A very-low-calorie diet (VLCD) intervention for the management of prediabetes and early Type 2 diabetes mellitus in a multi-ethnic cohort in Aotearoa New Zealand: The PROGRESS NZ feasibility study.

BACKGROUND AND OBJECTIVES: Very-low calorie diets (VLCD) achieve weight loss and remission of Type 2 diabetes (T2DM), but efficacy and acceptability in non-European populations is less clear. This feasibility study examines the impact of 10% weight loss through VLCD on metabolic and body composition outcomes in a multi-ethnic cohort of Aotearoa New Zealand (AoNZ) men with prediabetes/early T2DM, and VLCD tolerability/cultural acceptability. METHODS AND STUDY DESIGN: Participants followed a VLCD intervention (mean energy 3033kJ/day) until achievement of 10% weight loss. An oral glucose tolerance test (OGTT), hyperinsulinaemic isoglycaemic clamp with stable isotopes, hood calorimetry and dual-energy Xray absorptiometry (DXA) were undertaken before and after intervention. Qualitative data on VLCD tolerability/cultural acceptability were collected. RESULTS: Fifteen participants were enrolled; nine achieved 10% weight loss. In this group, mean HbA1c reduced by 4.8mmol/mol (2.4-7.1) and reverted to normoglycaemia in n=5/9; mean body weight reduced by 12.0 kg (11.0-13.1) and whole-body glucose disposal improved by 1.5 mg kgFFM-1 min-1 (0.7-2.2). Blood pressure and fasting triglycerides improved significantly. No changes in hepatic glu-cose metabolism were found. In all participants who attended completion testing, HbA1c reduced by 3.4mmol/mol (SD 3.5) and total weight by 9.0kg (SD 5.7). The intervention was highly tolerable/culturally acceptable however challenges with fulfilment of cultural obligations were described. CONCLUSIONS: Results support VLCD use in AoNZ however further work to investigate ethnic differences in physiological response to VLCDs and to optimise protocols for multi-ethnic populations are required.

Overnutrition, Hyperinsulinemia and Ectopic Fat: It Is Time for A Paradigm Shift in the Management of Type 2 Diabetes.

The worldwide incidence of prediabetes/type 2 has continued to rise the last 40 years. In the same period, the mean daily energy intake has increased, and the quality of food has significantly changed. The chronic exposure of pancreatic ß-cells to calorie excess (excessive energy intake) and food additives may increase pancreatic insulin secretion, decrease insulin pulses and/or reduce hepatic insulin clearance, thereby causing chronic hyperinsulinemia and peripheral insulin resistance. Chronic calorie excess and hyperinsulinemia may promote lipogenesis, inhibit lipolysis and increase lipid storage in adipocytes. In addition, calorie excess and hyperinsulinemia can induce insulin resistance and contribute to progressive and excessive ectopic fat accumulation in the liver and pancreas by the conversion of excess calories into fat. The personal fat threshold hypothesis proposes that in susceptible individuals, excessive ectopic fat accumulation may eventually lead to hepatic insulin receptor resistance, the loss of pancreatic insulin secretion, hyperglycemia and the development of frank type 2 diabetes. Thus, type 2 diabetes seems (partly) to be caused by hyperinsulinemia-induced excess ectopic fat accumulation in the liver and pancreas. Increasing evidence further shows that interventions (hypocaloric diet and/or bariatric surgery), which remove ectopic fat in the liver and pancreas by introducing a negative energy balance, can normalize insulin secretion and glucose tolerance and induce the sustained biochemical remission of type 2 diabetes. This pathophysiological insight may have major implications and may cause a paradigm shift in the management of type 2 diabetes: avoiding/reducing ectopic fat accumulation in the liver and pancreas may both be essential to prevent and cure type 2 diabetes.

Preoperative dietitian-led Very Low Calorie Diet (VLCD) Clinic for adults living with obesity undergoing gynaecology, laparoscopic cholecystectomy and hernia repair procedures: a pilot parallel randomised controlled trial.

