Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial.

BACKGROUND: Weight regain after bariatric surgery often starts after 1-2 y, but studies evaluating strategies to prevent weight regain are lacking. The aim of this intervention was to evaluate the efficacy of a 2-y-group-based lifestyle intervention starting approximately 2 y after Roux-en-Y gastric bypass (RYGB) compared with usual care on weight regain and related metabolic risk factors. METHODS: A total of 165 patients with a mean of 21 months (range 14-32) after RYGB were randomized to a lifestyle intervention group (LIG) or a usual care group (UCG). Of the 165 participants 86% completed the study. The LIG was offered 16 group meetings over 2 y with focus on healthy diet, physical activity, and behavioural strategies to prevent weight regain, in addition to usual care. RESULTS: Mean (SD) total weight loss at study start was 30.1 ± 8.2%, while weight regain during the intervention was 4.9 ± 7.4 and 4.6 ± 9.2% in the LIG and UCG, respectively (P = 0.84). There were no differences in metabolic risk factors between the groups. The LIG participants attended 8 ± 4 group meetings, with no difference in weight regain between participants with high compared to lower participation. In all the participants, a positive association between weight increase from nadir to study start and weight regain during the intervention was found. Participants who reported physical activity ≥ 150 min/wk had smaller % weight regain compared with less active participants (ß = - 5.2 [SE 2.0, 95% CI - 9.1 to - 1.4]). CONCLUSION: We found no difference in weight regain between LIG and UCG.

Plasma amino acids, adiposity, and weight change after gastric bypass surgery: are amino acids associated with weight regain?

PURPOSE: Plasma concentrations of several amino acids (AAs) are positively correlated with obesity. The aim of this study was to examine if selected plasma AAs are associated with weight regain from 2 to 4 years after Roux-en-Y gastric bypass (RYGB). METHODS: In a prospective study with 165 patients, we examined the relationship between plasma aromatic AAs (AAAs), branched chain AAs (BCAAs), and total cysteine (tCys) 2 years after RYGB, with BMI at 2 years and with weight change from 2 to 4 years after surgery. Analyses were adjusted for relevant covariates. RESULT: The investigated AAs at 2 years correlated positively with BMI at 2 years (P ≤ 0.003 for all). BCAAs and AAAs at 2 years correlated inversely with % weight loss from 0 to 2 years (P = 0.002 and P = 0.001, respectively), while the association was not significant for tCys (r = -0.14, P = 0.08). Plasma tCys at 2 years correlated positively with BMI at 4 years (P = 0.010) and with weight regain from 2 to 4 years (P = 0.015). CONCLUSION: Plasma AAAs, BCAAs, and tCys at 2 years were associated with BMI at 2 years. In addition, plasma AAAs and BCAAs at 2 years were associated with weight loss from 0 to 2 years, while tCys at 2 years was associated with weight regain from 2 to 4 years after RYGB. These results suggest that high tCys at 2 years may be used as a prognostic marker for future weight regain. The study was registered in ClinicalTrials.gov (NCT0 1270451).

The contribution of snacks to dietary intake and their association with eating location among Norwegian adults - results from a cross-sectional dietary survey.

BACKGROUND: Snack consumption has been reported to increase over recent decades. Little is known about possible associations between snack composition and snack eating location. In the present study, we aimed to describe the contribution of snacks to dietary intake in Norwegian adults and to investigate whether the composition of snacks differed according to where they were eaten. METHODS: Dietary data were collected in 2010 and 2011 using two telephone administered 24 h recalls about four weeks apart. In total, 1787 participants aged 18-70 years completed two recalls. The recorded eating locations were at home, other private household, work/school, restaurant/cafe/fast-food outlet and travel/meeting. RESULTS: Snacks contributed to 17% and 21% of the energy intake in men and women, respectively. Compared with main meals, snacks had a higher fiber density (g/MJ) and contained a higher percentage of energy from carbohydrates, added sugars and alcohol, while the percentages of energy from fat and protein were lower. The top five energy-contributing food groups from snacks were cakes, fruits, sugar/sweets, bread and alcoholic beverages. Snacks were mostly eaten at home (58% of all snacks) or at work/school (23% of all snacks). Snacks consumed at work/school contained less energy, had a higher percentage of energy from carbohydrates and had lower percentages of energy from added sugars, alcohol and fat than snacks consumed at home. Snacks consumed during visits to private households and at restaurants/cafe/fast-food outlets contained more energy, had a higher percentage of energy from fat and had a lower fiber density than snacks consumed at home. CONCLUSIONS: We conclude that snacks are an important part of the diet and involve the consumption of both favorable and less favorable foods. Snacks eaten at home or at work/school were generally healthier than snacks consumed during visits to other private households or at restaurants/cafe/fast-food outlets. Nutritional educators should recommend healthy snack options and raise awareness of the association between eating location and snack composition.

Great Health Benefits But No Change in Employment or Psychopharmaceutical Drug Use 2 Years After Roux-en-Y Gastric Bypass.

BACKGROUND: The aim was to examine health benefits and lifestyle factors after Roux-en-Y gastric bypass (RYGB). METHODS: Patients (n = 165) were investigated 2 years after RYGB in relation to psychopharmaceutical drugs, employment status, type 2 diabetes mellitus (T2DM), hypertension, metabolic syndrome (MetS), body weight, physical activity (PA), and energy intake. RESULTS: Excess weight loss (EWL) was 71.4 ± 20.6 %. Prevalence of T2DM, hypertension, and MetS was reduced (P < 0.001 for all). There were no changes in the use of psychopharmaceutical drugs (20.6 vs. 18.8 %, P = 0.549) or in the proportion of unemployed participants (37.7 vs. 33.3 %, P = 0.189) from pre- to post-surgery. Eighty-three percent achieved EWL ≥ 50 %. These subjects had a lower pre-surgery BMI. We found no differences in the prevalence of hypertension, T2DM, and MetS pre-surgery, but the prevalence was lower after surgery compared with subjects with EWL < 50 %. CONCLUSION: RYGB induced remission of T2DM, hypertension, and MetS 2 years after surgery. The benefit was greatest in the group with EWL ≥ 50 %. Despite excellent weight loss, there was no change in the use of psychopharmaceutical drugs or proportion of unemployed participants.

