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Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance

Weight loss and subsequent body weight maintenance are difficult for obese individuals despite the wide variety of dietary regimens and approaches. A substantial body of scientific evidence has shown that by simply varying the macronutrient distribution and composition of dietary factors, weight losses of varying amounts, longer-term body weight maintenance periods, better appetite regulation, and changes in features of the metabolic syndrome can be achieved. At present, renewed efforts are underway to increase the protein content of weight-loss diets, simultaneously restrict fat consumption to no more than 30%, favor polyunsaturated fat, have carbohydrates account for between 40 and 50% of total energy intake, and promote the consumption of low-glycemic foods. The present article reviews the scientific evidence for the effects of several dietary manipulations and sustainable strategies for weight loss and body weight stability as well as for treating specific features of the metabolic syndrome.

A dual epigenomic approach for the search of obesity biomarkers: DNA methylation in relation to diet-induced weight loss

Epigenetics could help to explain individual differences in weight loss after an energy‐restriction intervention. Here, we identify novel potential epigenetic biomarkers of weight loss, comparing DNA methylation patterns of high and low responders to a hypocaloric diet. Twenty‐five overweight or obese men participated in an 8‐wk caloric restriction intervention. DNA was isolated from peripheral blood mononuclear cells and treated with bisulfite. The basal and endpoint epigenetic differences between high and low responders were analyzed by methylation microarray, which was also useful in comparing epigenetic changes due to the nutrition intervention. Subsequently, MALDI‐TOF mass spectrometry was used to validate several relevant CpGs and the surrounding regions. DNA methylation levels in several CpGs located in the ATP10A and CD44 genes showed statistical baseline differences depending on the weight‐loss outcome. At the treatment endpoint, DNA methylation levels of several CpGs on the WT1 promoter were statistically more methylated in the high than in the low responders. Finally, different CpG sites from WT1 and ATP10A were significantly modified as a result of the intervention. In summary, hypocaloricdiet‐induced weight loss in humans could alter DNA methylation status of specific genes. Moreover, baseline DNA methylation patterns may be used as epigenetic markers that could help to predict weight loss.—Milagro, F. I., Campion, J., Cordero, P., Goyenechea, E., Gómez‐Uriz, A. M., Abete, I., Zulet, M. A., Martínez, J. A. A dual epigenomic approach for the search of obesity biomarkers: DNA methylation in relation to diet‐induced weight loss. FASEB J. 25, 1378–1389 (2011). www.fasebj.org

Obesity and metabolic syndrome: potential benefit from specific nutritional components.

The prevalence of metabolic syndrome (MetS) manifestations is rapidly increasing worldwide, and is becoming an important health problem. Actually, MetS includes a combination of clinical complications such as obesity (central adiposity), insulin resistance, glucose intolerance, dyslipidemia, non-alcoholic fatty liver disease and hypertension. All these alterations predispose individuals to type 2 diabetes and cardiovascular disease inducing earlier mortality rates among people. In general terms, it is difficult for patients to follow a standard long-term diet/exercise regime that would improve or alleviate MetS symptoms. Thus, the investigation of food components that may deal with the MetS features is an important field for ameliorate and facilitate MetS dietary-based therapies. Currently antioxidants are of great interest due to the described association between obesity, cardiovascular alterations and oxidative stress. On the other hand, high MUFA and PUFA diets are being also considered due to their potential benefits on hypertension, insulin resistance and triglyceride levels. Mineral composition of the diet is also relevant since high potassium intake may improve hypertension and high calcium consumption may promote lipid oxidation. Thus, although nutritional supplements are at the peak of dietetic therapies, the consumption of some specific foods (legumes, fatty fish, vegetables and fruits, etc) with bioactive components within an energy-restricted diet is a promising approach to manage MetS manifestations. Therefore, the present review focuses on some of the most important food components currently investigated to improve and make easier the nutritional MetS treatment.

Starches, sugars and obesity.

The rising prevalence of obesity, not only in adults but also in children and adolescents, is one of the most important public health problems in developed and developing countries. As one possible way to tackle obesity, a great interest has been stimulated in understanding the relationship between different types of dietary carbohydrate and appetite regulation, body weight and body composition. The present article reviews the conclusions from recent reviews and meta-analyses on the effects of different starches and sugars on body weight management and metabolic disturbances, and provides an update of the most recent studies on this topic. From the literature reviewed in this paper, potential beneficial effects of intake of starchy foods, especially those containing slowly-digestible and resistant starches, and potential detrimental effects of high intakes of fructose become apparent. This supports the intake of whole grains, legumes and vegetables, which contain more appropriate sources of carbohydrates associated with reduced risk of cardiovascular and other chronic diseases, rather than foods rich in sugars, especially in the form of sugar-sweetened beverages.

