned the location of the Neuroticism/Emotional stability trait, the CPM enables a comprehensive integration of major models of personality structure encompassing the Two-Factor Model, the FFM, and the HEXACO.

Personality traits relate to chronotype at both the phenotypic and genetic level.

INTRODUCTION: Diurnal preferences have been linked to personality but often with mixed results. The present study examines the relationships between sleep timing (chronotype), diurnal preferences, and the Five-Factor Model of personality traits at the phenotypic and genetic level. METHODS: Self- and informant-reports of the NEO Personality Inventory-3, self-reports of the Munich Chronotype Questionnaire, and DNA samples were available for 2,515 Estonian adults (Mage  = 45.76 years; 59% females). Genetic correlations were obtained through summary statistics of genome-wide association studies. RESULTS: Results showed that higher Conscientiousness and lower Openness to Experience were significant predictors of earlier chronotype. At the level of facets, we found that more straightforward (A2) and excitement-seeking (E5), yet less self-disciplined (C5) people were more likely to have later chronotypes. The nuance-level Polypersonality score was correlated with chronotype at r = .28 (p < .001). Conscientiousness and Openness were genetically related with diurnal preferences. The polygenic score for morningness-eveningness significantly predicted the Polypersonality score. CONCLUSION: Phenotypic measures of chronotype and personality showed significant associations at all three of levels of the personality hierarchy. Our findings indicate that the relationship between personality and morningness-eveningness is partly due to genetic factors. Future studies are necessary to further refine the relationship.

Self-esteem mediates effects of normal and pathological personality traits on subjective well-being.

As subjective well-being is foundational to understanding people, researchers have sought to uncover its correlates. Some theorizing proposes that effects of broad personality traits on subjective well-being constructs are mediated by self-esteem; unfortunately, evidence pertaining to this idea has been limited to the study of "normal" broad personality traits and limited measures of subjective well-being. Here, we provided a more comprehensive test of this theory, and we examined the dominance of self-esteem over normal and pathological broad personality traits in predicting an array of subjective well-being constructs. In a primarily college sample (N = 272), we found that self-esteem generally mediated the effects of all Five-Factor Model (FFM) traits except Agreeableness and all pathological personality traits-represented in the Personality Inventory of The Diagnostic and Statistical Manual of Mental Disorders traits (5th edition; PID-5)-except Antagonism on a set of subjective well-being measures; moreover, dominance analyses showed that self-esteem was generally more important than any FFM or PID-5 trait in predicting the subjective well-being measures. We discuss limitations of our study along with some of its basic and applied implications.

Stunting, wasting and breast-feeding as correlates of body composition in Cambodian children at 6 and 15 months of age.

The study aimed at assessing stunting, wasting and breast-feeding as correlates of body composition in Cambodian children. As part of a nutrition trial (ISRCTN19918531), fat mass (FM) and fat-free mass (FFM) were measured using 2H dilution at 6 and 15 months of age. Of 419 infants enrolled, 98 % were breastfed, 15 % stunted and 4 % wasted at 6 months. At 15 months, 78 % were breastfed, 24 % stunted and 11 % wasted. Those not breastfed had lower FMI at 6 months but not at 15 months. Stunted children had lower FM at 6 months and lower FFM at 6 and 15 months compared with children with length-for-age z ≥0. Stunting was not associated with height-adjusted indexes fat mass index (FMI) or fat-free mass index (FFMI). Wasted children had lower FM, FFM, FMI and FFMI at 6 and 15 months compared with children with weight-for-length z (WLZ) ≥0. Generally, FFM and FFMI deficits increased with age, whereas FM and FMI deficits decreased, reflecting interactions between age and WLZ. For example, the FFM deficits were -0·99 (95 % CI -1·26, -0·72) kg at 6 months and -1·44 (95 % CI -1·69; -1·19) kg at 15 months (interaction, P<0·05), while the FMI deficits were -2·12 (95 % CI -2·53, -1·72) kg/m2 at 6 months and -1·32 (95 % CI -1·77, -0·87) kg/m2 at 15 months (interaction, P<0·05). This indicates that undernourished children preserve body fat at the detriment of fat-free tissue, which may have long-term consequences for health and working capacity.

