Multidisciplinary Residential Program for the Treatment of Obesity: How Body Composition Assessed by DXA and Blood Chemistry Parameters Change During Hospitalization and Which Variations in Body Composition Occur from Discharge Up to One Year Follow-Up

Purpose Since obesity is a pathology characterized by a complex variable clinical presentation with comorbidities, multidisciplinary residential program (MRP) represents one of the best options for treating obesity. The purpose of this study was to evaluate the effectiveness of 8-weeks MRP on weight loss, body composition assessed by DXA and metabolic blood parameters between entry (T0) and discharge (T1). The secondary endpoint was the evaluation of the patients' adherence to diet during the check-up outpatient visits, at 2 (T2), 6 (T3) and 12 (T4) months after discharge. Methods One hundred and seventy-eight subjects were enrolled (61 males and 117 females, aged 58.5±13, BMI 41.3±6). The difference in values ​​(end of hospitalization compared to baseline) was calculated through the univariate GLM procedure, which provides regression analysis and analysis of variance for a variable dependent on one or more variables. Results There was a statistically significant (p<0.001) improvement of all parameters investigated: total mass (-5.68 kg), fat free mass (-1236.03 g), fat mass (-4416.85 g), fat mass index (-1724.56), visceral adipose tissue (-332.76 g), arm circumference (-1.63 cm) and calf circumference (-1.16 cm). The skeletal muscle index was not affected. Statistically significant improvement in glycaemic and lipid profile were reported. The BMI average reduction continued from discharge until T4. No statistically significant changes in fat free mass and visceral adipose tissue (VAT) were reported during a year of follow-up. Conclusion The present study demonstrated the clinical benefits of 8-weeks MRP, which includes hypocaloric diet, physical exercise, and psychological support.

Association between Ag-RP, alpha-MSH and cardiovascular risk factors regarding adherence to Diet Quality Index- International (DQI-I) among obese individuals

Introduction: Obesity is a strong promoter of cardiometabolic risk factors and is associated with several chronic comorbidities. Recently, the role of α-melanocyte stimulating hormone (α-MSH) and agouti related peptide (Ag-RP) in regulation of energy balance has attracted much attention. In current study, we evaluated the association between α-MSH and Ag-RP with cardiometabolic factors among obese individuals with different adherence to Diet Quality Index-International (DQI-I) values. Methods: In this research, 188 obese adults aged between 20 and 50 years old and body mass index (BMI) between 30 and 40 kg/m2 were recruited. Dietary intakes of participants and DQI-I calculation was performed using a semi-quantitative food frequency questionnaire (FFQ) with 132 food items. Serum glucose, lipids, insulin, and plasma α-MSH and Ag-RP levels were measured using ELISA kits. Homeostasis model assessment for insulin resistance index (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were also calculated. Results: Among those with the lowest adherence to DQI-I, Ag-RP was positively associated with systolic blood pressure (SBP) (P = 0.03) among males, which was associated with waist circumference (WC) (P = 0.01) and diastolic blood pressure (DBP) (P = 0.01). Moreover, among males with low and moderate adherence to DQI-I, α-MSH was positively associated with insulin (P = 0.04), weight (P = 0.03), WC (P < 0.01), SDP (P = 0.02) and DBP (P = 0.01). Also, Ag-RP showed a positive association with BMI values (R2 = 0.03; P = 0.03). Conclusion: According to our findings, in obese subjects with poor to moderate adherence to DQI-I, Ag-RP and α-MSH were in positive correlation with cardiometabolic risk factors. These findings further clarify the clinical importance of these parameters as prognostic factors of cardiometabolic abnormalities.

Beneficial Effects of Slow-Release Large Neutral Amino Acids after a Phenylalanine Oral Load in Patients with Phenylketonuria

The mainstay of phenylketonuria treatment is a low protein diet, supplemented with phenylalanine (Phe)-free protein substitutes and micronutrients. Adhering to this diet is challenging, and even patients with good metabolic control who follow the dietary prescriptions in everyday life ignore the recommendations occasionally. The present study explores the ability of slow-release large neutral amino acids (srLNAAs) to prevent Phe increase following a Phe dietary load. Fourteen phenylketonuric patients aged ≥13 years were enrolled in a 6-week protocol. Oral acute Phe loads of 250 and 500 mg were added to the evening meal together with srLNAAs (0.5 gr/kg). Phe and tyrosine were dosed before dinner, 2h-after dinner, and after the overnight fast. After oral Phe loads, mean plasma Phe remained stable and below 600 µmol/L. No Phe peaks were registered. Tyrosine levels significantly increased, and Phe/Tyrosine ratio decreased. No adverse events were registered. In conclusion, a single oral administration of srLNAAs at the dose of 0.5 gr/kg is effective in maintaining stable plasma Phe during acute oral loads with Phe-containing food and may be added to the dietetic scheme in situations in which patients with generally good adherence to diet foresee a higher than prescribed Phe intake due to their commitments.