Obesity can increase the risk of postoperative complications. Despite increased demand for patients living with obesity to lose weight prior to common surgical procedures, the impact of intentional weight loss on surgical outcomes is largely unknown. We aimed to conduct a pilot study to assess the feasibility of a full-scale randomised controlled trial (RCT) to examine the effect of preoperative dietitian-led Very Low Calorie Diet (VLCD) Clinic on surgical outcomes in gynaecology and general surgeries. Between August 2021 and January 2023, a convenience sample of adults living with obesity (BMI ≥ 30 kg/m2) awaiting gynaecology, laparoscopic cholecystectomy and ventral hernia repair procedures were randomised to dietitian-led VLCD (800-1000 kcal using meal replacements and allowed foods), or control (no dietary intervention), 2-12 weeks preoperatively. Primary outcome was feasibility (recruitment, adherence, safety, attendance, acceptability and quality of life (QoL)). Secondary outcomes were anthropometry and 30-d postoperative outcomes. Outcomes were analysed as intention-to-treat. Fifty-one participants were recruited (n 23 VLCD, n 28 control), mean 48 (sd 13) years, 86 % female, and mean BMI 35·8 (sd 4·6) kg/m2. Recruitment was disrupted by COVID-19, but other thresholds for feasibility were met for VLCD group: high adherence without unfavourable body composition change, high acceptability, improved pre/post QoL (22·1 ± 15 points, < 0·001), with greater reductions in weight (-5·5 kg VLCD v. -0·9 kg control, P < 0·05) waist circumference (-6·6 cm VLCD v. +0·6 control, P < 0·05) and fewer 30-d complications (n 4/21) than controls (n 8/22) (P > 0·05). The RCT study design was deemed feasible in a public hospital setting. The dietitian-led VLCD resulted in significant weight loss and waist circumference reduction compared with a control group, without unfavourable body composition change and improved QoL.

The Effect of a Very-Low-Calorie Diet (VLCD) vs. a Moderate Energy Deficit Diet in Obese Women with Polycystic Ovary Syndrome (PCOS)-A Randomised Controlled Trial.

We performed an open-label, randomised controlled trial to compare the effects of a very-low-calorie diet (VLCD) vs. moderate energy deficit approach on body weight, body composition, free androgen index (FAI), and metabolic markers in obese women with polycystic ovary syndrome (PCOS). Forty eligible patients were randomly assigned to a VLCD (n = 21) or a conventional energy deficit approach (n = 19) over the same period. After eight weeks, both groups experienced significant weight loss; however, this was greater in the VLCD arm (-10.9% vs. -3.9%, p < 0.0001). There was also a trend towards a reduction in FAI in the VLCD group compared to the energy deficit group (-32.3% vs. -7.7%, p = 0.07). In the VLCD arm, two women (18%) had a biochemical remission of PCOS (FAI < 4); this was not the case for any of the participants in the energy deficit arm. There was a significant within-group increase in the sex-hormone-binding globulin (p = 0.002) and reductions in fasting blood glucose (p = 0.010) and waist to hip ratio (p = 0.04) in the VLCD arm, but not in the energy deficit arm. The VLCD resulted in significantly greater weight reduction and was accompanied by more pronounced improvements in hyperandrogenaemia, body composition, and several metabolic parameters in obese women with PCOS as compared to the energy deficit approach.

Postmenopausal women's experiences of weight maintenance following a very low energy diet.

Introduction: Very low energy diets (VLEDs) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. There is a belief that such diets do not teach the lifestyle behavior changes needed for long-term weight maintenance. However, little is known about the lived experiences of people who have lost weight on a VLED in the long term. Methods: This study aimed to explore the behaviors and experiences of postmenopausal women who had followed a 4-month VLED (using total meal replacement products [MRPs]), followed by a food-based, moderately energy-restricted diet for an additional 8 months, as part of the TEMPO Diet Trial. Qualitative in-depth semi-structured interviews were conducted with 15 participants at 12 or 24 months (i.e., at 8 or 20 months post diet completion). Transcribed interviews were analyzed thematically using an inductive approach. Results: Undertaking a VLED was reported by participants to confer advantages in weight maintenance that previous weight loss attempts had not been able to do for them. Firstly, the rapid and significant weight loss, in conjunction with ease of use, was motivational and helped instill confidence in the participants. Secondly, the cessation of a normal diet during the VLED was reported by participants to break weight gain-inducing habits, allowing them to abandon unhelpful habits and to introduce in their place more appropriate attitudes toward weight maintenance. Lastly, the new identity, helpful habits and increased self-efficacy around weight loss supported participants during weight maintenance. Additionally, participants reported that ongoing occasional use of MRPs provided a useful and easy new strategy for countering weight regain and supporting their weight maintenance regimen. Conclusion: Among the participants in this qualitative study, most of whom had maintained a loss of over 10% of their baseline body weight at the time of interview, using a VLED in the context of a clinical weight loss trial conferred confidence, motivation and skills for weight maintenance. These findings indicate that VLEDs with clinical support could be successfully leveraged to set up behaviors that will support weight maintenance in the long term.

