Role of weight lost in breast cancer-related lymph / Importancia de la pérdida de peso en el linfedema secundario a cáncer de mama

Objective: Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. Methods: Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. Results: Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [−50 (−248 to 141) ml vs. 130 (−148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. Conclusions: Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus – right from the start – on weight management or weight-loss in obese patients.(AU)

Objetivo: Analizar los datos recopilados en la práctica clínica rutinaria sobre el impacto combinado de la actividad física y la reducción del índice de masa corporal (IMC) en la reducción de la prevalencia de linfedema secundario a cáncer de mama (BCRL). Métodos: Análisis de los datos obtenidos por la unidad de rehabilitación especializada, de 99 pacientes durante 18 meses, tras prescribirse una dieta específica, un programa deportivo y una terapia descongestiva completa (TDC). En las visitas de seguimiento se recopilaron datos personales, volumen del órgano afectado, peso, nivel de actividad física y FACT-B+4 (Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer). Resultados: Aunque el índice de masa corporal medio no reflejó cambios durante el periodo de evaluación, cerca del 13% de las pacientes habían perdido peso en la segunda semana de seguimiento, incrementándose este porcentaje al 30% en la tercera semana. Las mujeres que experimentaron pérdida de peso durante la tercera visita de seguimiento presentaron una reducción del volumen del órgano afectado [-50 (-248-141)ml vs. 130 (-148-355)ml, p<0,05] en comparación con las pacientes que habían ganado peso. No se estableció relación alguna entre la actividad física y los cambios de volumen de linfedema. Conclusiones: Aparte del tratamiento convencional con ortésicos y drenaje linfático manual, la prevención y tratamiento de BCRL debe centrarse, desde el inicio, en la gestión del peso o la pérdida de peso en las pacientes obesas.(AU)

The impact of surgical weight loss procedures on the risk of metachronous colorectal neoplasia: the differential effect of surgery type, sex, and anatomic location.

Patients with prior colorectal polyps are at high risk for metachronous colorectal neoplasia, especially in the presence of obesity. We assessed the impact of 2 common bariatric surgeries, vertical sleeve gastrectomy and roux-n-Y gastric bypass, on the risk of colorectal neoplasia recurrence. This nationally representative analysis included 1183 postbariatric adults and 3193 propensity score-matched controls, who all had prior colonoscopy with polyps and polypectomy. Colorectal polyps reoccurred in 63.8% of bariatric surgery patients and 71.7% of controls at a mean follow-up of 53.1 months from prior colonoscopy. There was a reduced odds of colorectal polyp recurrence after bariatric surgery compared with controls (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.58 to 0.83). This effect was most pronounced in men (OR = 0.58, 95% CI = 0.42 to 0.79), and post roux-n-Y gastric bypass (OR = 0.57, 95% CI = 0.41 to 0.79). However, the risk of rectal polyps or colorectal cancer remained consistent between groups. This study is the first to our knowledge to show a reduction in risk of polyp recurrence following bariatric surgery.

Examining spousal and family support as predictors of long-term weight loss and remission of type 2 diabetes following bariatric surgery in Singapore: a retrospective cohort study.

OBJECTIVES: Postoperative outcomes vary considerably across bariatric patients and may be related to psychosocial factors. In this study, we examined whether a patient's family support predicts postsurgical weight loss and the remission of type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study in Singapore. SETTING: Participants were recruited from a public hospital in Singapore. PARTICIPANTS: Between 2008 and 2018, 359 patients completed a presurgical questionnaire before undergoing gastric bypass or sleeve gastrectomy. OUTCOME MEASURES: As part of the questionnaire, patients described their family support in terms of structure (marital status, number of family members in the household) and function (marriage satisfaction, family emotional support, family practical support). Linear mixed-effects and Cox proportional-hazard models were used to examine whether these family support variables predicted percent total weight loss or T2DM remission up to 5 years postsurgery. T2DM remission was defined as glycated haemoglobin (HbA1c) <6.0% without medications. RESULTS: Participants had a mean preoperative body mass index of 42.6±7.7 kg/m2 and HbA1c (%) of 6.82±1.67. Marital satisfaction was found to be a significant predictor of postsurgical weight trajectories. Namely, patients who reported higher marital satisfaction were more likely to sustain weight loss than patients who reported lower marital satisfaction (ß=0.92, SE=0.37, p=0.02). Family support did not significantly predict T2DM remission. CONCLUSIONS: Given the link between marital support and long-term weight outcomes, providers could consider asking patients about their spousal relationships during presurgical counselling. TRIAL REGISTRATION NUMBER: NCT04303611.

