Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients.

BACKGROUND & AIMS: The effects of bariatric surgery in patients with nonalcoholic fatty liver disease (NASH) are not well established. We performed a prospective study to determine the biological and clinical effects of bariatric surgery in patients with NASH. METHODS: From May 1994 through May 2013, one hundred and nine morbidly obese patients with biopsy-proven NASH underwent bariatric surgery at the University Hospital of Lille, France (the Lille Bariatric Cohort). Clinical, biological, and histologic data were collected before and 1 year after surgery. RESULTS: One year after surgery, NASH had disappeared from 85% of the patients (95% confidence interval [CI]: 75.8%-92.2%). Compared with before surgery, patients had significant reductions in mean ± SD body mass index (BMI, from 49.3 ± 8.2 to 37.4 ± 7) and level of alanine aminotransferase (from 52.1 ± 25.7 IU/L to 25.1 ± 20 IU/L); mean levels of γ-glutamyltransferases were reduced from 51 IU/L before surgery (interquartile range [IQR], 34-87 IU/L) to 23 IU/L afterward (IQR, 14-33 IU/L) and mean insulin resistance index values were reduced from 3.6 ± 0.5 to 2.9 ± 0.5 (P < .01 for each comparison). NASH disappeared from a higher proportion of patients with mild NASH before surgery (94%) than severe NASH (70%) (P < .05) according to Brunt score. In histologic analysis, steatosis was detected in 60% of the tissue before surgery (IQR, 40%-80%) but only 10% 1 year after surgery (IQR, 2.5%-21.3%); the mean nonalcoholic fatty liver disease score was reduced from 5 (IQR, 4-5) to 1 (IQR, 1-2) (each P < .001). Hepatocellular ballooning was reduced in 84.2% of samples (n = 69; 95% CI: 74.4-91.3) and lobular inflammation in 67.1% (n = 55; 95% CI: 55.8-77.1). According to Metavir scores, fibrosis was reduced in 33.8% of patients (95% CI: 23.6%-45.2%). Patients whose NASH persisted 1 year after surgery (n = 12) had lost significantly less weight (change in BMI, 9.1 ± 1.5) than those without NASH (change in BMI, 12.3 ± 0.6) (P = .005). Patients who underwent laparoscopic gastric banding lost less weight (change in BMI, 6.4 ± 0.7) than those who underwent gastric bypass (change in BMI, 14.0 ± 0.5) (P < .0001), and a higher proportion had persistent NASH (30.4% vs 7.6% of those with gastric bypass; P = .015). CONCLUSIONS: Bariatric surgery induced the disappearance of NASH from nearly 85% of patients and reduced the pathologic features of the disease after 1 year of follow-up. It could be a therapeutic option for appropriate morbidly obese patients with NASH who do not respond to lifestyle modifications. More studies are needed to determine the long-term effects of bariatric surgery in morbidly obese patients with NASH.

Effect on blood lipids of two daily servings of Camembert cheese. An intervention trial in mildly hypercholesterolemic subjects.

As a concentrated source of saturated fat, cheese consumption is considered to be associated with increased cholesterolemia and generally forbidden in dietary guidelines for adults with hypercholesterolemia. The aim of this study was to evaluate the impact of saturated fatty acids on lipid parameters and blood pressure with regards to different types of dairy products: Camembert and full-fat yoghurt. One-hundred and fifty-nine moderate hypercholesterolemic subjects without treatment were instructed to consume two full-fat yoghurts (2 × 125 g) per day for 3 weeks (run-in period) and then for a further period of 5 weeks, either two full-fat yoghurts or two 30 g servings of Camembert cheese per day. We observed that over the 5-week daily consumption of two servings of Camembert cheese, blood pressure and serum lipids did not change in moderate hypercholesterolemic subjects. These results suggest that fermented cheese such as Camembert could be consumed daily without affecting serum lipids or blood pressure.

The long-term nutritional status in stroke patients and its predictive factors.

