Women with a low-satiety phenotype show impaired appetite control and greater resistance to weight loss.

This trial compared weight loss outcomes over 14 weeks in women showing low- or high-satiety responsiveness (low- or high-satiety phenotype (LSP, HSP)) measured by a standardised protocol. Food preferences and energy intake (EI) after low and high energy-density (LED, HED) meals were also assessed. Ninety-six women (n 52 analysed; 41·24 (SD 12·54) years; 34·02 (sd 3·58) kg/m2) engaged in one of two weight loss programmes underwent LED and HED laboratory test days during weeks 3 and 12. Preferences for LED and HED food (Leeds Food Preference Questionnaire) and ad libitum evening meal and snack EI were assessed in response to equienergetic LED and HED breakfasts and lunches. Weekly questionnaires assessed control over eating and ease of adherence to the programme. Satiety quotients based on subjective fullness ratings post LED and HED breakfasts determined LSP (n 26) and HSP (n 26) by tertile splits. Results showed that the LSP lost less weight and had smaller reductions in waist circumference compared with HSP. The LSP showed greater preferences for HED foods, and under HED conditions, consumed more snacks (kJ) compared with HSP. Snack EI did not differ under LED conditions. LSP reported less control over eating and reported more difficulty with programme adherence. In conclusion, low-satiety responsiveness is detrimental for weight loss. LED meals can improve self-regulation of EI in the LSP, which may be beneficial for longer-term weight control.

A Low Energy-Dense Diet in the Context of a Weight-Management Program Affects Appetite Control in Overweight and Obese Women.

Background: Low energy-dense (LED) foods reduce energy intake (EI); whether this effect is sustained over time and during weight loss is unknown. Objective: This trial examined the effects of LED compared with high energy-dense (HED) meals on appetite, EI, and control over eating in the laboratory and during a weight-management program that encourages unrestricted intake of LED foods [Slimming World, UK (SW)] compared with a self-led Standard Care program [NHS weight-loss plan (SC)]. Methods: Overweight and obese women [n = 96; mean ± SD age: 41.03 ± 12.61 y; mean ± SD body mass index (in kg/m2): 34.00 ± 3.61] were recruited from the SW or SC programs. Primary outcomes included appetite, food preferences (liking and wanting for LED and HED foods), cravings, and evening meal EI (LED, HED) in response to calorie-matched LED (≤0.8 kcal/g) and HED (≥2.5 kcal/g) breakfast and lunch meals. Probe-day tests were conducted at weeks 3 and 4 and repeated at weeks 12 and 13 in a within-day crossover design. Secondary outcomes, including body weight and program experience, were measured from weeks 1 to 14 in a parallel-group design. Dietary compliance was monitored with the use of weighed food diaries at weeks 3 and 12. Results: Intention-to-treat (ITT) and completers analyses showed that the SW group lost more weight than the SC group [ITT: -5.9% (95% CI: -4.7%, -7.2%) compared with -3.5% (-2.3%, -4.8%), P < 0.05; completers: -6.2% (-4.8%, -7.6%) compared with 3.9% (-2.5%, -5.2%), P < 0.05]. The SW group reported greater control over eating and more motivation to continue the program compared with the SC group. LED meals increased sensations of fullness and reduced hunger on probe days (P < 0.001). Total-day EI was 1057 ± 73 kcal less (95% CI: 912, 1203 kcal; 36%) under LED compared with HED conditions (P < .001). Liking for LED and HED foods and wanting for HED foods were lower before lunch under LED compared with HED conditions, and liking decreased to a greater extent after the LED lunch. The SW group reported fewer cravings under LED compared with HED conditions (P < 0.05). On probe days, appetite and EI outcomes did not differ between weeks 3 and 12 or between the SW and SC groups. Conclusion: LED meals improve appetite control in women attempting weight loss and the effect is sustainable. Consumption of LED meals likely contributed to weight loss in the SW program. This study was registered at clinicaltrials.gov as NCT02012426.

A Randomized Feasibility Trial of a New Lifestyle Referral Assessment Versus Usual Assessment in an Acute Cardiology Setting.

BACKGROUND: A healthy diet, taking exercise, and not smoking or consuming alcohol in excess are important to reduce the risk of cardiovascular disease either alone or in combination with statin medication. Health education, including providing information to patients on healthy living and guidance on how to achieve it, is a key nursing function. OBJECTIVES: This study aims first to assess the feasibility of conducting a full-scale trial of lifestyle referral assessment as shown by recruitment rate, data collection, and follow-up and second to assess proof of concept and explore possible mechanisms of change. METHODS: This was a single-center, randomized, 2-arm, parallel-group, unblinded feasibility trial conducted in an acute teaching hospital trust. Participants were followed up at 3 and 6 months after randomization. RESULTS: Eight hundred eighty-seven patients were screened for eligibility, of whom 132 (15%) were randomized into the trial. Of the patients allocated to the individualized assessment, 27% accepted referral or self-referred by 3 months in comparison to 5% allocated to the usual assessment. CONCLUSIONS: We demonstrated that a full-scale trial is feasible and that an individualized approach increased the number of patients accepting referral to a formal program and initiating lifestyle change. However, we should consider the aim of the assessment and ways in which the process of change can be optimized in order to produce long-term benefit for patients. TRIAL REGISTRATION: current controlled trials ISRCTN41781196.