Expression of Adipose Tissue Extracellular Matrix-Related Genes Predicts Weight Loss after Bariatric Surgery.

BACKGROUND: We evaluated the association between white adipose tissue parameters before bariatric surgery (BS) and post-surgical weight loss, with an especial focus on extracellular matrix (ECM) gene expression. METHODS: Paired samples from subcutaneous (SAT) and visceral adipose tissue (VAT) were obtained from 144 subjects undergoing BS. The association between total body weight loss (%TBWL) at 12 months after BS and the histological characteristics and gene expression of selected genes in SAT and VAT was analyzed. RESULTS: Fat cell area, size-frequency distribution, and fibrosis in SAT or VAT prior to surgery were not associated with %TBWL. On the contrary, the SAT expression of COL5A1 and COL6A3 was associated with %TBWL after BS (both p < 0.001), even after adjusting for age, gender, baseline BMI, and type 2 diabetes status (T2D). Furthermore, in logistic regression analyses, the expression of these genes was significantly associated with insufficient WL (IWL = TBWL < 20%) after BS (respectively, p = 0.030 and p = 0.031). Indeed, in ROC analysis, the prediction of IWL based on sex, age, BMI, T2D, and the type of surgery (AUC = 0.71) was significantly improved with the addition of SAT-COL5A1 gene expression (AUC = 0.88, Z = 2.13, p = 0.032). CONCLUSIONS: Our data suggest that the expression of SAT ECM-related genes may help explain the variability in TBWL following BS.

Perception and Awareness of Diabetes Risk and Reported Risk-Reducing Behaviors in Adolescents.

Importance: Lifestyle change is central to diabetes risk reduction in youth with overweight or obesity. Feeling susceptible to a health threat can be motivational in adults. Objective: To evaluate associations between diabetes risk perception and/or awareness and health behaviors in youth. Design, Setting, and Participants: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2011 to 2018. Participants included youths aged 12 to 17 years with body mass index (BMI) in the 85th percentile or higher without known diabetes. Analyses were conducted from February 2022 to February 2023. Main Outcomes and Measures: Outcomes included physical activity, screen time, and attempted weight loss. Confounders included age, sex, race and ethnicity, and objective diabetes risk (BMI, hemoglobin A1c [HbA1c]). Exposures: Independent variables included diabetes risk perception (feeling at risk) and awareness (told by clinician), as well as potential barriers (eg, food insecurity, household size, insurance). Results: The sample included 1341 individuals representing 8 716 794 US youths aged 12 to 17 years with BMI in the 85th percentile or higher for age and sex. The mean age was 15.0 years (95% CI, 14.9-15.2 years) and mean BMI z score was 1.76 (95% CI 1.73-1.79). Elevated HbA1c was present in 8.6% (HbA1c 5.7%-6.4%: 8.3% [95% CI, 6.5%-10.5%]; HbA1c ≥6.5%: 0.3% [95% CI, 0.1%-0.7%]). Nearly one-third of youth with elevated HbA1c reported risk perception (30.1% [95% CI, 23.1%-38.1%), while one-quarter (26.5% [95% CI, 20.0%-34.2%]) had risk awareness. Risk perception was associated with increased TV watching (ß = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (ß = -1.2 [95% CI, -2.0 to -0.4) but not with nutrition or weight loss attempts. Awareness was not associated with health behaviors. Potential barriers had mixed associations: larger households (≥5 members vs 1-2) reported lower consumption of non-home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (ß = -1.1 hours per day [95% CI, -2.0 to -0.3 hours per day), while public insurance (vs private) was associated with approximately 20 fewer minutes per day of physical activity (ß = -20.7 minutes per day [95% CI, 35.5 to -5.8 minutes per day]). Conclusions and Relevance: In this cross-sectional study including a US-representative sample of adolescents with overweight or obesity, diabetes risk perception and awareness were not associated with greater engagement in risk-reducing behaviors in youth. These findings suggest the need to address barriers to engagement in lifestyle change, including economic disadvantage.

