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This study aims to estimate the prevalence of special diets and analyze the sociodemographic profile, nutritional status, and eating habits of the Brazilian population that uses special diets. This cross-sectional study was conducted with data from the second 2017/2018 National Food Survey (n=45,689 individuals aged at least 10 years). We questioned the use of hypertension, diabetes, cholesterol, heart disease, and weight-loss diets. Dieting prevalence was estimated by sociodemographic characteristics and nutritional status, and logistic regression models were employed to assess factors associated with dieting. All analyses considered sample design and expansion factors. The prevalence of special diets was 14.3%. Weight-loss (5.2%) and hypertension (4.6%) diets were the most prevalent. Women, older adults, individuals with higher incomes, and obese individuals were more likely to follow any type of special diet than their peers.

O objetivo do presente estudo foi estimar a prevalência do uso de dietas especiais e analisar o perfil sociodemográfico, o estado nutricional e uso de sal, açúcar e adoçantes em brasileiros que realizam dietas especiais. Trata-se de um estudo transversal utilizando dados do segundo Inquérito Nacional de Alimentação 2017/2018 (n=45.689 indivíduos com pelo menos 10 anos de idade). Foi questionado o uso de dietas para hipertensão, diabetes, colesterol, doença do coração e para emagrecer. Foi estimada a prevalência do uso de dietas de acordo com características sociodemográficas e estado nutricional, e modelos de regressão logística foram utilizados para avaliar os fatores associados à realização de dietas. Todas as análises consideraram o desenho da amostra e os fatores de expansão. A prevalência do uso de dietas especiais foi de 14,3%, sendo as dietas para emagrecer (5,2%) e pressão alta (4,6%) as mais prevalentes. As mulheres, idosos, indivíduos de maior renda e com obesidade tiveram maiores chances de realizarem qualquer tipo de dieta especial quando comparados aos seus pares.

El objetivo del presente estudio fue estimar la prevalencia del uso de dietas especiales y analizar el perfil sociodemográfico, el estado nutricional y el uso de sal, azúcar y edulcorantes en brasileños que siguen dietas especiales. Se trata de un estudio transversal que utiliza datos de la segunda Encuesta Nacional de Alimentación 2017/2018 (n=45.689 personas de al menos 10 años). Se cuestionó el uso de dietas para la hipertensión, la diabetes, el colesterol, las enfermedades cardíacas y la pérdida de peso. Se estimó la prevalencia del uso de dieta según características sociodemográficas y estado nutricional, y se utilizaron modelos de regresión logística para evaluar factores asociados al uso de dieta. Todos los análisis consideraron el diseño muestral y los factores de expansión. La prevalencia del uso de dietas especiales fue del 14,3%, siendo las dietas para adelgazar (5,2%) y la hipertensión arterial (4,6%) las más prevalentes. Las mujeres, las personas mayores, las personas con mayores ingresos y las personas con obesidad tenían más probabilidades de seguir cualquier tipo de dieta especial en comparación con sus pares.

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BACKGROUND & AIMS: Obesity is associated with chronic low-grade inflammation, and adipose tissue inflammation is required for fatty tissue remodeling. Interestingly, immunosuppressed patients, as liver transplant recipients, often experience excessive weight gain. We investigated how liver recipients' inflammatory response affects body weight loss induced by dietary treatment. METHODS: Overweight liver recipients were paired with non-transplanted subjects to compare their peripheral immune profiles. RESULTS: Transplanted patients had similar profiles of peripheral blood mononuclear cells compared to controls but lower CD8lowCD56+CD16+NK cells and higher B lymphocytes. Patients showed lower serum concentrations of IFN-γ, TNF, IL-4, IL-2, and IL-10 and lower inflammatory responsiveness of peripheral blood mononuclear cells under inflammatory stimuli. Liver recipients paired with non-transplanted subjects followed a weight loss dietary plan for 6 months to verify body composition changes. After 3 and 6 months of nutritional follow-up, the control group lost more body weight than the liver recipient group. The control group decreased fat mass and waist circumference, which was not observed in transplanted patients. CONCLUSION: Therefore, liver recipients under immunosuppressant treatment responded less to different inflammatory stimuli. This impaired inflammatory milieu might be implicated in the lack of response to weight loss dietary intervention. Inflammation may be essential to trigger the weight loss induced by dietary prescription. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov identification number: NCT03103984.