Trajectory and determinants of change in lean soft tissue over the postpartum period.

The aim of this study was to characterise changes in lean soft tissue (LST) and examine the contributions of energy intake, physical activity and breast-feeding practices to LST changes at 3 and 9 months postpartum. We examined current weight, LST (via dual-energy X-ray absorptiometry), dietary intake (3-d food diary), physical activity (Baecke questionnaire) and breast-feeding practices (3-d breast-feeding diary) in forty-nine women aged 32·9 (sd 3·8) years. Changes in LST varied from -2·51 to +2·50 kg with twenty-nine women gaining LST (1·1 (sd 0·7) kg, P<0·001) and twenty women losing LST (-0·9 (sd 0·8) kg, P<0·001). Energy intake (133 (SD 42) v. 109 (SD 33) kJ/kg, P=0·019) and % kJ from fat at 3 months postpartum was higher in women who gained LST at 9 months postpartum (gained LST=34 (sd 5) % kJ; lost LST=29 (sd 4) % kJ, P=0·002). Women who gained LST reported breast-feeding their infants more frequently (gained LST=8 (sd 3) feeds/d; lost LST=5 (sd 1) feeds/d, P=0·014) and for more time per d (gained LST=115 (sd 78) min/d; lost LST=59 (sd 34) min/d, P=0·016) at 9 months postpartum. Energy intake and % kJ from fat at 3 months were significant predictors of LST gain (ß=0·08 (se 0·04) and 0·24 (se 0·09), respectively). This suggests that gain in LST may be associated with more frequent and longer episodes of breast-feeding at 9 months postpartum as well as dietary intake early in the postpartum period.

Relationship between BMI and adiposity among different ethnic groups in 2-year-old New Zealand children.

Age- and sex-based BMI cut-offs are used to define overweight and obesity, but the relationship between BMI and body composition has not been very well studied in children or compared between children of different ethnic groups. Body size and composition in childhood are also influenced by size at birth. Our aim was to compare body size and composition at 2 years in children with different ethnicity and size at birth. We prospectively followed a multi-ethnic cohort of 300 children born with risk factors for neonatal hypoglycaemia (infants of diabetics, large or small at birth or late preterm) to 2 years corrected age. Complete data on weight, height and head circumference and body composition using bioelectrical impedance 24±1 months corrected age were available in 209 children. At birth, compared with European children, Chinese, Indian and other ethnicity children were lighter, and Indian children had smaller head circumferences, but birth lengths were similar in all ethnic groups. At 2 years, Pacific children were heavier and had higher BMI z scores, and Indian children had smaller head circumferences and lower BMI z scores than those from other ethnic groups. However, fat mass and fat-free mass indices were similar in all groups. At median BMI, fat mass:fat-free mass ratio was 23 % lower in Pacific than in Indian children (0·22 v. 0·27, P=0·03). BMI is not a good indicator of adiposity in this multi-ethnic cohort of 2-year-old New Zealand children.

No-Reference Objective Video Quality Measure for Frame Freezing Degradation.

In this paper we present a novel no-reference video quality measure, NR-FFM (no-reference frame-freezing measure), designed to estimate quality degradations caused by frame freezing of streamed video. The performance of the measure was evaluated using 40 degraded video sequences from the laboratory for image and video engineering (LIVE) mobile database. Proposed quality measure can be used in different scenarios such as mobile video transmission by itself or in combination with other quality measures. These two types of applications were presented and studied together with considerations on relevant normalization issues. The results showed promising correlation values between the user assigned quality and the estimated quality scores.

The paediatric option for BodPod to assess body composition in preschool children: what fat-free mass density values should be used?