BACKGROUND: Malnutrition is common in the first few months after stroke and contributes to a poor overall outcome. We analyzed long-term weight changes and their predictive factors. METHODS: A total of 71 first-ever stroke patients were included in the study and examined (1) their weight on admission to the acute stroke unit (usual weight [UW]), on admission to the rehabilitation unit, on discharge from the rehabilitation unit, and then 1 year or more after the stroke (median time: 2.5 years), (2) the presence of malnutrition after stroke, and (3) possible predictive factors, namely, sociodemographic factors, clinical characteristics (concerning the stroke, the patient's current neurologic status and the presence of diabetes mellitus and depression), and the present nutritional state (including eating difficulties, anorexia, and changes in food intake and food preferences). RESULTS: Body weight fell (4.0 kg) during the patients' stay in the stroke unit, increased moderately in the rehabilitation unit (2.0 kg), and returned to the UW by the long-term measurement. However, at the last observation, 40.1% of the patients weighed markedly less than their UW, 38.0% weighed markedly more, and 21.1% were relatively stable. Predictors of weight change were a change in preferences for sweet food products and a change in food intake. Malnutrition was frequent (47.9%) and associated with reduced food intake, residence in an institution, and diabetes mellitus. CONCLUSIONS: Malnutrition was highly prevalent, with an important role of change in food intake and food preferences, which could result from brain lesions and specific regimens. Living in an institution needs consideration, as its negative effects can be prevented.

Influence of social factors on weight-related behaviors according to gender in the French adult population.

Although the prevalence of obesity is higher in low socioeconomic position (SEP), the relationship between SEP and body mass index (BMI) differs according to gender. The purpose of this study is to investigate the relationships between BMI and SEP according to gender and explore the weight-related behaviors. In a cross-sectional survey, 1646 French adults were weighed and answered a questionnaire about eating behavior (DEBQ), SEP markers, ideal weight perception, physical activity and smoking. Our study showed that BMI was inversely correlated with SEP score in women only, independently of other BMI-associated factors (age, restrained eating, smoking status, TV viewing and physical activity). The SEP gradient was the same in both genders for some weight-related behaviors, such as restrained eating, physical activity and TV viewing, but differs for others, such as smoking and weight consciousness. There was an interaction between the SEP score and the actual BMI on the ideal BMI in women only, thus the difference in ideal body weight according to SEP is mainly due to difference in obese women. Our study concluded that gender differences in the relationship between BMI and SEP could be mainly due to the subjects' perception of weight appropriateness and their weight-related behaviors.

A feasible and reliable self-administered parental assessment of children's lifestyle (SAPLACL): an ancillary study based on the VIF program.

OBJECTIVES: In children, achieving an acceptable degree of accuracy from dietary or physical activity (PA) assessments remains a challenge. Children tend to overestimate their time spent in daily PA and underestimate their dietary intake of fat and sugar. Because parents play a key role in family lifestyle decisions, including children's food choices and PA levels, it is important to investigate the responses of parents regarding their children's lifestyle habits. We aimed to develop a Self-Administered Parental Assessment of Children's Lifestyle (SAPLACL) questionnaire and test its feasibility and reliability in 191 parents (29 fathers and 162 mothers). RESULTS: For each part of the questionnaire, the rate of missing or improper responses ranged from 0 to 24%. The highest proportion of problems in understanding was reported for the dietary intake dimension, especially for snacking in front of the TV. Some difficulty was also found regarding the question on leisure PA. Test-retest agreement was observed in 54.7-100% of the respondents. Overall, the kappa coefficients were favorable. Thus, the parent self-report questionnaire is a valid and accurate tool for analyzing children's lifestyle habits in France.

Identification of several eating habits that mediate the association between eating behaviors and the risk of obesity.