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Soldiers of the Mexican Army with obesity were subjected to an intense 60-day weight-loss course consisting of a controlled diet, daily physical training, and psychological sessions. The nutritional treatment followed the European Society of Cardiology (ESC) recommendations, incorporating elements of the traditional milpa diet in the nutritional intervention. The total energy intake was reduced by 200 kcal every 20 days, starting with 1,800 kcal and ending with 1,400 kcal daily. On average, the participants reduced their body weight by 18 kg. We employed an innovative approach to monitor the progress of the twelve soldiers who completed the entire program. We compared the untargeted metabolomics profiles of their urine samples, taken before and after the course. The data obtained through liquid chromatography and high-resolution mass spectrometry (LC-MS) provided insightful results. Classification models perfectly separated the profiles pre and post-course, indicating a significant reprogramming of the participants' metabolism. The changes were observed in the C1-, vitamin, amino acid, and energy metabolism pathways, primarily affecting the liver, biliary system, and mitochondria. This study not only demonstrates the potential of rapid weight loss and metabolic pathway modification but also introduces a non-invasive method for monitoring the metabolic state of individuals through urine mass spectrometry data.

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Reducing ultra-processed foods (UPF) improves diet quality and may curb energy consumption. This study aimed to compare an intervention based on the reduction of UPF, according to the Dietary Guideline for the Brazilian Population (DGBP), with and without advice on energy intake. A parallel and randomised controlled trial was carried out with children with obesity from 7 to 12 years old. Both control (CG) and intervention groups (IG) participated monthly in 6 standardised educational activities based on the 10 steps of the DGBP. An individualised food plan was also provided to the IG. The rate of change for body mass index (BMI), waist circumference, body weight, and UPF consumption were investigated based on mixed-effect models. At the end of the study, the BMI declined in the IG (Δ = -0.27 kg/m2) compared to the CG (Δ = + 0.53 kg/m2) (p = .0002). Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months. Combining the qualitative approach of the DGBP with counselling on energy restriction through the diet plan proved to be effective in reducing childhood obesity. Clinical Trial Registration: This trial is registered at the Brazilian Registry of Clinical Trials (REBEC), under the RBR-3st5sn registry, available at http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn/. The datasets generated by the current study are not publicly available but are available from the corresponding author on reasonable request.

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We evaluated the effects of two low-energy diets with different glycaemic loads on arterial stiffness in adults with excess weight. This was a 45-day parallel-group, randomised clinical trial including seventy-five participants (20-59 years; BMI 32 kg/m2). They were assigned to two similar low-energy diets (reduction of ∼750 kcal.d-1) with macronutrient composition (55 % carbohydrates, 20 % proteins and 25 % lipids) but different glycaemic loads: high-glycaemic load (HGL 171 g.d-1; n 36) or low-glycaemic load (LGL 67 g.d-1; n 39). We evaluated: arterial stiffness (pulse wave velocity, PWV); augmentation index (AIx@75); reflection coefficient; fasting blood glucose; fasting lipid profile; blood pressure and body composition. We found no improvements in PWV (P = 0·690) and AIx@75 (P = 0·083) in both diet groups, but there was a decrease in the reflection coefficient in the LGL group (P = 0·003) compared with baseline. The LGL diet group showed reductions in body weight (Δ -4·9 kg; P = 0·001), BMI (Δ -1·6 kg/m2; P = 0·001), waist circumference (Δ -3·1 cm; P = 0·001), body fat (Δ -1·8 %; P = 0·034), as well as TAG (Δ -14·7 mg/dl; P = 0·016) and VLDL (Δ -2·8 mg/dl; P = 0·020). The HGL diet group showed a reduction in total cholesterol (Δ -14·6 mg/dl; P = 0·001), LDL (Δ -9·3 mg/dl; P = 0·029) but a reduction in HDL (Δ -3·7 mg/dl; P = 0·002). In conclusion, a 45-day intervention with low-energy HGL or LGL diets in adults with excess weight was not effective to improve arterial stiffness. However, the LGL diet intervention was associated with a reduction of reflection coefficient and improvements in body composition, TAG and VLDL levels.

