Partial Meal Replacement for Weight Loss after Stroke: Results of a Pilot Clinical Trial.

INTRODUCTION: Over half of patients with acute ischemic stroke are overweight or obese as defined by a body mass index (BMI) ≥25 kg/m2. Professional and government agencies recommend weight management for these persons to improve risk factors for cardiovascular disease, including hypertension, dyslipidemia, vascular inflammation, and diabetes. However, approaches to weight loss have not been adequately tested specifically in patients with stroke. In anticipation of a larger trial with vascular or functional outcomes, we tested the feasibility and safety of a 12-week partial meal replacement (PMR) intervention for weight loss in overweight or obese patients with a recent ischemic stroke. METHODS: This randomized open-label trial enrolled participants from December 2019 to February 2021 (with hiatus from March to August 2020 due to COVID-19 pandemic restrictions on research). Eligible patients had a recent ischemic stroke and BMI 27-49.9 kg/m2. Patients were randomized to a PMR diet (OPTAVIA® Optimal Weight 4 & 2 & 1 Plan®) plus standard care (SC) or SC alone. The PMR diet consisted of four meal replacements supplied to participants, two meals with lean protein and vegetables (self-prepared or supplied), and a healthy snack (also self-prepared or supplied). The PMR diet provided 1,100-1,300 calories per day. SC consisted of one instructional session on a healthy diet. Co-primary outcomes were ≥5% weight loss at 12 weeks and to identify barriers to successful weight loss among participants assigned to PMR. Safety outcomes included hospitalization, falls, pneumonia, or hypoglycemia requiring treatment by self or others. Due to the COVID-19 pandemic, study visits after August 2020 were by remote communication. RESULTS: We enrolled 38 patients from two institutions. Two patients in each arm were lost and could not be included in outcome analyses. At 12 weeks, 9/17 patients in the PMR group and 2/17 patients in the SC group achieved ≥5% weight loss (52.9% vs. 11.9%; Fisher's exact p = 0.03). Mean percent weight change in the PMR group was -3.0% (SD 13.7) and -2.6% (SD 3.4) in the SC group (Wilcoxon rank-sum p = 0.17). No adverse events were attributed to study participation. Some participants had difficulty completing home monitoring of weight. In the PMR group, participants reported that food cravings and dislike for some food products were barriers to weight loss. CONCLUSION: A PMR diet after ischemic stroke is feasible, safe, and effective for weight loss. In future trials, in-person or improved remote outcome monitoring may reduce anthropometric data variation.

Use of a Very Low Calorie Diet for Weight Loss in a Patient with Acute Kidney Injury and Class III Obesity: A Case Study.

Very low calorie diets (VLCDs) induce rapid weight loss through severe energy restriction resulting in ketosis. VLCD manufacturer guidelines list acute kidney injury (AKI) as a contraindication for use with concerns around further damage to kidney function through increased protein catabolic load, diuresis, and risk of electrolyte derangements. We report on the successful concurrent management of AKI alongside provision of a VLCD for weight loss in the acute setting in a patient with class III obesity and comorbid complications during a prolonged hospital stay. AKI resolved at week 5 of a 15-week VLCD program, with no adverse side effects noted on electrolytes, fluid, or kidney function. A weight loss of 76 kg was attained. VLCD appears safe for use in patients with AKI during hospitalization under close medical supervision. Both health system sustainability and patients may benefit from seizing the opportunity to address obesity during protracted hospital admission.

Intermittent fasting interventions to leverage metabolic and circadian mechanisms for cancer treatment and supportive care outcomes.

Intermittent fasting entails restricting food intake during specific times of day, days of the week, religious practice, or surrounding clinically important events. Herein, the metabolic and circadian rhythm mechanisms underlying the proposed benefits of intermittent fasting for the cancer population are described. We summarize epidemiological, preclinical, and clinical studies in cancer published between January 2020 and August 2022 and propose avenues for future research. An outstanding concern regarding the use of intermittent fasting among cancer patients is that fasting often results in caloric restriction, which can put patients already prone to malnutrition, cachexia, or sarcopenia at risk. Although clinical trials do not yet provide sufficient data to support the general use of intermittent fasting in clinical practice, this summary may be useful for patients, caregivers, and clinicians who are exploring intermittent fasting as part of their cancer journey for clinical outcomes and symptom management.

