The weight loss strategies of the baby boomers

Weight-loss strategies used by baby boomer men: a mixed methods approach

James et al, JHND Early View

Background

Baby Boomer men (those born in 1946–1964) are becoming obese at an earlier age compared to previous generations. The present study aimed to identify weight-loss strategies used by Baby Boomer men, to determine whether those strategies varied by weight status and to explore their dieting experiences.

Methods

The study used a cross-sectional survey of 211 men and 20 in-depth interviews.

Results

Men had a mean (SD) body mass index (BMI) of 29.35 (5.07) kg m–2, with 82% being overweight or obese. Fifty-six percent were currently trying to lose weight. Healthy weight-loss strategies included reducing portions, increasing physical activity, cutting back on fried foods, cutting back on sweets, cutting back on alcohol, using meal replacement drinks/bars and joining a weight-loss programme. Unhealthy strategies included skipping meals and using over-the-counter ‘diet pills’. Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss programme and used diet pills had significantly higher BMIs than men who said they did not (P < 0.05 for all). Interviews revealed that older men struggle to lose weight, ‘I’ve been struggling for the last 2–3 years’. ‘The last time I really tried to lose weight I stayed on the diet for just a day or two’. Wives were considered essential to their weight management success.

Conclusions

Men used a do-it-yourself weight-loss approach using both healthy and unhealthy strategies. Obese men were more likely to use unhealthy practices than overweight men.

Most cited papers from 2011-2015

Every citation-conscious author worth his or her salt takes some time every now and then to monitor the state of play using Web of Science, Scopus or similar. Journal editors are e more citation-conscious that most people on the planet, so here are the findings of my latest trawl through the archives. What are the most widely cited papers for JHND over the last 5 years? Top of the tree for 2011 was:

Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome

Staudacher et al.,

Background:  Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines.
Methods:  Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups.
Results:  In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001).
Conclusions:  A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.

The most cited paper of 2012 was:

British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults

McKenzie et al.,

Background:  Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder. Diet and lifestyle changes are important management strategies. The aim of these guidelines is to systematically review key aspects of the dietary management of IBS, with the aim of providing evidence-based guidelines for use by registered dietitians.
Methods:  Questions relating to diet and IBS symptom management were developed by a guideline development group. These included the role of milk and lactose, nonstarch polysaccharides (NSP), fermentable carbohydrates in abdominal bloating, probiotics and empirical or elimination diets. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines: Cinahl, Cochrane Library, Embase, Medline, Scopus and Web of Science. Evidence statements, recommendations, good practice points and research recommendations were developed.
Results:  Thirty studies were critically appraised. A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines. Three lines of dietary management were identified. First line: Clinical and dietary assessment, healthy eating and lifestyle management with some general advice on lactose and NSP. Second line: Advanced dietary interventions to improve symptoms based on NSP, fermentable carbohydrates and probiotics. Third line: Elimination and empirical diets. Research recommendations were also identified relating to the need for adequately powered and well designed randomised controlled trials.
Conclusions:  These guidelines provide evidence-based details of how to achieve the successful dietary management of IBS.

And from the 2013 crop, the most cited paper was:

Diet and the risk of unipolar depression in adults: systematic review of cohort studies

Sanhueza et al.,

Background

Nutrition may be a risk factor for unipolar depression. We aimed to review the association between dietary variables and the risk of depression.

Methods

Fifteen databases were searched up to May 2010. Only longitudinal studies for which outcomes were unipolar depression and/or depressive symptoms in adults were eligible for inclusion. Eleven studies were included and critically evaluated. Participants were in the age range 18–97 years and the study sample size was in the range 526–27 111. Follow-up ranged from 2 to 13 years. The diversity of dietary variables and nonlinear associations precluded formal meta-analysis and so a narrative analysis was undertaken.

Results

Variables inversely associated with depression risk were the consumption of nutrients such as folate, omega-3 fatty acids and monounsaturated fatty acids; foods such as olive oil and fish; and a diet rich in fruits, vegetables, nuts and legumes. Some of these associations varied by sex and some showed a nonlinear association.