Comparison of Weight Reduction, Change in Parameters and Safety of a Very Low Carbohydrate Diet in Comparison to a Low Carbohydrate Diet in Obese Japanese Subjects with Metabolic Disorders.

Recently, low-carbohydrate diets (LCDs) have gained worldwide attention. LCDs are potentially effective for Japanese overweight and obese individuals with metabolic disorders. However, few randomized trials of LCDs have focused on the difference between LCDs and VLCDs. We conducted a randomized, prospective study of 42 Japanese, obese adults aged 28-65 years to evaluate the efficacy and safety of LCD and VLCD. To ensure the accuracy of the study, all test meals were provided, and compliance was checked using a smartphone app. Body composition measurements and blood tests were performed before and after the 2-month dietary intervention. The results showed that both methods significantly reduced body weight and fat, and also improved lipid abnormalities and liver function. In the current study, the reductions in weight and fat were comparable. The results of a questionnaire at the end of the study indicated that the LCD was easier to carry out than the VLCD, suggesting that the LCD was sustainable. The present study was unique in that it was a randomized, prospective study of Japanese subjects and that accurate data were obtained by providing meals.

The relationship between preoperative weight loss and intra and post-bariatric surgery complications: an appraisal of the current preoperative nutritional strategies.

Preoperative weight loss before a bariatric surgery reduces long-term complications, but there is no solid evidence for short-term or perioperative complications. This review highlights recent evidence on dietary protocols and the possible correlation between weight loss and surgical complications. Updated evidence was searched in PubMedDirect with the terms "preoperative very low-calorie diet or very-low-calorie ketogenic diet or low-fat diet or intermittent fasting or Mediterranean diet and bariatric surgery or bariatric surgery complications." The main characteristics of each diet, achievements related to weight loss, liver reduction, peri and postoperative outcomes, surgical complications, tolerance, and adherence to the diet are presented from the selected studies. There are few reports about the Mediterranean diet as a strategy to reach these goals. The VLCKD has been associated with better body weight reduction and lesser postoperative complications risk. However, the results in animal models are still controversial. When comparing VLCD with an LCD, there is no apparent superiority between one against the other one. However, LCD has shown better tolerance and adherence than VLCD. There is still a need for more controlled studies to define the best preoperative dietary treatment for weight loss before bariatric surgery since there are controversial positions regarding this issue.

Italian Ketogenic Mediterranean Diet in Overweight and Obese Patients with Prediabetes or Type 2 Diabetes.

Obesity is a multifactorial disease strongly associated with insulin resistance and/or type 2 diabetes mellitus. Correct nutrition represents a valid strategy to fight these dysmetabolic pathologies responsible for numerous diseases, including inflammatory and cardiovascular ones. Medical nutrition therapy, including a Mediterranean diet (MD) and a very low-calorie ketogenic diet (VLKCD), is the first-line treatment for prediabetes/diabetes and overweight/obesity. Eighty patients (forty women and forty men) affected by overweight/obesity and type 2 diabetes mellitus or impaired glucose tolerance or impaired fasting glucose (51 (ys) ± 1.75; BMI (kg/m2) 33.08 ± 1.93; HA1c (%): 6.8% ± 0.25) were enrolled at the University Service of Diet Therapy, Diabetology and Metabolic Diseases, Policlinico Riuniti Hospital of Foggia, and subjected to a very-low-calorie Mediterranean diet and a very-low-calorie ketogenic Mediterranean diet for thirty days. Both diets result in a marked decrease in body weight (kg) and BMI (kg/m2). At the same time, only the very-low-calories ketogenic Mediterranean diet reduced waist and hip circumferences. Both diets helped reduce fat mass, but a major loss was achieved in a very low-calorie ketogenic Mediterranean diet. Among gluco-metabolic parameters, only the very-low-calorie ketogenic Mediterranean diet group showed a significant decrease in fasting blood glucose and HbA1c, insulin, C-peptide total cholesterol, LDL, and triglycerides. The results of our study seem to show that the very-low-calorie ketogenic Mediterranean diet is a good strategy to improve rapidly metabolic, anthropometric, and body composition parameters in patients with prediabetes or diabetes and overweight/obesity.

