A behavioral weight-loss intervention, but not metformin, decreases a marker of gut barrier permeability: results from the SPIRIT randomized trial

Author(s):  
Curtis Tilves ◽  
Hsin-Chieh Yeh ◽  
Nisa Maruthur ◽  
Stephen P. Juraschek ◽  
Edgar R. Miller ◽  
...  
Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Curtis Tilves ◽  
Hsin-Chieh Yeh ◽  
Nisa Maruthur ◽  
Stephen Juraschek ◽  
Edgar R Miller ◽  
...  

Background: Serum lipopolysaccharide-binding protein (LBP), a surrogate biomarker for gut barrier permeability, is higher in adults with obesity and type 2 diabetes and may trigger inflammation. It is unknown whether a behavioral weight loss intervention or metformin — current first-line treatments for obesity or diabetes — can reduce gut permeability. Objective: To determine the effects of behavioral weight loss intervention or metformin, compared to self-directed weight loss, on serum LBP. Methods: SPIRIT was a parallel-arm, randomized trial of adult cancer survivors with overweight or obesity. Participants were randomized to a self-directed weight loss (control), metformin, or coach-directed (healthy diet/physical activity) weight loss arm. Of 121 randomized participants, a random subset (n=88) had LBP measured at baseline, 6-months, and 12-months post intervention. The effects of interventions on LBP over time were assessed using generalized estimating equations (GEE). Models were further adjusted for absolute change in fiber intake to investigate potential mediation. Results: Arms were balanced by sex (83% female), race (48% black), and age (mean 60 years). There were no between-group differences in LBP at baseline (median 42.3 μg/dL). Over the 12-month period, only the coach-directed and metformin arms showed weight loss (both mean -3% from baseline). Similar increases in LBP were seen in the self-directed and metformin arms, while a decrease in LBP was seen in the coach-directed arm ( figure ). In GEE models, the difference in slopes between the coach vs. self-directed arms was statistically significant (β=-1.67, p=0.037), but not between the metformin and self-directed arms (β=0.003, p=0.997). The effect of coach-directed weight loss on LBP was similar by sex and race and was not mediated by changes in fiber intake. Conclusion: The manner of weight loss can differentially impact gut permeability and thus subsequent exposure to proinflammatory microbial products.


Obesity ◽  
2021 ◽  
Vol 29 (3) ◽  
pp. 512-520
Author(s):  
John M. Jakicic ◽  
Kelliann K. Davis ◽  
Renee J. Rogers ◽  
Sally A. Sherman ◽  
Susan Barr ◽  
...  

Obesity ◽  
2009 ◽  
Vol 17 (10) ◽  
pp. 1891-1899 ◽  
Author(s):  
Carmen D. Samuel-Hodge ◽  
Larry F. Johnston ◽  
Ziya Gizlice ◽  
Beverly A. Garcia ◽  
Sara C. Lindsley ◽  
...  

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
John M Jakicic ◽  
Kelliann K Davis ◽  
Bethany Barone Gibbs ◽  
Diane Helsel ◽  
Wendy C King ◽  
...  

Introduction: Few studies have examined behavioral weight loss interventions with respect to change in cardiovascular disease risk factors in young adults (aged 18 to 35 years). Hypothesis: We tested the hypothesis that a 6 month behavioral weight loss intervention resulted in significant improvements in selective cardiovascular disease risk factors in young adults. Methods: Data are presented as median [25 th , 75 th percentiles]. 470 participants (age: 30.9 [27.8, 33.7] years); BMI: 31.2 [28.4, 34.3] kg/m 2 ) were enrolled in a 6 month behavioral weight loss intervention that included weekly group sessions and prescribed an energy restricted diet and moderate-to-vigorous physical activity. Assessments included weight using a standardized protocol, resting blood pressure, and fasting lipids, glucose, and insulin. Statistical significance of change was according to tests of symmetry or the Wilcoxon matched pairs signed ranks test. Results: The primary outcome (weight) was available for 424 of the 470 participants (90.2%). Weight significantly decreased (-7.8 kg [-12.2, -3.7]) (p<0.0001). Systolic (-4.0 mmHg [-8.5, 0.5] and diastolic blood pressure (-3.0 mmHg [-6.5, 1.0]) decreased (p<0.0001). Total cholesterol (-13 mg/dl [-28.0, 2.0]), LDL cholesterol (-9.5 mg/dl [-21.7, 2.0]), triglycerides (-8.5 mg/dl [-44.0, 9.0]), glucose (-4.0 mg/dl [-8.0, 1.0]), and insulin (-2.6 mIU/L [-5.9, 0.7]) decreased (p<0.0001, n=416). There was not a significant change in HDL cholesterol (p=0.72). Conclusions: In conclusion, after 6 months, weight loss was observed in young adults assigned to this behavioral intervention that focused on physical activity and diet modification. They tended to also have improved cardiovascular disease risk factors. This may demonstrate an approach to reducing cardiovascular disease risk in young adults. Supported by NIH (U01HL096770) and AHA (12BGIA9410032)