Conclusions

At the study level, weaknesses in the assessment of exposure and outcome may have introduced bias. Most studies investigated a cohort subgroup that may have resulted in selection bias. At the review level, there is a risk of publication bias and, in addition, narrative analyses are more prone to subjectivities than meta-analyses. Diet may potentially influence the risk of depression, although the evidence is not yet conclusive. Strengthening healthy-eating patterns at the public health level may have a potential benefit. Robust prospective cohort studies specially designed to study the association between diet and depression risk are needed.

Our most cited paper from 2014 was:

Dietary sorbitol and mannitol: food content and distinct absorption patterns between healthy individuals and patients with irritable bowel syndrome

Yao et al.,

Background

Sorbitol and mannitol are naturally-occurring polyol isomers. Although poor absorption and induction of gastrointestinal symptoms by sorbitol are known, the properties of mannitol are poorly described. We aimed to expand data on food composition of these polyols, and to compare their absorptive capacities and symptom induction in patients with irritable bowel syndrome (IBS) and healthy individuals.

Methods

Food samples were analysed for sorbitol and mannitol content. The degree of absorption measured by breath hydrogen production and gastrointestinal symptoms (visual analogue scales) was evaluated in a randomised, double-blinded, placebo-controlled study in 21 healthy and 20 IBS subjects after challenges with 10 g of sorbitol, mannitol or glucose.

Results

Certain fruits and sugar-free gum contained sorbitol, whereas mannitol content was higher in certain vegetables. Similar proportions of patients with IBS (40%) and healthy subjects (33%) completely absorbed sorbitol, although more so with IBS absorbed mannitol (80% versus 43%; P = 0.02). Breath hydrogen production was similar in both groups after lactulose but was reduced in patients with IBS after both polyols. No difference in mean (SEM) hydrogen production was found in healthy controls after sorbitol [area-under-the-curve: 2766 (591) ppm 4 h–1] or mannitol [2062 (468) ppm 4 h–1] but, in patients with IBS, this was greater after sorbitol [1136 (204) ppm 4 h–1] than mannitol [404 (154) ppm 4 h–1P = 0.002]. Overall gastrointestinal symptoms increased significantly after both polyols in patients with IBS only, although they were independent of malabsorption of either of the polyols.

Conclusions

Increased and discordant absorption of mannitol and sorbitol occurs in patients with IBS compared to that in healthy controls. Polyols induced gastrointestinal symptoms in patients with IBS independently of their absorptive patterns, suggesting that the dietary restriction of polyols may be efficacious.

It may be early days yet, but the most cited paper so far in 2015 is:

Nutrition in early life and the programming of adult disease: a review

Langley-Evans Foetal development and infancy are life stages that are characterised by rapid growth, development and maturation of organs and systems. Variation in the quality or quantity of nutrients consumed by mothers during pregnancy, or infants during the first year of life, can exert permanent and powerful effects upon developing tissues. These effects are termed ‘programming’ and represent an important risk factor for noncommunicable diseases of adulthood, including the metabolic syndrome and coronary heart disease. This narrative review provides an overview of the evidence-base showing that indicators of nutritional deficit in pregnancy are associated with a greater risk of type-2 diabetes and cardiovascular mortality. There is also a limited evidence-base that suggests some relationship between breastfeeding and the timing and type of foods used in weaning, and disease in later life. Many of the associations reported between indicators of early growth and adult disease appear to interact with specific genotypes. This supports the idea that programming is one of several cumulative influences upon health and disease acting across the lifespan. Experimental studies have provided important clues to the mechanisms that link nutritional challenges in early life to disease in adulthood. It is suggested that nutritional programming is a product of the altered expression of genes that regulate the cell cycle, resulting in effective remodelling of tissue structure and functionality. The observation that traits programmed by nutritional exposures in foetal life can be transmitted to further generations adds weight the argument that heritable epigenetic modifications play a critical role in nutritional programming. For those who are interested in such things, the most cited paper of all time for the Journal of Human Nutrition and Dietetics is a review article by Carrie Ruxton and colleagues:

The health benefits of omega-3 polyunsaturated fatty acids: a review of the evidence.

