Monica C. Serra

A Structured Diet and Exercise Program Promotes Favorable Changes in Weight Loss, Body Composition, and Weight Maintenance

BACKGROUND A number of diet and exercise programs purport to help promote and maintain weight loss. However, few studies have compared the efficacy of different methods. OBJECTIVE To determine whether adherence to a meal-replacement-based diet program (MRP) with encouragement to increase physical activity is as effective as following a more structured meal-plan-based diet and supervised exercise program (SDE) in sedentary obese women. DESIGN Randomized comparative effectiveness trial. PARTICIPANTS/SETTING From July 2007 to October 2008, 90 obese and apparently healthy women completed a 10-week university-based weight loss trial while 77 women from this cohort also completed a 24-week weight maintenance phase. INTERVENTION Participants were matched and randomized to participate in an MRP or SDE program. MAIN OUTCOME MEASURES Weight loss, health, and fitness-related data were assessed at 0 and 10 weeks on all subjects as well as at 14, 22, and 34 weeks on participants who completed the weight maintenance phase. STATISTICAL ANALYSES PERFORMED Data were analyzed by multivariate analysis of variance for repeated measures. RESULTS During the 10-week weight loss phase, moderate and vigorous physical activity levels were significantly higher in the SDE group with no differences observed between groups in daily energy intake. The SDE group lost more weight (-3.1 ± 3.7 vs -1.6 ± 2.5 kg; P = 0.03); fat mass (-2.3 ± 3.5 vs -0.9 ± 1.6 kg; P = 0.02); centimeters from the hips (-4.6 ± 7 vs -0.2 ± 6 cm; P = 0.002) and waist (-2.9 ± 6 vs -0.6 ± 5 cm; P = 0.05); and, experienced a greater increase in peak aerobic capacity than participants in the MRP group. During the 24-week maintenance phase, participants in the SDE group maintained greater moderate and vigorous physical activity levels, weight loss, fat loss, and saw greater improvement in maximal aerobic capacity and strength. CONCLUSIONS In sedentary and obese women, an SDE-based program appears to be more efficacious in promoting and maintaining weight loss and improvements in markers of health and fitness compared to an MRP type program with encouragement to increase physical activity.

Soymilk supplementation does not alter plasma markers of inflammation and oxidative stress in postmenopausal women.

Aging is associated with increasing levels of systemic inflammation and oxidative stress, both of which contribute to the progression of cardiovascular disease. Attenuation of such processes via dietary intervention has significant public health implications. Soyfoods, as a source of high-quality protein and isoflavones, may improve such indices, although such effects in healthy aging women are not well delineated. The purpose of this study was to test the hypothesis that 4 weeks of daily soymilk consumption would improve systemic markers of inflammation and oxidative stress in postmenopausal women when compared with a dairy control. In September 2009, a single-blind, randomized, controlled trial was conducted on 31 postmenopausal women at Baylor University, Waco, Tex. Subjects were randomly assigned to consume 3 servings of vanilla soy (n = 16) or reduced fat dairy (n = 15) milk per day for 4 weeks. Plasma markers of inflammation (tumor necrosis factor alpha [TNF-alpha], interleukin [IL]-1beta, IL-6) and oxidative stress (superoxide dismutase [SOD], glutathione peroxidase [GPx], cyclooxygenase-2 [COX-2]) were obtained before and after supplementation. No significant differences were observed for any of the plasma inflammatory (TNF-alpha, P = .08; IL-1beta, P = .14; IL-6, P = .26) or oxidative stress (SOD, P = .68; GPx, P = .58; COX-2, P = .99) variables by dietary treatment group. Despite good dietary compliance, our study failed to show a significant effect of soymilk consumption on markers of inflammation and oxidative stress in this postmenopausal female population. Potential reasons for this nonsignificant finding are discussed, and future research directions are presented.

