Metabolic adaptation following gastric bypass surgery: results from a 2-year observational study.

BACKGROUND/OBJECTIVES: Metabolic adaptation is the lowering of basal metabolic rate (BMR) beyond what is predicted from changes in fat mass (FM) and fat-free mass (FFM) and may hamper weight-loss progression. It is unclear whether metabolic adaptation occurs following gastric bypass surgery (GBP) and if it persists. The aim of this study was to evaluate the reduction in BMR that is not explained by changes in body composition in patients following GBP compared to a weight-stable comparator group. SUBJECTS: Thirty-one patients [77.4% female; mean BMI 45.5(SD 7.0) kg/m2; age 47.4(11.6)y] who underwent GBP, and 32 time-matched comparators [50% female; BMI 27.2(4.6) kg/m2; age 41.8(13.6)y) were evaluated at 1-month pre-surgery, 3-, 12- and 24-months post-surgery. METHODS: BMR was measured under standardised residential conditions using indirect calorimetry and body composition using DXA. Linear regression analyses assessed metabolic adaptation post-surgery. RESULTS: After surgery, patients lost a quarter of their body weight [-25.6%(1.8%); p < 0.0001] consisting mainly of FM (4:1 FM to FFM loss ratio) at 24-months post-surgery. Absolute BMR (MJ/d) reduced by 25.7% at 24-months post-surgery with values becoming similar to the comparator group from 3-months post-surgery. Positive associations were observed between changes in BMR and changes in FFM and FM (P < 0.03). Metabolic adaptation was present in patients during the 1) rapid weight loss phase (6.9 kg/month at 3-months post-surgery) (p = 0.011), 2) slower weight loss phase (1.6 kg/month from 3 to 12-months post-surgery) (p < 0.0001), and, 3) weight maintenance phase (24-months post-surgery) (p = 0.00073). However, the degree of metabolic adaptation observed in GBP patients was similar to the weight-stable comparator group (no metabolic adaptation) from 12-months post-surgery onwards (3-months; p = 0.01, 12-months; p = 0.26, 24-months post-surgery; p = 0.70). CONCLUSION: These results suggest that there is a potential biological mechanism of surgery that attenuates the expected postoperative downregulation in BMR thus helping GBP patients maintain weight loss.

Oromotor and somatic taste reactivity during sucrose meals reveals internal state and stimulus palatability after gastric bypass in rats.

After Roux-en-Y gastric bypass (RYGB), rats consume less high-energy foods and fluids, though whether this reflects a concomitant change in palatability remains unclear. By measuring behavior during intraorally delivered liquid meals across days (1 water, 8 sucrose sessions), we showed that RYGB rats (RYGB, n = 8/sex) consumed less 1.0 M sucrose than their sham surgery counterparts (SHAM, n = 8 males, n = 11 females) but displayed similarly high levels of ingestive taste reactivity responses at the start of infusions. Relative to water, both groups increased intake of sucrose, and ingestive responses were dominated by tongue protrusions rather than mouth movements. Thus, RYGB animals still found sucrose palatable despite consuming less than the SHAM group. As the intraoral infusion progressed but before meal termination, aversive behavior remained low and both RYGB and SHAM animals showed fewer ingestive responses, predominantly mouth movements as opposed to tongue protrusions. This shift in responsiveness unrelated to surgical manipulation suggests negative alliesthesia, or a decreased palatability, as rats approach satiation. Notably, only in RYGB rats, across sessions, there was a striking emergence of aversive behavior immediately after the sucrose meal. Thus, although lower intake in RYGB rats seems independent of the hedonic taste properties of sucrose, taste reactivity behavior in these animals immediately after termination of a liquid meal appears to be influenced by postoral events and reflects a state of nimiety or excessive consumption. Measurement of taste reactivity behaviors during an intraorally delivered meal represents a promising way to make inferences about internal state in nonverbal preclinical models.

Food Intake Following Gastric Bypass Surgery: Patients Eat Less but Do Not Eat Differently.