Determinants of health-related quality of life in patients with celiac disease: a structural equation modeling

Background We aimed to investigate the determinants of Health-related quality of life (HRQOL) in Iranian patients with celiac disease (CD) using the structural equation modeling (SEM). Methods In the present cross-sectional study, a total of 170 adult patients with CD were recruited. The information regarding adherence to diet, symptom severity, and HRQOL were collected using the celiac disease adherence test (CDAT), gastrointestinal symptom rating scale (GSRS), and SF-36 questionnaire respectively. Association between various studied variables and HRQOL was assessed using SEM. The standardized regression weights were used to assess total, direct and indirect effects. The model fit indices were used to assess the “goodness of fit” between the hypothesized models. Results The mean age of participants was 37.57 ± 9.59 years. The results of SEM indicated that the overall fit of our model was acceptable. Adherence to the diet, GSRS score, occupation, and education level was significantly related to PCS of SF-36; and adherence to the diet, GSRS score, and education level were significantly correlated with MCS of SF-36. The analysis of indirect associations indicated that only adherence to diet indirectly via GSRS score was significantly associated with PCS and MCS of SF-36. Conclusion In adult patients with celiac disease, HRQOL was associated with age, education, adherence to GFD, and GSRS score. Additionally, occupation and disease duration were associated with HRQOL only in women and men respectively.

Diet Intervention Study through Telemedicine Assistance for Systemic Nickel Allergy Syndrome Patients during the COVID-19 Pandemic

Background: Restrictions due to the COVID-19 pandemic limited patients’ access to hospital care. The aims of this study were to assess dietary nutritional status, quality of life (QoL), and adherence to dietary therapy before and after 30-day personalized diet therapy through telenutrition tools in patients with systemic nickel allergic syndrome (SNAS). Methods: Each SNAS patient underwent the following allergological procedures: (a) face-to-face visit (nutritional visit and QoL evaluation) with prescription of one out of five personalized and balanced dietary plans different for calorie intake, (b) video call visit for dietary evaluation and assessment of adherence to diet after 15 days, and (c) video call visit for dietary and QoL evaluation and assessment of adherence to diet therapy after 30 days (end of study). Results: We enrolled 20 SNAS patients. After 15 and 30 days, we found a statistically significant improvement in anthropometric findings after diet therapy, a significant adherence rate to low-nickel diet (60% and 80%, respectively), and an improvement in QoL with an increase in almost all psychometric indices. Conclusions: Our study demonstrates that telenutrition can be a valid tool to monitor nutritional status and adherence to balanced low-Ni diet positively affecting QoL in SNAS patients during the COVID-19 pandemic.

Family history of obesity and the influence on physical activity and dietary adherence after bariatric surgery

Background The causes of obesity are multifactorial, with genetic, environmental, behavioural and societal contributions. These factors also affect adherence to diet and exercise after bariatric surgery. The objective of this study was to evaluate changes in perceived obesity-related stigma, exercise and dietary adherence perioperatively as well as what demographic factors most influence the magnitude of these changes. Methods Validated questionnaires regarding perception of stigma and adherence to diet and exercise regimens were administered to 104 bariatric surgery patients preoperatively and postoperatively at three, six and 12 months. Scoring was compared for improvement, and concomitant factors were analysed for effect on magnitude of improvement. Results Our study found overall improvement in perception of stigma as well as adherence to diet and exercise regimens. Those with a family history of obesity had less robust improvement compared to those without a family history of obesity. Those who were Caucasian also did not have as robust of an improvement in their scores. Conclusions Patient perception of obesity-related stigma and adherence to diet and exercise regimens improve after bariatric surgery. However, a patient with a family history of obesity and/or a Caucasian ethnicity may have a less robust improvement in these facets.