Ruxton et al., The UK dietary guidelines for cardiovascular disease acknowledge the importance of long-chain omega-3 polyunsaturated fatty acids (PUFA) – a component of fish oils – in reducing heart disease risk. At the time, it was recommended that the average n-3 PUFA intake should be increased from 0.1 to 0.2  g day−1. However, since the publication of these guidelines, a plethora of evidence relating to the beneficial effects of n-3 PUFAs, in areas other than heart disease, has emerged. The majority of intervention studies, which found associations between various conditions and the intake of fish oils or their derivatives, used n-3 intakes well above the 0.2 g day−1recommended by Committee on Medical Aspects of Food Policy (COMA). Furthermore, in 2004, the Food Standards Agency changed its advice on oil-rich fish creating a discrepancy between the levels of n-3 PUFA implied by the new advice and the 1994 COMA guideline. This review will examine published evidence from observational and intervention studies relating to the health effects of n-3 PUFAs, and discuss whether the current UK recommendation for long-chain n-3 PUFA needs to be revisited.

Association of cannabinoid receptor polymorphism with lipid profile

Polymorphism G1359A of the cannabinoid receptor gene (CNR1): allelic frequencies and influence on cardiovascular risk factors in a multicentre study of Castilla-Leon

de Luis et al., JHND Early View

Background

A polymorphism (1359 G/A) of the CNR1 gene was reported as a common polymorphism in Caucasian populations and was related to cardiovascular risk factors. The present study aimed to investigate the allelic distribution of polymorphism (G1359A) of the CB1 receptor gene in a geographical area of Spain (Community of Castilla y Leon) and to evaluate the influence of this polymorphism on obesity anthropometric parameters and cardiovascular risk factors in the fasted state in obese patients.

Methods

A population of 341 obese subjects was analysed. Tetrapolar electrical bioimpedance measurement, blood pressure measurement, a serial assessment of nutritional intake with 3 days of written food records and a biochemical analysis were all performed.

Results

One hundred and seventy-seven patients (51.9%) had the genotype G1359G (wild-type group) and 164 (48.1%) patients were A carriers: G1359A (136 patients; 39.9%) or A1359A (28 patients; 8.2%) (mutant type group). The Health Area of Palencia had a lower frequency of wild-type genotype and G allelic frequency than all the other Health Areas. Segovia and Burgos Areas had a higher frequency of wild-type genotype and G allelic frequency than the other Health Areas. High-density lipoprotein (HDL) cholesterol was higher in the mutant type group and blood tryglicerides were lower in the same group.

Conclusions

In conclusion, the novel finding of the present study is the association of the mutant type group G1359A and A1359A with a better lipid profile (triglycerides and HDL cholesterol) than the wild-type group. The frequencies of this polymorphism are different among Health Areas of Castilla y Leon (Spain).

Fat mass predicts cardiometabolic risk in young adults

Indices of adiposity as predictors of cardiometabolic risk and inflammation in young adults

Pourshahidi et al., JHND Early View 

Background

Studies investigating obesity and cardiometabolic risk have focused on ‘at-risk’ populations and methodological inconsistencies have produced equivocal findings. The present cross-sectional study investigated indices of body composition as predictors of cardiometabolic risk and their relationship with inflammation in apparently healthy young adults.

Methods

A fasting blood sample was taken from consenting adults (160 males, 32 females, aged 18–40 years) for assessment of cardiometabolic risk markers (blood pressure, lipid profiles and insulin resistance) and inflammatory markers (C-reactive protein, tumour necrosis factor-α, interleukin-6, interleukin-10 and adiponectin). Together with anthropometry, fat mass (FM) and fat-free mass (FFM) were determined by dual-energy X-ray absorptiometry. FM was expressed in absolute terms (kg), as well as relative to total body weight (%), height [FM index (FMI, kg m−2)] and FFM (FM : FFM,%).

Results

Although anthropometric indices were associated with most cardiometabolic risk markers, the strongest relationship was observed with FMI. Relative to having a low cardiometabolic risk (≤2 markers above clinically relevant cut-offs), each kg m−2 increase in FMI, increased the likelihood of having an increased cardiometabolic risk by 29% (odds ratio = 1.29; 95% confidence interval = 1.12–1.49). Inflammatory markers were not associated with body composition or cardiometabolic risk.

Conclusions

FMI was the strongest predictor of overall cardiometabolic risk but not inflammation per se. However, anthropometric indices, such as body mass index and waist-to-height ratio, remain valuable surrogate measures of adiposity in this group, particularly when risk markers are considered independently.

