Nutritional counselling in adults promoting adherence to the Mediterranean diet as adjuvant in the treatment of major depressive disorder (INDEPT): a randomized open controlled trial study protocol.

BACKGROUND: Major Depressive Disorder (MDD) is a leading cause of disability worldwide. Approximately one-third of patients with MDD do not respond to treatment, and often exhibit elevated inflammation biomarkers, which are associated with worse prognosis. Previous research has linked healthier dietary patterns, such as the Mediterranean Diet (MedDiet), with a lower risk of MDD and symptoms of depression, potentially due to their anti-inflammatory properties. The aim of this study is to evaluate the effectiveness of a nutritional counselling intervention promoting MedDiet to alleviate symptoms of depression in adults recently diagnosed with MDD and presenting with elevated inflammation biomarkers. METHODS: This study is a randomized controlled trial (RCT) that will recruit adults from outpatient clinics, between the ages of 18 and 70 years who have been diagnosed with MDD and are currently receiving treatment with the first prescribed antidepressant, and who exhibit elevated inflammation biomarkers (interleukin-6 and/or C-reactive protein). The control group will receive treatment-as-usual (TAU) only. The primary outcome of the study will be the change in symptoms of depression, as measured by the Beck Depression Inventory 2 (BDI-II), after 12 weeks of intervention. Data analysis will follow an intention-to-treat approach. Secondary outcomes will include changes in inflammation biomarkers, quality of life, adherence to the MedDiet, and cost-effectiveness of nutritional counselling. All outcomes will be assessed at baseline, after the 12-week intervention, and at 6- and 12-months post-baseline. DISCUSSION: This study will be the first RCT to evaluate the effect of a nutritional intervention with anti-inflammatory properties, as an adjuvant in the treatment of MDD, in individuals diagnosed with MDD and elevated inflammation biomarkers. The results of this study may contribute to the development of more effective and personalized interventions for MDD patients with elevated inflammation biomarkers.

Case report: Wernicke-Korsakoff syndrome after bariatric surgery.

Vitamin and mineral deficiencies are prevalent nutritional disorders following bariatric surgery. Although they are more prevalent after malabsorptive procedures such as bypass, they also occur in restrictive procedures such as gastric sleeve. The mechanisms that lead to the occurrence of these deficits are related to the presence of poor nutritional intake or poor adherence to multivitamins and multimineral supplementation. Wernicke-Korsakoff syndrome (WKS) is an acute neurological disorder resulting from thiamine deficiency. This syndrome is composed of two distinct phases: first, Wernicke Encephalopathy (WE), the acute phase of this syndrome, which is characterized by a triad of mental confusion, ocular signs, and ataxia, followed by the chronic phase of WKS, called Korsakoff's syndrome (KS), which is known for the presence of anterograde amnesia and confabulation. We aimed to report a case of a patient with WKS after bariatric surgery. The patient's retrospective chart review was performed in order to retrieve the relevant clinical data. The patient was a 24-year-old female student with a BMI of 48 kg/m2 who underwent sleeve gastrectomy surgery for morbid obesity. Over the following 2 months, recovery from surgery was complicated by non-specific symptoms such as nausea, recurrent vomiting, and a significant reduction in food intake, which led the patient to visit the emergency department six times with hospitalization on the last occasion for a definitive diagnosis. During the 15 days of hospitalization, the patient developed ocular diplopia, nystagmus, complaints of rotatory vertigo, and gait abnormalities. A magnetic resonance imaging of the head was performed but revealed no significant changes. After a formal neurological assessment, treatment with parenteral thiamine (100 mg, three times a day) was started without prior dosing. The observed clinical improvement confirmed the diagnosis of WKS. Bariatric surgery may contribute to thiamine deficiency and, consequently, to WKS. Education about the adverse consequences of malnourishment is mandatory before and after the surgery. Investigation of nutritional deficiencies both pre- and post-operatively is crucial in order to prevent complications such as WKS.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

INDIVIDUO: Results from a patient-centered lifestyle intervention for obesity surgery candidates.

