Kosthold blant personer med nedsatt glukosetoleranse

Sammendrag Diabetes er en alvorlig sykdom i seg selv og har mange komplikasjoner. Det er et folkehelseproblem. Forekomsten av diabetes er økende både i industrialiserte land og utviklingsland. Type 2-diabetes er sterkt assosiert til overvekt, abdominal fedme og alder. Kunnskapen om kostholdet til personer som står i risiko for å utvikle diabetes er mangelfull, da det er utført få kostholdsundersøkelser i den gruppen. Flere store intervensjonsstudier har vist mer enn 50 % risikoreduksjon i utvikling av diabetes ved hjelp av livsstilssendring. Det er veldokumenter at personer som får diabetes har økt risiko for utvikling av hjerte- og karsykdommer, nefropati og retinopati. Av den grunn er det viktig med tidlig intervensjon i risikogrupper for diabetes. I forbindelse med kartleggingsstudien av ukjent diabetes, Glukosebelastnings Prosjekt (GLUP) i Helseundersøkelsen i Nord-Trøndelag (HUNT) ble det gjennomført en kostholdsundersøkelse; blant personer med forstyrrelser i blodsukkerreguleringen og personer med normal glukosetoleranse. Denne masteroppgaven er et delprosjekt til nevnte kostholdsundersøkelse. Hovedmålet for masteroppgaven var å undersøke om det var forskjeller i kostholdet mellom 58 personer med nedsatt glukosetoleranse (impaired glucose tolerance, IGT) og 111 personer med normal glukosetoleranse (kontroll gruppe). I tillegg ønsket man å undersøke hvorvidt kostholdet fulgte offisielle norske næringsstoffanbefalinger og anbefalinger for forebygging av type 2-diabetes. Undersøkelsen ble gjennomført ved hjelp av et kvantitativt matvarefrekvens-spørreskjema. Undersøkelsen viste at kvinner med IGT hadde signifikant høyere abdominal fedme, målt ved livmål og liv-hofte ratio, sammenliknet med personer med normal glukosetoleranse (p<0,01). Vi fant ingen forskjeller når det gjaldt måltidsmønster verken hos menn eller kvinner med IGT sammenholdt med kontrollgruppen. Inntaket av melk og fløte var høyere (p=0,01), grovt brød var lavere (p=0,03) og inntaket av kaffe var lavere (p=0,04) blant kvinner med IGT sammenliknet med kvinner i kontrollgruppen. Hos mennene fant vi høyere (p=0,02) inntak av lettmelk og høyere (p=0,02) inntak av saft med sukker blant menn med IGT sammenliknet med mennene i kontrollgruppen. Denne undersøkelsen viste at det var små forskjeller i kostholdet mellom personer med IGT og personer med normal glukosetoleranse. Undersøkelsen viste at både personer med IGT og personer med normal glukosetoleranse hadde for høyt fettinntak, for høyt inntak av mettede fettsyrer og for lite fiber sammenlignet med anbefalingene. Dette kan tyde på økt risiko for utvikling av insulinresistens, nedsatt glukosetoleranse og type 2-diabetes i begge gruppene avhengig av kosthold, grad av overvekt, disposisjon og alder

Are the Human Rights Conventions Really Objectionable

Background Diet-induced weight loss (WL) is usually accompanied by increased appetite, a response that seems to be absent when ketogenic diets are used. It remains unknown if sex modulates the appetite suppressant effect of ketosis. Objective The aim of this study was to examine if sex modulates the impact of WL-induced changes in appetite and if ketosis alters these responses. Methods Ninety-five individuals (55 females) with obesity (BMI [kg/m 2]: 37 ± 4) underwent 8 wk of a very-low-energy diet, followed by 4 wk of refeeding and weight stabilization. Body composition, plasma concentration of β-hydroxybutyrate (β-HB) and appetite-related hormones (active ghrelin, active glucagon-like peptide 1 [GLP-1], total peptide YY [PYY], cholecystokinin and insulin), and subjective feelings of appetite were measured at baseline, week 9 in ketosis, and week 13 out of ketosis. Results The mean WL at week 9 was 17% for males and 15% for females, which was maintained at week 13. Weight, fat, and fat-free mass loss were greater in males (P < 0.001 for all) and the increase in β-HB at week 9 higher in females (1.174 ± 0.096 compared with 0.783 ± 0.112 mmol/L, P = 0.029). Basal and postprandial GLP-1 and postprandial PYY (all P < 0.05) were significantly different for males and females. There were no significant sex × time interactions for any other appetite-related hormones or subjective feelings of appetite. At week 9, basal GLP-1 was decreased only in males (P < 0.001), whereas postprandial GLP-1 was increased only in females (P < 0.001). No significant changes in postprandial PYY were observed over time for either sex. Conclusions Ketosis appears to have a greater beneficial impact on GLP-1 in females. However, sex does not seem to modulate the changes in the secretion of other appetite-related hormones, or subjective feelings of appetite, seen with WL, regardless of the ketotic state. This trial was registered at clinicaltrials.gov as NCT01834859

