Direct access lifestyle training improves liver biochemistry and causes weight loss but uptake is suboptimal in patients with non-alcoholic fatty liver disease.

Objective: To evaluate the uptake and effectiveness of an existing open access lifestyle intervention forged in collaboration between a third sector organisation, funded by local government and a secondary care non-alcoholic fatty liver disease (NAFLD) service in the North West of England. Method: A service outcome evaluation using pre-post comparison design was conducted to analyse changes between baseline clinical health records and 12 week follow up for NAFLD patients who completed the lifestyle intervention. Lifestyle factors, weight loss, changes in alanine aminotransferase (ALT) enzymes and lipid profiles were compared between patients who completed the programme versus 1:1 matched patients who did not. Results: Only 16 of 167 NAFLD patients offered the intervention completed the programme. Intervention patients achieved significant weight loss (-2.3% p ≤ 0.05) over 12 weeks, where the non-intervention group had non-significant weight gain (+0.95%). ALT improved by 20IU/L in the interventional group and 15 IU/L in the non-intervention group; however, this was not statistically different. Conclusion: This study presents first of its kind evaluation of a service collaboration in the UK. Only 1 in 10 patients offered the opportunity completed the programme, a limitation that could affect future strategies. Patient and public involvement research is needed to identify barriers to participation, address adherence issues and identify support mechanisms for lifestyle interventions with NAFLD patients

Men and women respond differently to rapid weight loss : Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW)

Aims Materials and methods The PREVIEW lifestyle intervention study ( Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women. All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI >= 25 kg/m(2)) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score. Results Conclusions In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 +/- 0.15 in men and by 1.35 +/- 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia. An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.Peer reviewe

Efficacy of dietary and physical activity intervention in non-alcoholic fatty liver disease: a systematic review

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, with prevalence above 30% in many adult populations. Strongly associated with obesity, weight loss through diet and physical activity is the mainstay of its management. Weight loss can be difficult to achieve and maintain however, and uncertainty exists as to which lifestyle changes are most effective. Objective: The aim of this work was to systematically evaluate randomised controlled trials assessing diet, exercise or combination interventions aimed at reducing steatosis or markers of NAFLD activity. Design: Medline, Scopus and Cochrane databases were searched from January 1st 1980 through to July 31st 2016, for intervention trials assessing the effects of diet, weight loss, exercise or any combination thereof, on NAFLD disease markers in human adults. Risk of publication bias and study quality was assessed using the American Dietetic Association Quality Criteria Checklist. Results: From a total of 1710 identified records, 24 articles met the inclusion and exclusion criteria; 6 assessed weight loss using dietary restriction, 10 assessed exercise and 8 were combination interventions. While all of the trials demonstrated significant reduction in steatosis and/or markers of NAFLD activity, combination interventions appear to be the most effective at improving NAFLD. Results suggest that 5-10% weight loss using a modestly hypocaloric diet of 500kcal less per day than calculated energy requirement, in combination with 30-60 minutes exercise on 3-5 days per week should be recommended. Conclusions: We conclude this amount of weight loss is achievable in the trial setting but is challenging in the clinical environment. High intensity, multidisciplinary intervention in specialist clinics is likely to be required in order to manage NAFLD by lifestyle modification alone. This systematic review protocol was registered prospectively at PROSPERO as CRD42016032764

Η εργασία των αλλοδαπών υπηκόων κρατών μελών της Ε.Ε.