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This retrospective study evaluated energy and nutrient intake of dogs in a weight loss programme. Ninety-four obese dogs were divided into three groups: G5-15: from 5% to 15% body weight (BW) loss (n = 55); G155-25: from 15.1% to 25% BW loss (n = 29); and G > 25: more than 25.1% BW loss (n = 10). Five brands of kibble diets designed for weight loss were analysed for crude protein, amino acids, fat, dietary fibre, and minerals. The food metabolizable energy (ME) was estimated (NRC, 2006). Data were compared inside each group using the paired t test and between groups with analysis of variance and Tukey tests (p < 0.05). The BW loss (weeks in regimen) was: G5-15, 9.8% ± 2.7% (13.5 ± 5.7 weeks); G15-25, 17.5% ± 2.7% (22.6 ± 11.9 weeks); G > 25, 30.0% ± 2.1% (50.4 ± 17.4% weeks; p < 0.01). The mean weekly BW loss rate was similar between groups (0.8% ± 0.3%; p > 0.05) but was higher during the first (0.96.6% ± 0.5%) than in the second (0.64% ± 0.4%) half of the regimen (p < 0.01). At beginning ME intake for BW loss did not differ (251.6 ± 32.2 kJ/kg0.75 /day), but it was lower for G > 25 in the second half of the regimen (230.3 ± 44.3; p = 0.02). Considering the observed ME intake of each dog, depending on the commercial product, intake below recommended for maintenance was verified for crude protein in 1%-20% of the dogs, methionine in 4%-38% of dogs, methionine plus cystine in 4%-22% of dogs, tryptophan in 7%-93% of dogs, potassium in 2%-85% of dogs and magnesium in 1% up to 95% of dogs. Although the diets presented elevated nutrient concentrations per MJ, due to the reduced energy allowance, the estimated intake of several nutrients was lower than the recommendations, highlighting the importance of changing the formulation perspective, which must prioritize the actual nutrient intake per kg of BW during the energy deficit.

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OBJECTIVES: The aim of this study was to evaluate the effects of 8 wk of time-restricted eating (TRE) along with a caloric restriction on metabolic profile, metabolic rate, symptoms of mood, and eating disorders and weight loss in women with overweight or obesity. METHODS: Women age 18 to 59 y with a body mass index of ≥25 kg/m2 were enrolled in this parallel-arm, randomized, clinical trial. Participants were randomly allocated into two groups (8-h TRE or non-TRE group) using a 2:1 allocation strategy. Both groups received a diet plan with caloric restriction. Body weight, resting metabolic rate, metabolic profile, and symptoms of mood and eating disorders were evaluated at baseline and on follow up. RESULTS: Thirty-six subjects were included in this study, with 24 in the TRE group and 12 in the non-TRE group. Subject in the TRE group showed more pronounced loss of weight, body fat mass, and fat-free mass than those in the non-TRE group. These losses were not associated with changes in resting metabolic rate, metabolic profile, and eating or mood disorder symptoms. CONCLUSIONS: This study showed that 8 wk of TRE does not influence behavioral parameters in individuals with overweight or obesity, but could lead to weight loss.