A Carbohydrate-Restricted Diet during Resistance Training Promotes More Favorable Changes in Body Composition and Markers of Health in Obese Women with and without Insulin Resistance

Abstract Objective: To determine whether sedentary obese women with elevated levels of homeostatic model assessment (HOMA) insulin resistance (ie, > 3.5) experience greater benefits from an exercise + higher-carbohydrate (HC) or carbohydrate-restricted weight loss program than women with lower HOMA levels. Methods: 221 women (age, 46.5 ± 12 years; body weight, 90.3 ± 16 kg; body mass index, 33.8 ± 5 kg/m2) participated in a 10-week supervised exercise and weight loss program. The fitness program involved 30 minutes of circuit-style resistance training 3 days per week. Subjects were prescribed low-fat (30%) isoenergetic diets that consisted of 1200 kcals per day for 1 week (phase 1) and 1600 kcals per day for 9 weeks (phase 2) with HC or higher protein (HP). Fasting blood samples, body composition, anthropometry, resting energy expenditure, and fitness measurements were obtained at 0 and 10 weeks. Subjects were retrospectively stratified into lower (LH) or higher (HH) than 3.5 HOMA groups. Data were analyzed by multivariate analysis of variance with repeated measures and are presented as mean ± standard deviation changes from baseline. Results: Baseline HOMA levels in the LH group were significantly lower than those in the HH group (LH, 0.6 ± 0.7; HH, 6.3 ± 3.4; P = 0.001). Diet and training significantly decreased body weight (−3.5 ± 3 kg), fat mass (−2.7 ± 3 kg), blood glucose (−3%), total cholesterol (−4.5%), low-density lipoproteins (−5%), triglycerides (−5.9%), systolic blood pressure (−2.6%), and waist circumference (−3.7%), while increasing peak aerobic capacity (7.3%). Subjects in the HP group experienced greater weight loss (−4.4 ± 3.6 kg vs −2.6 ± 2.9 kg), fat loss (−3.4 ± 2.7 kg vs −1.7 ± 2.0 kg), reductions in serum glucose (3% vs 2%), and decreases in serum leptin levels (−30.8% vs −10.8%) than those in the HC group. Participants in the HH (−14.1%) and HP-HH (−21.6%) groups observed the greatest reduction in serum blood glucose. Conclusion: A carbohydrate-restricted diet promoted more favorable changes in weight loss, fat loss, and markers of health in obese women who initiated an exercise program compared with a diet higher in carbohydrate. Additionally, obese women who initiated training and dieting with higher HOMA levels experienced greater reductions in blood glucose following an HP diet.

Soy and the exercise-induced inflammatory response in postmenopausal women

Aging is associated with increasing inflammation and oxidative stress in the body, both of which can have negative health effects. Successful attenuation of such processes with dietary countermeasures has major public health implications. Soy foods, as a source of high-quality protein and isoflavones, may improve such indices, although the effects in healthy postmenopausal women are not well delineated. A single-blind, randomized controlled trial was conducted in 31 postmenopausal women who were assigned to consume 3 servings of soy (n = 16) or dairy (n = 15) milk per day for 4 weeks. Parameters of systemic inflammation (tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6)) and the oxidative defense system (superoxide dismutase (SOD), glutathione peroxidase, cyclooxygenase-2) were measured post supplementation, before and after an eccentric exercise bout performed to elicit an inflammatory response. A significant group-by-time effect for plasma TNF-alpha was observed (p = 0.02), with values in the dairy group increased post supplementation and then decreasing into the postexercise period. Additionally, significant time effects were observed for plasma SOD (p < 0.0001) and IL-6 (p < 0.0001) in the postexercise period. Overall results from our study do not support the notion that 4 weeks of daily soy milk ingestion can attenuate systemic elevations in markers of inflammation or oxidative defense. However, data do suggest that the downhill-running protocol utilized in this study can be effective in altering systemic markers of inflammation and oxidative defense enzyme activity, and that the ingestion of soy may help prevent fluctuations in plasma TNF-alpha.