The effect of body mass index reduction on intraocular pressure in a large prospective cohort of apparently healthy individuals in Israel.

PURPOSE: To investigate the effect of change in body mass index (BMI) on intraocular pressure (IOP) in a large cohort of apparently healthy volunteers who underwent an annual comprehensive screening examinations. METHODS: This study included individuals who were enrolled in the Tel Aviv Medical Center Inflammation Survey (TAMCIS) and had IOP and BMI measurements at their baseline and follow up visits. Relationships between BMI and IOP and the effect of change in BMI on IOP were investigated. RESULTS: A total of 7,782 individuals had at least one IOP measurement at their baseline visit, and 2,985 individuals had ≥2 visits recorded. The mean (SD) IOP (right eye) was 14.6 (2.5) mm Hg and mean (SD) BMI was 26.4 (4.1) kg/m2. IOP positively correlated with BMI levels (r = 0.16, p<0.0001). For individuals with morbid obesity (BMI≥35 kg/m2) and ≥2 visits, a change in BMI between the baseline and first follow-up visits correlated positively with a change in the IOP (r = 0.23, p = 0.029). Subgroup analysis of subjects who had a reduction of at least 2 BMI units showed a stronger positive correlation between change in BMI and change in IOP (r = 0.29, p<0.0001). For this subgroup, a reduction of 2.86 kg/m2 of BMI was associated with a reduction of 1 mm Hg in IOP. CONCLUSIONS: BMI loss correlated with reduction in IOP, and this correlation was more pronounced among morbidly obese individuals.

Immunostimulant potential of Moringa Oleifera leaves alcoholic extract versus Oregano Essential Oil (OEO) against cyclophosphamide-induced immunosuppression in broilers chicks.

The current study was conducted to evaluate the immunoenhancement effect of Moringa oleifera leaves alcoholic extract (MOLE) versus Oregano essential oil (OEO) against cyclophosphamide induced immunosuppression in broilers chicks. A total of a three hundred one-day-old chicks were assigned randomly into three main dietary groups, control, MOLE, and OEO for 14 days. After 14 days the three main experimental groups were subdivided into six groups, control, cyclophosphamide, MOLE, MOLE and Cyclophosphamide, OEO, and OEO and cyclophosphamide. Each group of these six groups was subdivided into three subgroups. Supplementation of broiler chicks with MOLE and OEO for 14 days significantly increased body weight compared to the control group. However, injection of broiler chicks with cyclophosphamide significantly induced body weight loss, impaired immunological response represented by decreasing total leukocytic count, differential leukocytic count, phagocytic activity, phagocytic index, and hemagglutinin inhibition titer for New Castle disease virus, lymphoid organs depletion, and increased the mortality rate. In contrast, supplementation of cyclophosphamide treated chicks with MOLE and OEO significantly reduced cyclophosphamide induced body weight loss and impaired immunological responses, as it showed significant increase in body weight, total leukocytic count, differential leukocytic count, phagocytic activity, phagocytic index, and hemagglutinin inhibition titer for New Castle disease virus, lymphoid organs proliferation, and reduced the mortality rate. This study indicated that MOLE and OEO supplementation ameliorated cyclophosphamide induced body weight loss and impaired immunological responses.

A randomized-controlled trial to evaluate the app-based multimodal weight loss program zanadio for patients with obesity.

OBJECTIVE: This study aimed to evaluate the effectiveness of the app-based, multimodal weight loss program zanadio. METHODS: A randomized-controlled trial was conducted from January 2021 to March 2022. A total of 150 adults with obesity were randomized into an intervention group and used zanadio for 1 year or into a wait list control group. The primary end point, weight change, and the secondary end points, quality of life, well-being, and waist to height ratio, were assessed every 3 months for up to 1 year via telephone interviews and online questionnaires. RESULTS: After 12 months, participants of the intervention group lost, on average, -7.75% (95% CI: -9.66% to -5.84%) of their initial weight, achieving a clinically relevant and statistically stronger weight reduction than the control group (mean = 0.00% [95% CI: -1.98% to 1.99%]). All secondary end points improved significantly in the intervention group, with significantly greater improvements in well-being and waist to height ratio than in the control group. CONCLUSIONS: This study showed that adults with obesity who have used zanadio achieved a significant and clinically relevant weight loss within 12 months and improved further obesity-related health variables compared with a control group. Because of its effectiveness and flexible applicability, the app-based multimodal treatment zanadio might alleviate the present care gap for patients with obesity in Germany.