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OBJECTIVE: The aim of this study was to test the effects of repetitive active transcranial direct current stimulation (tDCS) over the right dorsolateral prefrontal cortex (rDLPFC) associated with a hypocaloric diet on glucose homeostasis in people with excessive weight. METHODS: Adults with overweight or obesity were selected in a randomized, double-blind pilot study to complete 4 weeks (20 sessions) of fixed-dose tDCS (2 mA, 20 minutes) delivered over the rDLPFC and associated with a standard hypocaloric diet. Participants were randomly assigned (1:1) and stratified by sex to the active tDCS group (active) or the sham tDCS group (sham). Changes in glucose homeostasis were assessed in a 4-hour liquid meal tolerance test, performed before and after the intervention. RESULTS: Twenty-eight participants were randomized (79% with obesity; mean [SD] age 37.6 [5.8] years). After the intervention, fasting plasma glucose (mean [95% CI], -7.8 mg/dL [-14.0 to -1.6]) and insulin levels (-7.7 µIU/mL [-13.9 to -1.6]) decreased in the active compared with the sham. Similarly, the Matsuda insulin sensitivity index increase in the active (4.7 pmol-1  × mmol-1 [1.6 to 7.8]) compared with the sham (0.6 pmol-1  × mmol-1 [-1.4 to 3.2]). CONCLUSIONS: Repetitive, active tDCS over the rDLPFC could be a promising noninvasive technique to improve glucose homeostasis in individuals with overweight or obesity on a low-calorie diet, highlighting the importance of investigating this intervention modality in individuals with type 2 diabetes mellitus.

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BACKGROUND: A nutrient-poor and hypocaloric diet may be associated with lower handgrip strength (HGS), whereas a high-quality or balanced diet may be associated with higher HGS. However, no study has used the NOVA system for classifying food by their degree of processing. OBJECTIVE: To analyze the association between food consumption according to the degree of food processing and HGS in Brazilian teenagers. METHODS: This cross-sectional study included teenagers aged 18 and 19 years old from the 1997/98 São Luís' birth cohort, Maranhão, Brazil. HGS (kilogram-force) was measured via a Jamar Plus + dynamometer. Food consumption was assessed using a semiquantitative food frequency questionnaire. The energy intake of culinary preparations (unprocessed or minimally processed food and processed culinary ingredients), processed, and ultra-processed foods was evaluated in percentages and categorized in tertiles. The associations between each food group intake and HGS was estimated via crude and adjusted linear regression models. A directed acyclic graph was used to identify confounding factors. RESULTS: We evaluated 2,433 teenagers, 52.1% of which were girls. For boys, adjusted analysis showed an association between the highest HGS and the 3rd tertile of culinary preparation consumption (ß: 1.95; 95%CI: 0.80; 3.10) and between the lowest HGS and the 3rd tertile of ultra-processed food consumption (ß: -2.25; 95%CI: -3.40; -1.10). Among girls, the consumption of culinary preparations in the 3rd tertile was associated with higher HGS (ß: 0.76; 95%CI: 0.05; 1.46). CONCLUSIONS: Higher consumption of culinary preparations and lower consumption of ultra-processed foods can contribute to reduce the chance of lower HGS in adult life. Interventions to promote the development and preservation of muscle strength should include dietary recommendations.

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OBJECTIVE: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. METHODS: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. RESULTS: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. CONCLUSIONS: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

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AIM: To evaluate whether dietary pattern changes, antioxidant supplementation or 5-10% weight loss could improve disease activity (skin and joint) in patients with psoriatic arthritis (PsA). METHODS: A total of 97 PsA patients were enrolled in this 12-week randomized, double-blinded, placebo-controlled trial. Patients were randomized into three groups: Diet-placebo (hypocaloric diet + placebo supplementation); Diet-fish (hypocaloric diet + 3 g/day of omega-3 supplementation; and Placebo. Food intake (3-day registry, Healthy Eating Index (HEI), and the Dietary Inflammatory Index (DII)), body composition (whole-body dual-energy X-ray absorptiometry (DXA), weight and waist circumference) and disease activity (PASI, BSA, BASDAI, DAS28-ESR, DAS28-CRP and MDA) were evaluated at baseline and after the 12-week intervention. Statistical analysis used the intention-to-treat approach. The P value was considered to indicate significance when below 0.05. RESULTS: After 12 weeks, DAS28-CRP and BASDAI scores improved, especially in the Diet-placebo group (- 0.6 ± 0.9; p = 0.004 and - 1.39 ± 1.97; p = 0.001, respectively). In addition, a higher proportion of patients achieved minimal disease activity (MDA) in all groups. The Diet-fish group showed significant weight loss (- 1.79 ± 2.4; p = 0.004), as well as waist circumference (- 3.28 ± 3.5, p < 0.001) and body fat (- 1.2 ± 2.2, p = 0.006) reductions. There was no significant correlation between weight loss and disease activity improvement. Each 1-unit increase in the HEI value reduced the likelihood of achieving remission by 4%. Additionally, each 100-cal daily intake increase caused a 3.4-fold DAS28-ESR impairment. CONCLUSION: A 12-week hypocaloric intervention provided suitable control of joint disease activity in patients with PsA, regardless of weight loss. Adding omega-3 supplementation caused relevant body composition changes but not disease activity improvement. TRIAL REGISTRATION: The study was recorded on Clinicaltrials.gov (NCT03142503).