Weight Regain after a Diet-Induced Loss Is Predicted by Higher Baseline Leptin and Lower Ghrelin Plasma Levels

CONTEXT Appetite-related hormones may play an important role in weight regain after obesity therapy. OBJECTIVE Our objective was to investigate the potential involvement of ghrelin, leptin, and insulin plasma levels in weight regain after a therapeutic hypocaloric diet. DESIGN A group of obese/overweight volunteers (49 women and 55 men; 35 ± 7 yr; 30.7 ± 2.4 kg/m(2)) followed an 8-wk hypocaloric diet (-30% energy expenditure) and were evaluated again 32 wk after treatment. Body weight as well as plasma fasting ghrelin, leptin, and insulin concentrations were measured at three points (wk 0, 8, and 32). RESULTS After the 8-wk hypocaloric diet, the average weight loss was -5.0 ± 2.2% (P < 0.001). Plasma leptin and insulin concentrations decreased significantly, whereas ghrelin levels did not markedly change. In the group regaining more than 10% of the weight loss, leptin levels were higher (P < 0.01), whereas ghrelin levels were lower (P < 0.05). No differences were observed in insulin levels. Weight regain at wk 32 was negatively correlated with ghrelin and positively associated with leptin levels at baseline (wk 0) and endpoint (wk 8). These outcomes showed a gender-specific influence, being statistically significant among men for ghrelin and between women for leptin. Moreover, a decrease in ghrelin after an 8-wk hypocaloric diet was related to an increased risk for weight regain (odds ratio = 3.109; P = 0.008) whereas a greater reduction in leptin (odds ratio = 0.141; P = 0.001) was related to weight-loss maintenance. CONCLUSIONS Subjects with higher plasma leptin and lower ghrelin levels at baseline could be more prone to regain lost weight, and hormones levels could be proposed as biomarkers for predicting obesity-treatment outcomes.

Energy-restricted diets based on a distinct food selection affecting the glycemic index induce different weight loss and oxidative response

BACKGROUND & AIMS Low glycemic index (GI) based diets could influence the accompanying physiological adaptations to energy restriction in the treatment of obesity. It was aimed to investigate the effects of two energy-restricted diets with different food distribution and GI values on weight loss and energy metabolism in the nutritional treatment of obesity. SUBJECTS AND METHODS Participants (n=32; BMI: 32.5+/-4.3 kg/m(2)) were randomly assigned to follow two energy-restricted diets with higher-GI or lower-GI for 8 weeks. The energy restriction was -30% in relation to energy expenditure. Anthropometry, energy expenditure and mitochondrial oxidation were assessed at baseline and at the endpoint of the intervention. Body weight was also measured one year after the treatment. The work was approved by the ethical committees of the University of Navarra (54/2006). RESULTS Volunteers consuming the lower-GI diet showed a significantly higher weight loss than their counterparts (-5.3+/-2.6% vs -7.5+/-2.9%; p=0.032), although the decrease in resting energy expenditure (REE) was similar between groups (p=0.783). Mitochondrial oxidation was significantly affected by the type of diet (p=0.001), being activated after the lower-GI treatment (p=0.022). Interestingly, one year after the nutritional intervention weight regain was only statistically significant in the higher-GI group (p=0.033). CONCLUSIONS Lower-GI energy-restricted diets achieved through a specific differential food selection can improve the energy adaptations during obesity treatment, favouring weight loss and probably weight maintenance compared with higher-GI hypocaloric diets.

A hypocaloric diet enriched in legumes specifically mitigates lipid peroxidation in obese subjects

Legume intake could specifically protect against lipid peroxidation in addition to the effects associated to weight loss when included in hypocaloric diets. Thus, 30 obese subjects (age: 36 ± 8 years and BMI: 32.0 ± 5.3 kg/m2) were nutritionally treated by a 8-week energy restriction ( − 30% energy expenditure) with a legume enriched diet (4 days/week servings, ) or without legumes (control diet (CD), ). Body weight, circulating cholesterol, oxidized LDL (ox-LDL), malondialdehyde (MDA) and urinary 8-isoprostane F2α (8-iso-PGF2α) were measured at baseline and at endpoint. After the nutritional intervention, all obese subjects lost weight, specially those individuals who followed the legumes-enriched diet as compared to the CD ( − 7.7 ± 3 vs. − 5.3 ± 2.7%; p = 0.023), which was accompanied by marked decreases in total cholesterol levels (p < 0.001) and statistically significant diet-related reductions on plasma ox-LDL, plasma MDA and urinary 8-iso-PGF2α output. Therefore, a balanced diet with moderate caloric restriction including 4 day/week legume servings empowered the oxidative stress improvement related to weight loss through a reduction in lipid peroxidation as compared to a control hypocaloric diet.