BACKGROUND: Lack of robust research methodology for assessing ingestive behavior has impeded clarification of the mediators of food intake following gastric bypass (GBP) surgery. OBJECTIVES: To evaluate changes in directly measured 24-h energy intake (EI), energy density (ED) (primary outcomes), eating patterns, and food preferences (secondary outcomes) in patients and time-matched weight-stable comparator participants. METHODS: Patients [n = 31, 77% female, BMI (in kg/m2) 45.5 ± 1.3] and comparators (n = 32, 47% female, BMI 27.2 ± 0.8) were assessed for 36 h under fully residential conditions at baseline (1 mo presurgery) and at 3 and 12 mo postsurgery. Participants had ad libitum access to a personalized menu (n = 54 foods) based on a 6-macronutrient mix paradigm. Food preferences were assessed by the Leeds Food Preference Questionnaire. Body composition was measured by whole-body DXA. RESULTS: In the comparator group, there was an increase in relative fat intake at 3 mo postsurgery; otherwise, no changes were observed in food intake or body composition. At 12 mo postsurgery, patients lost 27.7 ± 1.6% of initial body weight (P < 0.001). The decline in EI at 3 mo postsurgery (-44% from baseline, P < 0.001) was followed by a partial rebound at 12 mo (-18% from baseline), but at both times, dietary ED and relative macronutrient intake remained constant. The decline in EI was due to eating the same foods as consumed presurgery and by decreasing the size (g, MJ), but not the number, of eating occasions. In patients, reduction in explicit liking at 3 mo (-11.56 ± 4.67, P = 0.007) and implicit wanting at 3 (-15.75 ± 7.76, P = 0.01) and 12 mo (-15.18 ± 6.52, P = 0.022) for sweet foods were not matched by reduced intake of these foods. Patients with the greatest reduction in ED postsurgery reduced both EI and preference for sweet foods. CONCLUSIONS: After GBP, patients continue to eat the same foods but in smaller amounts. These findings challenge prevailing views about the dynamics of food intake following GBP surgery. This trial was registered as clinicaltrials.gov as NCT03113305.

Methodological issues in assessing change in dietary intake and appetite following gastric bypass surgery: A systematic review.

Gastric bypass surgery is an effective long-term treatment for individuals with severe obesity. Changes in appetite, dietary intake, and food preferences have all been postulated to contribute to postoperative body weight regulation, however, findings are inconsistent. The aim of this systematic review was to evaluate the current literature on changes in dietary intake and appetite following gastric bypass surgery, in the context of the methodology used and the analysis, interpretation, and presentation of results. Four databases were systematically searched with terms related to "gastric bypass surgery," "appetite," and "dietary intake," and 49 papers (n = 2384 patients after gastric bypass) were eligible for inclusion. The evidence indicated that only a reduction in overall energy intake and an increase in postprandial satiety are maintained beyond 6-month post-surgery, whereas relative macronutrient intake and premeal hunger remain unchanged. However, available data were limited by inconsistencies in the methods, analysis, presentation, and interpretation of results. In particular, there was a reliance on data collected by subjective methods with minimal acknowledgment of the limitations, such as misreporting of food intake. There is a need for further work employing objective measurement of appetite and dietary intake following gastric bypass surgery to determine how these mechanisms may contribute to weight regulation in the longer term.

Application of the Healthy Eating Index-2015 and the Nutrient-Rich Food Index 9.3 for assessing overall diet quality in the Japanese context: Different nutritional concerns from the US.

OBJECTIVES: While it is widely perceived that the diet consumed by Japanese is healthy, empirical evidence supporting this notion is limited. In this cross-sectional study, we assessed the overall diet quality of Japanese using the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), and compared diet quality scores between Japanese and Americans. METHODS: We used 1-d dietary record data from 19,719 adults (aged ≥20 y) in the Japanese National Health and Nutrition Survey 2012 and the first 24-h dietary recall data from 4614 adults in the US NHANES 2011-2012. RESULTS: As expected, a higher total score of the HEI-2015 and NRF9.3 was associated with favorable patterns of overall diet in the Japanese population. The range of total score was wide enough for both HEI-2015 (5th percentile 37.2; 95th percentile 67.2) and NRF9.3 (5th percentile 257; 95th percentile 645). Both HEI-2015 and NRF9.3 distinguished known differences in diet quality between sex, age, and smoking status. The mean total scores of HEI-2015 and NRF9.3 were similar between Japanese (51.9 and 448, respectively) and US adults (52.8 and 435, respectively). However, component scores between the 2 populations were considerably different. For HEI-2015, Japanese had higher scores for whole fruits, total vegetables, green and beans, total protein foods, seafood and plant proteins, fatty acids, added sugars, and saturated fats, but lower scores for total fruits, whole grains, dairy, refined grains, and sodium. For NRF9.3, the intakes of vitamin C, vitamin D, potassium, added sugars, and saturated fats were more favorable in Japanese, while those of dietary fiber, vitamin A, calcium, iron, magnesium, and sodium were less favorable. CONCLUSIONS: This study suggests the usefulness of HEI-2015 and NRF9.3 for assessing the diet quality of Japanese, as well as for highlighting different nutritional concerns between Japan and the US.