Characteristics of Patients Reporting Presumed Problematic Drinking Behavior After Gastric Bypass: Exploring Long-Term Data From the BAROBS Study

ObjectiveTo explore patients’ long-term experiences with drinking alcohol after Roux-n-Y gastric bypass (RYGB) for conceptualizing what may indicate problematic drinking behavior after bariatric surgery.Study DesignThree-center, observational study.Patients546 adult patients undergoing RYGB in the period 2003-2009 in Norway.Main Outcome MeasuresSelf-reported data on drinking behavior and experiences related to alcohol collected 10-15 years after surgery.ResultsOut of the 959 patients undergoing RYGB in the period, 29 were diseased and 546 participated in this follow-up study (58.7%). Focusing on suspicious changes in drinking behavior, 8.8% reported drinking more, 11.5% consumed alcohol at least twice a week, and 10.6% consumed at a minimum of 6 units of alcohol at a frequency of at least once monthly. The nature of hangovers had changed for about a third of the patients, with 21.6% reporting these to feel weaker or absent. Repeated alcoholic blackouts were reported by 11.9%. A subgroup of the patients were categorized as displaying presumed problematic drinking behavior(PPDB). Among the PPDB-men there was a significant association to having had a fall last year (6 (100.0%) PPDB-patients vs. 30 (29.7%) non-PPDB, p&lt;.001). Among the PPDB-women, there was a significant association to having had alcohol problems prior to surgery (7 (70.0%) PPDB-patients vs. 67 (17.7%) non-PPDB, p&lt;.001). Less significant associations to PPDB reported for explorative purposes were lack of patient education (men) (16 (26.2%) PPDB-patients vs. 8 (61.5%) non-PPDB, p=.014); more than 3 months persistent musculoskeletal pain (women) (45 (15.3%) PPDB-patients vs. 29 (24.6%) non-PPDB, p=.026); subjective problems with memory (women) (58 (20.7%) PPDB-patients vs. 10 (9.1%) non-PPDB, p=.006); and, receiving professional help for mental problems last 12 months (women) (29 (22.7%) PPDB-patients vs. 45 (14.7%) non-PPDB, p=.043).ConclusionA subset of patients display drinking behaviors that may be consistent with postsurgical alcohol problems. Screening instruments like AUDIT may not be sufficiently specific to capture several risk behaviors occurring after bariatric surgery

Timeline of adaptive physiological responses with progressive weight loss in individuals with obesity on a very-low energy diet

Relapse after weight loss remains the biggest challenge in obesity management, likely due to a combination of reduced compliance with diets and exercise regimes and adaptive physiological responses to weight loss. Despite reduced total energy expenditure, the drive to eat is known to increase after weight loss. However, when weight loss is induced with ketogenic diets the expected increase in appetite seems to be absent. The aim of this PhD thesis was to identify the timeline of changes in both appetite and energy expenditure variables with progressive weight loss in individuals with obesity on a ketogenic very-low energy diet (VLED). One hundred adult (43±10 years of age) participants (45 males) with obesity (BMI: 37±4 kg/m2) underwent 8 weeks of a ketogenic VLED, followed by 4 weeks refeeding and 1 -year weight maintenance program. Body weight and composition, resting metabolic rate (RMR), exercise induced energy expenditure (EIEE) and appetite (subjective appetite feelings and plasma concentration of appetite hormones: active ghrelin (AG), glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and cholecystokinin (CCK)) were assessed at baseline and week 13, and 1-year (Study III). In a sub-study (31 participants) the same variables were additionally collected at day-3, 5 and 10 % weight loss and week 9 (Studies I and II). In study I: Hunger and desire to eat feelings in fasting were increased at day-3 and 5 % weight loss despite ketosis and no changes in basal AG plasma concentration (compared with baseline). After refeeding and with a 17 % weight loss, both fasting hunger and AG plasma concentration were increased compared with baseline. In study II: RMR was reduced for the first time at 5 % weight loss, and EIEE at all levels of power (10, 25 and 50 Watt (W)) reduced at 10 % weight loss, followed by stabilisation. Adaptive thermogenesis was only seen transiently at 10 % weight loss. Refeeding had no significant impact on the above variables. In study III: A 16 % WL outside of ketosis was associated with an increase in fasting and postprandial hunger ratings and postprandial fullness. These were accompanied by a significant rise in basal and postprandial AG concentrations and a reduction in postprandial CCK. At 1-year follow-up, with sustained WL, fasting hunger and postprandial fullness ratings remained increased. Basal and postprandial AG remained elevated, while postprandial CCK was increased and PYY decreased. In conclusion, an increased drive to eat should be expected up to 3 weeks (5 % weight loss) on a ketogenic VLED, but thereafter, appetite feelings return to baseline levels for as long as participants are ketotic. A fall in RMR should be anticipated at ≥ 5 % weight loss and a reduction in EIEE at >10 % weight loss. With refeeding, the drive to eat increases and this is sustained up to 1-year follow-up with weight loss maintenance, but it may be balanced out by increased fullness after a meal. Patients with obesity, and health professionals working with this patient group, should be aware of these findings. This should be discussed against patient’s expectations and strategies need to be put in place to support those undergoing weight loss during the critical periods