Meal types as sources for intakes of fruits, vegetables, fish and whole grains among Norwegian adults.

OBJECTIVE: To study how different meals contribute to intakes of fruits, vegetables, fish and whole grains in a group of Norwegian adults and in subgroups of this population. Moreover, to investigate the consequences of skipping the meal contributing most to the intake of each food group (main contributing meal). DESIGN: Cross-sectional dietary survey in Norwegian adults. Dietary data were collected using two non-consecutive telephone-administered 24 h recalls. The recorded meal types were breakfast, lunch, dinner, supper/evening meal and snacks. SETTING: Nationwide, Norway (2010-2011). SUBJECTS: Adults aged 18-70 years (n 1787). RESULTS: Dinner was the main contributing meal for fish and vegetables, while snacks were the main contributing meal for fruit intake. For whole grains, breakfast was the main contributing meal. The main contributing meal did not change for any of the food groups when studying subgroups of the participants according to intake of each food group, educational level or age. A substantially lower intake of the food groups in question was found on days when the main contributing meal was skipped. CONCLUSIONS: Intakes of fruits, vegetables, fish and whole grains largely depend on one meal type. Inclusion of these foods in other meals in addition to the main contributing meal, preferably replacing energy-dense nutrient-poor foods, should be promoted.

Concentrations of phthalates and bisphenol A in Norwegian foods and beverages and estimated dietary exposure in adults.

Phthalates and bisphenol A (BPA) are ubiquitous in our environment. These chemicals have been characterized as endocrine disruptors that can cause functional impairment of development and reproduction. Processed and packaged foods are among the major sources of human exposure to these chemicals. No previous report showing the levels of these chemicals in food items purchased in Norway is available. The aim of the present study was to determine the concentration of ten different phthalates and BPA in foods and beverages purchased on the Norwegian market and estimate the daily dietary exposure in the Norwegian adult population. Commonly consumed foods and beverages in Norway were purchased in a grocery store and analysed using gas- and liquid chromatography coupled with mass spectrometry. Daily dietary exposures to these chemicals in the Norwegian adult population were estimated using the latest National dietary survey, Norkost 3 (2010-2011). This study showed that phthalates and BPA are found in all foods and beverages that are common to consume in Norway. The detection frequency of phthalates in the food items varied from 11% for dicyclohexyl phthalate (DCHP) to 84% for di-iso-nonyl phthalate (DiNP), one of the substitutes for bis(2-ethylhexyl) phthalate (DEHP). BPA was found in 54% of the food items analysed. Among the different phthalates, the highest concentrations were found for DEHP and DiNP in the food items. Estimated dietary exposures were also equally high and dominated by DEHP and DiNP (400-500 ng/kg body weight (bw)/day), followed by di-iso-butyl phthalate (DiBP), di-n-butyl phthalate (DnBP), di-n-octyl phthalate (DnOP) and di-iso-decyl phthalate (DiDP) (30-40 ng/kg bw/day). Dimethyl phthalate (DMP), diethylphthalate (DEP) and DCHP had the lowest concentrations and the exposures were around 10-20 ng/kg bw/day. Estimated dietary exposure to BPA was 5 ng/kg bw/day. In general, levels of phthalates and BPA in foods and beverages from the Norwegian market are comparable to other countries worldwide. Grain and meat products were the major contributors of exposure to these chemicals in the Norwegian adult population. The estimated dietary exposures to these chemicals were considerably lower than their respective tolerable daily intake (TDI) values established by the European Food Safety Authority (EFSA).

Eating location is associated with the nutritional quality of the diet in Norwegian adults.

OBJECTIVE: To study the association between dinner eating location and the nutritional quality of the specific dinner meal and the whole-day dietary intake and to compare the diets of those consuming ≥25% of energy out of home and at school/work (SOH; substantial out-of-home eaters) with those consuming <25% of energy out (NSOH; non-substantial out-of-home eaters). DESIGN: Cross-sectional dietary survey using two non-consecutive 24 h recalls. Recorded eating locations were at home, other private households, work/school, restaurant/cafeteria/fast-food outlet and travel/meeting. SETTING: Nationwide, Norway (2010-2011). SUBJECTS: Adults aged 18-70 years (n 1746). RESULTS: Dinners at restaurants and other private households were higher in energy than home dinners (P < 0.01). Restaurant dinners contained less fibre (g/MJ; P < 0.01) and had a higher percentage of alcohol consumers (P < 0.05), while dinners at other private households had a higher percentage of energy from sugar (P < 0.001) and a higher percentage of consumers of sugar-sweetened beverages (P < 0.05) than home dinners. Most differences between dinners consumed at different eating locations were also observed in dietary intakes for the whole day. SOH-eaters had a higher energy intake (P < 0.01), a higher percentage of energy from sugar (P < 0.01) and a lower fibre intake (P < 0.01) than NSOH-eaters. The percentages of consumers of alcohol and sugar-sweetened beverages were higher (P < 0.01) among SOH-eaters. CONCLUSIONS: Dinner eating location was significantly associated with the nutritional quality of the diet, both for the specific dinner meal and for whole-day intake. Our data generally point to healthier dinners being consumed at home. SOH-eaters had a less favourable dietary intake than NSOH-eaters.