What Is the Optimal Time on a Low-Calorie Diet Prior to Laparoscopic Anti-reflux Surgery? A Prospective Case-Controlled Study.

INTRODUCTION: A very low-calorie diet (VLCD) or low-calorie diet (LCD) is often used prior to laparoscopic surgery to optimize access to the hiatus. Much debate exists in the literature regarding the required duration for a VLCD or LCD, and how to evaluate the presence of a fatty liver. The aim of our study was to determine the optimal amount of time on an LCD to achieve maximal liver volume reduction, and to assess the accuracy of the InBody 230® vs. bedside ultrasonography vs. magnetic resonance imaging (MRI) in the measurement of liver volume. METHODS: Seventeen consecutive patients undergoing laparoscopic anti-reflux surgery were recruited into the study. Each patient underwent body composition analysis with the InBody® 230, liver ultrasound, and liver MRI. Patients then began an LCD with a weekly ultrasound assessment until the day before surgery when they underwent repeat body composition analysis, liver ultrasound, and MRI. RESULTS: The mean age was 54 years (range 21, 74). Maximal liver volume loss was noted within 3 weeks for 88% of participants, with 47% achieving their maximal liver volume reduction after the first week of an LCD. The mean reduction in liver volume was 16%, 18.6%, and 19% for MRI, ultrasound, and body composition analysis, respectively. CONCLUSION: Close to 90% of patients require 3 weeks or less on an LCD to achieve maximal liver volume loss prior to laparoscopic anti-reflux surgery. Body composition analysis and bedside ultrasonography were both as accurate as the gold standard MRI in the assessment of liver volume.

Changes in anthropometric, biochemical, oxidative, and DNA damage parameters after 3-weeks-567-kcal-hospital-controlled-VLCD in severely obese patients with BMI ≥ 35 kg m-2.

BACKGROUND & AIMS: Severe obesity and its comorbidities relate to increased genomic instability/cancer risk. Obesity in Croatia is rapidly increasing, and long diets are sometimes the reason for obese to quit health improvement programs. A shorter diet with more strict calorie reduction could also lead to weight reduction and health improvements, but data are scarce. We tested for the first time if a very low-calorie diet (VLCD) can improve anthropometric, biochemical and genomic stability parameters in severely obese with BMI ≥ 35 kg m-2. METHODS: 22 participants were chosen among those regularly attending the hospital for obesity control, with no other previous treatment for bodyweight reduction. Under 24 h medical surveillance, patients received 3-weeks-567-kcal-hospital-controlled-VLCD composed of 50-60% complex carbohydrates, 20-25% proteins, and 25-30% fat, with the attention to food carbo-glycemic index, in 3 meals freshly prepared in hospital. We analyzed changes in body weight, BMI, basal metabolism rate, waist-hip ratio, visceral fat level, body fat mass, percent body fat, skeletal muscle mass, basal metabolism, energy intake, lipid profile, thyroid hormones, TSH, and genomic instability (alkaline and oxidative FPG comet assay) before and on the last VLCD day. RESULTS: Diet caused BMI reduction (in average 3-4 BMI units' loss), excessive weight loss (between 10 and 35%), significant weight loss (average 9 kg, range 4.8-14.4 kg) and a significant decrease in glucose, insulin, urea, cholesterol, HDL-c, LDL-c, oxidative (FPG) and DNA damage (alkaline comet assay) levels. CONCLUSIONS: The diet can lead to ≥10% excessive weight loss, significant health, and genomic stability improvement, and keep severely obese interest in maintaining healthy habits. The study was registered at ClinicalTrials.gov as NCT05007171 (10.08.2021).

Elective Surgery in Adult Patients with Excess Weight: Can Preoperative Dietary Interventions Improve Surgical Outcomes? A Systematic Review.

