Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome: ABESO 2022

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.info:eu-repo/semantics/publishedVersio

Evidências de saúde relacionadas a suplementação ou dieta com óleo de coco: revisão de escopo

Orientador: Prof. Dr. Carlos Eduardo da Rocha GarciaCoorientadores: Profª. Dra. Helena Hiemisch Lobo Borba e Prof. Dr. Roberto PontaroloDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Ciências Farmacêuticas. Defesa : Curitiba, 17/03/2022Inclui referências: p. 83-95Resumo: Introdução: o consumo de óleo de coco (OC) como suplemento alimentar ou parte da dieta tem sido avaliado devido as expectativas de benefícios à saúde e estratégias de marketing. O OC é composto principalmente por triglicerídeos de cadeia média (TCM), diferentemente de outros óleos e gorduras vegetais compostos majoritariamente de triglicerídeos de cadeia longa. Os TCM possuem menores estruturas carbônicas e são metabolizados de forma comparativamente ágil, podendo ser associados a possíveis benefícios à saúde. Objetivo: mapear as evidências de saúde relacionadas ao uso do OC na suplementação oral ou na dieta humana. Metodologia: a revisão de escopo envolveu pesquisa em banco de dados (Pubmed/Medline, Scopus e Web of Science), utilizando termos previamente definidos, e busca manual. Os estudos foram avaliados por dois revisores independentes e seus dados analisados. As revistas fonte dos artigos selecionados foram caracterizadas perante a área de estudo e fator de impacto, segundo Qualis e Journal Citation Reports (JCR). Resultados e discussão: foram selecionados 77 artigos publicados entre 1958-2021. A maioria dos estudos foram realizados no Brasil (nº de estudos/frequência) (14/18%), seguido pelos Estados Unidos (12/12%), Espanha (6/8%), Índia (5/6,5%) e Malásia (5/6,5%). O desenho de estudo mais frequente (62%) utilizado foi o Ensaio Clínico Randomizado (ECR). As áreas de estudo das revistas fonte foram: Ciências da Saúde (73%), Ciências Agrárias (15%), Ciências Biológicas (10%) e Ciências Humanas e Sociais (3%). Segundo a Qualis, a maioria dos estudos foram publicados com maior frequência em revistas A1 (21%) e A2 (7%), enquanto 22% não possuíam classificação. As aplicações de saúde investigadas referente ao OC foram 15. O uso do OC proporcionou resultado positivos com maior frequência nas seguintes condições em saúde (nº de estudos/frequência): fonte energética (3/100%); síndrome metabólica (1/100%); ação antioxidante (1/100%), melhora na qualidade de vida (1/100%); sintomas relativos à COVID 19 (1/100%), Doença de Alzheimer (3/75%); obesidade (8/62,5%), marcadores inflamatórios (10/60%); modulação lipídica (25/56%); influência nos índices glicêmicos (9/67%) e Doença coronariana (5/42%). Na influência sobre a absorção de nutrientes os efeitos positivos foram observados em 50% (n=2). A nulidade foi o desfecho mais frequente em (nº de estudos/frequência): saciedade (7/57%); efeito cetogênico (1/100%), efeitos na microbiota intestinal (2/100%) e melhora do desempenho das atividades físicas (1/100%). Apenas um desfecho negativo foi verificado frente a modulação lipídica. Conclusão: esta revisão tornou possível o mapeamento de publicações, evidenciando desfechos conflitantes em diferentes aplicações. Estudos futuros podem avaliar abordagens específicas e proporcionar melhor compreensão sobre as alegações de saúde, as quais devem acompanhar o uso do OC como suplemento alimentar ou substituinte da dieta.Abstract: Introduction: Consumption of coconut oil (OC) as a dietary supplement or part of the diet has been evaluated due to expectations of health benefits and marketing strategies. OC is composed mainly of medium chain triglycerides (CMT), unlike other vegetable oils and fats composed mostly of long-chain triglycerides. CMTs have smaller carbon structures and are metabolized in a comparatively agile manner and may be associated with possible health benefits. Objective: to map the health evidence related to the use of OC in oral supplementation or in the human diet. Methodology: the scope review involved database research (Pubmed/Medline, Scopus, and Web of Science), using previously defined terms, and manual search. The studies were evaluated by two independent reviewers and their data were analyzed. The source journals of the selected articles were characterized by the area of study and impact factor, according to Qualis and Journal Citation Reports (JCR). Results and discussion: 77 articles published between 1958-2021 were selected. Most studies were conducted in Brazil (number of studies/frequency) (14/18%), followed by the United States (12/12%), Spain (6/8%), India (5/6.5%) and Malaysia (5/6.5%). The most frequent study design (62%) used was the Randomized Clinical Trial (ECR). The areas of study of the source journals were Health Sciences (73%), Agrarian Sciences (15%), Biological Sciences (10%) and Human and Social Sciences (3%). According to Qualis, most studies were published more frequently in journals A1 (21%) and A2 (7%), while 22% had no classification. The health applications investigated for the OC were 15. The use of OC provided positive results more frequently in the following health conditions (number of studies/frequency): energy source (3/100%); metabolic syndrome (1/100%); antioxidant action (1/100%), improvement in quality of life (1/100%); symptoms related to COVID 19 (1/100%), Alzheimer's disease (3/75%); obesity (8/62.5%), inflammatory markers (10/60%); lipid modulation (25/56%); influence on glycemic indices (9/67%) and coronary heart disease (5/42%). In the influence on nutrient absorption, positive effects were observed in 50% (n=2). Nullity was the most frequent outcome in (number of studies/frequency): satiety (7/57%); ketogenic effect (1/100%), effects on intestinal microbiota (2/100%) and improvement in physical activity performance (1/100%). Only one negative outcome was verified against lipid modulation. Conclusion: this review made it possible to map publications, evidencing conflicting outcomes in different applications. Future studies may evaluate specific approaches and provide a better understanding of health claims, which should accompany the use of OC as a dietary supplement or diet substitute