Lifestyle modification adherence among patients attending diabetes clinics in selected hospitals in Remo zone Ogun State, Nigeria

Objective: Lifestyle modification is an essential component of self-management of diabetes mellitus. This study assessed adherence to diet and exercise recommendations and elucidated the factors that influence adherence in patients living with diabetes. Method: A cross-sectional study involving 300 patients attending diabetes clinics in some selected hospitals in Ogun State, Nigeria. Structured questionnaires were used to obtain information on the socio-demographic characteristics, and PRECEDE factors of lifestyle-modification adherence in the study participants. Pearson’s correlation and Chi-square test were used to assess the association between the variables, while binary logistic regression was used to determine the predictors of adherence to dietary recommendations. Results: The mean age of the study respondents was 62.7 years. The proportion of respondents who adhered to dietary and exercise recommendations were 87.8% and 45.6% respectively. There were no statistically significant linear relationships between scores for each PRECEDE factor and scores for adherence to diet and exercise. Respondents’ age, body mass index, and duration of illness had a statistically significant association with adherence to diet (P< 0.001, P=0.021, and P=0.041 respectively). On logistic regression analysis, participants 60 years and older had a higher likelihood of adhering to dietary modification than younger participants [AOR=2.6, P < 0.001]. Conclusion: The adherence of patients living with diabetes to dietary recommendations was satisfactory while adherence to exercise recommendations was very poor. There is a need for health care workers, especially at the primary and secondary levels to implement strategies that will enhance reinforcing and enabling factors for exercise adherence.

Insights of healthcare providers and patients on implementation of dietary/lifestyle intervention for reversal of obesity and type 2 diabetes: a qualitative study

Background: A diet plan that includes limiting eating frequency to twice a day along with other lifestyle modification was implemented as part of a campaign for diabetes reversal. The objective of this study was to identify facilitators and barriers to practice of this self-management regime among adults with type 2 diabetes mellitus (T2DM) living in urban communities.Methods: Participants included purposively sampled 10 diabetics recruited from 12 Diabetes Reversal Centres (DRCs) located across Maharashtra, Goa, Karnataka and Gujarat in India. Additionally, healthcare providers (including 10 doctors and 10 coordinators) from these centres were interviewed. Data collection employed in-depth interviews using structured interview guides. Thematic data analysis was undertaken to identify themes.Results: Continued rapport and supervisory role of the healthcare providers in the DRCs was the key facilitator in helping patients to assume responsibility and adhere to the diet regime for self-management. Visible reduction in sugar levels and body weight were other rewarding benefits that motivated sustained compliance. Social and cultural aspects (including social functions and formalities) was a perceived barrier that interfered with adherence to diet regime and goals. A common suggestion from both the healthcare providers and patients was the need to expand this initiative through capitalizing on use of relevant technological devices.Conclusions: In conclusion, a self-management patient model where there is continued and active involvement of healthcare providers through all stages is a recipe for success. However, this initiative can be further strengthened through complementing it with individualized, context-driven solutions to address the barriers.

Qualitative Evaluation of a Diet Self-Monitoring Tool in a Sample of Older Adults

Objectives Adherence to diet self-monitoring tools typically declines over time. Diet self-monitoring tools often ask people to itemize their foods and record their serving sizes. This method of tracking does not conform to food guides that resemble a plate. The objective of this study is to explore the perceptions of healthy older adults on the usability of a traditional food journal (Journal) compared to a simplified plate-based (Plate) tool based on the 2019 Canada's Food Guide. Methods A crossover study design was used to evaluate the two tools. Participants (n = 48) were randomized to track their food on three days using either the Journal or the Plate for one week then the other tool for the following week. Once complete, 45 participants completed semi-structured interviews to assess their perceptions of the tools and their preferences. Results were analyzed using thematic analysis to identify emerging themes. Results The main themes identified for the Plate were “easy”, “visual”, and “quick” whereas for the Journal were “detail”, “quantification”, and “familiarity”, with 46.7% and 46.7% preferring the Plate and Journal respectively (6.7% preferred neither tool). When asked about using the tools for future dietary changes, 62.2% and 31.1% preferred the Plate and Journal respectively (6.7% preferred neither tool). Conclusions A simplified tool such as a plate is an acceptable self-monitoring tool for older adults. Future studies will be test adherence to self-monitoring using this simplified plate based self-monitoring tool. Funding Sources R. Howard Webster Foundation