Maria Luger

Feasibility and efficacy of an isocaloric high-protein vs. standard diet on insulin requirement, body weight and metabolic parameters in patients with type 2 diabetes on insulin therapy.

AIMS To determine the feasibility and efficacy of a high-protein diet compared with a standard diet aiming for weight maintenance in insulin treated type-2 diabetic patients on insulin requirement, body weight and metabolic parameters over 12 weeks. METHODS In a randomized controlled trial we assigned 44 type-2 diabetic patients on insulin therapy either to high-protein or standard diet over 12 weeks. Parameters were evaluated at baseline and monthly. RESULTS After 12 weeks, the high protein diet significantly decreased insulin requirement (9.4 ± 16.3 vs. +0.8 ± 4.8 IU, mean ± SD; p=0.007), fasting plasma glucose (41.7 ± 62.5 vs. 2.1 ± 39.0 mg dl(-1); p=0.02), body mass index (1.1 ± 0.8 vs. 0.3 ± 0.7 kg m(-2); p=0.003), fat-free (0.8 ± 0.5 vs. 0.2 ± 0.5 kg; p=0.001), fat mass (2.6 ± 1.7 vs. 0.8 ± 1.6 kg; p=0.001) and increased serum folate (4.2 ± 8.3 vs. − 0.8 ± 5.5 nmol l(-1); p=0.04) compared to the standard diet. These beneficial metabolic effects are most likely related to the achieved weight loss. No significant differences between groups in renal function were observed. CONCLUSIONS In this study we demonstrate that a high protein diet with emphasis on plant source protein vs. a standard diet is feasible in insulin-treated type-2 diabetic patients and reduces insulin requirement and body weight and improves metabolic parameters up to 12 weeks. A high protein diet can thus be considered as an appropriate diet choice for type-2 diabetic patients.

Influence of intravenous thiamine supplementation on blood lactate concentration prior to cardiac surgery: A double-blinded, randomised controlled pilot study.

BACKGROUND Stress related to surgery and critical illness depletes thiamine, essential in energy metabolism, and might result in high blood lactate concentrations and higher mortality. OBJECTIVES We hypothesised that thiamine supplementation would increase blood concentration of thiamine and reduce blood lactate concentration postoperatively. Moreover, we aimed to identify the prevalence of, and risk factors for, high blood lactate concentrations. DESIGN This was a double-blind, randomised controlled pilot study from February to July 2012 including 30 patients scheduled for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Patients were assigned randomly to receive thiamine (300 mg in 0.9% Normal saline solution) or placebo (0.9% Normal saline) preoperatively. MAIN OUTCOME MEASURES One arterial blood sample was taken preoperatively and another postoperatively to measure thiamine concentration, and multiple samples were taken during surgery and ICU stay to determine lactate concentrations. Twenty-four hour urine samples were collected to measure urinary thiamine concentration. Preoperatively, we assessed extracellular mass to body cell mass ratio (ECM/BCM). RESULTS The mean (SD) age of the patients was 58 (12) years, 73% were overweight, 10% were malnourished and the prevalence of thiamine deficiency was 10%. Patients in the thiamine group had significantly higher blood thiamine concentrations 2 days postoperatively [805.2 ± 289.8 ng g-1 haemoglobin (Hb)] than those in the placebo group (591.2 ± 100.7 ng g-1 Hb, P < 0.01). The mean blood lactate concentration changed significantly over time, but did not differ significantly between the groups. Patients with ECM/BCM more than 1 had higher lactate concentrations on admission to ICU than those with ECM/BCM less than 1 (2.1 ± 0.7 vs. 1.7 ± 0.6, P = 0.09) and were at a significantly greater risk of having a higher lactate concentration on ICU admission [odds ratio (OR) 13.5, 95% confidence interval (95% CI) 1.0 to 179.4, P < 0.05]. On the basis of these results, a sample size calculation for a larger study has been facilitated. CONCLUSION Thiamine supplementation caused normalisation of blood and urine concentrations postoperatively but without a significant reduction in lactate concentration or clinical outcome. Body composition played an important role in lactate formation. Further research focusing on preoperative screening and optimal treatment of high lactate concentrations in this specific population is warranted. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01524315.

Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies

Objective: Partly inconsistent findings from previous reviews have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development. The aim was to systematically review the recent evidence in children and adults. Methods: Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted. Results: 30 publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. 63% of the studies were of good, 30% of medium quality, and none was funded by industry. Conclusion: Recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the new one, we conclude that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water.

Changes of dietary patterns during participation in a web-based weight-reduction programme.

OBJECTIVE To examine the weight-loss success associated with distinct dietary patterns and to determine changes of these dietary patterns during participation in a web-based weight-reduction programme. DESIGN Factor analysis was used to identify the dietary patterns of twenty-two food groups that were administered in 14 d dietary protocols at baseline and after 3 months. Successful weight loss (≥5% of initial weight) and BMI were calculated. Logistic regression analyses were used to assess the rates of weight-loss success from each dietary pattern and changing or remaining in the initial dietary pattern. A generalised linear mixed model was used to estimate the effects of changing or staying in a dietary pattern on change in BMI. SUBJECTS Adults (n 1635) aged 18-81 years. SETTING Users of a web-based weight-reduction programme (2006-2012). RESULTS Participants who aligned to a healthful dietary pattern at baseline (OR=1·8; 95% CI 1·5, 2·3) and after 3 months (OR=1·5; 95% CI 1·2, 1·9) had a greater chance of successfully losing weight. After adjusting for age, sex, initial dietary pattern and BMI, participants who started with or changed to the healthful dietary pattern had a greater chance of being successful (OR=1·4; 95% CI 1·1, 1·7) and a higher BMI reduction of 0·30 (95% CI 0·2, 0·5) kg/m(2) compared with those who started with or changed to the energy-dense or high-carbohydrate dietary pattern. CONCLUSIONS A favourable healthful dietary pattern at the beginning and after 3 months was positively associated with anthropometry. However, successful weight loss was feasible in each dietary pattern.

Worksite Prevalence of (un)Diagnosed Cardiovascular Risk Factors From a Health-Check-Program in An Austrian Company.

Objective: This investigation aims to determine cardiovascular disease risk profile in a cohort of employees. Methods: In 704 participants, within the Special Institute for Preventive Cardiology And Nutrition health-check-program, body mass index, waist circumference, blood pressure (BP), lipids, glucose, and 10-year cardiovascular disease risk were assessed. Results: Mean age was 37 (10) years (20% women) with 25.5 (3.9) kg/m2. A total of 38% demonstrated overweight, 44% abdominal obesity, 12% obesity, and 19% metabolic syndrome. We found a significant difference in increased BP versus diagnosed hypertension (47% vs 14%; P < 0.001). Increasing age was a significant predictor of metabolic syndrome (odds ratio [95% confidence interval] = 1.08 [1.06 to 1.10]; P < 0.001). Ten percent had intermediate and 8% high cardiovascular disease risk. A total of 79% demonstrated at least one risk factor. Conclusions: We detected high prevalence of risk factors particularly increased BP and abdominal obesity. Workplace prevention programs should aim in initially identifying risk factors and subsequently improving lifestyle.

Using digital photography in a clinical setting: a valid, accurate, and applicable method to assess food intake