Adherence to dietary and physical activity guidelines among shift workers: associations with individual and work-related factors.

OBJECTIVES: Shift work is associated with adverse effects on the health and lifestyle behaviours of employees. This study aimed to examine factors associated with adherence among shift workers to selected indicators of dietary and physical activity guidelines. METHODS: A cross-sectional study was conducted on 1300 shift workers. Data were collected using a 15 minute telephone-administered questionnaire. Logistic regression methods were used for data analysis. RESULTS: Male shift workers (p<0.001, OR=0.55, 95% CI 0.40 to 0.74) and those of lower socioeconomic status (p=0.046, OR=0.75, 95% CI 0.57 to 0.99) were significantly less likely to consume five or more daily servings of fruits and vegetables. Shift workers with access to workplace vending machines were significantly more likely to consume soft drinks at least weekly (p=0.003, OR=1.64, 95% CI 1.18 to 2.27). Middle-aged shift workers (p=0.012, OR=0.65, 95% CI 0.46 to 0.91) and those reporting insufficient break times at work (p=0.026, OR=0.69, 95% CI 0.49 to 0.96) were significantly less likely to be sufficiently active. CONCLUSIONS: Individual, work schedule and workplace environment related factors were independently associated with selected indicators of adherence to dietary and physical activity guidelines in this cohort of shift workers.

Proceedings from the 2018 Association for Chemoreception Annual Meeting Symposium: Bariatric Surgery and Its Effects on Taste and Food Selection.

This article provides a summary of the topics discussed at the symposium titled "Bariatric Surgery and Its Effects on Taste and Food Selection," which was held at the Fortieth Annual Meeting of the Association for Chemoreception Sciences. Bariatric surgery such as Roux-en-Y gastric bypass (RYGB) is currently one of the most effective treatments available for weight loss and Type 2 diabetes. For this reason, it is of great interest to clinicians as well as to basic scientists studying the controls of feeding and energy balance. Despite the commonly held view by clinicians that RYGB patients change their food preferences away from fats and sugars in favor of less energy dense alternatives such as vegetables, the empirical support for this claim is equivocal. It is currently thought that the taste and palatability of fats and sugars are affected by the surgery. Some key preclinical and clinical findings addressing these issues were evaluated in this symposium.

Thirteen-Year Trends in Dietary Patterns among Japanese Adults in the National Health and Nutrition Survey 2003⁻2015: Continuous Westernization of the Japanese Diet.

We examined 13-year trends in dietary patterns, using data from the National Health and Nutrition Survey, Japan 2003⁻2015. In repeated, independent cross-sectional studies, dietary intake was assessed with a one-day weighed dietary record in 88,527 Japanese adults aged ≥20 years. Using principal component analysis based on the daily consumption of 31 food groups, we identified three dietary patterns, the "plant food and fish", "bread and dairy", and "animal food and oil" patterns. In the whole sample, the "plant food and fish" pattern score decreased while the "bread and dairy" and "animal food and oil" pattern scores increased. The decreasing trends in the "plant food and fish" pattern were observed in all subgroups considered. The increasing trends in the "bread and dairy" pattern were similar across sexes and by current smoking status. However, in terms of age, occupation, and weight status, the increasing trends were only evident in particular subgroups (i.e., age 50⁻64 and ≥65 years; security/transportation/labor occupation and nonworker; and normal weight and overweight participants). For the "animal food and oil" pattern, the increasing trends were observed in all subgroups, except for the youngest age group (20⁻34 years old). This study suggests continuous Westernization of the Japanese diet.