The Lipid-Lowering Effects of 4 Weeks of Daily Soymilk or Dairy Milk Ingestion in a Postmenopausal Female Population

Alterations in plasma cholesterol concentrations, especially increases in low-density lipoprotein (LDL), are well-known risk factors in the development of atherosclerosis. Numerous studies have examined the lipid-lowering effects of functional soy-containing foods, but few have specifically examined soymilk, with equivocal findings reported. In September 2008, a single-blind, randomized, controlled trial was conducted on 32 postmenopausal women at Baylor University, Waco, TX, USA. After a 2-week run-in period, subjects were randomly assigned to consume three servings of vanilla soy (n = 16) or reduced-fat dairy (n = 16) milk per day for 4 weeks. Plasma lipid profiles were obtained pre- and post-supplementation. Plasma high-density lipoprotein, LDL, and triglycerides were not significantly different between groups post-intervention (P = .45) or from baseline (P = .83). Separate analysis of plasma total cholesterol levels yielded similar results (P = .19 and P = .92, respectively). Furthermore, subanalyses controlling for dyslipidemia (n = 23) and lipid-lowering medication usage (n = 28) did not significantly alter results. Despite good dietary compliance, our study failed to show a significant hypocholesterolemic effect of soymilk consumption in this postmenopausal female population. Potential reasons for this nonsignificant finding are discussed, and future research directions are presented.

Protein and Amino Acid Supplementation Does Not Alter Proteolytic Gene Expression following Immobilization

Objective. To determine if supplementation of protein and amino acids (PAA) decreases skeletal muscle expression of atrophy-related genes, muscle mass, and strength during immobilization in humans. Methods. Twenty males wore a lower-limb immobilization boot for 28 days and consumed either a PAA supplement (28 g protein) or carbohydrate placebo (28 g maltodextrose), while consuming their normal daily diet. Testing sessions included dietary analysis, lower-leg girth and body composition measurements, strength testing, and gastrocnemius muscle biopsies. Muscle was analyzed for mRNA expression of markers in the ubiquitin and calpain systems, myostatin, TNF-α, and NF-κB. Results. All genes of interest increased over time (P < .05), but there was no difference between groups. Lower-leg girth decreased over time (P = 0.02); however, there were no significant changes in body composition or strength. Conclusion. Short-term lower-limb disuse, despite the absence of significant muscle atrophy, is associated with increases in skeletal muscle gene expression of several proteolysis-related genes. These changes do not appear to be altered by oral PAA supplementation.

The Effects of a Long-Term Physical Activity Intervention on Serum Uric Acid in Older Adults at Risk for Physical Disability

Observational studies show a relationship between elevated serum uric acid (UA) and better physical performance and muscle function. The purpose of this paper was to determine whether regular participation in an exercise intervention, known to improve physical functioning, would result in increased serum UA. For this study, 424 older adults at risk for physical disability were randomized to participate in either a 12-mo moderate-intensity physical activity (PA) or a successful aging (SA) health education intervention. UA was measured at baseline, 6, and 12 mo (n = 368, 341, and 332, respectively). Baseline UA levels were 6.03 ± 1.52 mg/dl and 5.94 ± 1.55 mg/dl in the PA and SA groups, respectively. The adjusted mean UA at month 12 was 4.8% (0.24 mg/dl) higher in the PA compared with the SA group (p = .028). Compared with a health education intervention, a 1-yr PA intervention results in a modest increase in systemic concentration of UA in older adults at risk for mobility disability.

Effects of 28 days of dairy or soy ingestion on skeletal markers of inflammation and proteolysis in post-menopausal women