This systematic review summarises the literature regarding the impact of preoperative dietary interventions on non-bariatric surgery outcomes for patients with excess weight/obesity, a known risk factor for poor surgical outcomes. Four electronic databases were searched for non-bariatric surgery studies that evaluated the surgical outcomes of a preoperative diet that focused on weight/fat loss or improvement of liver steatosis. Meta-analysis was unfeasible due to the extreme heterogeneity of variables. Fourteen studies, including five randomised controlled trials, were selected. Laparoscopic cholecystectomy, hernia repair, and liver resection were most studied. Diet-induced weight loss ranged from 1.4 kg to 25 kg. Preoperative very low calorie diet (≤800 kcal) or low calorie diet (≤900 kcal) for one to three weeks resulted in: reduction in blood loss for two liver resection and one gastrectomy study (-27 to -411 mL, p < 0.05), and for laparoscopic cholecystectomy, reduction of six minutes in operating time (p < 0.05) and reduced difficulty of aspects of procedure (p < 0.05). There was no difference in length of stay (n = 7 studies). Preoperative ≤ 900 kcal diets for one to three weeks could improve surgical outcomes for laparoscopic cholecystectomy, liver resection, and gastrectomy. Multiple randomised controlled trials with common surgical outcomes are required to establish impact on other surgeries.

The Potential Roles of Very Low Calorie, Very Low Calorie Ketogenic Diets and Very Low Carbohydrate Diets on the Gut Microbiota Composition.

Several studies have described a strong correlation between diet, weight loss, and gut microbiota composition. The aim of this review was to evaluate the potential effects of energy-restricted diets, namely very low calorie diets (VLCDs), very low calorie ketogenic diets (VLCKDs), and very low carbohydrate diets (VLCarbDs), on the composition of the gut microbiota in humans. We performed a literature search using the following terms (with their abbreviations or acronyms): "very low calorie diet", "very low calorie ketogenic diet", "very low carbohydrate diet", and "gut microbiota". Our search strategy retrieved nine eligible studies. Overall, VLCDs and VLCarbDs affected the Bacteroidetes to Firmicutes ratio in obese patients, leading to a reduction in short-chain fatty acid production by fecal microbiota associated with Clostridial cluster XIVa. This reduction particularly affected Roseburia and Eubacterium rectale, the two most abundant butyrate-producing bacteria in human feces. VLCKDs preserved the core fecal microbiome, but altered the composition of fecal microbial populations in relation to the plasma metabolome and fecal bile acid composition. In particular, VLCKD-induced weight loss resulted in a reduction in E. rectale and Roseburia, an increase in Christensenellaceae and Akkermansia while not all studies show a decrease in Faecalibacterium prausnitzii. Although very few studies have analyzed the effects of VLCarbDs and VLCDs on gut microbiota, significant diet-induced changes in fecal microbiota composition have been observed. Further studies are needed.

Corrigendum: The Potential Roles of Very Low Calorie, Very Low Calorie Ketogenic Diets and Very Low Carbohydrate Diets on the Gut Microbiota Composition.

[This corrects the article DOI: 10.3389/fendo.2021.662591.].

Efficacy of a dietitian-led very low calorie diet (VLCD) based model of care to facilitate weight loss for obese patients prior to elective, non-bariatric surgery.

BACKGROUND: Elective surgery in obese adults carries a higher risk of post-operative infection and prolonged hospital stays, and surgeons may postpone surgery for patients with obesity until they lose weight. The present study aimed to determine the efficacy of a dietitian-led very low calorie diet (VLCD)-based model of care with respect to achieving weight loss for obese patients prior to surgery. METHODS: This mixed-methods study included a medical chart audit of patients referred to a VLCD-based model over 23 months, as well as a survey of recently treated patients and surgeons who utilised the model. Preoperative weight loss targets were set by surgeons, and the dietitian prescribed individualised VLCD-based treatment. Efficacy was determined as weight loss considered sufficient for surgery, clinical safety of VLCD-based treatment, feasibility, and stakeholder value. Pre/post-intervention differences in clinical measures were explored by paired t-test or Wilcoxon tests as appropriate. RESULTS: Data on seventy-eight eligible patients [mean (SD) 45 (13) years, 90% female, body mass index 44.3 (6.2) kg m-2 ] demonstrated significant mean (SD) weight loss of 7.4% (5.3%) body weight (P < 0.05). Most patients (70%, n = 50/71) achieved sufficient weight loss to proceed to surgery. Fifty-six per cent of patients reported mild side effects (n = 43/77) and none led to treatment cessation. Surgeons reported VLCD-based treatment made operations easier (83%, n = 10/12) and shorter (75%, n = 9/12) and all recommended the model of care. All surveyed patients (n = 24) reported satisfaction with their VLCD-based model experience. CONCLUSIONS: A dietitian-led VLCD-based model achieved sufficient weight loss to facilitate elective surgery for most patients. The approach was feasible, highly valued by patients and surgeons, and resulted in perceived surgical benefits.