A qualitative exploration of the shift work experience: the perceived effect on eating habits, lifestyle behaviours and psychosocial wellbeing.

Background: Approximately 17% of the European workforce is engaged in shift work. How the experience of shift work impacts on the dietary and lifestyle practices of workers is unclear. Methods: Overall, 15 focus groups were conducted by two researchers, with 109 participants. The initial focus group was carried out with both researchers present, to ensure consistency in facilitation. Both researchers thematically analysed all data collected. Results: Shift work was described as affecting many areas of workers' lives. Three overarching themes were identified: (i) impact on eating behaviour; (ii) impact on other lifestyle behaviours including physical activity, sleep, alcohol consumption, smoking; and (iii) impact on psychosocial health and wellbeing. There appeared to be overlap between the effect of shift work and the effect of individual internal factors in influencing workers' decision-making with regard to lifestyle practices. Conclusions: Shift work affects many areas of workers' lives, negatively impacting on eating and lifestyle behaviours and psychosocial health. This study augments the current literature as it highlights the role internal motivation plays in workers' lifestyle choices. The research should help inform the development of public health strategies to minimize the impact of shift work, such as specialist behavioural change interventions specific to this group.

Prevalence and characteristics of misreporting of energy intake in Japanese adults: the 2012 National Health and Nutrition Survey.

BACKGROUND AND OBJECTIVES: Information on a whole array of characteristics associated with dietary misreporting in a representative sample in each country is still limited. Using data from the 2012 National Health and Nutrition Survey, Japan, we investigated the prevalence and characteristics of under- and over-reporting of energy intake among 19,986 Japanese adults aged >=20 years. METHODS AND STUDY DESIGN: Each individual's energy intake was calculated based on a 1-day semi-weighed dietary record. Under-, plausible, and over-reporters were identified based on the 95% confidence limits 1) for agreement between the ratio of energy intake to basal metabolic rate and a physical activity level for sedentary lifestyle (1.55), and 2) of the expected ratio of energy intake to estimated energy requirement of 1.0, assuming 'low active' level of physical activity. RESULTS: Almost all subjects (>=92.8%) were classified as plausible reporters by any of the methods applied, with very low percentages of under- and over-reporters (<=6.3% and <=2.0%, respectively). Under-reporting was associated with younger age, overweight and obesity (compared with normal weight), current smoking (compared with never smoking), no alcohol drinking (compared with drinking everyday), and household consisting of a single person (compared with that consisting of two persons). Over-reporting was associated with gender (female), normal weight (compared with overweight), and household consisting of a single person. CONCLUSIONS: Overall mean energy intake obtained in this sample of Japanese adults appears to be plausible, but caution should be exercised when assessing the plausibility of energy intake in some subgroups.

Greenhouse gas emissions of self-selected diets in the UK and their association with diet quality: is energy under-reporting a problem?

BACKGROUND: While the admittedly limited number of epidemiological findings on the association between diet-related greenhouse gas emissions (GHGE) and diet quality are not always consistent, potential influence of bias in the estimation of diet-related GHGE caused by misreporting of energy intake (EI) has not been investigated. This cross-sectional study evaluated diet-related GHGE in the UK and their association with diet quality, taking account of EI under-reporting. METHODS: Dietary data used were from the National Diet and Nutrition Survey rolling programme 2008/2009-2013/2014, in which 4-day food diaries were collected from 3502 adults aged ≥19 years. Diet-related GHGE were estimated based on 133 food groups, using GHGE values from various secondary sources. Diet quality was assessed by the healthy diet indicator (HDI), Mediterranean diet score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score. EI misreporting was assessed as reported EI divided by estimated energy requirement (EI:EER). RESULTS: Mean value of daily GHGE was 5.7 kg carbon dioxide equivalents (CO2eq), which is consistent with those reported from a number of national representative samples in other European countries. Mean EI:EER was 0.74. Assuming that all the dietary variables were misreported in proportion to the misreporting of EI, the mean value of the misreporting-adjusted diet-related GHGE was 8.2 kg CO2eq/d. In the entire population, after adjustment for potential confounders (i.e., age, sex, ethnicity, socioeconomic classification, smoking status and physical activity), diet-related GHGE were inversely associated with HDI and DASH score but not with MDS. However, with further adjustment for EI:EER, diet-related GHGE showed inverse associations with all three measures of diet quality. Similar associations were observed when only under-reporters (EI:EER < 0.70; n = 1578) were analysed. Conversely, in the analysis including only plausible reporters (EI:EER 0.70-1.43; n = 1895), diet-related GHGE showed inverse associations with all diet quality measures irrespective of adjustment. CONCLUSIONS: With taking account of EI under-reporting, this study showed inverse associations between diet-related GHGE and diet quality not only in the entire sample but also in the separate analyses of plausible reporters and under-reporters, as well as potential underreporting of diet-related GHGE.