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Obesity is the most common nutritional disorder in dogs and it is associated with many comorbidities. Some obesity risk factors have already been established, however, the evaluation of the effect of different individual variables on weight loss induced by calorie restriction, although very important, is still poorly explored. The weight loss protocol can be updated and improved by more precise and adjusted equations throughout the weight loss program in the clinical routine practice. Therefore, the objective of this study was to analyze weight loss program dynamics in groups according to reproductive status, age, body size, and breed, as well as to define more accurately the amount of calories per target metabolic weight throughout the program. Data of 1,053 cases, presented between 2012 and 2019 at the Veterinary Hospital of the School of Veterinary Medicine and Animal Science of the University of São Paulo (FMVZ-USP) were retrospectively analyzed. A total of 77 obese dogs (body condition scores 8/9 or 9/9) of different ages, breeds, sizes, and reproductive status were selected. These dogs did not have any concomitant illnesses and successfully completed the weight loss program. Statistical analysis was performed and values of p≤0.05 were considered significant. The proposed weight loss program was based on an energy restriction protocol where daily energy intake (in kcal) was estimated as 70 kcal × target weight0.75. The target weight (TW) was defined as 80% of the animal's current weight. The average calorie intake for weight loss (calories x target weight0.75) was lower for spayed females (62.36), differing from intact males (66.14) and neutered males (65.41), while intact females (63.66) showed intermediate values without differing between groups (p = 0.015). There were no differences between weight loss calories according to age (p = 0.473) or body size (p = 0.084), allowing the use of the same mathematical equation for intact and neutered dogs; for dogs older than 1 year and of different body sizes. Regarding the breed, the average calorie intake was lower (p = 0.002) in mixed breed dogs (61.54xTW0.75) when compared to obesity-prone purebred dogs (64.17xTW0.75) and other purebreds (65.27xTW0.75). It was concluded that spayed females and mixed breed dogs have greater difficulty in losing weight, that is, they need fewer calories per metabolic body weight for the weight loss program to succeed. A more accurate equation for energy requirement for weight loss can improve chances of success, therefore improving compliance and helping clinical management of obesity in dogs.

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BACKGROUND: Mexico is ranked second in obesity in adults worldwide and resident physicians are not exempt from this problem. Inadequate diet and physical inactivity are associated factors. Bioimpedance has greater precision than anthropometry. OBJECTIVE: To analyze the difference between degree of physical activity, caloric intake and body composition in Internal Medicine residents according to their degree of residence. MATERIAL AND METHODS: Cross-sectional study. Resident physicians of both sexes, from second, third and fourth degree of training were included; they were fasting. Vital signs were taken; a Rapid Assessment of Physical Activity (RAPA) questionnaire, anthropometry, a 24-hour reminder, and bioelectrical impedance analysis were administered. Descriptive statistics, Kruskal-Wallis and chi squared tests were used. RESULTS: 84 resident physicians were included, 48 were male. The median age was of 27 years (26-28). There was a prevalence of 46.4% of overweight and obesity, despite the hypocaloric diet in 89%. Bioelectrical impedance analysis showed that 72.6% of residents had elevated body fat, 71% sub-optimal degree of physical activity and 23.7% arterial hypertension. CONCLUSIONS: A high prevalence of overweight and obesity was found with differences in body composition and suboptimal level of physical activity. It is important to correct bad eating habits and improve physical activity to reduce risks in this population.