Fluids and the elderly in long-stay rehabilitation

A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital

Gaff et al., JHND Early View

Background

Adequate hydration is key to good clinical care and essential for preventing problems in elderly patients such as constipation, pressure sores and confusion. The present study aimed to evaluate fluid provision and consumption in elderly patients against current standards for Scottish hospitals.

Methods

A service evaluation, of fluid provision and consumption over 24 h by elderly orthopaedic rehabilitation patients in a long-stay hospital in Scotland was conducted. Fluids provided and consumed from trolley services, those at meal times and beverages from jugs of water were measured. The average fluid content of a jug, cup and glass on each ward was determined. Each jug of water provided was recorded, as was the acceptance of hot and cold drinks offered. Intake was determined by measuring the leftover water in each jug when these were refreshed and any leftover liquid in patients’ cups deducted from that provided. Observations were made with respect to the presentation and encouragement of fluids.

Results

Fifty-eight patients (12 males, 46 female, aged ≥65 years) were monitored, of whom 56 were provided with more than the recommended minimum fluid per day [mean (SEM) = 2379 (82) mL]; however, mean intake was lower than recommended [mean (SEM) = 1302 (60) mL; P = 0.002]. Provision of drinks from a trolley service [mean (SEM) = 956 (44) mL] was less than fluid from jugs [mean (SEM) = 1398 (54) mL; = 0.002]; however, the consumption of drinks from the trolley was greater [77% consumed, mean (SEM) = 770 (46) mL] than from jugs [41% mean (SEM) = 514 (36) mL; < 0.001].

Conclusions

Patients consumed significantly more fluid from individual beverages than jugs. Consideration of the method of fluid provision is important with respect to influencing fluid intakes.

Weight loss with portion-controlled meals

Portion-controlled meals provide increases in diet quality during weight loss and maintenance

Ptomey et al., JHND Early View

Background

Behavioural weight-loss interventions utilising portion-controlled meals (PCMs) produce significant decreases in weight. However, their impact on diet quality during weight maintenance is unknown. The present study aimed to assess the influence of a weight management intervention employing PCMs and increased physical activity on diet quality during weight loss and weight maintenance.

Methods

One hundred and ninety-seven overweight and obese adults [67% women; mean (SD) BMI = 34.0 (4.6) kg m−2; age = 46.1 (8.9) years] completed an 18-month trial. The weight-loss phase (0–6 months) consisted of energy restriction, which was achieved using PCMs plus fruits and vegetables and increased physical activity. During weight maintenance (6–18 months), participants consumed a diet designed to maintain weight loss. Body weight and dietary intake were assessed at baseline, and at 6, 12 and 18 months. The Healthy Eating Index-2010 (HEI) was calculated using data obtained from 3-day food records.

Results

Mean (SD) body weight was 14.3% (6.6%) and 8.7% (8.0%) below baseline at 6 and 18 months, respectively. The mean (SD) HEI-2010 score after weight loss [66.6 (9.4)] was significantly higher than baseline [46.4 (8.9)] and remained significantly higher than baseline at 18 months [57.7 (10.6)] (both P < 0.001).

Conclusions

A weight management intervention using PCMs resulted in both clinically significant weight loss and increased diet quality scores, demonstrating that the use of PCMs during weight loss allows for meaningful changes in diet quality during weight maintenance.

Cannabinoid receptor polymorphism and macronutrient intake

Association of G1359A polymorphism of the cannabinoid receptor gene (CNR1) with macronutrient intakes in obese females

De Luis et al., JHND Early View

Background

The endogenous cannabinoid system plays a role in metabolic aspects of body weight and feeding behaviour. A polymorphism (1359 G/A) (rs1049353) of the CB1 gene was reported as a common polymorphism in the Caucasian population. The present study aimed to investigate the association of the polymorphism (G1359A) of the CB1 receptor gene on macronutrient intake in females with obesity.

Methods

A sample of 896 females was analysed. A bioimpedance measurement, a blood pressure measurement, a serial assessment of nutritional intake with 3 days of written food records, and a biochemical analysis were all performed. The genotype of the CNR1 receptor gene polymorphism (rs1049353) was studied.