[Weight Loss Experience of Highly Obese Young Adult Who Underwent Bariatric Surgery].

PURPOSE: This study aimed to explore the weight loss experience of highly obese young people who underwent bariatric surgery. METHODS: Data were collected, from October 2021 to April 2022, through individual in-depth interviews with eight highly obese young adults who underwent bariatric surgery and analyzed using Colaizzi's phenomenological method. RESULTS: The following four theme clusters were extracted. First, 'The unbearable sorrow of obese people' explains the process of choosing bariatric surgery after fluctuations and frustration despite countless repeated weight loss attempts. Second, 'The impact aftermath of bariatric surgery' revealed participants struggling in the face of unexpected changes due to bariatric surgery. Third, 'Efforts to rebuild a healthy myself' demonstrated the struggle to regain health by using the surrounding support system to overcome the difficulties of this surgical procedure. Lastly, 'Facing life by getting rid of the yoke of obesity' displayed the experiences of the participants who felt ambivalent about their changed appearance, but coping positively with the new life. CONCLUSION: This study provides an in-depth understanding of the weight loss experiences of highly obese adolescents who underwent bariatric surgery and presents a new perspective on clinical practice. The results of this study are expected to be useful in developing and applying systematic and customized nursing interventions before and after bariatric surgery.

The Impact of the Pre-operative Neutrophil-lymphocyte Ratio as the Predictive Marker of Post-operative Weight Loss and Improving Diabetes in Sleeve Gastrectomy.

PURPOSE: The aim was to investigate the impact of the neutrophil-lymphocyte ratio (NLR) in sleeve gastrectomy (SG). METHODS: 15 obese patients were enrolled in this study ; mean body weight (BW) 127.5kg ; mean body mass index (BMI) 46.7kg/m2. 10 of these were diabetics who underwent a SG. The impact of the pre-operative NLR on the percentage of excess weight loss (%EWL) and remission of diabetes 1 year post-operative were examined. RESULTS: The %EWL at 1 year post-operative were 46.3%. Improvements were also evident in the diabetes at 1 year post-operative : complete remission (CR) 40%, partial remission (PR) 20% and Improve 40%. Comparing pre-operative NLR in %EWL<50% and ≧50% in 1 year post-operative, <50% was 2.64 and ≧50% was 2.03. The NLR in CR and PR was significantly lower than that in Improve. CONCLUSIONS: The pre-operative NLR may be a predictive marker of weight loss and improving diabetes after SG. J. Med. Invest. 70 : 140-144, February, 2023.

DO HELICOBACTER PYLORI INFECTION AND ERADICATION THERAPY STATUS INFLUENCE WEIGHT LOSS OUTCOMES AND ENDOSCOPIC FINDINGS AFTER ROUX-EN-Y GASTRIC BYPASS?A HISTORICAL COHORT STUDY.

BACKGROUND: Currently, there is conflicting evidence linking Helicobacter pylori (HP) infection with weight loss and endoscopic findings after Roux-en-Y gastric bypass (RYGB). OBJECTIVE: To identify correlations between HP infection and its eradication with weight loss and endoscopic findings after RYGB. METHODS: This is an observational retrospective cohort study based on a prospectively collected database of individuals who underwent RYGB from 2018-2019 at a tertiary university hospital. HP infection and the HP eradication therapy outcomes were correlated with post-operative weight loss and endoscopic findings. Individuals were classified according to the status of HP infection into four groups: no infection; successful eradication; refractory infection; and new-onset infection. RESULTS: Of 65 individuals, 87% were female and the mean age was 39±11.2 years. Body mass index significantly decreased from 36.2±3.6 to 26.7±3.3 kg/m2 one year after RYGB (P<0.0001). The percentage of total weight loss (%TWL) was 25.9±7.2% and the percentage of excess weight loss was 89.4±31.7%. HP infection prevalence decreased from 55.4% to 27.7% (p=0.001); 33.8% never had HP infection, 38.5% were successfully treated, 16.9% had refractory infection and 10.8 % had new-onset HP infection. %TWL was 27.3±7.5% in individuals who never had HP, 25.4±8.1% in the successfully treated, 25.7±5.2% in those with refractory infection, and 23.4±6.4% in the new-onset HP infection group; there were no significant differences among the four groups (P=0.6). Pre-operative HP infection significantly associated with gastritis (P=0.048). New-onset HP infections significantly associated with a lower frequency of jejunal erosions after surgery (P=0.048). CONCLUSION: No effects of the HP infection on weight loss were identified in individuals undergoing RYGB. A higher prevalence of gastritis was observed in individuals with HP infection before RYGB. New-onset HP infection after RYGB was a protective factor for jejunal erosions.

Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis.

To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) and ambulatory BP in patients with obesity or overweight, the authors performed a meta-analysis. PubMed, Embase, and Scopus databases were searched up to June 2022. Studies that compared clinic or ambulatory BP with weight loss were included. A random effect model was applied to pool the differences between clinic BP and ambulatory BP. Thirty-five studies, for a total of 3219 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 5.79 mmHg (95% CI, 3.54-8.05) and 3.36 mmHg (95% CI, 1.93-4.75) after a mean body mass index (BMI) reduction of 2.27 kg/m2 , and the SBP and DBP were significantly reduced by 6.65 mmHg (95% CI, 5.16-8.14) and 3.63 mmHg (95% CI, 2.03-5.24) after a mean BMI reduction of 4.12 kg/m2 . The BP reductions were much larger in patients with a BMI decrease ≥3 kg/m2 than in patients with less BMI decrease, both for clinic SBP [8.54 mmHg (95% CI, 4.62-12.47)] versus [3.83 mmHg (95% CI, 1.22-6.45)] and clinic DBP [3.45 mmHg (95% CI, 1.59-5.30)] versus [3.15 mmHg (95% CI, 1.21-5.10)]. The significant reduction of the clinic and ambulatory BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.

How effective are lifestyle interventions for overweight women trying to conceive?

PURPOSE OF REVIEW: To summarize and critically review the current knowledge on the effectiveness of lifestyle modifications for overweight women trying to conceive. RECENT FINDINGS: Overweight is associated with a wide spectrum of disorders, which may directly or indirectly affect fertility [from menstrual cycle irregularities to a lower chance of live birth after assisted reproductive technology (ART) treatment]. Weight loss through nonpharmaceutical lifestyle interventions is achievable. Weight loss can normalize menstrual cycle irregularities and can increase fecundability. Pregnancy-associated risks, such as gestational diabetes can be decreased by preconception weight reduction. SUMMARY: Weight loss through lifestyle changes (i.e., lower caloric intake and increased physical activity), may increase fecundability and may have a positive impact on the course of pregnancy, delivery, and neonatal outcomes. Accordingly, women should be motivated to reduce their weight before conception. However, the effectiveness of life-style intervention programs for women actively seeking medical support in achieving pregnancy has not convincingly been demonstrated. In the few randomized controlled trials (RCTs), selection bias for trial participation by patient motivation may have been present, yet participant attrition was still high and mean effects were small, casting doubts on the utility of such programs in routine care. Pharmacological and surgical intervention may be more effective or necessary complements to lifestyle intervention programs.

Changes in body weight and cardiovascular risk factors in a Chinese population with type 2 diabetes mellitus: a longitudinal study.

Introduction: The primary care management of blood glucose, blood pressure, lipid profiles, and body weight is important among patients with type 2 diabetes mellitus (T2DM) to prevent disease progression. Information on how weight changes would improve or deteriorate cardiovascular (CV) risk factors is warranted for making primary care recommendations. We aimed to investigate the changes in body weight and CV risk factors and to analyse their association in a Chinese population with T2DM. Methods: We retrieved longitudinal data between 2020 and 2021 from 1,758 adult primary care patients enrolled in a diabetic retinopathy (DR) screening programme. Linear associations of changes in body weight with CV risk factors were explored. Multivariable logistic regression analysis was performed to examine associations between different weight change categories and the worsening of CV risk factors. Results: The mean age of all the participants was 63.71 years, and over half of participants were females. During a one-year follow-up period, 24.7% of patients had a weight loss of ≥3%, while 22.2% of patients had a weight gain of ≥3%. Patients who had a weight loss of ≥3% were more likely to prevent the worsening of haemoglobin A1c (HbA1c) and triglycerides, while those who had a weight gain of ≥3% tended to have worsened HbA1c, lipid profiles, and blood pressure. Conclusion: Results from this real-world investigation suggested the concurrent need for weight loss intervention among patients who are overweight or obese and weight gain prevention among patients whose body weight falls within the normal range in the context of community-based diabetes management.