Weight Loss Strategies and the Risk of Skeletal Muscle Mass Loss.

With energy intake restriction and exercise remaining the key diet and lifestyle approaches to weight loss, this is not without potential negative implications for body composition, metabolic health, and quality and quantity of life. Ideally, weight loss should be derived almost exclusively from the fat mass compartment as this is the main driver of metabolic disease, however, several studies have shown that there is an accompanying loss of tissue from the fat-free compartment, especially skeletal muscle. Population groups including post-menopausal women, the elderly, those with metabolic disease and athletes may be particularly at risk of skeletal muscle loss when following a weight management programme. Research studies that have addressed this issue across a range of population groups are reviewed with a focus upon the contribution of resistance and endurance forms of exercise and a higher intake dietary protein above the current guideline of 0.8 g/kg body weight/day. While findings can be contradictory, overall, the consensus appears that fat-free and skeletal muscle masses can be preserved, albeit to varying degrees by including both forms of exercise (but especially resistance forms) in the weight management intervention. Equally, higher intakes of protein can protect loss of these body compartments, acting either separately or synergistically with exercise. Elderly individuals in particular may benefit most from this approach. Thus, the evidence supports the recommendations for intakes of protein above the current guidelines of 0.8 g/kg body weight/d for the healthy elderly population to also be incorporated into the dietary prescription for weight management in this age group.

Long-term effects of weight-reducing diets in people with hypertension.

BACKGROUND: All major guidelines for antihypertensive therapy recommend weight loss. Dietary interventions that aim to reduce body weight might therefore be a useful intervention to reduce blood pressure and adverse cardiovascular events associated with hypertension. OBJECTIVES: Primary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events). Secondary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction. SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 3), Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. We also contacted authors of relevant papers about further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of at least 24 weeks' duration that compared weight-reducing dietary interventions to no dietary intervention in adults with primary hypertension. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risks of bias and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. In case of moderate or larger heterogeneity as measured by Higgins I2, we used a random-effects model. MAIN RESULTS: This second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. We judged the risks of bias as unclear or high for all but two trials. No study included mortality as a predefined outcome. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight-reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). None of the trials evaluated adverse events as designated in our protocol. The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight-loss diets as compared to controls: systolic blood pressure: mean difference (MD) -4.5 mm Hg (95% CI -7.2 to -1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD -3.2 mm Hg (95% CI -4.8 to -1.5 mm Hg) (3 studies, 731 participants). We judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD -4.0 kg (95% CI -4.8 to -3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though we did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight-loss interventions. AUTHORS' CONCLUSIONS: In this second update, the conclusions remain unchanged, as we found no new trials. In people with primary hypertension, weight-loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials.

Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil

Objective: To identify the frequency of disordered eating (DE) and unhealthy weight control behaviors (UWCB) among adolescents and associations with age, sex, actual weight status, perceived weight status, and body image dissatisfaction. Methods: Cross-sectional study of 1,156 adolescents. DE was assessed using a specific self-report questionnaire, UWCB by specific behaviors that were not typically recommended for weight management, and body dissatisfaction by Stunkard's silhouettes. Results: The frequency of DE was 17.3%, and that of UWCB, 31.9%; 80.1% of participants were dissatisfied with body image. Perception of oneself as overweight was associated with 1.795-fold odds of DE. Those with UWCB had 7.389-fold odds of DE, while DE increased the odds of UWCB 7.280-fold. Girls, participants who perceived themselves as overweight, and those who reported body dissatisfaction were 2.266, 2.381, and 1.752 times more likely to have UWCB, respectively. Conclusion: A high prevalence of UWCB and a moderate prevalence of DE behaviors was found in adolescents from the city of São Paulo, Brazil. Those who perceived themselves as overweight had more DE and UWCB, and both behaviors were related. UWCB was more common in girls and among those dissatisfied with their bodies.

Changes in Bone Marrow Fat upon Dietary-Induced Weight Loss.