Resolution of Metabolic syndrome with reduction of visceral adipose tissue in a 47 year old patient with Type 2 Diabetes Mellitus.

BACKGROUND AND AIMS: Metabolic syndrome (MetS), defined as a cluster of metabolic abnormalities including visceral adiposity, insulin resistance, hypertension, and dyslipidemia, now affects more than a third of adults in the United States highlighting the need for effective complementary approaches to current treatments. METHODS: We present a case report of a 47-year-old man with a history of MetS and poorly controlled Type 2 Diabetes Mellitus (T2D) who completed a 20Lighter program (20L) including a very low calorie diet (VLCD). At the time of enrollment his BMI was 32.7, HbA1c was 9.6%, and prescription medication history included lisinopril, lovastatin, and metformin, glimepiride, and combination sitagliptin/metformin. RESULTS: Fifteen weeks after beginning 20L (6 weeks after program completion) marked reduction of weight, visceral adipose tissue and normalization of HbA1C was seen, and all medications were withdrawn. CONCLUSIONS: While longer follow-up is required, this case report shows that a comprehensive program including a relatively short period of nutritionally complete VLCD, followed by gradual return to moderate dietary lifestyle is capable of producing clinically significant improvements in health and quality of life in individuals with MetS and poorly controlled T2D.

Implementation of a very low calorie diet program into the pre-operative model of care for obese general elective surgery patients: Outcomes of a feasibility randomised control trial.

AIM: The present article aimed to evaluate the feasibility of implementing a very low calorie diet (VLCD) weight loss program into the pre-operative model of care for elective general surgery patients with obesity. METHODS: A prospective, randomised control trial of adults with obesity awaiting elective general surgery was conducted at an outpatient clinic at a tertiary hospital. Patients were randomised to the intervention group, an 8-week VLCD program incorporating Optifast (Nestle Health, Germany) shakes, or to standard care (generic healthy eating information). Data were collected at baseline, week 8 and at 30 days post-surgery. The primary outcome of the study was feasibility, which was evaluated through demand, practicality, integration and acceptability measures. RESULTS: Forty-six participants (M 17: F 23, mean age 51.6 (13.1) years) with a mean body mass index ≥ 30 kg/m2 (40.5 kg/m2 (5.9)) were recruited. There was a higher mean weight loss in the intervention group (n = 23) compared to the control group (n = 14) (-6.5 vs +0.15 kg; P = <.001), with no excessive loss of muscle mass (MM), measured by bioelectrical impedance analysis. The reduction in waist circumference was greater for the intervention (n = 21) compared to control group (n = 5) (-6.11 vs +1.36 cm; P = .003). Quality of life increased significantly in the intervention group (P < .001). CONCLUSIONS: The pre-operative VLCD program produced clinically meaningful rapid weight loss pre-surgery and improved quality of life without an excessive loss of MM.

Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients With Obesity and Mild Kidney Failure.

Very low-calorie ketogenic diets (VLCKD) are an effective and increasingly used tool for weight loss. Traditionally considered high protein, ketogenic diets are often looked at with concern by clinicians due to the potential harm they pose to kidney function. We herein evaluated the efficacy and safety of a VLCKD in patients with obesity and mild kidney failure. A prospective observational real-life study was conducted on ninety-two patients following a VLCKD for approximately 3 months. Thirty-eight had mild kidney failure and fifty-four had no renal condition and were therefore designated as control. Anthropometric parameters, bioelectrical impedance and biochemistry data were collected before and at the end of the dietary intervention. The average weight loss was nearly 20% of initial weight, with a significant reduction in fat mass. We report an improvement of metabolic parameters and no clinically relevant variation regarding liver and kidney function. Upon stratification based on kidney function, no differences in the efficacy and safety outcomes were found. Interestingly, 27.7% of patients with mild renal failure reported normalization of glomerular filtrate after dietary intervention. We conclude that, when conducted under the supervision of healthcare professionals, a VLCKD is an effective and safe treatment for weight loss in patients with obesity, including those affected by mild kidney failure.