Metabolically Healthy Obesity

Accumulating evidence suggests that not all obese subjects are at increased cardiometabolic risk and that the “metabolically healthy obese” phenotype may exist in the absence of metabolic abnormalities. Limited data regards the determinants of metabolically healthy obesity exist, particularly in relation to genetics, dietary and lifestyle behaviours. In light of the current obesity epidemic, it is clear that current “one size fits all” approaches to tackle obesity are largely unsuccessful. Whether dietary, lifestyle and/or therapeutic interventions, based on stratification of obese individuals according to their metabolic health phenotype, are more effective remains to be seen, with limited and conflicting data available. This book includes original research articles and reviews of the scientific literature that contribute to our understanding of the role of clinical, biological, genetic, and environmental factors in metabolically healthy and unhealthy obesity

Contemporary nutritional transition: determinants of diet and its impact on body composition

The world has experienced a marked shift in the global BMI distribution towards reduced undernutrition and increased obesity. The collision between human biology, shaped over the millennia and modern technology, globalization, government policies and food industry practices have worked to create far-reaching energy imbalance across the globe. A prime example is the clash between our drinking habits and our biology. The shift from water and breast milk as the only beverages available, to a vast array of caloric beverages was very rapid, shaped both by our tastes and aggressive marketing of the beverage industry. Our biology, shaped over millennia by daily consumption of water and seasonal availability of food, was not ready to compensate for the liquid energies. Other dietary changes were similarly significant, particularly the shift towards increased frequency of eating and larger portions. The roles of the food and beverage production, distribution and marketing sectors in not only shaping our diet but also accelerating these changes must be understood. Apart from the role of beverages, there is much less consensus about the role of various components of our diet in energy imbalance. Understanding the determinants of change in the key components of our diet through an array of research provides insights into some of the options we face in attempting to attain a great balance between energy intake and expenditures while creating an overall healthier dietary pattern. A few countries are systematically addressing the causes of poor dietary and physical activity patterns and high energy imbalance

Role of Dietary Carbohydrate Source in the Development of Obesity in Rodent Models of Diet-Induced Obesity

Dietary macronutrient composition plays a critical role in health and disease. The contribution of dietary carbohydrate source in the development of obesity and related diseases is often given minimal attention. The present studies demonstrate that both quantitative and qualitative changes in dietary carbohydrate influence body composition and adiposity in a rodent model of diet-induced obesity. In heterozygous (fa/+) Zuker rats, consumption of a high-fat, carbohydrate free ad libitum, attenuated weight gain and adiposity by increasing energy efficiency and blunting expression of fatty acid synthase, a key enzyme in de novo lipogenesis. These effects were independent of significant changes in plasma insulin levels. Moreover, the addition of a modest level of sucrose to the high-fat diet completely reversed the effects of carbohydrate restriction, resulting in significant increases in body weight and adiposity, mediated in part by enhanced expression of fatty acid synthase. In a separate series of experiments, we evaluated the effect of ad libitum or energy restricted (70% of ad libitum) high-fat diets, varying in carbohydrate source on adiposity in aP2-Agouti transgenic mice. In the context of an energy restricted diet, animals consuming diets shown to result in lower postprandial blood glucose levels (ROLL and MUNG) reduced adipose tissue accumulation in the perirenal and retroperitoneal and resulted in smaller adipocytes compared with diets evoking greater postprandial blood glucose excursions. In ad libitum fed animals, the expression of lipogenic enzymes in the liver and selected adipose tissue depots was significantly enhanced by consumption of a high-fat, sucrose-rich diet. Expression of genes or fatty acid oxidation was enhanced in the muscle of animals consuming the low-glucose response diets. These data suggest that dietary carbohydrate source modulates adipose tissue accumulation and body weight by partitioning substrate utilization between lipid oxidation in skeletal muscle, and reducing lipogenesis in visceral adipose tissue