Σκοπός της παρούσας μελέτης είναι να παρουσιάσει, κατά τρόπο ευσύνοπτο, το κρίσιμο ζήτημα της εργασίας των αλλοδαπών υπηκόων κρατών μελών της Ένωσης και της συνακόλουθης κοινωνικοασφαλιστικής καλύψεώς τους. Αρχικά, θα γίνει λόγος για την αρχή της μη διάκρισης που διαπνέει το σύνολο των σχετικών διατάξεων και συνιστά απαραίτητη προϋπόθεση για τη λειτουργία μιας εσωτερικής και ανοικτής αγοράς. Στη συνέχεια θα αναλυθεί η ευρωπαϊκή ιθαγένεια, η εξέλιξη της νομολογίας του Δικαστηρίου αναφορικά με αυτήν καθώς και η σχέση της με τον διακινούμενο εργαζόμενο. Τα εργασιακά και κοινωνικά δικαιώματα όπως κατοχυρώνονται στον Χάρτη των Θεμελιωδών Δικαιωμάτων της Ένωσης. Ακολουθεί διεξοδική προβολή των δικαιωμάτων της ελεύθερης κυκλοφορίας των εργαζομένων και της ελεύθερης παροχής υπηρεσιών στην Ε.Ε., ερευνάται το θεσμικό πλαίσιο στο οποίο αυτές γεννήθηκαν και εξελίχθηκαν, υπό την επαγρυπνούσα πάντα νομολογία του Δικαστηρίου. Στο δεύτερο μέρος ερευνάται η ευρωπαϊκή κοινωνική πολιτική και οι πολύπλευρες παρεμβάσεις της Ε.Ε. στο δίκαιο της κοινωνικής ασφάλισης. Ως πρώτη έκφραση του δικαιώματος στην κοινωνική ασφάλεια, παρουσιάζεται ο συντονισμός των εθνικών συστημάτων κοινωνικής ασφάλισης. Έπεται η συμπληρωματική ασφάλιση και τέλος, γίνεται αναφορά στην αρχή της ισότητας ανδρών και γυναικών στην κοινωνική ασφάλιση.This paper aims at presenting, in a concise manner, the critical issue of the labour of the EU member countries’ foreign citizens and of their concomitant social-insurance coverage. Initially, there will be an allusion to the principal of non-discrimination, which pervades the body of the relevant regulations and poses an indispensable precondition for the operation of a domestic and open market. Subsequently, European citizenship is going to be analyzed, along with the evolution of the Court of Justice case-law regarding the aforementioned European Citizenship, as well as its affiliation with the ‘migrant worker’ and the social rights, as those are enshrined by the EU Charter of Fundamental Rights. A thorough illustration of the rights of ‘free – movement – workers’ and of their ‘freedom – to – provide – services’ follow, as well as of the institutional framework, within which these services occurred and evolved, under the ever-vigilant case-law of the Court of Justice. In the second part, the European social policy is canvassed, along with the multilateral EU interventions on the social security legislation. As a first expression of the right for social security, the coordination of the national social-security systems is presented. Then, supplementary social security follows and finally the principle of equal treatment of both men and women in terms of social security