Background: Aging is associated with increased local inflammation and resultant proteolysis in skeletal muscle. In animal models, soy supplementation is a beneficial countermeasure against muscle inflammation and proteolysis; however, the effect on aging humans is not clear. Methods: A single-blinded, randomized, controlled trial was conducted on 31 post-menopausal women. Volunteers were randomly assigned to consume three servings of soy (n=16) or dairy (n=15) milk each day for 28 days. The expression of inflammation-responsive (TNF-α, IL-1β, IL-6) and proteolytic (calpain 1, calpain 2, ubiquitin, E2, atrogin-1, muRF-1) genes in skeletal muscle was determined using real-time polymerase chain reaction before and after supplementation, and then after a downhill run performed to elicit muscle damage. Results: While no group by time interactions were observed, significant main effects for time were observed for IL-1β, IL-6, calpain 2, and atrogin-1 mRNA post exercise. Further analysis revealed that, compared with post-supplementation values, calpain 2 and atrogin-1 mRNA significantly increased at 4 h post exercise (p=0.01 and p<0.01, respectively), whereas IL-1β and IL-6 mRNA significantly decreased at 4 h post exercise (both p<0.01). Conclusions: Soy or dairy milk supplementation at the amount ingested for 28 days does not appear to preferentially inhibit the expression of inflammation-responsive and proteolytic genes that were assessed, and does not attenuate the eccentric exercise-induced up-regulation in the proteolytic genes.

Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke

Background: Accelerometers can objectively measure steps taken per day in individuals without gait deficits, but accelerometers also have the ability to estimate frequency, intensity, and duration of physical activity. However, thresholds to distinguish varying levels of activity intensity using the Actical brand accelerometer are standardized only for the general population and may underestimate intensity in stroke. Objective: To derive Actical activity count thresholds specific to stroke disability for use in more accurately gauging time spent at differing activity levels. Methods: Men (n = 18) and women (n = 10) with chronic hemiparetic gait (4 ± 2 years latency, 43% Caucasian, 56% African-American, ages of 47–83 years, BMI 19–48 kg/m2) participated in the study. Actical accelerometers were placed on the non-paretic hip to obtain accelerometry counts during eight activities of varying intensity: (1) watching TV; (2) seated stretching; (3) standing stretching; (4) floor sweeping; (5) stepping in place; (6) over-ground walking; (7) lower speed treadmill walking (1.0 mph at 4% incline); and (8) higher speed treadmill walking (2.0 mph at 4% incline). Simultaneous portable monitoring (Cosmed K4b2) enabled quantification of energy cost for each activity in metabolic equivalents (METs, or oxygen consumption in multiples of resting level). Measurements were obtained for 10 min of standard rest and 5 min during each of the eight activities. Results: Regression analysis yielded the following new stroke-specific Actical minimum thresholds: 125 counts per minute (cpm) for sedentary/light activity, 667 cpm for light/moderate activity, and 1546 cpm for moderate/vigorous activity. Conclusion: Our revised cut points better reflect activity levels after stroke and suggest significantly lower thresholds relative to those observed for the general population of healthy individuals. We conclude that the standard, commonly applied Actical thresholds are inappropriate for this unique population.

Sarcopenia and Physical Function in Middle-Aged and Older Stroke Survivors

OBJECTIVES To determine the prevalence of sarcopenia in stroke survivors using different methodologies, and compare a subset of the stroke group to age-, sex-, and body mass index (BMI)-matched nonstroke control counterparts. DESIGN Cohort study. SETTING A Veterans Affairs medical center and a university hospital. PARTICIPANTS Mild to moderately disabled participants >6 months after onset of stroke aged 40 to 84 years (N=190, 61% men, 57% African American; mean BMI ± SEM, 29±1kg/m2). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry scans to assess appendicular lean mass (ALM). Rates of sarcopenia were determined using 4 established methods: (1) ALM/height2 (ALM/ht2); (2) European Working Group on Sarcopenia in Older Persons; (3) International Working Group on Sarcopenia; and (4) ALM/BMI. RESULTS Sarcopenia prevalence in our stroke cohort ranged between 14% and 18%. The stroke survivor subset (n=38) matched one-for-one with control counterparts for race, sex, age ±4 years and BMI ±2.5kg/m2 had higher prevalence rates compared with their nonstroke counterparts (13.2% vs 5.3%, P<.0001). ALM/ht2 was related to 6-minute walking speed (r=.28, P<.01) and peak oxygen consumption (L/min: r=.58, P<.0001) for the stroke group. CONCLUSIONS Stroke survivors show an elevated prevalence of sarcopenia when considering age, sex, and race compared with nonstroke individuals.