INTRODUCCIÓN: México es segundo lugar mundial en obesidad en adultos y los médicos residentes no están exentos de este problema. La dieta inadecuada y la inactividad física son factores asociados. La bioimpedancia tiene mayor precisión que la antropometría. OBJETIVO: analizar la diferencia entre grado de actividad física, ingesta calórica y composición corporal en residentes de Medicina Interna de acuerdo con su grado de residencia. MATERIAL Y MÉTODOS: estudio transversal. Se incluyeron médicos residentes de ambos sexos de segundo, tercero y cuarto grado, quienes participaron en ayuno. Se les tomaron signos vitales, se les otorgó el cuestionario Rapid Assesment of Physical Activity (RAPA), antropometría, recordatorio de 24 horas y medición de composición corporal por bioimpedancia. Se empleó estadística descriptiva, prueba de Kruskal-Wallis y chi cuadrada. RESULTADOS: se incluyeron 84 médicos residentes, 48 (57.14%) fueron del género masculino. La mediana de edad fue de 27 años (26-28). Se encontró una prevalencia de sobrepeso y obesidad de 46.4% a pesar de la dieta hipocalórica en el 89%. La medición por bioimpedancia indicó que 72.6% tuvo grasa corporal elevada, 71% grado de actividad física subóptimo y 23.7% hipertensión arterial. CONCLUSIONES: se encontró una alta prevalencia de sobrepeso y obesidad con diferencias en la composición corporal y el nivel subóptimo de actividad física. Es importante corregir los malos hábitos alimenticios y mejorar la actividad física para reducir riesgos en esta población.

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Dietary approaches are essential to control obesity, but the effectiveness of changes in meal frequency (MF) as a strategy for body weight loss or maintenance remain unclear. This study aimed to evaluate the influence of MF of a hypocaloric diet on weight loss, body composition, active ghrelin levels and metabolic indicators of obese women. This is a randomized, parallel clinical trial, including 40 women divided into two groups that received a hypocaloric diet with different MFs: MF6: six meals per day, and MF3: three meals per day. Dietary, laboratory, anthropometric and body composition indicators were assessed, as well as energy expenditure (EE), before and after the 90 days of the intervention. Dietary consumption did not differ between groups, before or after intervention. The two groups reduced their energy intake after intervention, but there were no differences between the groups. Waist circumference (WC) was reduced and resting metabolic rate had increased in the MF3 group at the end compared to baseline. Moreover, there was a significant difference in the triglyceride levels between groups after intervention, with an important reduction in the MF3 group, although changes in body composition, blood glucose, plasma ghrelin levels and EE variables did not differ between the groups at the end. It is concluded that, the hypocaloric diet with different MF each day did not change weight loss, body composition or insulin responsiveness, but there was an improvement of triglyceridemia in the MF3 group. The present study suggests that eating snacks between meals is not an important factor for weight loss and improvement of metabolic health in women with obesity.