Precision Nutrition and Metabolic Syndrome Management

Precision nutrition is an emerging concept encompassing an integrated action considering not only the genetic/epigenetic makeup and ethnic aspects of individuals, but other personalized phenotypical features, such as family and individual clinical issues, previous diseases and therapeutic treatments, perinatal nutrition, food likes/dislikes, allergies/intolerances, lifestyle attitudes and patterns, social and cultural circumstances or religious beliefs, etc. In this context, chronic disease prevalence is a global public health problem itself, which is also accompanied by a number of complications, including insulin resistance, hypertension, hypercholesterolemia, fatty liver, inflammation, oxidative status and immunocompetence disturbances, and other adverse manifestations related to metabolic syndrome, which may need individualized nutritional approaches. Therefore, the current Special Issue attempts to provide specific nutritional strategies to prevent or treat the complications associated with metabolic syndrome features concerning diabetes, vascular events, liver diseases, dyslipemia, and cancer with a precision nutrition scope

Association entre le profil d'acides gras et la prévalence d'obésité : études écologique et transversale

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

The Effect of Diet and Nutrition on Postprandial Metabolism

The postprandial period is the metabolic phase that directly follows the ingestion of a meal. This period is critical to the handling of nutrients to feed the body throughout the whole day but it is also a time of challenge for the body’s metabolism, which has to be flexible and adaptable regarding the quantity and the quality of the nutrient intake. Changes in postprandial metabolism have been considered to be potential early markers in the pathophysiological course, finally leading to an increased risk of disease development. This book aimed to broaden and add to the research on the importance of postprandial metabolism in nutrition. The book includes literature reviews that cover the broad state of the art of our knowledge about postprandial metabolism, fine original studies of the complex changes in metabolism, and the physiological processes that are considered to drive the onset of pathogenesis. Finally, a series of examples on how nutrient content (especially proteins, sucrose, and lipids) can influence the postprandial metabolism over a wide range of phenomena operating during the postprandial period and how they could contribute to tipping the body towards adverse health processes

Public health nutrition intervention to enhance healthy eating and lifestyle modification among Lebanese women with Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy disorder in reproductive age women. The symptoms of this disorder are the androgen excess seen with anovulation/oligoovulation or morphologically ovarian cysts. The aim of the study was to assess the efficacy of public health nutrition intervention designed to enhance healthy eating and lifestyle modification among PCOS patients attended the obstetrics and gynecology clinic at the American University of Beirut Medical Centre (AUB-MC) in Beirut, Lebanon. A prospective hospital based public health nutrition intervention was proposed in which 76 women with PCOS were recruited in the pilot study and 588 women were recruited in the scale-up intervention divided between PCOS and non-PCOS. During the scale up phase non-PCOS women were recruited to study the effect of the nutritional counseling on them as a way to compare the outcome with PCOS women. Recruited population were divided into 8 groups; group A: overweight/obese PCOS patient’s intervention (received weight management program with nutritional guidelines). Group B: overweight/ obese PCOS controls (received the usual heath care by the gynecologist), Group C: lean PCOS controls (received the usual heath care by the gynecologist), Group D: lean PCOS intervention (received weight maintenance program with nutritional guidelines ), Group E: overweight/obese non-PCOS patient’s intervention (received weight management program with nutritional guidelines) ,Group F: overweight/ obese non-PCOS controls, Group G: lean non- PCOS intervention (received weight maintenance program with nutritional guidelines), Group H: lean non-PCOS controls. Data were collected using a pre-validated questionnaire to capture sociodemographic variables, nutritional status, and physical activity, psychological and medical status. Blood analysis was carried out to determine biochemical indices. Assessment of study indicators were carried out at baseline, after 3 and 6 months from inception of intervention (pilot as well scale up). Patients in intervention groups attended a 6 month tailored nutrition counseling/education program (2 sessions per month), to enhance their understanding of their dietary intake and assist them with weight management, physical activity, healthy cooking, lifestyle, and food shopping. Following a six months pilot study intervention results have shown that 7% weight loss was achieved in overweight/ obese intervention groups and weight maintenance in lean intervention groups( Group A,B,C and D). There was a significant reduction in waist (-4.2 cm (±5.6)) and hip circumference (-3.1cm (±3.5)) with P < 0.001. There was no significant biochemical markers change (fasting blood sugar, CRP, LDL-C,HDL-C,TG,total cholesterol, fasting insulin, total testosterone,Vit D), however there was an increase in physical activity (3.1 hours/week (±1.5)) , and decrease in anxiety and depression score ( BDI-II and BAD-7); -0.8 (±0.8) and -0.7 (±0.7) with P<0,001 compared to interventions. Following six months scale up intervention, the results have shown a weight reduction among overweight/obese PCOS women (group A) who lost, on average, 8.2 kg (P=0.001). Whilst non-PCOS women lost, on average 11.6 kg (P<0.001)(Group E). Controls gained weight ( Group B, D F and H). The biochemical, psychological and reproductive profile showed significant improvements among PCOS women (P<0.001). Pregnancy rate increased to 70% among women trying to conceive. The results of this study have shown this intervention to be effective in Lebanese women with PCOS, decreasing their initial body weight by 5%- 10% and improving their reproductive, metabolic and endocrine profiles. This suggests the need for a nutritional intervention (nutritional guidelines) for women diagnosed with PCOS patients as a first line treatment. The study results support the effectiveness of lifestyle modification diet for PCOS women