Self-Reported Gastrointestinal Symptoms Two To Four Years After Bariatric Surgery. A Cross-Sectional Study Comparing Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy

Background Roux-en-Y gastric bypass (RYGBP) and laparoscopic sleeve gastrectomy (LSG) are efficient methods for weight loss (WL) and WL maintenance in severe obesity. However, the knowledge of gastrointestinal (GI) symptoms after surgery is limited. This study aimed to compare the severity of GI symptoms, pain, and self-rated health 2 to 4 years after RYGBP and LSG surgery. Methods In this cross-sectional study, RYGBP and LSG patients answered a questionnaire including the Gastrointestinal Symptom Rating Scale (GSRS), questions from the Brief Pain Inventory (BPI), and self-rated health (SRH). Results A total of 172/303 (57%) responded, RYGBP (n=73) and LSG (n=99). The mean age was 45.3 (SD 11.1) years (74% females). There was no evidence of a difference in total GSRS scores between the surgical methods (p=0.638). There were higher scores of reflux symptoms in LSG vs. RYGBP (both median 1, 75-percentile 2.5 vs. 1.0, p <0.001) and higher consumption of acid-reducing medication after LSG (32% vs. 12%, p <0.001). Pain scores were low in both groups; however, average abdominal pain was higher for RYGBP, median 2 (IQR 0–4) vs. median 1 (IQR 0–3) for LSG (p = 0.025). There was no significant difference in SRH. Conclusions Patients undergoing RYGBP and LSG surgery reported similar total GSRS scores and low pain scores 2 to 4 years after surgery. However, reflux symptoms and use of acid-reducing medication occurred more frequently after LSG surgery, while abdominal pain was more frequent in RYGBP surgery. These findings are important for surgical decision-making and follow-up

Physiological Predictors of Weight Regain at 1-Year Follow-Up in Weight-Reduced Adults with Obesity

Objective: This study aimed to assess whether changes in resting metabolic rate (RMR), exercise‐induced energy expenditure (EIEE), and appetite following weight loss (WL) are associated with weight regain at 1 year.Methods: Thirty‐six adults with obesity underwent 8 weeks of a very‐low‐energy diet, followed by 4 weeks of refeeding and a 1‐year maintenance program. RMR, EIEE, appetite ratings, and active ghrelin, peptide YY, glucagon‐like peptide‐1, cholecystokinin, and insulin concentrations were measured at baseline, week 13, and 1 year.Results: A 17% WL (−20 ± 5 kg [mean ± SD]; range: −11.7 to −32.2 kg;\ua0P

Association between habitual sleep duration/quality and appetite markers in individuals with obesity