Legume-, Fish-, or High-Protein-Based Hypocaloric Diets: Effects on Weight Loss and Mitochondrial Oxidation in Obese Men

The nutritional composition of dietary intake could produce specific effects on metabolic variables such as mitochondrial oxidation, whose understanding could contribute to apply more individualized weight-lowering strategies. This study assessed the effects of four hypocaloric diets with high protein content or different food distribution on metabolic changes and mitochondrial oxidation accompanying weight loss. Thirty-five obese men (body mass index of 31.8 +/- 3.0 kg/m(2) and 38 +/- 7 years old) were randomly assigned to one of the four treatments (8 weeks): control diet (C-diet); legume diet (L-diet); fatty fish diet (FF-diet); or high-protein diet (HP-diet). Body composition, blood pressure, resting energy expenditure, mitochondrial oxidation, blood biomarkers, and dietary intake were assessed. The HP-diet and L-diet achieved the greater body weight reduction (-8.4 +/- 1.2% and -8.3 +/- 2.9%, respectively), as compared to the C-diet (-5.5 +/- 2.5%; P = .042). The high-density lipoprotein cholesterol concentrations were reduced in all dietary groups except for the FF-diet. Total and low-density lipoprotein cholesterol levels were significantly improved by the L-diet (P < .05), while the homeostatic model assessment index of insulin resistance value was significantly reduced in those men following the HP-diet. Mitochondrial oxidation was specifically activated by the HP-diet and L-diet at the end of the study. Interestingly, a lineal regression model explained about 25% (P = .029) of the mitochondrial oxidation variability as influenced by the diet changes once adjusted by resting energy expenditure. The specific consumption of legumes or high protein content within a hypocaloric diet could activate mitochondrial oxidation, which could involve additional benefits to those associated with the weight reduction.

Different dietary strategies for weight loss in obesity: role of energy and macronutrient content.

Obesity is a chronic disorder caused by an imbalance of the energy metabolism with high associated burdens. Therefore, huge efforts are being currently devoted in studying new types of hypoenergetic diets and their composition, in order to characterise more specific, long-lasting and safe slimming protocols. A number of investigations are trying to determine the specific influence of the macronutrient distribution in energy-restricted diets on the management of excessive body weight. In this context, very-low-energy diets supplying between 1670 and 3350 kJ (400 and 800 kcal)/d have been beneficial in short-term treatments causing a weight loss of 300-500 g/d. Such strategies place more emphasis on energy restriction than on the macronutrient composition of the diet prescription. Weight loss produced by either low-carbohydrate or low-fat moderately energy-restricted diets ranges from 0.5 to 1.0 kg/week, while diets with high or moderately high protein content have also been applied in weight-reducing programmes by inducing losses of 0.2-0.4 kg/week. Other factors that determine weight loss by dieting are sex, age, initial body weight, race, genetics, regional fat deposition, etc, which must be taken into account to explain the variability in the outcomes of different low-energy diets. Therefore, more research is needed about the impact of diets with different fuel substrates and foods on the characteristics of the weight-loss process.

Specific insulin sensitivity and leptin responses to a nutritional treatment of obesity via a combination of energy restriction and fatty fish intake

BACKGROUND Nutritional strategies to treat obesity often influence neuroendocrine factors related to body weight control. The present study aimed to investigate whether the inclusion of three fatty fish servings per week within a hypocaloric diet may have specific healthy effects on insulin and leptin functions. METHODS Thirty-two subjects (body mass index = 31.6 +/- 3.5 kg m(-2)) aged 36 +/- 7 years, were assigned to a control or fish-based energy-restricted diet over an 8-week period. Anthropometry, body composition, lipid profile, leptin and insulin values were measured at the start and at the end of the dietary intervention. RESULTS Both experimental diets resulted in a similar mean weight loss (control = 5.3 +/- 2.6% versus fish-based = 5.5 +/- 2.5%; P = 0.783). A significant reduction in insulin resistance, as determined by the homeostatic model assessment index (HOMA-IR = insulin x glucose/22.5), was observed after the fish-based intervention. The change in circulating leptin was higher in the fish-based diet compared to the control group. Sixteen percent of the variability in the change of adjusted-leptin could be explained (P = 0.034) by the HOMA index change and the type of diet. CONCLUSIONS Three servings a week of fatty fish included in an energy-restricted diet appears to be a valid strategy for specifically improving insulin sensitivity and leptin levels in obese subjects, which could involve a better body weight regulation after a nutritional intervention period.