Air displacement plethysmography utilises a two-component model to assess body composition, which relies on assumptions regarding the density of fat-free mass (FFM). To date, there is no evidence as to whether Lohman's or Wells et al.'s FFM density values are more accurate in young children. Therefore, the aims of this study were to compare total body fat percentage (TBF%) assessed using the BodPod with both Lohman's and Wells et al.'s FFM density values with TBF% from the three-component (3C) model in forty healthy Swedish children aged 5·5 years. Average TBF% calculated using Lohman's FFM density values underestimated TBF% in comparison with the corresponding value assessed using the 3C model (22·2 (sd 5·7) and 25·1 (sd 5·5) %, respectively; P<0·001). No statistically significant difference was observed between TBF% assessed using Wells et al.'s FFM density values and the 3C model (24·9 (sd 5·5) and 25·1 (sd 5·5) %, respectively; P=0·614). The Bland and Altman plots for TBF% using both Lohman's and Wells et al.'s FFM density values did not show any bias across the range of body fatness (Lohman: r 0·056, P=0·733 and Wells et al.: r -0·006, P=0·970). These results indicate that Wells et al.'s FFM density values should be used when assessing body composition with the paediatric option for BodPod in 5-year-old children. However, future studies are needed to confirm these results in other populations, including a wider age range of children.

Body composition during early infancy and developmental progression from 1 to 5 years of age: the Infant Anthropometry and Body Composition (iABC) cohort study among Ethiopian children.

Early nutrition and growth have been found to be important early exposures for later development. Studies of crude growth in terms of weight and length/height, however, cannot elucidate how body composition (BC) might mediate associations between nutrition and later development. In this study, we aimed to examine the relation between fat mass (FM) or fat-free mass (FFM) tissues at birth and their accretion during early infancy, and later developmental progression. In a birth cohort from Ethiopia, 455 children who have BC measurement at birth and 416 who have standardised rate of BC growth during infancy were followed up for outcome variable, and were included in the statistical analysis. The study sample was restricted to mothers living in Jimma town who gave birth to a term baby with a birth weight ≥1500 g and no evident congenital anomalies. The relationship between the exposure and outcome variables was examined using linear-mixed regression model. The finding revealed that FFM at birth was positively associated with global developmental progression from 1 to 5 years (ß=1·75; 95 % CI 0·11, 3·39) and from 4 to 5 years (ß=1·34; 95 % CI 0·23, 2·44) in the adjusted model. Furthermore, the rate of postnatal FFM tissue accretion was positively associated with development at 1 year of age (ß=0·50; 95 % CI 0·01, 0·99). Neither fetal nor postnatal FM showed a significant association. In conclusion, fetal, rather than postnatal, FFM tissue accretion was associated with developmental progression. Intervention studies are needed to assess whether nutrition interventions increasing FFM also increase cognitive development.

Systematic review and meta-analysis of the effect of protein and amino acid supplements in older adults with acute or chronic conditions.

The loss of lean body mass, muscle strength and physical function causes significant problems in older adults. Protein and amino acid supplements can preserve muscle strength but the effect on function is variable. We conducted a systematic literature review and meta-analysis to investigate the effect of protein and amino acid supplementation on fat-free mass, muscle strength and physical function in malnourished, frail, sarcopenic, dependent or elderly with acute or chronic conditions, with or without rehabilitation exercise. Databases searched included Medline, BIOSIS, CINAHL, Cochrane Library, EBM Reviews, Embase, Pre-Medline, ProQuest, PubMed and Scopus. Retrieved articles were assessed by two reviewers using the Cochrane Risk of Bias (ROB) Tool. In all, thirty nine randomised controlled trails (n 4274) were included. The studies used a range of protein or essential amino acid (EAA) supplements in a variety of settings, including hospital, community and long-term care. Only seven studies had low ROB and no effect of supplementation was found on any outcomes. Analysis of all thirty-nine studies suggest protein and EAA supplements may improve fat-free mass, muscle strength and physical function (standardised mean difference 0·21-0·27, all P<0·005), but significant heterogeneity and ROB was evident. Predetermined subgroup analysis found undernourished elderly benefitted most; EAA were the most effective supplements and small beneficial effects were seen without rehabilitation exercise. The high heterogeneity and few studies with low ROB limits the conclusions and more high quality studies are needed to determine the best nutritional strategies for the maintenance of strength and function with increasing age.