The impact of laparoscopic Roux-en-Y gastric bypass on sleep quality and duration after one year of follow-up.

BACKGROUND AND AIMS: Several studies have shown the association between obesity and sleep. Roux-en-Y gastric bypass (RYGB) surgery may improve sleep disturbances in patients with obesity by influencing a variety of factors. This study aims to evaluate the impact of bariatric surgery on sleep quality. METHODS: Patients with severe obesity referred to the obesity clinic of a center from September 2019 to October 2021 were collected. The patients were divided into two groups, depending on whether they underwent RYGB surgery. Medical comorbidities and self-report questionnaires regarding sleep quality, anxiety, and depression were collected at baseline and 1-year follow-up. RESULTS: 54 patients were included, including 25 in the bariatric surgery group and 29 in the control group. However, five patients in the RYGB surgery group and four patients in the control group were lost in the follow-up. Pittsburgh Sleep Quality Index (PSQI) was decreased from a mean of 7.7 to 3.8 in the bariatric surgery group (p-value<0.001). In contrast to the control group, the number of patients with obstructive sleep apnea was significantly reduced in the bariatric surgery group. CONCLUSIONS: We showed a significant improvement in sleep quality following RYGB surgery. Obstructive sleep apnea, obesity/overweight, and depressive symptoms significantly improved in our study. There is a lack of a better understanding of the association between these factors and sleep quality following surgery. Therefore, further studies are recommended regarding this issue.

Ethiopian orthodox fasting is associated with weight reduction and body composition changes among healthy adults: a prospective cohort study.

The Ethiopian Orthodox Christian (EOC) fasts, although adopted for religious purposes, combines aspects of energy restriction, time-restricted feeding, and a vegan dietary pattern, all of which have been independently associated with weight loss and healthier body composition. However, combined effect of these practices as part of EOC fast remains unknown. This longitudinal study design evaluated the effect of EOC fasting on body weight and body composition. Information on socio-demographic characteristics, physical activity level, and fasting regimen followed was captured through an interviewer-administered questionnaire. Weight and body composition measurements were taken before and at the end of major fasting seasons. Body composition parameters were measured by bioelectrical impedance (BIA), Tanita® BC-418®, Japan). Significant changes in body weight and body composition were observed for both fasts. Significant decreases in body weight (14/44 day fast: - 0.45; P = 0.004/- 0.65; P = 0.004), FFM (- 0.82; P = 0.002/- 0.41; P < 0.0001), and trunk fat mass (- 0.68; P < 0.0001/- 0.82; P < 0.0001) were observed after adjusting for covariates including age, sex, and physical activity. The EOC fasting regimen leads to significant reductions of body weight and compositions. Longer fasting duration led to much higher effects in body weight and body composition and may be non-pharmacological strategy in prevention or treatment of chronic diseases.

Long-term effect of intensive lifestyle intervention on cardiometabolic risk factors and microvascular complications in patients with diabetes in real-world clinical practice: a 10-year longitudinal study.