BACKGROUND: Bone marrow fat is implicated in metabolism, bone health and haematological diseases. Thus, this study aims to analyse the impact of moderate weight loss on bone marrow fat content (BMFC) in obese, healthy individuals. METHODS: Data of the HELENA-Trial (Healthy nutrition and energy restriction as cancer prevention strategies: a randomized controlled intervention trial), a randomized controlled trial (RCT) among 137 non-smoking, overweight or obese participants, were analysed to quantify the Magnetic Resonance Imaging (MRI)-derived BMFC at baseline, after a 12-week dietary intervention phase, and after a 50-week follow-up. The study cohort was classified into quartiles based on changes in body weight between baseline and week 12. Changes in BMFC in respect of weight loss were analysed by linear mixed models. Spearman's coefficients were used to assess correlations between anthropometric parameters, blood biochemical markers, blood cells and BMFC. RESULTS: Relative changes in BMFC from baseline to week 12 were 0.0 ± 0.2%, -3.2 ± 0.1%, -6.1 ± 0.2% and -11.5 ± 0.6% for Q1 to Q4. Across all four quartiles and for the two-group comparison, Q1 versus Q4, there was a significant difference (p < 0.05) for changes in BMFC. BMFC was not associated with blood cell counts and showed only weaker correlations (<0.3) with metabolic biomarkers. CONCLUSION: Weight loss is associated with a decrease of BMFC. However, BMFC showed no stronger associations with inflammatory and metabolic biomarkers.

Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil.

OBJECTIVE: To identify the frequency of disordered eating (DE) and unhealthy weight control behaviors (UWCB) among adolescents and associations with age, sex, actual weight status, perceived weight status, and body image dissatisfaction. METHODS: Cross-sectional study of 1,156 adolescents. DE was assessed using a specific self-report questionnaire, UWCB by specific behaviors that were not typically recommended for weight management, and body dissatisfaction by Stunkard's silhouettes. RESULTS: The frequency of DE was 17.3%, and that of UWCB, 31.9%; 80.1% of participants were dissatisfied with body image. Perception of oneself as overweight was associated with 1.795-fold odds of DE. Those with UWCB had 7.389-fold odds of DE, while DE increased the odds of UWCB 7.280-fold. Girls, participants who perceived themselves as overweight, and those who reported body dissatisfaction were 2.266, 2.381, and 1.752 times more likely to have UWCB, respectively. CONCLUSION: A high prevalence of UWCB and a moderate prevalence of DE behaviors was found in adolescents from the city of São Paulo, Brazil. Those who perceived themselves as overweight had more DE and UWCB, and both behaviors were related. UWCB was more common in girls and among those dissatisfied with their bodies.

How dieting might make some fatter: modeling weight cycling toward obesity from a perspective of body composition autoregulation.

The notion that dieting makes some people fatter has in the past decade gained considerable interest from both epidemiological predictions and biological plausibility. Several large-scale prospective studies have suggested that dieting to lose weight is associated with future weight gain and obesity, with such predictions being stronger and more consistent among dieters who are in the normal range of body weight rather than in those with obesity. Furthermore, the biological plausibility that dieting predisposes people who are lean (rather than those with overweight or obesity) to regain more body fat than what had been lost (referred to as fat overshooting) has recently gained support from a re-analysis of data on body composition during weight loss and subsequent weight recovery from the classic longitudinal Minnesota Starvation Experiment. These have revealed an inverse exponential relationship between the amount of fat overshot and initial adiposity, and have suggested that a temporal desynchronization in the recoveries of fat and lean tissues, in turn residing in differences in lean-fat partitioning during weight loss vs. during weight recovery (with fat recovery faster than lean tissue recovery) is a cardinal feature of fat overshooting. Within a conceptual framework that integrates the relationship between post-dieting fat overshooting with initial adiposity, the extent of weight loss and the differential lean-fat partitioning during weight loss vs. weight recovery, we describe here a mathematical model of weight cycling to predict the excess fat that could be gained through repeated dieting and multiple weight cycles from a standpoint of body composition autoregulation.

Porcentaje de grasa corporal en adolescentes asociado con conductas alimentarias de riesgo, hogar y sexo / Body fat percentage in adolescent among eating risk behaviors, home and sex