Free-Living Energy Balance Behaviors Are Associated With Greater Weight Loss During a Weight Loss Program.

Introduction: Free-living movement (physical activity [PA] and sedentary behavior [SB]) and eating behaviors (energy intake [EI] and food choice) affect energy balance and therefore have the potential to influence weight loss (WL). This study explored whether free-living movement and/or eating behaviors measured early (week 3) in a 14-week WL programme or their change during the intervention are associated with WL in women. Methods: In the study, 80 women (M ± SD age: 42.0 ± 12.4 years) with overweight or obesity [body mass index (BMI): 34.08 ± 3.62 kg/m2] completed a 14 week WL program focused primarily on diet (commercial or self-led). Body mass (BM) was measured at baseline, and again during week 2 and 14 along with body composition. Free-living movement (SenseWear Armband) and eating behavior (weighed food diaries) were measured for 1 week during week 3 and 12. Hierarchical multiple regression analyses examined whether early and early-late change in free-living movement and eating behavior were associated with WL. The differences in behavior between clinically significant weight losers (CWL; ≥5% WL) and non-clinically significant weight losers (NWL; ≤ 3% WL) were compared. Results: The energy density of food consumed [ß = 0.45, p < 0.001] and vigorous PA [ß = -0.30, p < 0.001] early in the intervention (regression model 1) and early-late change in light PA [ß = -0.81 p < 0.001], moderate PA [ß = -1.17 p < 0.001], vigorous PA [ß = -0.49, p < 0.001], total energy expenditure (EE) [ß = 1.84, p < 0.001], and energy density of food consumed [ß = 0.27, p = 0.01] (regression model 2) significantly predicted percentage change in BM. Early in the intervention, CWL consumed less energy dense foods than NWL [p = 0.03]. CWL showed a small but significant increase in vigorous PA, whereas NWL showed a slight decrease in PA [p = 0.04]. Conclusion: Both early and early-late change in free-living movement and eating behaviors during a 14 week WL program are predictors of WL. These findings demonstrate that specific behaviors that contribute to greater EE (e.g., vigorous PA) and lower EI (e.g., less energy-dense foods) are related to greater WL outcomes. Interventions targeting these behaviors can be expected to increase the effectiveness of WL programs.

Lifestyle referral assessment in an acute cardiology setting: study protocol for a randomized controlled feasibility trial.

BACKGROUND: Lifestyle and behaviour change are important factors in the prevention of cardiovascular disease and reduction of premature mortality. Public health initiatives have focused on opportunities for healthcare staff to deliver lifestyle advice routinely in primary and secondary care but there is no consistent approach to onward referrals and the rate of uptake of advice remains low. We do not know if advice is more effective in supporting behaviour change when a systematic approach is taken that includes identification of barriers to change, directing patients toward services, referral to services, and feedback on outcome. METHODS AND DESIGN: This is a single-centre, randomized, unblinded feasibility trial in an acute hospital setting which aims to assess the feasibility of a definitive trial and provide proof of concept for the systematic delivery of individualized lifestyle advice in patients managed through an acute cardiology in-patient service.Patients will be recruited before discharge and randomized to two groups. A control group will receive the usual lifestyle assessment and referral, while an intervention group will receive the usual assessment plus the new individualized lifestyle assessment and referral. The new assessment will inform assignment of each patient to one of three categories based on personal barriers to change. Patients may be referred to a formal lifestyle-change programme, through the 'Leeds Let's Change' website, or they may be guided in self-management, using goal setting, or they may be assigned to a 'deferment' category, for reassessment at follow-up. These latter patients will be given a contact card for the 'Leeds Let's Change' service. DISCUSSION: Lifestyle change is an important mechanism for improving health and wellbeing across the population but there are widely acknowledged difficulties in addressing lifestyle factors with patients and supporting behaviour change. A systematic approach to assessment would facilitate audit and provide an indicator of the quality of care. The new assessment template has been designed to be quick and easy to use in practice and could, for example, be added to a primary care consultation or form part of a nursing discharge assessment in an acute setting. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41781196.

Manipulation of glycemic response with isomaltulose in a milk-based drink does not affect cognitive performance in healthy adults.

Previous research suggests that glucoregulation and nutrient interventions, which alter circulating glucose, impact cognitive function. To examine the effect of modulating glycemic response using isomaltulose on cognitive function 24 healthy male adult participants consumed energy and macronutrient-matched milk-based drinks containing 50 g isomaltulose, 50 g sucrose or a water control in a counterbalanced within-subject design. Interstitial glucose was measured continuously in 12 subjects and all provided 9 capillary measures on each test day. A 30-min cognitive test battery was administered before and twice (+35 and +115 min) after drink ingestion. Immediate, delayed, recognition, verbal and working memory, and psychomotor performance were assessed. Glycemic profiles induced by the drinks differed significantly during the first but not the second post-drink test battery. Neither administration of the sucrose nor isomaltulose drinks produced consistent effects on verbal or working memory, or psychomotor performance. This study used isomaltulose as an investigative tool to lower glycemic response. Importantly, it demonstrates a lack of effect of modulating glucose on cognitive performance based on reliable, continuously measured glycemia. It refutes the hypothesis that glycemia is associated with cognitive performance and questions the suggestion that isomaltulose has an effect on cognitive performance.