INTRODUCTION: Intensive lifestyle intervention (ILI) has significantly reduced incidence of diabetes and improved many cardiovascular disease risk factors. We evaluated long-term effects of ILI on cardiometabolic risk factors, and microvascular and macrovascular complications among patients with diabetes in real-world clinical practice. RESEARCH DESIGN AND METHODS: We evaluated 129 patients with diabetes and obesity enrolled in a 12-week translational model of ILI. At 1 year, we divided participants into group A, who maintained <7% weight loss (n=61, 47.7%), and group B, who maintained ≥7% weight loss (n=67, 52.3%). We continued to follow them for 10 years. RESULTS: The total cohort lost an average of 10.8±4.6 kg (-9.7%) at 12 weeks and maintained an average weight loss of 7.7±10 kg (-6.9%) at 10 years. Group A maintained 4.3±9.5 kg (-4.3%) and group B maintained 10.8±9.3 kg (-9.3%) of weight loss at 10 years (p<0.001 between groups). In group A, A1c decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but rebounded to 7.7±1.4% at 1 year and 8.0±1.9% at 10 years. In group B, A1c decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks then increased to 6.8±1.2% at 1 year and 7.3±1.5% at 10 years (p<0.05 between groups). Maintenance of ≥7% weight loss at 1 year was associated with a 68% lower risk of developing nephropathy for up to 10 years compared with maintenance of <7% weight loss (adjusted HR for group B: 0.32, 95% CI 0.11, 0.9, p=0.007). CONCLUSIONS: Weight reduction in patients with diabetes can be maintained for up to 10 years in real-world clinical practice. Sustained weight loss is associated with significantly lower A1c at 10 years and improvement in lipid profile. Maintenance of ≥7% weight loss at 1 year is associated with decreased incidence of diabetic nephropathy at 10 years.

A randomized controlled trial examining the effects of behavioral weight loss treatment on hippocampal volume and neurocognition.

BACKGROUND/PURPOSE: Obesity in midlife is an established risk factor for dementia. In middle-aged adults, elevated body mass index (BMI) is associated with lower neurocognition and smaller hippocampal volumes. It is unclear whether behavioral weight loss (BWL) can improve neurocognition. The purpose of this study was to evaluate whether BWL, compared to wait list control (WLC), improved hippocampal volume and neurocognition. We also examined if baseline hippocampal volume and neurocognition were associated with weight loss. METHODS: We randomly assigned women with obesity (N = 61; mean±SD age=41.1 ± 9.9 years; BMI=38.6 ± 6.2 kg/m2; and 50.8% Black) to BWL or WLC. Participants completed assessments at baseline and follow-up including T1-weighted structural magnetic resonance imaging scans and the National Institutes of Health (NIH) Toolbox Cognition Battery. RESULTS: The BWL group lost 4.7 ± 4.9% of initial body weight at 16-25 weeks, which was significantly more than the WLC group which gained 0.2 ± 3.5% (p < 0.001). The BWL and WLC groups did not differ significantly in changes in hippocampal volume or neurocognition (ps>0.05). Baseline hippocampal volume and neurocognition scores were not significantly associated with weight loss (ps>0.05). CONCLUSIONS AND IMPLICATIONS: Contrary to our hypothesis, we found no overall benefit of BWL relative to WLC on hippocampal volumes or cognition in young- and middle-aged women. Baseline hippocampal volume and neurocognition were not associated with weight loss.

Neural correlates of inhibitory control in severe class III compared with class I/II obesity using a sample of endometrial cancer survivors seeking weight loss.

OBJECTIVE: No prior studies have evaluated inhibitory control in people with severe class III compared with class I/II obesity. Thus, the study aim was to evaluate inhibitory control and neural correlates of response inhibition by obesity class using a sample of endometrial cancer (EC) survivors with obesity, who have a higher risk of overall but not cancer-specific mortality. METHODS: Forty-eight stage I EC survivors with obesity (class I/II: n = 21; class III: n = 27) seeking weight loss in a lifestyle intervention at baseline completed a stop signal task during functional magnetic resonance imaging. RESULTS: It was found that participants with class III obesity had a longer stop signal reaction time (mean [SD], 278.8 [51.3] vs. 251.5 [34.0] milliseconds, p < 0.01) compared with those with class I/II obesity, indicating that patients with EC with severe obesity had greater impulsivity and poorer inhibitory control. Results also showed increased activation in the thalamus and superior frontal gyrus for the incorrect versus correct inhibition contrast in class III but not class I/II obesity (whole brain cluster corrected, p < 0.05). CONCLUSIONS: These results provide novel insights into inhibitory control and corresponding neural correlates in severe versus less severe classes of obesity and highlight the importance of targeting inhibitory control processes in weight-loss interventions, particularly for people with severe obesity and greater impulsivity.

Family-based weight stigma and psychosocial health: A multinational comparison.

OBJECTIVE: Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS: Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS: Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (ß coefficients = |0.08-0.13|). CONCLUSIONS: Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.