2012 ◽  
Vol 39 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Lisa M. McAndrew ◽  
Melissa A. Napolitano ◽  
Leonard M. Pogach ◽  
Karen S. Quigley ◽  
Kerri Leh Shantz ◽  
...  

Obesity ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Dale S. Bond ◽  
J. Graham Thomas ◽  
Richard B. Lipton ◽  
Julie Roth ◽  
Jelena M. Pavlovic ◽  
...  

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Laura P Svetkey ◽  
Stephen S Intille ◽  
Bryan C Batch ◽  
Leonor Corsino ◽  
Crystal C Tyson ◽  
...  

Background: Obesity affects young adults, leading to future morbidity and mortality. Early behavioral intervention may promote long-term weight control. Mobile technology-based (mHealth) interventions may be particularly effective in young adults. We compared both an mHealth behavioral weight loss intervention and a personal coaching weight loss intervention to no intervention (and to each other) in overweight/obese young adults. Methods: We randomized 365 generally healthy adults age 18-35 years with BMI > 25 kg/m2 (overweight or obese) to 24-months of intervention delivered primarily via investigator-designed cell phone (CP) or intervention delivered primarily via in-person (6 weekly) and by phone (23 monthly) coaching (PC), compared to usual care control group (Control). Primary outcome was weight change from baseline to 24 months. This study was conducted as part of the Early Adult Reduction of weight through LifestYle (EARLY) cooperative trials. Results: Randomized participants (N=365) had mean BMI 35 kg/m2, mean age 29yrs, were 70% women, 36% African American, 6% Latino. Final weight was obtained in 86%; missing weight was multiply imputed. At 24 months, weight loss was not different in either PC or CP vs Control (see Figure). Weight loss in PC was significantly greater than Control at 6 months. From baseline to 24 months, clinically significant weight loss (> 3% per national guidelines) occurred in 40% of PC, 34% of CP, and 30% of Control. Conclusions: mHealth alone may not be sufficient for weight loss in young adults but mHealth-enhanced contact with an interventionist has a modest short-term effect. Future interventions should maximize the complementarity of mHealth and personal contact to achieve larger and more sustained effect.


2015 ◽  
Vol 33 (28) ◽  
pp. 3169-3176 ◽  
Author(s):  
Cheryl L. Rock ◽  
Shirley W. Flatt ◽  
Tim E. Byers ◽  
Graham A. Colditz ◽  
Wendy Demark-Wahnefried ◽  
...  

Purpose Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer. The Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) study is the largest weight loss intervention trial among survivors of breast cancer to date. Methods In this multicenter trial, 692 overweight/obese women who were, on average, 2 years since primary treatment for early-stage breast cancer were randomly assigned to either a group-based behavioral intervention, supplemented with telephone counseling and tailored newsletters, to support weight loss or a less intensive control intervention and observed for 2 years. Weight and blood pressure were measured at 6, 12, 18, and 24 months. Longitudinal mixed models were used to analyze change over time. Results At 12 months, mean weight loss was 6.0% of initial weight in the intervention group and 1.5% in the control group (P < .001). At 24 months, mean weight loss in the intervention and control groups was 3.7% and 1.3%, respectively (P < .001). Favorable effects of the intervention on physical activity and blood pressure were observed. The weight loss intervention was more effective among women older than 55 years than among younger women. Conclusion A behavioral weight loss intervention can lead to clinically meaningful weight loss in overweight/obese survivors of breast cancer. These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival.


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