The effect of weight change over a 2-year period on inflammatory status in postmenopausal women.

BACKGROUND/OBJECTIVES: Body fat distribution has been shown to be a predictor of adhesion molecule and inflammatory marker expression albeit the effect of modest weight change on concentrations of adhesion molecules and inflammatory markers in postmenopausal women are not fully understood. The primary aim was to investigate the effects of weight change on adhesion molecules and inflammatory markers over 24 months in postmenopausal women. SUBJECTS/METHODS: Body composition was assessed in 254 healthy postmenopausal women using dual-energy X-ray absorptiometry (DXA). Adhesion molecules and inflammatory markers were analysed by multiplex ELISA. Participants weight gain/loss at 24 months was defined as any value that was either above/below the weight value recorded at baseline. RESULTS: Postmenopausal women with an average weight loss of 3% had significantly decreased leptin concentrations by 18% at 24 months (P < 0.01). A 4% increase in body weight or a 9% increase in FMI significantly increased intercellular adhesion molecule-1 (ICAM-1), tumour necrosis factor-α (TNF-α) and leptin concentrations in postmenopausal women at 24 months (P < 0.01). CONCLUSIONS: Modest weight loss in postmenopausal women has a lowering effect on leptin concentrations over 24 months which may improve inflammatory status whilst modest weight gain increases ICAM-1, leptin and TNF-α, markers which are associated with a pro-inflammatory state and vascular complications.

Indices of adiposity as predictors of cardiometabolic risk and inflammation in young adults.

BACKGROUND: Studies investigating obesity and cardiometabolic risk have focused on 'at-risk' populations and methodological inconsistencies have produced equivocal findings. The present cross-sectional study investigated indices of body composition as predictors of cardiometabolic risk and their relationship with inflammation in apparently healthy young adults. METHODS: A fasting blood sample was taken from consenting adults (160 males, 32 females, aged 18-40 years) for assessment of cardiometabolic risk markers (blood pressure, lipid profiles and insulin resistance) and inflammatory markers (C-reactive protein, tumour necrosis factor-α, interleukin-6, interleukin-10 and adiponectin). Together with anthropometry, fat mass (FM) and fat-free mass (FFM) were determined by dual-energy X-ray absorptiometry. FM was expressed in absolute terms (kg), as well as relative to total body weight (%), height [FM index (FMI, kg m(-2) )] and FFM (FM : FFM,%). RESULTS: Although anthropometric indices were associated with most cardiometabolic risk markers, the strongest relationship was observed with FMI. Relative to having a low cardiometabolic risk (≤2 markers above clinically relevant cut-offs), each kg m(-2) increase in FMI, increased the likelihood of having an increased cardiometabolic risk by 29% (odds ratio = 1.29; 95% confidence interval = 1.12-1.49). Inflammatory markers were not associated with body composition or cardiometabolic risk. CONCLUSIONS: FMI was the strongest predictor of overall cardiometabolic risk but not inflammation per se. However, anthropometric indices, such as body mass index and waist-to-height ratio, remain valuable surrogate measures of adiposity in this group, particularly when risk markers are considered independently.

Dietary and lifestyle habits and the associated health risks in shift workers.