Timeline of changes in adaptive physiological responses, at the level of energy expenditure, with progressive weight loss.

Diet-induced weight loss (WL) is associated with reduced resting and non-resting energy expenditure (EE), driven not only by changes in body composition but also potentially by adaptive thermogenesis (AT). When exactly this happens, during progressive WL, remains unknown. The aim of this study was to determine the timeline of changes in RMR and exercise-induced EE (EIEE), stemming from changes in body composition v. the presence of AT, during WL with a very-low-energy diet (VLED). In all, thirty-one adults (eighteen men) with obesity (BMI: 37 (sem 4·5) kg/m2; age: 43 (sem 10) years) underwent 8 weeks of a VLED, followed by 4 weeks of weight maintenance. Body weight and composition, RMR, net EIEE (10, 25 and 50 W) and AT (for RMR (ATRMR) and EIEE (ATEIEE)) were measured at baseline, day 3 (2 (sem 1) % WL), after 5 and 10 % WL and at weeks 9 (16 (sem 2) %) and 13 (16 (sem 1) %). RMR and fat mass were significantly reduced for the first time at 5 % WL (12 (sem 8) d) (P<0·01 and P<0·001, respectively) and EIEE at 10 % WL (32 (sem 8) d), for all levels of power (P<0·05), and sustained up to week 13. ATRMR was transiently present at 10 % WL (-460 (sem 690) kJ/d, P<0·01). A fall in RMR should be anticipated at ≥5 % WL and a reduction in EIEE at ≥10 % WL. Transient ATRMR can be expected at 10 % WL. These physiological adaptations may make progressive WL difficult and will probably contribute to relapse.

Effect of the Health Tourism weight loss programme on body composition and health outcomes in healthy and excess-weight adults.

Excess weight loss while minimising fat-free mass (FFM) loss is important for health. Travel is a particular period at risk for weight gain and for which the effects of a short-term intensive weight loss programme have not been studied. Therefore, we studied the effect of a novel, 1-week supervised health travel programme combining high volume, low-to-moderate intensity exercise and energy intake restriction on weight, body composition and health outcomes in adults. Weight was also monitored for 12 weeks after the programme. In all, thirty-six subjects (nineteen men, seventeen women) consisting of sixteen excess-weight (BMI: 27·1 (sd 1·7) kg/m2) and twenty healthy-weight (BMI: 22·3 (sd 1·8) kg/m2) individuals participated. Subjects performed 1 h of slow-paced intermittent jogging three times per d and other leisure activities, whereas consuming only provided foods without water restriction. Body mass significantly decreased from pre- to post-intervention in excess-weight and healthy-weight individuals (-3·5 (sd 1·5) and -3·5 (sd 1·3) %, respectively; P<0·001 for both), and losses were maintained at 12 weeks post-intervention in both groups (-6·3 (sd 3·8) and -1·7 (sd 4·0) %, respectively; P<0·01 for both). Fat mass also significantly decreased in both groups (excess weight: -9·2 (sd 4·6) %: healthy weight: -13·4 (sd 9·0) %; P<0·01 for both), whereas FFM was maintained. Similar improvements were observed for blood biochemistry and pressure in both groups. This short-term weight loss intervention yielded favourable outcomes in both excess- and healthy-weight adults, particularly a 3·5 % weight loss with no significant change to FFM. In addition, participants maintained weight loss for at least 12 weeks. Of multiple programme choices, the Health Tourism weight loss programme's results indicate that it is a viable option.