Objective: Eating behaviors play important roles in the development of obesity. A better knowledge of the psychological aspects of eating behaviors in individuals with and without obesity and their consequences on daily eating and lifestyle habits would be informative. The Three-Factor Eating Questionnaire (TFEQ)-R21 assesses the psychometrics of eating behavior. The objectives of the study were to establish which eating habits were or were not associated with TFEQ eating behaviors, and to quantify the extent to which those eating habits mediated the association between TFEQ eating behaviors and obesity risk. Methods: Data were obtained from the Gene and Environment Case-Control Obesity Study from northern France. It included 2237 individuals with obesity and 403 individuals without obesity. Eating behaviors were assessed according to the TFEQ-R21. Two activity levels (physical activity and television watching) and six eating habits (e.g., plate size, having one serving or at least two servings of the main meal, …) were evaluated. Regression and mediation analyses were performed. Results: Higher cognitive restraint, higher uncontrolled eating (UE) and higher emotional eating (EE) were associated with a higher risk of obesity, independently of each other and of age, sex, socio-economic status and physical activity. Cognitive restraint was negatively associated with having at least two servings, while UE and EE were associated with several obesogenic habits such as eating in front of the television or eating at night. Each of these obesogenic habits mediated between 3% and 20% of the association between UE or EE and obesity. Conclusions: Psychological eating behaviors were associated with several lifestyle and eating habits in both individuals with and without obesity. Moreover, some eating habits partially mediated (between 3% and 20%) the association between TFEQ eating behaviors and obesity risk. For clinicians, this study shows that simple, easy-to-ask questions on specific daily eating habits can provide essential information to better understand and manage patients with obesity.

Dietary recommendations of the French Society for Rheumatology for patients with chronic inflammatory rheumatic diseases.

This article presents the 1st set of dietary recommendations of the French Society for Rheumatology for patients suffering from chronic inflammatory rheumatic diseases (IRD) made by a working group consisting of 12 rheumatology experts, 3 physician nutrition specialists, 1 internal medicine specialist, 1 registered dietician and 3 representatives from patient associations. This group relied on a systematic literature review and on expert opinions, while taking into consideration not only the joint effects of diet in IRD but also the extra-articular ones. Eight general principles and nine recommendations were established. The general principles emphasize that nutritional advice is not a substitute for pharmacological treatment of IRD and that it is an integral part of the patients' overall care, which could help the patient actively participate in their care. The recommendations propose supporting weight loss in subjects who are overweight or obese, a Mediterranean-type diet and supplementation in polyunsaturated fatty acids, mainly omega-3. Conversely, gluten-free diets (in the absence of celiac disease), vegetarian/vegan diets, fasting and elimination of dairy products should not be proposed. Supplementation with vitamins or trace elements is not indicated for controlling chronic IRD activity, while the use of probiotics or spices is not recommended given the limited or disparate data.

Feasibility and reliability of the Self Administered Children's Lifestyle Assessment (SACLA), a new tool to measure children's lifestyle behaviors: the VIF Program.

OBJECTIVES: To develop a self-administered children health-related behaviors assessment, and to test its feasibility and reliability in a group of French children. METHODS: A sample of 216 children participated in the first stage of this study, dedicated to the feasibility assessment. An independent sample of 99 children participated in the assessment of reliability via questionnaire test and retest. RESULTS: Missing or inappropriate responses on different parts of the questionnaire ranged from 0 to 35%, more evident on the drink intake and sleep areas. Some questions in fact have been modified or removed. No problems were reported on the dimensions of physical activity habits and sedentary behaviors. The mean percentage of agreement in test-retest reliability for the questionnaire dimensions was 78% (47-99%). Overall, kappa coefficients were good. CONCLUSIONS: This questionnaire is an acceptable and reliable instrument for assessing lifestyle habits in French children.

Trends in prevalence of childhood overweight and obesity in a community-based programme: The VIF Programme.

BACKGROUND: Obesity in children is considered the main childhood health problem. OBJECTIVE: To assess the impact of 7-year community-based interventions on the trend prevalence of overweight and obesity in French preschool children and primary school children between 2008 and 2015. METHODS: Two cross-sectional studies were performed in the last grade of every pre-school and primary schools of 6 cities in 2008 and 2015. In 2008 and 2015, 3387 children and 3415 children (aged 5 and 11 years old) participated in the 2 surveys. Interventions consisted to promote physical activity, healthy diet, sleep habits and well-being. Prevalence of overweight and obesity were defined according to age- and sex-specific BMI cut-off points. Priority education area of the schools was also recorded. RESULTS: Prevalence of overweight and obesity decreased significantly between 2008 and 2015 in children from pre-schools (18.1% vs 13.0%) and primary schools (20.9% vs 16.9%) (P < 0.05). No effects of priority education area and sex were found related to the decrease of prevalence in overweight and obesity. CONCLUSIONS: Our results show that over 7 years period, the community-based intervention has a positive impact on the overweight and obesity prevalence in childhood. These results are promising and encouraging in addressing obesity and related issues in French young boys and girls.

Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease.

BACKGROUND & AIMS: Severe obesity is implicated in development of nonalcoholic fatty liver disease (NAFLD). Bariatric surgery induces weight loss and increases survival time of obese patients, but little is known about its effects on liver damage. We performed a 5-year prospective study to evaluate fibrosis and nonalcoholic steatosis (NASH) in severely obese patients after bariatric surgery. METHODS: Bariatric surgery was performed on 381 patients. Clinical and biological data, along with liver biopsies, were collected before and at 1 and 5 years after surgery. RESULTS: Five years after surgery, levels of fibrosis increased significantly, but 95.7% of patients maintained a fibrosis score

Latent variables and structural equation models for longitudinal relationships: an illustration in nutritional epidemiology.

BACKGROUND: The use of structural equation modeling and latent variables remains uncommon in epidemiology despite its potential usefulness. The latter was illustrated by studying cross-sectional and longitudinal relationships between eating behavior and adiposity, using four different indicators of fat mass. METHODS: Using data from a longitudinal community-based study, we fitted structural equation models including two latent variables (respectively baseline adiposity and adiposity change after 2 years of follow-up), each being defined, by the four following anthropometric measurement (respectively by their changes): body mass index, waist circumference, skinfold thickness and percent body fat. Latent adiposity variables were hypothesized to depend on a cognitive restraint score, calculated from answers to an eating-behavior questionnaire (TFEQ-18), either cross-sectionally or longitudinally. RESULTS: We found that high baseline adiposity was associated with a 2-year increase of the cognitive restraint score and no convincing relationship between baseline cognitive restraint and 2-year adiposity change could be established. CONCLUSIONS: The latent variable modeling approach enabled presentation of synthetic results rather than separate regression models and detailed analysis of the causal effects of interest. In the general population, restrained eating appears to be an adaptive response of subjects prone to gaining weight more than as a risk factor for fat-mass increase.

Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes.

OBJECTIVE: A school-based nutrition information programme was initiated in 1992 in two towns in northern France (Fleurbaix and Laventie, FL) and was followed by a number of community-based interventions. We took the opportunity to measure the outcomes in terms of childhood obesity and overweight over the next 12 years. DESIGN: Repeated, cross-sectional, school-based survey. For the school years beginning in 1992, 2000, 2002, 2003 and 2004, the height and weight of all 5- to 12-year-old children attending school were measured in FL. In 2004, the same assessments were made in two comparison towns with similar socio-economic characteristics but no intervention. SETTING: Fleurbaix and Laventie (intervention towns), Bois-Grenier and Violaines (comparison towns), northern France. SUBJECTS: In 2002, 2003 and 2004, respectively 515, 592 and 633 children were measured in FL (participation rate of 95-98% of all eligible individuals); in the comparison towns, 349 children were measured in the 2004 school year (98% of the towns' school population). RESULTS: After an initial increase, trends in mean BMI and prevalence of overweight started to reverse. Compared with 2002, the age-adjusted OR for overweight in FL was significantly lower in 2003 and 2004 (but for girls only). In the 2004 school year, the overweight prevalence was significantly lower in FL (8.8%) than in the comparison towns (17.8%, P < 0.0001). CONCLUSION: These data suggest that, over a long period of time, interventions targeting a variety of population groups can have synergistic effects on overweight prevalence. This gives hope that it is possible to reverse trends towards increasing overweight by actions at the community level.

Cognitive restraint, uncontrolled eating and emotional eating: correlations between parent and adolescent.