Resumen: Objetivo: Determinar la asociación de las conductas alimentarias de riesgo (CAR) y el hogar con el porcentaje de grasa corporal (PGC) en los adolescentes, modificado por sexo. Material y métodos: Se analizó la información de una cohorte de 2 388 adolescentes de Morelos, México, de 2004 a 2007. Se realizaron técnicas descriptivas y modelos de regresión lineal múltiple de efectos mixtos. Resultados: El cambio del PGC es -1.4 puntos porcentuales (EE 0.22), en hombres -3.1 (EE 0.35) y en mujeres 0.2 (EE 0.21). El cambio del PGC en relación con CAR y el hogar es diferente por sexo. El modelo múltiple muestra que realizar dieta se asocia con el incremento del PGC (1.25 IC95% 0.68-1.83) en mujeres y en hombres (1.74 IC95% 0.60-2.88). En relación con la familia, las mujeres muestran una relación positiva con el incremento del PGC de acuerdo con que sientan o no que su familia no las quiere a veces o nunca (valor p de tendencia <0.001); los hombres muestran en la variable de "Satisfecho de la ayuda que recibe se su familia" una asociación marginal. Conclusiones: Realizar dieta sin supervisión se asocia con el incremento en el PGC, lo que da un efecto contrario a lo deseado; esto se asocia con relaciones familiares y es diferente entre sexo.

Abstract: Objective: To determine the association of risky eating behaviors and the home with the percentage of body fat in adolescents, modified by gender. Materials and methods: We analyzed the information of a cohort of 2 388 adolescents from Morelos in Mexico, from 2004 to 2007. Descriptive techniques and multiple linear regression models of mixed effects were performed. Results: The change in body fat percentage (PGC) is -1.4 percentage points, in men -3.1, in women 0.2. The change of the PGC in relation to CAR's and the household is different by sex. The multiple model shows that diet is associated with an increase in PGC (1.25 IC95% 0.68-1.83) in women, in men of 1.74 (95% CI 0.60-2.88). In relation with the family, women show a positive relationship with the increase in the percentage of body fat according to whether they feel that their family does not love them sometimes or never (value p of trend <0.001), men show in the variable "Satisfied with the help your family receives", a marginal association. Conclusions: Performing a diet without supervision is associated with an increase in the PGC, giving an effect contrary to what is desired. This is associated with family relationships, and is different between sex.

Fucus vesiculosus and Ascophyllum nodosum Ameliorate Liver Function by Reducing Diet-Induced Steatosis in Rats.

The Asian coastal communities have used the brown seaweeds Fucus vesiculosus and Ascophyllum nodosum since ancient times. Recently, some in vitro and in vivo studies have demonstrated their abilities in reducing risk factors for metabolic syndrome. Here, we analyzed the protective effect of a phytocomplex extracted from these seaweeds on the deposition of fat in the liver after the administration of a high-fat diet (HFD) to rats for five weeks. The administration of F. vesiculosus and A. nodosum led to significant reductions in microvescicular steatosis and plasma biochemical and lipid parameters, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total and conjugated bilirubin, and triglycerides. Furthermore, the postprandial glycemic peak was delayed and significantly reduced (p < 0.01) by the algal extract administration. In conclusion, this extract is effective in reducing microvescicular steatosis and improving glycemic control, thereby lowering the risk of nonalcoholic fatty liver disease, obesity, and diabetes, diseases related to the consumption of fat and sugar-enriched diets.

[Body fat percentage in adolescent among eating risk behaviors, home and sex]. / Porcentaje de grasa corporal en adolescentes asociado con conductas alimentarias de riesgo, hogar y sexo.

OBJECTIVE: To determine the association of risky eating behaviors and the home with the percentage of body fat in adolescents, modified by gender. MATERIALS AND METHODS: We analyzed the information of a cohort of 2 388 adolescents from Morelos in Mexico, from 2004 to 2007. Descriptive techniques and multiple linear regression models of mixed effects were performed. RESULTS: The change in body fat percentage (PGC) is -1.4 percentage points, in men -3.1, in women 0.2. The change of the PGC in relation to CAR's and the household is different by sex. The multiple model shows that diet is associated with an increase in PGC (1.25 IC95% 0.68-1.83) in women, in men of 1.74 (95% CI 0.60-2.88). In relation with the family, women show a positive relationship with the increase in the percentage of body fat according to whether they feel that their family does not love them sometimes or never (value p of trend <0.001), men show in the variable "Satisfied with the help your family receives", a marginal association. CONCLUSIONS: Performing a diet without supervision is associated with an increase in the PGC, giving an effect contrary to what is desired. This is associated with family relationships, and is different between sex.