BACKGROUND: Preoperative nutritional counseling provides an opportunity to ameliorate patients' clinical condition and build-up adequate habits and perception of competence. Study aimed to evaluate: (a) the effect of INDIVIDUO on weight and metabolic control; (b) the impact of INDIVIDUO on psychosocial variables associated with successful weight-control. METHODS: Two-arms randomised controlled single-site study, with six-month duration. Patients were recruited from an Obesity Treatment Unit's waiting list. For the intervention group (IG), an operating procedure manual was used, nutritionists received training/supervision regarding INDIVIDUO's procedures. Control group (CG) received health literacy-promoting intervention. Intention-to-treat and per-control analysis were used. Outcomes included weight, metabolic control variables (blood pressure, glycemia, insulinemia, triglycerides, cholesterol), measures of eating and physical activity patterns, hedonic hunger, autonomous/controlled regulation, perceived competence for diet (PCS-diet) and quality of life. Primary outcomes were weight and metabolic control. Effect size was estimated by odds ratio and Cohens'd coefficient. RESULTS: Overall, 94 patients participated (IG:45; CG:49) and 60 completed the study (IG:29; CG:31). Intervention patients lost an excess 9.68% body weight (%EWL), vs. 0.51% for CG. Adjusting for age and baseline BMI, allocation group remained an independent predictor of %EWL (B=8.43, 95%CI: 2.79-14.06). IG had a six-fold higher probability (OR: 6.35, 95%CI: 1.28-31.56) of having adequate/controlled fasting glycemia at final evaluation. PCS-diet at final evaluation was independently predicted by baseline PCS-diet (B=0.31, 95%CI: 0.06-0.64), variation in autonomous regulation (B=0.43, 95%CI: 0.15-0.71) and allocation group (B=0.26, 95%CI: 0.04-1.36). CONCLUSIONS: Results on weight and metabolic control support INDIVIDUO as a valuable clinical tool for obesity surgery candidates counseling. Additionally, intervention associated with perceived competence for weight-control behaviours and autonomous regulation.

Assessing quality of life in severe obesity: development and psychometric properties of the ORWELL-R.

PURPOSE: Several health-related quality-of-life (HRQoL) dimensions are affected by obesity. Our goal was to characterize the psychometric properties of the ORWELL-R, a new obesity-related quality-of-life instrument for assessing the "individual experience of overweightness". METHODS: This psychometric assessment included two different samples: one multicenter clinical sample, used for assessing internal consistency, construct validity and temporal reliability; and a community sample (collected through a cross-sectional mailing survey design), used for additional construct validity assessment and model fit confirmation. RESULTS: Overall, 946 persons participated (188 from the clinical sample; 758 from community sample). An alpha coefficient of 0.925 (clinical sample) and 0.934 (community sample) was found. Three subscales were identified (53.2 % of variance): Body environment experience (alpha = 0.875), Illness perception and distress (alpha = 0.864), Physical symptoms (alpha = 0.674). Adequate test-retest reliability has been confirmed (ICC: 0.78 for the overall score). ORWELL-R scores were worse in the clinical sample. Worst HRQoL, as measured by higher ORWELL-R scores, was associated with BMI increases. ORWELL-R scores were associated with IWQOL-Lite and lower scores in happiness. CONCLUSIONS: ORWELL-R shows good internal consistency and adequate test-retest reliability. Good construct validity was also observed (for convergent and discriminant validity) and confirmed through confirmatory factor analysis (in both clinical and community samples). Presented data sustain ORWELL-R as a reliable and useful instrument to assess obesity-related QoL, in both research and clinical contexts.

[Promoting sustainable behavior change in body weight control]. / Promovendo mudanças comportamentais sustentáveis no controlo do peso corporal.