The purpose of this study was to examine, in a general population, the resemblance in eating behaviour between adolescents and their parents. This study was based on the first examination of a community-based epidemiological study in Northern France. Subjects were offspring aged 14-22 years (135 boys and 125 girls) and their parents (174 fathers and 205 mothers). The Three-Factor Eating Questionnaire Revised 18-item version (TFEQ-R18) identified three aspects of eating behaviour: cognitive restraint of eating, uncontrolled eating and emotional eating. Familial resemblance in eating behaviour was measured by partial Spearman's correlations, adjusted for age and body mass index. Sons' uncontrolled eating was positively related to fathers' cognitive restraint of eating (r = 0.36), but not to fathers' uncontrolled eating (r = 0.07), nor to mothers' eating behaviour. Sons' cognitive restraint of eating was related to no parental eating behaviour scores. In daughters, cognitive restraint of eating was positively related to mothers' uncontrolled eating (r = 0.26), but not to mothers' cognitive restraint of eating (r = 0.13). Daughters' uncontrolled eating and emotional eating were positively associated with the same scores in mothers. Finally, daughters' eating behaviour was not related to fathers' eating behaviour. In conclusion, correlations in eating behaviour were higher with the parent of the same gender, and eating behaviours in adolescents seem to reflect opposition to parents' behaviour more than familial resemblance.

Influence of weight loss on plasma ghrelin responses to high-fat and high-carbohydrate test meals in obese women.

BACKGROUND: Diet-induced weight loss is associated with an increase in fasting ghrelin. The influence of weight loss on postprandial ghrelin response remains discussed, but the specific response to macronutrients is not known. OBJECTIVE: The objective of the study was to assess the influence of weight loss in obese women on the plasma ghrelin response to a fat- or carbohydrate-rich meal. DESIGN: Seventeen obese women (mean body mass index 37.6 +/- 5 kg/m2) were given an energy-restricted diet (800 kcal/d) for 7 wk, followed by a maintenance diet for 1 wk. Before and after the weight reduction diet, each woman was given (in random order) two isoenergetic test meals, corresponding to 40% of daily energy needs. The test meals contained either 80% fat and 20% protein or 80% carbohydrate and 20% protein. Blood samples were collected over a 10-h period. Two-way ANOVA with repeated measures was used to assess the effect of the test meal on variables. RESULTS: Weight loss (-11.2 +/- 1.4 kg) was associated with a significant decrease in baseline plasma insulin (9.7 +/- 4.1 to 7.9 +/- 2.4 mU/ml; P < 0.0001) and leptin (25.9 +/- 8.3 to 17.2 +/- 7.8 ng/ml; P < 0.0001) and an increase in plasma ghrelin (1.86 +/- 1.05 to 2.28 +/- 1.48 ng/ml; P < 0.05). Before weight loss, there was no significant difference in postprandial ghrelin response between the test meals. After weight reduction, the ghrelin response was more pronounced after the carbohydrate test meal than after the fat test meal (P < 0.02). CONCLUSION: Weight loss is associated with an improved postprandial plasma ghrelin response to a carbohydrate meal, whereas the response to a fat meal is not modified.

Is restrained eating a risk factor for weight gain in a general population?

BACKGROUND: In modern societies characterized by abundant and accessible foods, restrained eating may become an adaptive behavior to limit weight gain. OBJECTIVE: We assessed the relations between eating behavior (EB) and adiposity in a general population over a 2-y period. DESIGN: We recruited 466 adults and 271 adolescents in 1999 on a geographical basis to participate in a longitudinal study. At the initial examination and 2 y later, they answered an EB questionnaire, the Three-Factor Eating Questionnaire-R18, which measured cognitive restraint (CR), uncontrolled eating, and emotional eating. On the same occasions, several measures of adiposity were also obtained: body mass index (BMI; in kg/m2), waist circumference, the sum of 4 skinfold thicknesses, and percentage body fat. Relations between EB and adiposity were tested separately in adults and adolescents by using mixed linear regressions after adjustment for age, sex, and (in adolescents) Tanner pubertal stage. RESULTS: At baseline, CR was positively associated with BMI in normal-weight subjects (mean BMI: 21.4 in the lowest to 23.3 in the highest CR quintile; P < 0.001) but not in overweight adults (P = 0.25). Initial CR did not predict change in adiposity variables (BMI change: P = 0.79 in adults, P = 0.57 in adolescents and young adults). Conversely, a high initial BMI was associated with a larger increase in CR (beta = 20.1, P < 0.0001 in adults; beta = 21.7, P = 0.003 in adolescents and young adults). CONCLUSIONS: Restrained eating is strongly associated with adiposity in normal-weight subjects but not in overweight subjects. However, restrained eating does not promote weight gain.

Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity.

BACKGROUND: Laparoscopic bariatric operations can be technically challenging in massively obese patients. The potential of the intragastric balloon for preoperative weight reduction was evaluated in candidates for laparoscopic Roux-en-Y gastric bypass (LRYGBP) with super obesity. METHODS: From January 2004 to March 2005, 10 patients with super obesity who were potential candidates for LRYGBP were included in a prospective observational study. An intragastric balloon was placed endoscopically under general anesthesia. Patients were then followed by a multidisciplinary team until removal of the balloon after 6 months. Weight, BMI, and percent excess weight lost (%EWL) were monitored after 1, 3 and 6 months. RESULTS: The 10 patients were all female with mean +/- SD age of 33+/-11 years (range 17-51). Initial weight was 175+/-25 kg (range 135-223) and initial BMI was 64+/-7 kg/m2 (range 59-78). After completion of 1, 3 and 6 months, weight, BMI, and %EWL reached respectively: 166+/-27 kg*, 165+/-27 kg*, and 169+/-26 kg*; 61.1+/-7.6 kg/m2*, 60.8+/-8.4 kg/m2*, and 61+/-8.2 kg/m2*; 9+/-5%, 10+/-7%, 7+/-6%. (*=P<0.01 vs preop). CONCLUSION: In potential candidates for LRYGBP with super obesity, preoperative placement of an intragastric balloon can reduce the excess weight by 10% within 3 months. Extending this period failed to improve these results further.

Validation of noninvasive biomarkers (FibroTest, SteatoTest, and NashTest) for prediction of liver injury in patients with morbid obesity.

BACKGROUND: Liver biopsy is considered as the gold standard for assessing nonalcoholic fatty liver disease (NAFLD) histologic lesions in patients with morbid obesity. The aim of this study was to determine the diagnostic utility of noninvasive markers of fibrosis (FibroTest), steatosis (SteatoTest), and steatohepatitis (NashTest, ActiTest) in these patients. MATERIALS AND METHODS: Two hundred and eighty-eight patients presenting with interpretable baseline operative biopsy and biomarkers, in an ongoing prospective cohort of patients treated with bariatric surgery, were included. Histology (NAFLD activity score, or NAFLD scoring system) and biochemical measurements were centralized and blinded to other characteristics. The area under the receiver operating characteristic curves (AUROC), sensitivity, specificity, positive and negative predictive values were assessed. Weighted AUROC (Obuchowski method) was used to prevent multiple testings and a spectrum effect. RESULTS: The prevalence of advanced fibrosis (bridging) was 6.9%, advanced steatosis (>33%) was 48%, and steatohepatitis was 6.9% (NAFLD scoring system>4). Weighted AUROCs of the tests were as follows (mean, 95% confidence interval, significance): FibroTest for advanced fibrosis: 0.85, 0.83-0.87, P<0.0001; SteatoTest for advanced steatosis: 0.81, 0.79-0.83, P<0.0001; and ActiTest for steatohepatitis: 0.77, 0.73-0.81, P<0.0001. CONCLUSION: In patients with morbid obesity, the diagnostic performances of the FibroTest, SteatoTest, and ActiTest were statistically significant, thereby possibly reducing the need for biopsy in this population.

[Obesity prevention, how?]. / Obésité: quelle prévention?