ABSTRACTBackground/objectivesRegular monitoring of food intake is hardly integrated in clinical routine. Therefore, the aim was to examine the validity, accuracy, and applicability of an appropriate and also quick and easy-to-use tool for recording food intake in a clinical setting.Subjects/methodsTwo digital photography methods, the postMeal method with a picture after the meal, the pre–postMeal method with a picture before and after the meal, and the visual estimation method (plate diagram; PD) were compared against the reference method (weighed food records; WFR). A total of 420 dishes from lunch (7 weeks) were estimated with both photography methods and the visual method. Validity, applicability, accuracy, and precision of the estimation methods, and additionally food waste, macronutrient composition, and energy content were examined.ResultsTests of validity revealed stronger correlations for photography methods (postMeal: r = 0.971, p < 0.001; pre–postMeal: r = 0.995, p < 0.001) compared to the visual estimation method (r = 0.810; p < 0.001). The pre–postMeal method showed smaller variability (bias < 1 g) and also smaller overestimation and underestimation. This method accurately and precisely estimated portion sizes in all food items. Furthermore, the total food waste was 22% for lunch over the study period. The highest food waste was observed in salads and the lowest in desserts.ConclusionsThe pre–postMeal digital photography method is valid, accurate, and applicable in monitoring food intake in clinical setting, which enables a quantitative and qualitative dietary assessment. Thus, nutritional care might be initiated earlier. This method might be also advantageous for quantitative and qualitative evaluation of food waste, with a resultantly reduction in costs.

Concerning the Manuscript “The Effect of Roux-en-Y vs Omega-Loop Gastric Bypass on Liver, Metabolic Parameters and Weight Loss”

We are pleased to receive an inspiring discussion from the scientific community concerning the abovementioned paper. As liver metabolism in the bariatric field is currently a hot topic and seems worthwhile and necessary to attract attention. Furthermore, histopathological changes in the first preoperative months during the phase with highest weight loss and metabolically changes are of great interest. In our clinic, we use a bypassed loop (biliopancreatic limb) of no more than 200 cm, aware that even with 200 cm of bypassed small bowel, the rate of experienced malnutrition is up to 1.1% [1]. Patients after bariatric surgery are at high risk for microand macronutrient deficiencies and its consequences. They need postoperative nutritional care, especially during the first 6 months, the period with greatest weight loss. Sufficient nutrient intake (protein and micronutrients) is often critical and has to be monitored according to the current guidelines [2–5], which is done in our outpatient clinic as it is a member organization of the European Association for the Study of Obesity (EASO) Collaborating Centres for Obesity Management (COMs) Network. As the degree of hepatic dysfunction can be important in predicting postoperative adverse events and mortality in those patients with suspected liver disease [6], preoperatively we screen all patients for hepatic dysfunction via laboratory tests, abdomen sonography and transient elastography (FibroScan), a novel diagnostic tool to assess liver fibrosis. In case of inconclusive results or high probability of liver fibrosis/cirrhosis, a preoperative liver biopsy, in particular cases, is carried out. Furthermore, patients at risk should be followed up very closely, as we do in monthly consultations during the first six postoperative months. Unfortunately, we have to report that we found an error in the calculation formula for EWL%. Referring to these results (EWL% of 59 ± 19%, RYGB vs. 77 ± 14% OLGB)our data are comparable with other studies which reported an EWL% range from 59 to 63% in Roux-en-Y gastric bypass [7–13] and 65 to 89% in omega-loop gastric bypass [7, 8, 13]. As we used WL% for our other calculations, this error has no influence on the remaining results. * Renate Kruschitz renate.kruschitz@meduniwien.ac.at

Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

Objective: Structured obesity treatment programs at primary care level are becoming increasingly important. However, evidence from current treatment approaches in the long term is lacking. In view of this fact we evaluated a standardized, meal replacement-based weight loss program (myLINE®; AENGUS, Graz, Austria) according to the currently applicable guidelines. Methods: Data of overweight and obese individuals (n = 70) who participated at least 36 months in the program were analyzed. Data were collected at baseline (T0) as well as after 1, 3, 6, 12, 24, and 36 (T1-T36) months. Body composition was measured by conventional anthropometry and bioelectrical impedance analysis. Results: Compared to T0, a maximum weight, BMI, fat mass, absolute body cell mass (BCM) reduction and an increase of relative BCM could be seen at T6. Subsequently, the findings reveal a significant reduction of body weight and body fat and a satisfying development of body cell mass during the observation period of 36 months. Conclusion: The evaluated program complies with national and international guidelines for the therapy of obesity in adults and is efficient and meaningful for a long-term therapeutic use in primary care..