Results

Five hundred and sixteen patients (57.6%) had the genotype G1359G (non-A carriers) and 380 (42.4%) patients had G1359A (328 patients, 36.6%) or A1359A (52 patients, 5.8%) (A carriers). Triglycerides and high-density lipoprotein (HDL) cholesterol levels were higher in A non-A allele carriers than non-A allele carriers. The intakes of dietary cholesterol and saturated fat for the upper tertile (T3) compared to the baseline tertile were inversely associated with the CB1-R 1359 G/A polymorphism [odds ratio (OR) = 0.59; 95% confidence interval (CI) = 0.30–0.92 and OR = 0.66; 95% CI = 0.39–0.91, respectively]. These data were observed in the second tertile (T2) (OR = 0.61; 95% CI = 0.29–0.94 and OR = 0.58; 95% CI = 0.31–0.90, respectively).

Conclusions

The present study reports an association of the A allele with a better lipid profile (triglycerides and HDL cholesterol) than non-A allele carriers. In addition, this polymorphism is associated with a specific macronutrient intake, as well as with low cholesterol and fat saturated intakes.

Marjoram tea and polycystic ovary syndrome

The effect of marjoram (Origanum majorana) tea on the hormonal profile of women with polycystic ovary syndrome: a randomised controlled pilot study

Haj-Husein et al., JHND Early View

Background

In traditional medicine, marjoram herb (Origanum majorana) is locally reputed for its ability to restore hormonal balance and to regulate the menstrual cycle. Therefore, this pilot study aimed to investigate the effects of marjoram tea on the hormonal profile of women with polycystic ovary syndrome (PCOS) in a randomised, double-blind, placebo-controlled trial.

Methods

Twenty-five patients were assigned to receive marjoram tea or a placebo tea twice daily for 1 month (intervention group: n = 14; placebo group: n = 11). The hormonal and metabolic parameters measured at baseline, as well as after the intervention, were: follicle-stimulating hormone, luteinising hormone, progesterone, oestradiol, total testosterone, dehydroepiandrosterone-sulphate (DHEA-S), fasting insulin and glucose, homeostasis model assessment for insulin resistance (HOMA-IR) and glucose to insulin ratio.

Results

Marjoram tea significantly reduced DHEA-S and fasting insulin levels (< 0.05) by a mean (SD) of 1.4 (0.5) μmol L−1 and 1.9 (0.8) μU mL−1, respectively. In comparison to the placebo group, the change was only significant for DHEA-S (= 0.05) but not for insulin (= 0.08). HOMA-IR was not reduced significantly in the intervention group (= 0.06), although the change was significant compared to the placebo group (< 0.05).

Conclusions

The results obtained in the present study show the beneficial effects of marjoram tea on the hormonal profile of PCOS women because it was found to improve insulin sensitivity and reduce the levels of adrenal androgens. Further research is needed to confirm these results and to investigate the active components and mechanisms contributing to such potential beneficial effects of marjoram herb.

Patient’s understanding of type 2 diabetes management

A qualitative investigation of patients’ understanding of carbohydrate in the clinical management of type 2 diabetes

Breen et al., JHND Early View

Background

A healthy diet is the cornerstone of type 2 diabetes (T2DM) self-management. Carbohydrate is of particular interest as the nutrient with the greatest direct effect on blood glucose (BG) levels. The present study aimed to explore T2DM patients’ understanding of carbohydrate and beliefs around the role of carbohydrate in T2DM management.

Methods

Fifteen semi-structured interviews were conducted with T2DM patients. Interviews were audio-recorded and transcribed, and a deductive thematic approach to analysis was employed using the Framework method.

Results

Four significant themes emerged: (i) a naïve conceptual understanding of carbohydrate and sugar-centric specificity to dietary behaviours; (ii) a narrow focus on BG management to the neglect of overall dietary balance; (iii) positive reception of moderate dietary advice focused on portion control from healthcare professionals (HCPs); and (iv) the impact of external moderators of dietary choices, including the influence of significant others, emotional and opportunistic eating and budgetary constraints.

Conclusions

Participants’ beliefs and understanding of carbohydrate led to an overemphasis on sugar restriction for blood glucose control to the neglect of their overall dietary balance. Diabetes educators need to place greater emphasis on the role of various types of carbohydrate foods for glycaemic control, as well as on concepts of wider metabolic health, during T2DM dietary education. Participants placed a high level of trust and value on practical, moderate portion control advice from HCPs regarding carbohydrate foods. However, HCPs need to be cognisant of external moderators of behaviour, such as the influence of family and friends, budgetary constraints and environmental eating triggers.