Obesity prevention, aims both at reducing the body mass index (BMI) of the population but also at preventing worsening of obesity in most obese patients. To achieve this, it is necessary to obtain population level lasting change behavior by exploiting the different levers of individual behavior, but also environmental and societal. Universal prevention is aimed at all members of the community, it must rely on all stakeholders: the state (legislation information campaigns), local authorities (planning), and the middle school work. Selective prevention is aimed at groups or individuals at high risk such as low social classes, more affected by severe obesity. These groups can be achieved through actions of prevention and health if these actions are real actions of community health, incorporating the values and representations of the community, building on existing networks, and strengthening social links between individuals. Targeted prevention is for people who have weight problems and those who have a high risk of illness related to overweight. In this case the aim is to avoid a further increase in weight gain, prevent consequences of obesity, prevent weight regain among those who have lost weight. Physicians have a vital role to play in raising awareness and support of patients for whom they remain the major health. referent Obesity can become a model for a new approach to medicine, based on work in synergy with the social actors and social and health care.

Family dietary coaching to improve nutritional intakes and body weight control: a randomized controlled trial.

OBJECTIVE: To test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in free-living (noninstitutionalized) children and parents. DESIGN: Randomized controlled trial. SETTING: Fifty-four elementary schools in Paris, France. PARTICIPANTS: One thousand thirteen children (mean age, 7.7 years) and 1013 parents (mean age, 40.5 years). INTERVENTION: Families were randomly assigned to group A (advised to reduce fat and to increase complex carbohydrate intake), group B (advised to reduce both fat and sugar and to increase complex carbohydrate intake), or a control group (given no advice). Groups A and B received monthly phone counseling and Internet-based monitoring for 8 months. OUTCOME MEASURES: Changes in nutritional intake, body mass index (calculated as weight in kilograms divided by height in meters squared), fat mass, physical activity, blood indicators, and quality of life. RESULTS: Compared with controls, participants in the intervention groups achieved their nutritional targets for fat intake and to a smaller extent for sugar and complex carbohydrate intake, leading to a decrease in energy intake (children, P < .001; parents, P = .02). Mean changes in body mass index were similar among children (group A, + 0.05, 95% confidence interval [CI], - 0.06 to 0.16; group B, + 0.10, 95% CI, - 0.03 to 0.23; control group, + 0.13, 95% CI, 0.04-0.22; P = .45), but differed in parents (group A, + 0.13, 95% CI, - 0.01 to 0.27; group B, - 0.02, 95% CI, - 0.14 to 0.11; control group, + 0.24, 95% CI, 0.13-0.34; P = .001), with a significant difference between group B and the control group (P = .01). CONCLUSIONS: Family dietary coaching improves nutritional intake in free-living children and parents, with beneficial effects on weight control in parents. Trial Registration clinicaltrials.gov Identifier: NCT00456911.

The evolution of severe steatosis after bariatric surgery is related to insulin resistance.

BACKGROUND & AIMS: In severely obese patients, factors implicated in the evolution of severe steatosis after bariatric surgery remain unresolved. Our aim was to determine whether insulin resistance (IR) influences the histologic effects induced by bariatric surgery. METHODS: We prospectively included 185 severely obese patients (body mass index >/=35 kg/m(2)) referred for bariatric surgery. The evolution of IR (IR index = 1/quantitative insulin sensitivity check index) and liver injury with consecutive biopsy was concomitantly assessed before and 1 year after surgery. RESULTS: At preoperative biopsy, 27% of severely obese patients disclosed severe steatosis (>/=60%). The alanine aminotransferase (P = .01) and IR indexes (P = .04) were independent predictive factors of severe steatosis at baseline. One year after surgery, surgical treatment induced a decrease in body mass index (9.5 kg/m(2); P < .0001), steatosis score (8.5%; P < .0001), and IR index (0.29; P < .0001). The preoperative IR index (P = .01) and preoperative steatosis (P = .006) were independent predictive factors in the persistence of severe steatosis after surgery. Moderate or severe steatosis was more frequently observed in patients who had conserved a higher IR index after surgery than in patients who had improved their IR index (44% vs 20.2%; P = .04). CONCLUSIONS: IR was independently associated with severe steatosis and predicted its persistence after surgery. The amelioration of IR after surgery is associated with a decrease in the amount of fat. Taken together, the results of this prospective study in severely obese patients demonstrate that severe steatosis and its evolution after surgery are intimately connected with IR.