Traditionally only a small proportion of the workforce was engaged in shift work. Changing economic pressures have resulted in increased engagement in shift work, with approximately 17 % of the workforce in Europe engaged in this work pattern. The present narrative review aimed to summarise the data on the effects of shift work on the diet, lifestyle and health of employees, while addressing the barriers to, and opportunities for, improving health among shift workers. Shift work can result in low-quality diet and irregular eating patterns. Adverse health behaviours are also reported; particularly increased smoking and poor sleep patterns. These altered lifestyle habits, in conjunction with disruption to circadian rhythms, can create an unfavourable metabolic phenotype which facilitates the development and progression of chronic disease. Although the data are inconclusive due to issues such as poor study design and inadequate control for confounding factors; shift workers appear to be at increased mental and physical health risk, particularly with regard to non-communicable diseases. Information is lacking on the obstacles to leading a healthier lifestyle while working shifts, and where opportunities lie for intervention and health promotion among this group. In order to provide an informed evidence base to assist shift workers in overcoming associated occupational hazards, this gap must be addressed. This review highlights the unique nutritional issues faced by shift workers, and the subsequent effect on health. In societies already burdened with increased incidence of non-communicable chronic diseases, there is a clear need for education and behaviour change interventions among this group.

Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012.

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2012, we investigated the prevalence and characteristics of under-reporting and over-reporting of energy intake (EI) among 19 693 US adults ≥20 years of age. For the assessment of EI, two 24-h dietary recalls were conducted using the US Department of Agriculture Automated Multiple-Pass Method. Under-reporters, acceptable reporters and over-reporters of EI were identified by two methods based on the 95 % confidence limits: (1) for agreement between the ratio of EI to BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI to estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield's equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming 'low active' level of physical activity. The risk of being an under-reporter or over-reporter compared with an acceptable reporter was analysed using multiple logistic regression. Percentages of under-reporters, acceptable reporters and over-reporters were 25·1, 73·5 and 1·4 %, respectively, based on EI:BMR, and 25·7, 71·8 and 2·5 %, respectively, based on EI:EER. Under-reporting was associated with female sex, older age, non-Hispanic blacks (compared with non-Hispanic whites), lower education, lower family poverty income ratio and overweight and obesity. Over-reporting was associated with male sex, younger age, lower family poverty income ratio, current smoking (compared with never smoking) and underweight. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999-2012 (n 28 794). In conclusion, we found that misreporting of EI, particularly under-reporting, remains prevalent and differential in US adults.

Sex differences in the composition of weight gain and loss in overweight and obese adults.

Sex differences in the ratio of fat mass (FM):fat-free mass (FFM) during weight change should differentially affect the extent of weight change during energy imbalance in men and women. In the present study, we determined FM and FFM contents by dual-energy X-ray absorptiometry and calculated the P-ratios (protein energy/total energy) of excess weight and weight loss during a randomised controlled trial of four commercial weight loss regimens. Overweight and obese women (n 210) and men (n 77) were studied at baseline and at 2 and 6 months during weight loss on four dietary regimens: Dr Atkins' New Diet Revolution; The Slim-Fast Plan; Weight-Watchers programme; Rosemary Conley's Diet and Fitness Plan. At baseline, the percentage of FFM (%FFM) and P-ratios of excess weight were 40 % and 0·071 for men and 27 % and 0·039 for women. At 2 months, men had lost twice as much weight as women and three times more FFM than women, indicating higher FFM content and P-ratios of weight loss for men, 0·052, than for women, 0·029, with no dietary effects. Between 2 and 6 months, the rate at which weight was lost decreased and the %FFM of weight loss decreased to similar low levels in men (7 %) and women (5 %): i.e. P-ratios of 0·009 and 0·006, respectively, with no dietary effects. Thus, for men compared with women, there were greater FFM content and P-ratios of weight change, which could partly, but not completely, explain their greater weight loss at 2 months. However, protein-conserving adaptations occur with increasing weight loss and over time, more extensively in men, eventually eliminating any sex difference in the composition of weight loss.

Evidence for NQO1 and NQO2 catalyzed reduction of ortho- and para-quinone methides.