OBJETIVO: Determinar la asociación de las conductas ali- mentarias de riesgo (CAR) y el hogar con el porcentaje de grasa corporal (PGC) en los adolescentes, modificado por sexo. MATERIAL Y MÉTODOS: Se analizó la información de una cohorte de 2 388 adolescentes de Morelos, México, de 2004 a 2007. Se realizaron técnicas descriptivas y modelos de regresión lineal múltiple de efectos mixtos. RESULTADOS: El cambio del PGC es -1.4 puntos porcentuales (EE 0.22), en hombres -3.1 (EE 0.35) y en mujeres 0.2 (EE 0.21). El cambio del PGC en relación con CAR y el hogar es diferente por sexo. El modelo múltiple muestra que realizar dieta se asocia con el incremento del PGC (1.25 IC95% 0.68-1.83) en mu- jeres y en hombres (1.74 IC95% 0.60-2.88). En relación con la familia, las mujeres muestran una relación positiva con el incremento del PGC de acuerdo con que sientan o no que su familia no las quiere a veces o nunca (valor p de tendencia <0.001); los hombres muestran en la variable de "Satisfecho de la ayuda que recibe se su familia" una asociación marginal. CONCLUSIONES: Realizar dieta sin supervisión se asocia con el incremento en el PGC, lo que da un efecto contrario a lo deseado; esto se asocia con relaciones familiares y es diferente entre sexo.

The ketogenic diet: Pros and cons.

Diets have been at the center of animated debates for decades and many claims have been made in one direction or the other by supporters of opposite camps, often with limited evidence. At times emphasis has been put on a single new aspect that the previous diets had overlooked and the new one was to embrace in order to improve weight loss and well-being. Unfortunately, very few randomized clinical trials involving diets have addressed the combined question of weight loss and cardiovascular outcomes. The recently introduced ketogenic diet requires a rigorous limitation of carbohydrates while allowing a liberal ingestion of fats (including saturated fats) and has generated a flurry of interest with many taking the pro position and as many taking the cons position. The ketogenic diet causes a rapid and sensible weight loss along with favourable biomarker changes, such as a reduction in serum hemoglobin A1c in patients with diabetes mellitus type 2. However, it also causes a substantial rise in low density lipoprotein cholesterol levels and many physicians are therefore hesitant to endorse it. In view of the popular uptake of the keto diet even among subjects not in need of weight loss, there is some preoccupation with the potential long-term consequences of a wide embrace of this diet by large segments of the population. On the contrary, numerous lines of evidence show that plant-based diets are associated with reduction in oncological and cardiovascular diseases and a prolonged life span. The debate reproduced in this article took place during a continuous medical education program between two cardiologists with largely differing views on the matter of effectiveness, sustainability, and safety of the ketogenic diet compared to alternative options.

Exercise Mitigates the Loss of Muscle Mass by Attenuating the Activation of Autophagy during Severe Energy Deficit.

The loss of skeletal muscle mass with energy deficit is thought to be due to protein breakdown by the autophagy-lysosome and the ubiquitin-proteasome systems. We studied the main signaling pathways through which exercise can attenuate the loss of muscle mass during severe energy deficit (5500 kcal/day). Overweight men followed four days of caloric restriction (3.2 kcal/kg body weight day) and prolonged exercise (45 min of one-arm cranking and 8 h walking/day), and three days of control diet and restricted exercise, with an intra-subject design including biopsies from muscles submitted to distinct exercise volumes. Gene expression and signaling data indicate that the main catabolic pathway activated during severe energy deficit in skeletal muscle is the autophagy-lysosome pathway, without apparent activation of the ubiquitin-proteasome pathway. Markers of autophagy induction and flux were reduced by exercise primarily in the muscle submitted to an exceptional exercise volume. Changes in signaling are associated with those in circulating cortisol, testosterone, cortisol/testosterone ratio, insulin, BCAA, and leucine. We conclude that exercise mitigates the loss of muscle mass by attenuating autophagy activation, blunting the phosphorylation of AMPK/ULK1/Beclin1, and leading to p62/SQSTM1 accumulation. This includes the possibility of inhibiting autophagy as a mechanism to counteract muscle loss in humans under severe energy deficit.

The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide.