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CONTEXT: Nonalcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the adult population, making it one of the most common chronic liver diseases worldwide and a major public health problem. Still, there is no consensus on the most appropriate nutritional intervention for disease treatment. OBJECTIVE: To systematize and synthesize the results of randomized controlled trials that have evaluated the effect of dietary interventions with different, quantitative, macronutrient compositions on hepatic steatosis attenuation, serum levels of alanine aminotransferase, aspartate aminotransferase, lipid profile, glucose metabolism markers, and anthropometric parameters of adults and the elderly (age ≥ 60 years) with NAFLD. DATA SOURCES: MEDLINE databases via PubMed, Embase, Science Direct, LILACS, Web of Science, ClinicalTrials.gov, and Cochrane Library were searched. Randomized controlled trials that compared interventions as diets with values ≤ 45% or 20% of the total daily energy intake from carbohydrates or lipids, respectively, compared with dietary reference intakes, were included. DATA EXTRACTION: Risk of bias was assessed through the Cochrane Collaboration tool. The meta-analysis was only performed to evaluate the effect of carbohydrate-modified diets on the outcome variables. The number of participants and mean values and respective standard deviations of the outcome variables were extracted and used to calculate weighted mean differences and their respective 95%CIs. RESULTS: The search strategy resulted in 21 146 studies, of which 10 were retained for qualitative analysis and 6 were included in the meta-analysis. From the analysis of 10 studies were identified 8 articles in which low-calorie diets were evaluated and 3 interventions that used an isocaloric diet. Only 3 studies were classified as having low risk of bias. CONCLUSION: The observed effects on hepatic steatosis, serum alanine aminotransferase and aspartate aminotransferase levels, parameters of lipid and glucose metabolism, and anthropometric variables were mostly related to a hypocaloric diet. The use of reduced macronutrient interventions had no efficacy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42018088824.

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BACKGROUND: Lipids are essential components of cells that participate in metabolic and endocrine regulation and reproductive functions. The main organs where lipid regulation takes place are the liver and adipose tissue. Besides, when each tissue- specific action cannot be exerted, it could lead to several endocrine-metabolic disorders closely related to PCOS, such as non-alcoholic fatty liver disease (NAFLD) and obesity. OBJECTIVE: This work aims to discuss the impact of lipid alterations on metabolic and reproductive health. Therefore, this review focus on the importance of carrying out an integrated study of the molecular pathways affected in PCOS for developing target therapies. RESULTS: Lipids play a major role in PCOS pathogenesis. In this regard, failures in lipid regulation, synthesis, and/or homeostasis contribute to metabolic and reproductive abnormalities, such as those seen in PCOS. Several lipid pathways and regulators are altered in this pathology, leading to dysfunctions that worsen reproductive functions. Therefore, there are several treatments to manage dyslipidemias. Non-pharmacological therapies are considered a first-line treatment being the pharmacological treatments a second-line option. CONCLUSION: The best treatment to improve the lipid profile is lifestyle intervention, a combination of hypocaloric diet and exercise. Regarding pharmacological therapies, a combination of fibrate and statins would be the most recommended drugs. Still, in PCOS women, treatment with metformin or TZDs not only modulates the lipid metabolism, but also improves ovulation. In addition, metformin with lifestyle interventions has positive effects on the metabolic and reproductive features of PCOS patients.

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PURPOSE: We compared the effect of diets with different amounts and sources of dietary protein on insulin sensitivity (IS) in subjects with obesity and insulin resistance (IR). METHODS: Eighty subjects with obesity (BMI ≥ 30 kg/m2) and IR (Matsuda index < 4.3 and HOMA-IR ≥ 2.5) over 18 years old were randomized to four groups for a one-month period: a normal protein diet (< 20%) with a predominance of animal protein (Animal NP) or vegetable protein (Vegetable NP) and a high-protein diet (25-30%) with a predominance of animal protein (Animal HP) or vegetable protein (Vegetable HP). Baseline and final measurements of body weight, body composition, biochemical parameters, blood pressure (BP), resting energy expenditure and plasma amino acid profiles were performed. RESULTS: Body weight, BMI and waist circumference decreased in all groups. Interestingly, the IS improved more in the Animal HP (Matsuda index; 1.39 vs 2.58, P = 0.003) and in the Vegetable HP groups (Matsuda index; 1.44 vs 3.14, P < 0.0001) after one month. The fat mass, triglyceride levels, C-reactive protein levels and the leptin/adiponectin index decreased; while, the skeletal muscle mass increased in the Animal and Vegetable HP groups. The BP decreased in all groups except the Animal NP group. CONCLUSION: Our study demonstrates that a high-protein hypocaloric diets improves IS by 60-90% after one month in subjects with obesity and IR, regardless of weight loss and the source of protein, either animal or vegetable. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (NCT03627104), August 13, 2018.

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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.