The effect of mediterranean lifestyle οn biochemical and clinical characteristics of patients with non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in Western societies and is strongly associated with the presence of metabolic syndrome. Numerous studies support a strong correlation between several food groups and the likelihood of having NAFLD. Currently, lifestyle changes remain the cornerstone therapy of the disease. Thus, the aim of this thesis was to investigate the effect of several lifestyle components as risk factors for NAFLD, and by using these data to design and implement a disease management protocol, based on a lifestyle intervention. For this reason, four studies have been conducted, including: a) one cross-sectional study in a sample of 136 NAFLD patients and a study of 100 NAFLD patients and 55 healthy volunteers, b) a systematic review and meta-analysis of 20 randomized controlled interventions related to lifestyle modification, and then based on the results of the above studies, c) a randomized controlled clinical trial of 63 patients with NAFLD. Patients were equally and randomly assigned either (a) in a Mediterranean diet group (MD) or (b) in a Mediterranean lifestyle group (MDL), or (c) in a control group (CG). Participants of groups (a) and (b) attended an intensive 6-month intervention program aimed at weight loss and increasing adherence to the MD, while in the MDL group additional information for increasing physical activity and improving sleep habits were given. The CG patients received only written information for a healthy lifestyle. According to the results of the epidemiological studies, physical activity and optimal sleep duration (≥7 and ≤9 hours / day) were associated with reduced likelihood, whereas sweets consumption with a higher likelihood of having NAFLD. Moreover, high adherence to a healthy lifestyle pattern, rich in low-fat dairy, vegetables and fish, along with optimal sleep duration, was associated with reduced levels of insulin resistance and liver stiffness in patients with NAFLD. The meta-analysis results showed that exercise only or diet plus exercise interventions can improve liver enzyme levels, intrahepatic fat and histological characteristics of patients. Indeed, exercise appeared to exert beneficial effects on intrahepatic triglycerides and glucose metabolism, regardless of weight loss. According to the results of the controlled randomized clinical study, it was shown that an intensive 6-month intervention based on a hypocaloric MD or on MDL can improve liver enzymes and liver stiffness, as well as oxidative stress levels in patients with NAFLD, independently of weight loss, compared to common clinical practice. In conclusion, the results of the present thesis highlight the role of the Mediterranean diet as an effective, efficient and feasible way to manage NAFLD patients in daily clinical practice.Η μη αλκοολική λιπώδης νόσος του ήπατος (NAFLD) αποτελεί τη συχνότερη αιτία ηπατικής διαταραχής στις δυτικές κοινωνίες σχετιζόμενη ισχυρά με την παρουσία μεταβολικού συνδρόμου. Πληθώρα μελετών υποστηρίζουν ισχυρές συσχετίσεις μεταξύ διαφόρων ομάδων τροφίμων και την πιθανότητα παρουσίας NAFLD. Επί του παρόντος, οι αλλαγές στον τρόπο ζωής παραμένουν ο ακρογωνιαίος λίθος αντιμετώπισης της νόσου. Ο σκοπός της παρούσας διδακτορικής διατριβής ήταν να διερευνήσει τη θέση των διαφόρων συνιστωσών του τρόπου ζωής ως παράγοντες κινδύνου της NAFLD, και βάσει των δεδομένων αυτών να σχεδιάσει και να υλοποιήσει ένα πρωτόκολλο αντιμετώπισης της νόσου, βασισμένο σε μία παρέμβαση που αφορούσε τον τρόπο ζωής των ασθενών. Γι’ αυτό τον λόγο διενεργήθηκαν 4 μελέτες: α) μία συγχρονική μελέτη σε ένα δείγμα 136 ασθενών με NAFLD και μία μελέτη 100 ασθενώv και 55 υγιών εθελοντών), β) μία συστηματική ανασκόπηση-μετα-ανάλυση 20 τυχαιοποιημένων ελεγχόμενων παρεμβάσεων που σχετίζονταν με την τροποποίηση του τρόπου ζωής, και λαμβάνοντας υπόψη τα αποτελέσματα των παραπάνω μελετών, γ) μία τυχαιοποιημένη ελεγχόμενη κλινική μελέτη σε ένα δείγμα 63 ασθενών με NAFLD. Οι ασθενείς τυχαιοποιήθηκαν ισάριθμα είτε (α) στην ομάδα μεσογειακής δίαιτας (ΜΔ) ή (β) στην ομάδα μεσογειακού τρόπου ζωής (ΜΤΖ), είτε (γ) στην ομάδα ελέγχου (OE). Οι συμμετέχοντες των ομάδων (α) και (β) παρακολούθησαν ένα εντατικό πρόγραμμα παρέμβασης 6 μηνών με στόχο την απώλεια βάρους και την αύξηση της προσκόλλησης στη ΜΔ, ενώ στην ομάδα ΜΤΖ, δόθηκαν επιπλέον οδηγίες για αύξηση της φυσικής δραστηριότητας και βελτίωση των συνηθειών ύπνου. Οι ασθενείς της ΟΕ έλαβαν μόνο γραπτές γενικές οδηγίες ενός υγιεινού τρόπου ζωής. Σύμφωνα με τα αποτελέσματα των επιδημιολογικών μελετών, το υψηλότερο επίπεδο φυσικής δραστηριότητας και η συνιστώμενη διάρκεια ύπνου (≥7 και ≤9 ώρες/ημέρα) συσχετίστηκαν με μειωμένη πιθανότητα, ενώ η κατανάλωση γλυκών με υψηλότερη πιθανότητα παρουσίας NAFLD. Επιπλέον, η υψηλή προσκόλληση σε ένα υγιεινό πρότυπο πλούσιο σε γαλακτοκομικά προϊόντα χαμηλών λιπαρών, λαχανικά και ψάρια, παράλληλα με υψηλή συμμόρφωση στη συνιστώμενη διάρκεια ύπνου, συσχετίστηκε με μειωμένα επίπεδα αντίστασης στην ινσουλίνη και ηπατική ακαμψία στους ασθενείς με NAFLD. Από τα αποτελέσματα της μετα-ανάλυσης, φάνηκε ότι οι παρεμβάσεις μόνο με άσκηση ή συνδυασμού δίαιτας και άσκησης, μπορούν να βελτιώσουν τα επίπεδα ηπατικών ενζύμων, ενδοηπατικού λίπους, καθώς και ιστολογικά χαρακτηριστικά των ασθενών. H άσκηση μάλιστα, φάνηκε να ασκεί ευεργετική επίδραση στα ενδοηπατικά τριγλυκερίδια και σε δείκτες μεταβολισμού της γλυκόζης, ανεξάρτητα της απώλειας βάρους. Από τη διεξαγωγή της κλινικής μελέτης, φάνηκε ότι μία εντατικοποιημένη παρέμβαση διάρκειας 6 μηνών, βασισμένη είτε σε μία υποθερμιδική ΜΔ είτε στον ΜΤΖ, βελτιώνει τα επίπεδα ηπατικών ενζύμων, ηπατικής ακαμψίας και το επίπεδο οξειδωτικού στρες των ασθενών με NAFLD, ανεξάρτητα της απώλειας βάρους, συγκριτικά με τη συνήθη πρακτική αντιμετώπισης. Συμπερασματικά, από τα αποτελέσματα της παρούσας διδακτορικής διατριβής αναδεικνύεται ο ρόλος της μεσογειακής δίαιτας ως ένας αποτελεσματικός, αποδοτικός και εφικτός τρόπος διαχείρισης των ασθενών με NAFLD στην καθημερινή κλινική πρακτική

Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies

Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. In recent years, interest in the role of diet in the treatment of FGIDs has increased. Currently, interest focuses on the low-FODMAP diet (LFD), the fructose- or lactose-restricted diet (FRD or LRD), the gluten-free diet (GFD), and the Mediterranean diet (MD). In this review, we focus on the role of these dietary patterns in the FGIDs most commonly diagnosed in clinical practice, namely irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and functional constipation (FC). Fifteen clinical trials were systematically reviewed (both RCTs and single-arm clinical trials). We demonstrated the lack of high-quality intervention trials. Based on current evidence, low-FODMAP diet, LRD, FRD, and GFD have no place in daily clinical practice for the management of children and adolescents with FGIDs. Nevertheless, some patients with IBS or RAP may experience some benefit from the use of a low-FODMAP diet or FRD/LRD. Limited data suggest that MD may be promising in the management of FGIDs, especially in IBS patients, but more data are required to investigate the mechanisms of its protective effects

Knowledge of Dietitians on Gut Microbiota in Health—An Online Survey of the European Federation of the Associations of Dietitians (EFAD)

Explorations of current knowledge of dietitians about gut-health interconnection and the role of diet in gut microbiota manipulation are rather scarce in the literature. In this online survey we assessed the perceived and current knowledge of dietitians across Europe about gut microbiota and systemic health, nutrition as a modulator of the gut ecosystem, and the role of probiotics and prebiotics. Pre-graduate dietetic students and other professionals were also invited to participate. A total of 179 full responses were recorded (dietitians, n = 155), mainly from Southern and Western regions. Most participants (>78.0%) reported an average to good level of perceived knowledge, with significant positive correlations between perceived and current knowledge in all sections and overall (p for all p for all <0.05). In conclusion, this online survey shed some light on the current knowledge of dietitians across Europe about gut microbiota parameters, including dietary modulation, highlighting in parallel possible knowledge determinants. Potential areas for future educational efforts in this rather unexplored field were indicated

Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis

Background/Objectives Although lifestyle modifications remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD), the optimal lifestyle intervention is still controversial. The aim of this meta-analysis was to evaluate the effect of exercise and/or dietary interventions, type or intensity of exercise and type of diet, on liver function outcomes (liver enzymes, intrahepatic fat and liver histology), as well as on anthropometric and glucose metabolism parameters in NAFLD patients. Subjects/Methods Literature search was performed in Scopus and US National Library of Medicine databases to identify all randomized controlled clinical trials (RCTs) in adult patients with NAFLD, diagnosed through imaging techniques or liver biopsy, published in English between January 2005 and August 2016. Studies&apos; quality was evaluated using the Cochrane Risk of Bias Tool. Heterogeneity was tested using the Cochran&apos;s Q test and measured inconsistency by I2. Effect size was calculated as the standardized mean difference (SMD). The meta-analysis was performed in accordance with PRISMA guidelines. Results Twenty RCTs with 1073 NAFLD patients were included. Compared to standard care, exercise improved serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (all P &amp;lt; 0.05). Ιntrahepatic fat also improved, irrespectively of weight change (SMD = − 0.98, 95% CI: − 1.30 to − 0.66). Regarding the type of exercise, aerobic compared to resistance exercise did not yield any superior improvements on liver parameters, whereas moderate-to-high volume moderate-intensity continuous training was more beneficial compared to continuous low-to-moderate-volume moderate-intensity training or high intensity interval training. Interventions combining exercise and diet showed decreases in ALT (P &amp;lt; 0.01) and improvement in NAFLD activity score (SMD = − 0.61, 95% CI: − 1.09 to − 0.13). Moderate-carbohydrate diets yielded similar changes in liver enzymes compared to low/moderate-fat diets. Conclusions Exercise alone or combined with dietary intervention improves serum levels of liver enzymes and liver fat or histology. Exercise exerts beneficial effects on intrahepatic triglycerides even in the absence of weight loss. © 2016 Elsevier Inc