The epidemic of obesity is growing steadily across the whole world. Obesity is not only a merely aesthetic disease but is the "mother" of most chronic diseases such as associated with a range of type 2 diabetes, cardiovascular disease, obstructive sleep apnea, and cancer. However, although there is a need to find a strategy to stop this epidemic disease, most of the times the current nutritional strategies are not effective in weight loss and in long term weight maintenance. Very low-calorie ketogenic diets (VLCKD) is increasingly establishing as a successful nutritional pattern to manage obesity; this is due to rapid weight loss that gives rise to a positive psychological cycle which in turn increases the compliance to diet. Another important key point of VLCKD is the ability to preserve fatty free mass which is known to play a role of paramount importance in glucose metabolism. Despite the clinical evidence of VLCKD there are paucity of data regarding to its management. Therefore, we will provide a useful guide to be used by nutrition experts taking care of subjects with obesity. In particular, we will report recommendations on the correct use of this therapeutic approach for weight loss and management of side effects.

Improving Compliance with Very Low Energy Diets (VLEDs) Prior to Bariatric Surgery-a Randomised Controlled Trial of Two Formulations.

INTRODUCTION: Preoperative very low energy diets (VLEDs) improve access during bariatric surgery. Compliance with traditional VLED is variable, mainly due to gastrointestinal side effects. Formulite™ is a new formulation of VLED, with higher protein, soluble fibre and probiotics. AIMS: To compare traditional VLED (Optifast™) with the new VLED (Formulite™) and assess compliance, weight loss, satisfaction, side effects and surgical access. METHODS: This was a randomised double-blinded study involving patients scheduled for bariatric surgery. The primary outcome was compliance, assessed by urinary ketone concentration and proportion of patients in ketosis at 2 weeks. Secondary outcomes were weight loss, satisfaction and patient reported outcomes, gastrointestinal side effects and operative conditions. RESULTS: There were 69 participants: 35 in the Formulite™ group and 34 in the Optifast™ group. Ketosis at 2 weeks was achieved in both groups (88.5% vs 83.3%, Formulite™ vs. Optifast™, p = 0.602). Urinary ketones were higher with Formulite™ (1.5 vs 15 mmol/L, p = 0.030). Total body weight loss percentage, hunger and operative conditions were similar in both groups. Formulite™ produced less flatulence (score 3 vs 2, p = 0.010) and emotional eating (score 2 vs 1, p = 0.037); however, Optifast™ ranked higher in terms of taste (score 4 vs 3, p = 0.001) and overall satisfaction (score 5 vs 7, p = 0.011). CONCLUSIONS: Compliance over 2 weeks was high in both VLEDs with most subjects achieving ketosis. Overall satisfaction was moderately high, although variable. Whilst Formulite™ is a viable alternative to Optifast™, better formulations of VLED that addresses key adverse effects, whilst achieving ketosis, would be of significant value.

Very low carbohydrate diet and SGLT-2-inhibitor: double jeopardy in relation to ketoacidosis.

Diabetic euglycaemic ketoacidosis is a possible adverse effect of sodium-glucose co-transporter-2 inhibitors (SGLT2i). We report a case in which the combination of SGLT2i and a strict very low-carbohydrate diet led to severe diabetic ketoacidosis in a young Caucasian man with type 2 diabetes.

The life expectancy of patients with metabolic syndrome after weight loss: study protocol for a randomized clinical trial (LIFEXPE-RT).

BACKGROUND: To date, surgeons and physicians have found positive results treating metabolic syndrome with surgical and non-surgical weight loss therapies. The purpose of this study was to evaluate changes in telomere length in patients with metabolic syndrome after weight loss. METHODS/DESIGN: This study is a three-arm randomized controlled trial. The first group is composed of patients who have undergone stapleless bypass surgery (one anastomosis gastric bypass with an obstructive stapleless pouch and anastomosis (LOAGB-OSPAN)). The second group of patients underwent standard gastric bypass surgery (laparoscopic mini-gastric bypass-one anastomosis gastric bypass (LMGB-OAGB). The patients in the third group received non-surgical weight loss therapy, including a hypocaloric diet with energy restriction (- 500 kcal/day). The aim is to compare changes-telomere length, body mass index, comorbidities, and quality of life-in patients with metabolic syndrome after weight loss. DISCUSSION: To the best of our knowledge, this is the first randomized study to simultaneously compare the effects of surgical and non-surgical weight loss on changes in telomere length. It could provide a solution to the growing problem of metabolic syndrome. Normalization of the body mass index results in improvements in the health of patients with metabolic syndrome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03667469 . Registered on 11 September 2018.