Study Objectives: To assess if habitual sleep duration/quality was associated with appetite in individuals with obesity, and if the association was modulated by sex. Methods: Sleep duration/quality was measured with Pittsburgh Sleep Quality Index score in 95 healthy adults with obesity (BMI: 36.6 ± 4.2 kg/m2). Subjective feelings of appetite were assessed using visual analogue scales, and plasma concentrations of active ghrelin, total peptide YY, active glucagon-like peptide 1, cholecystokinin (CCK) and insulin were measured in fasting and every 30 min up to 2.5 h after a meal. Results: No significant associations were found between sleep duration, or overall quality, and appetite in all participants. However, a worse sleep efficiency was associated with lower postprandial CCK, a shorter habitual sleep was associated with lower postprandial desire to eat and a lower daytime dysfunction was associated with higher prospective food consumption in fasting (P<0.05, for all). In males, a shorter habitual sleep duration and a worse subjective sleep quality were associated with increased basal and postprandial active ghrelin (P<0.05, P<0.01, P<0.01 and P<0.05, respectively). Also, a shorter habitual sleep was associated with lower basal and postprandial insulin (P<0.05 for both) and a worse overall sleep quality with lower postprandial insulin (P<0.05). In females, a worse overall sleep quality was associated with lower postprandial active ghrelin (P<0.05), and short habitual sleep with higher postprandial insulin (P<0.05). Conclusion: A worse habitual sleep efficiency is associated with blunted postprandial CCK secretion in individuals with obesity. The association between habitual sleep duration/quality and insulin and active ghrelin seems to be modulated by sex, but more studies are needed to confirm these finding

Association between ketosis and changes in appetite markers with weight loss following a very low‐energy diet

ObjectiveThe purpose of this study was to examine whether the degree of ketosis, measured as plasma β‐hydroxybutyrate (βHB) in fasting, was associated with changes in appetite feelings and plasma concentration of appetite‐related hormones after weight loss.MethodsA total of 87 individuals with obesity (BMI: 36.5 ± 4.0 kg/m2; age: 42.4 ± 9.7 years; 39 males) underwent 8 weeks of a very low‐energy diet. Body weight/composition, plasma concentration of βHB, and appetite‐related hormones (active ghrelin, active glucagon‐like peptide 1 [GLP‐1], total peptide YY, cholecystokinin [CCK], and insulin) and subjective appetite feelings were measured at baseline and week 9.ResultsParticipants lost 17.7 ± 4.1 kg and were ketotic (βHB: 1.24 ± 0.82 mmol/L in fasting) at week 9. A negative association was found between βHB in fasting at week 9 and changes in basal (r = −0.315,\ua0P = 0.003) and postprandial ghrelin concentration (r = −0.286,\ua0P = 0.008), and a positive association was found with the change in postprandial GLP‐1 (r = 0.244,\ua0P = 0.025) and CCK (r = 0.228,\ua0P = 0.035). No association was seen between βHB in fasting and changes in peptide YY or subjective feelings of appetite.ConclusionsβHB plasma concentration in fasting is associated with lower concentrations of the hunger hormone ghrelin and increased concentrations of the satiety hormones GLP‐1 and CCK. Future studies should explore the molecular mechanisms by which βHB modulates the secretion of gut hormones

Effect of a ketogenic diet on pain and quality of life in patients with lipedema: The LIPODIET pilot study

Background Lipedema is an underdiagnosed condition in women, characterized by a symmetrical increase in subcutaneous adipose tissue (SAT) in the lower extremities, sparing the trunk. The lipedema SAT has been found to be resistant to diet, exercise and bariatric surgery, in regard to both weight loss (WL) and symptom relief. Current experience indicates that a low carbohydrate and high fat (LCHF-diet) might have a beneficial effect on weight and symptom management in lipedema. Objective To assess the impact of an eucaloric low carbohydrate, high fat (LCHF)-diet on pain and quality of life (QoL) in patients with lipedema. Methods Women diagnosed with lipedema, including all types and stages affecting the legs, (age 18-75 years, BMI 30-45 kg/m2) underwent 7 weeks (wk) of LCHF-diet and, thereafter 6 wk of a diet following the Nordic nutrition recommendations. Pain (visual analog scale) and QoL (questionnaire for lymphedema of the limbs), weight and body composition were measured at baseline, wk 7 and 13. Results Nine women (BMI: 36.7±4.5kg/m2 and age: 46.9±7 years) were recruited. The LCHF diet induced a significant WL -4.6±0.7 kg (-4.5±2.4%), P<0.001 for both, and reduction in pain (-2.3±0.4 cm, P=0.020). No correlation was found between WL and changes in pain at wk 7 (r = 0.283, P = 0.460). WL was maintained between wk 7 and 13 (0.3±0.7 kg, P=0.430), but pain returned to baseline levels at wk 13 (4.2±0.7 cm ,P=0.690). A significant increase in general QoL was found between baseline and wk 7 (1.0 (95% CI (2.0, 0.001), P=0.050) and 13 (1.0 95% CI (2.0, 0.001) P=0.050), respectively. Conclusion A LCHF-diet is associated with reduction in perceived pain and improvement in QoL, in patients with lipedema. Larger randomized clinical trials are needed to confirm these findings