There is a wide acknowledgement of obesity as a relevant clinical entity. Such relevance can be inferred by the huge worldwide amount of research and related health promotion and clinical efforts. Though the evidence sustains some cues for the therapeutic success, the overall long-term effectiveness of obesity treatment tends to be not so satisfactory. Scientific literature is not unequivocal in key areas of nutritional intervention, such as the magnitude of caloric restriction, proportion of macronutrients, meal frequency, among others. The same applies to the area of physical activity recommendation for weight control. As a correlate of this scenario of incertitude, there is a proliferation of interventions and there is a clear need to integrate the scientific and clinical evidence. This paper presents a narrative literature review of key issues of clinical practice in obesity, regarding a set of actions that, in the overall, have as main purpose the promotion of reduction and/or control of body weight. The role of the health professional is highlighted as a facilitator of acquisition of habits that favor weight control, by integrating the professional's scientific knowledge with the patient's readiness for and capacity to change.

A obesidade assume atualmente uma importância óbvia, expressa pelos esforços de investigação, de saúde pública e clínicos, a nível mundial. Se a evidência produzida aponta para algumas direções de sucesso terapêutico, a efetividade destas a médio ou longo prazo tende a ser pouco satisfatória. A literatura não é inequívoca em áreas nucleares da intervenção nutricional para tratamento da obesidade, como sejam a magnitude da restrição energética, a proporção dos macronutrientes, o fracionamento alimentar, entre outros. O mesmo acontece na área da recomendação de atividade física. Proliferam assim as formas de intervenção e importa portanto fazer um exercício de integração da evidência científica e clínica. Este artigo consiste numa revisão narrativa de questões centrais para a prática da intervenção em obesidade, nomeadamente no que toca às ações que, no seu conjunto, visam a redução e/ou controlo do peso corporal e seus benefícios. Salienta-se o papel do profissional de saúde como promotor de hábitos que favorecem o controlo do peso corporal, numa perspetiva que integra o saber científico do profissional com a disponibilidade e capacidade para a mudança do doente. 

[Intra-gastric ballon in the treatment of morbid obesity]. / Balão intra-gástrico no tratamento da obesidade mórbida.

BACKGROUND: Intragastric balloon is a temporary treatment for weight loss with proven safety and efficacy when associated with lifestyle intervention. It is indicated in the super--obese who are candidates for bariatric surgery to lose weight and to reduce their high surgical risk. Our aim was to retrospectively evaluate the results of the patients in whom this device was inserted during a three-year period from the beginning of this practice in the Hospital de Santa Maria. METHODS: Data from the medical records in what concerns bioanthropometric characteristics in the beginning and following balloon removal were reviewed and submitted to descriptive analysis. RESULTS: Fifty-seven patients underwent intragastric balloon placement, of whom 46 female and 11 male, with median age 44,2 ± 11,77 years. Median body mass index (BMI) 51,6 ± 9,45 kg/m(2). Five patients were lost to follow-up. The balloon was inserted for a median time of 206 ± 62,62 days, during which there was a median weight loss of 17,2 ± 9,46 kg, a reduction of 6,7 ± 3,73 kg/m(2) in BMI and a mean excessive weight loss of 26,7 ± 16,99%. There were 5 patients in whom serious complications occurred, one of which died. One half of the patients went on to bariatric surgery. The median time between balloon removal and surgery was 241,6 ± 243,66 days in which there was a median weight variation of + 3,5 ± 11,69 kg. The remaining patients: 15 dropped out further treatment, 5 patients are under medical therapy and have no invasive procedure scheduled, 4 patients are to be submitted to another balloon insertion and 2 patients were submitted to the insertion of a second balloon during the time this article refers to. CONCLUSIONS: Our findings are similar to some previously described. Intragastric balloon is a temporary and efficacious option in the treatment of morbid obesity. However, it is very important to strictly select the patients and to have a good coordination with the Surgical department so that results can be optimized.