NAD(P)H: quinone oxidoreductase (NQO1) and NRH:quinone oxidoreductase 2 (NQO2) catalyze the two-electron reduction of quinones and thereby prevent generation of toxic radicals. Quinone methides (QMs) covalently react with cellular macromolecules to form DNA adducts and/or protein conjugates resulting in toxicity and carcinogenesis. Based on similar structural features of quinones and QMs, it is logical to assume that NQO1 and/or NQO2 could also catalyze the two-electron reduction of QMs. However, hitherto the reduction of QMs, as both endogenous and/or exogenous biological substrates, by either NQO1/NQO2 has never been demonstrated. Here we show for the first time that both NQO1 and NQO2 can catalyze the reduction of electrophilic ortho-/para-QMs. The involvement of the enzyme in the reduction of p-cresol quinone methide (PCQM) and o-cresol quinone methide (OCQM) was demonstrated by reappearance of NQO1/NQO2-FAD peak at 450 nm after addition of the QMs to the assay mixture. Further reduction of methides by NQO1/NQO2 was confirmed by analyzing the assay mixture by tandem mass spectrometry. Preliminary kinetic studies show that NQO2 is faster in reducing QMs than its homolog NQO1, and moreover, ortho-QMs are reduced faster than para-QMs. Enzyme-substrate docking studies showed results consistent with enzyme catalysis. Thus, NQO1/NQO2 can play a significant role in deactivation of QMs.

A qualitative study of psychological, social and behavioral barriers to appropriate food portion size control.

BACKGROUND: Given the worldwide prevalence of overweight and obesity, there is a clear need for meaningful practical healthy eating advice - not only in relation to food choice, but also on appropriate food portion sizes. As the majority of portion size research to date has been overwhelmingly quantitative in design, there is a clear need to qualitatively explore consumers' views in order to fully understand how food portion size decisions are made. Using qualitative methodology this present study aimed to explore consumers' views about factors influencing their portion size selection and consumption and to identify barriers to appropriate portion size control. METHODS: Ten focus groups with four to nine participants in each were formed with a total of 66 persons (aged 19-64 years) living on the island of Ireland. The semi-structured discussions elicited participants' perceptions of suggested serving size guidance and explored the influence of personal, social and environmental factors on their food portion size consumption. Audiotapes of the discussions were professionally transcribed verbatim, loaded into NVivo 9, and analysed using an inductive thematic analysis procedure. RESULTS: The rich descriptive data derived from participants highlight that unhealthy portion size behaviors emanate from various psychological, social and behavioral factors. These bypass reflective and deliberative control, and converge to constitute significant barriers to healthy portion size control. Seven significant barriers to healthy portion size control were apparent: (1) lack of clarity and irrelevance of suggested serving size guidance; (2) guiltless eating; (3) lack of self-control over food cues; (4) distracted eating; (5) social pressures; (6) emotional eating rewards; and (7) quantification habits ingrained from childhood. CONCLUSIONS: Portion size control strategies should empower consumers to overcome these effects so that the consumption of appropriate food portion sizes becomes automatic and habitual.

Serving size guidance for consumers: is it effective?

Larger portion sizes (PS) may be inciting over-eating and contributing to obesity rates. Currently, there is a paucity of data on the effectiveness of serving size (SS) guidance. The aims of the present review are to evaluate SS guidance; the understanding, usability and acceptability of such guidance, its impact on consumers and potential barriers to its uptake. A sample of worldwide SS guidance schemes (n 87) were identified using targeted and untargeted searches, overall these were found to communicate various inconsistent and often conflicting messages about PS selection. The available data suggest that consumers have difficulty in understanding terms such as 'portion size' and 'serving size', as these tend to be used interchangeably. In addition, discrepancies between recommended SS and those present on food labels add to the confusion. Consumers generally understand and visualise SS best when expressed in terms of household measures rather than actual weights. Only a limited number of studies have examined the direct impact of SS guidance on consumer behaviour with equivocal results. Although consumers recognise that guidance on selecting SS would be helpful, they are often unwilling to act on such guidance. The challenge of achieving consumer adherence to SS guidance is formidable due to several barriers including chronic exposure to larger PS, distorted consumption norms and perceptions, the habit of 'cleaning one's plate' and language barriers for ethnic minorities. In conclusion, the impact of SS guidance on consumers merits further investigation to ensure that future guidance resonates with consumers by being more understandable, usable and acceptable.

Endometrioid ovarian carcinoma in a woman with a history of infertility and multiple in-vitro fertilization treatment cycles.

Ovarian cancer is rarely diagnosed during assisted reproduction. Several case-control and cohort studies have described its incidence within the infertile population well after the assisted reproductive process. We present a case of endometrioid adenocarcinoma that developed during the ovarian stimulation process and show corresponding ultrasound images of its development.