Effect of a Whey Protein Supplement on Preservation of Fat Free Mass in Overweight and Obese Individuals on an Energy Restricted Very Low Caloric Diet.

The obesity epidemic has caused a widespread interest in strategies to achieve a healthy "high quality" weight loss, where excess fat is lost, while fat free mass (FFM) is preserved. In this study, we aimed to examine the effect of whey protein supplementation given before night sleep on FFM preservation during a 4-week (wk) period on a very low caloric diet (VLCD). Twenty-nine obese subjects (body mass index (BMI) > 28 kg/m²) completed a 4-week intervention including a VLCD and a walking program (30 min walking × 5 times per week). Subjects were randomly assigned to either control (CON, n = 15) or a whey protein supplement (PRO, 0.4 g protein/kg/day, n = 14), ingested before bedtime. Body composition (dual-energy X-ray absorptiometry, DXA), blood analysis and physical test were performed pre and post intervention. We measured nitrogen excretion in three 24 h urine collections (Day 0, 7 and 28) to assess nitrogen balance. Changes in nitrogen balance (NB) after 7 and 28 days was different between treatment groups (interaction p < 0.05). PRO was in NB after 7 days and in positive NB at day 28. In contrast, CON was in negative NB at day 7, but in NB at day 28. Nevertheless, no significant group differences were observed in the change in pre- and post-FFM measurements (-2.5 kg, [95% CI: 1.9; 3.1], p = 0.65). In conclusion, ingestion of a whey protein supplement before bedtime during a 4-week period on a VLCD improved nitrogen balance, but did not lead to any significant improvement in the quality of the weight loss in regard to observed changes in body composition and health parameters compared with controls.

The Impact of Self-Reported Impulsivity on the Course of Weight Is Mediated by Disinhibited Eating.

This study investigates the impact of impulsivity and the mediating role of disinhibited eating behaviour (DEB) on weight and weight trajectories in a large data set including obese non-treatment seeking individuals (obese control, n = 138) and obese individuals who were either receiving a conventional treatment program (n = 227) or bariatric surgery (n = 123). Data was assessed one, 4 and 9 years after baseline including self-reports for impulsivity and DEB. Results suggest a significant association between impulsivity and body mass index, which is partially mediated by DEB. Longitudinally, the influence of impulsivity on the course of weight after 9 years was fully mediated by DEB in obese control but not in the treatment groups. The results indicate an interplay between impulsivity and DEB with respect to obesity. Further research is needed to clarify how the mediation works and when it exerts its effect, in order to identify those that might profit from a specific (impulsivity-reducing) training. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Impact of Bariatric Surgical Intervention on Peripheral Blood Neutrophil (PBN) Function in Obesity.

AIM: The aim of this study was to investigate the impact of weight loss following gastric band surgery on multiple measures of peripheral blood neutrophil (PBN) function. MATERIAL AND METHODS: Twenty-three obese patients undergoing gastric band surgery were recruited to a longitudinal intervention study, alongside non-obese, healthy gender- and age-matched controls. Eighteen pairs of patients and controls completed all stages of the study. PBNs were isolated by density centrifugation and a comprehensive analysis of PBN function was undertaken at various stages of the patients' bariatric surgical care pathway. RESULTS: Obese patients exhibited exaggerated PBN activity in response to various stimuli, characterised by higher reactive oxygen species (ROS) generation (n = 18, p < 0.001) and release of pro-inflammatory cytokines (n = 10, p < 0.05) and lower PBN extracellular trap (NET) formation (n = 18, p < 0.01). PBN chemotactic accuracy was also impaired prior to surgery (n = 18, p < 0.01). Weight loss was associated with normalised NET production and lower ROS production and cytokine release relative to healthy controls. However, chemotactic accuracy remained impaired in patients. CONCLUSIONS: Weight loss following gastric band surgery was associated with a decrease in the pro-inflammatory activities of peripheral blood neutrophils (PBNs). A hyper-inflammatory PBN phenotype, involving excess ROS and cytokine release, reduced NET formation and chemotaxis, may lead to a reduced ability to eliminate infection, alongside inflammation-mediated tissue damage in obese individuals.