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. 2018 May 26;11(Suppl 1):1–364. doi: 10.1159/000489691

25th European Congress on Obesity, Vienna, Austria, May 23-26, 2018: Abstracts

PMCID: PMC7019188  PMID: 29804106

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Obes Facts. 2018 May 26;11(Suppl 1):1.

PL1.1 Personalised approaches

H S Orer 1

Introduction

The use of patient-specific information to tailor precise treatments is the essence of the personalized medicine. The ultimate aim is to have interventions as efficient as possible without adverse reactions.

Methods

A systematic review of the literature was made to evaluate the current status of genomic medicine with relation to obesity.

Results

The emergence of evidence-based medicine marks the culminating point of the modern (or analog) era where randomized controlled trials are the backbone of the clinical research. However, with the advent of molecular biology in the late 20th century, genomics has fast taken center stage of the treatment. Pharmacogenomic studies showed that not all drugs act the same way in all individuals, even though the diagnosis is the same. As the gene-wide analyses become affordable, genetic profiling has become an essential part of the patient management in targeted therapy protocols. Gene-based technologies also have a predictive value, an unprecedented opportunity to develop biomarkers. The acknowledgment of patient heterogeneity compromises the statistical power of randomized controlled trials. New measures to assess efficacy and safety of the new drugs are emerging. Exceptional responders, or “outliers” who were once excluded from data analyses or concealed in the background noise, are now seen as an opportunity to pinpoint unique mechanisms of action of drugs. However, such a precision renders the data generalization problematic and the development of the new therapy modalities too costly. Until now, rare diseases and cancers are the two main avenues of research to implement personalized medicine. In the future, complex disorders and other conditions, including obesity will increasingly enter into its scope.

Conclusion

Both inherited genetic and environmentally-modified epigenetic factors contribute to the development of obesity, and the complications emerge in many years. Therefore, it is difficult to establish a direct link between obesity and organ dysfunctions. Gene networks that serve as an on-off switch in the presence of appropriate epigenetic factors are important drug targets. Besides the therapy focus, prevention will also be an important area of research in the coming years. Especially, genomic risk assessment and associated lifestyle changes may be of value to prevent the obesity preemptively. Financial bottlenecks fast become a significant limitation to the development of personalized treatments. A major problem in obesity management may be that by putting too much emphasis on the genetic constituency, one may fail to engage the patients in lifestyle changes. Moreover, in such a lucrative field, marketing efforts may overtake the science, and ethically questionable practices may prevail.

Obes Facts. 2018 May 26;11(Suppl 1):1.

PL2.1 Is obesity a trigger for puberty?

K K Ong 1

Introduction

The timing of puberty, the transition from child to adult, varies widely between individuals. This wide variation is implicated in psychological concerns and risk-taking behaviours during adolescence, and it also has important relevance for long-term health. In general, earlier timing of puberty is associated with higher risks for premature mortality and health outcomes, such as obesity, type 2 diabetes, cardiovascular disease and sex steroid-sensitive cancers.

Methods

This talk will highlight findings from cohort studies, trials and population genetics studies.

Results

A major role of childhood obesity in promoting earlier timing of puberty is supported by many epidemiological studies, particularly in girls. On the contrary, obese boys are sometimes reported to have delayed puberty. Secular trends towards earlier puberty timing appear to coincide with population-level markers of nutritional sufficiency, but it is curious that the secular trends have slowed in settings where childhood obesity is still rising. Genome-wide association studies (GWAS), which genotype hundreds of thousands of common genetic variants located across the entire genome, have identified hundreds of specific genetic determinants of pubertal timing. These findings substantiate strong mechanistic links between obesity and earlier timing of puberty, as well as between earlier timing of puberty and later disease risks. While many genomic loci implicate genes that regulate the hypothalamo-pituitary-gonadal axis, many others implicate genes that regulate energy homeostasis and weight gain, as well as obesity-independent pathways to later disease.

Conclusion

Puberty timing is an important outcome to be considered in the evaluation of interventions that aim to avoid or reduce childhood obesity.

Obes Facts. 2018 May 26;11(Suppl 1):1–2.

PL3.1 Novel aspects in neuroendocrine and energy homeostasis regulation by peripheral signals acting through the CNS. Implications for obesity therapeutics

C Mantzoros 1

Introduction

In the mid-1990s, the discovery of the hormone leptin raised hopes that researchers had finally found a treatment for obesity. With its name based on the Greek word “leptos” (meaning thin), leptin secreted by fat cells appeared to switch off the urge to eat in preclinical animal studies.

Methods

While those findings did not translate to humans who are overweight or obese, subsequent work by Mantzoros and his colleagues in the field resulted in the paradigm-shifting concept that fat tissue is not an inert energy storage organ but an active endocrine organ – a concept that revolutionized the way endocrinologists view metabolic disorders and has contyributed to our understanding of neuroendocrine regulation, obesity, insulin resistance, and their consequences which include diabetes, cardiovascular disease, and malignancies. In more recent studies,

Results

Mantzoros and colleagues are using, neuroanatomical, neurocognitive and neuroimaging studies to examine how environmental and dietary factors interact with hormones to alter activity in the brain and thus neuroendocrine regulation of human physiology and eating behavior.

Conclusion

Novel physiology findings will be presented along with translational research contributions that propel forward our understanding of the physiology and therapeutic utility on leptin and adipokines in humans, the development of novel treatments for neuroendocrine and metabolic disease, and the physiology of other key molecules and hormones secreted by muscle and the gastrointestinal tract such as incretins that regulate appetite and obesity in humans.

Conflicts of Interest

Shareholder: Coherus, Pangea and Pnoe, Consulting or grant fees through my Institution: Novo, Esai, Aegerion, Intarcia

Obes Facts. 2018 May 26;11(Suppl 1):2.

PL4.1 Global Food Policy and Obesity

K Brownell 1

Understanding the conditions that make obesity so prevalent, and identifying opportunities for prevention, requires knowledge of policies and practices that affect food systems overall. Food assistance programs in the context of international development, for example, are intended to address world hunger but affect broader food systems in ways that likely influence obesity. Intersections will be discussed around four food policy areas: obesity; food insecurity; agriculture and environment; and food safety and defense. There is considerable depth of expertise in each area, but too little interaction across areas. Coordinated food policies could lead to wins across areas, stronger coalitions of groups supporting particular policies, and better anticipation of unintended consequences. A model for coordination of world policy will be presented, with special attention to implications for addressing obesity.

Obes Facts. 2018 May 26;11(Suppl 1):2.

PL5.1 Large-scale regulatory changes focused on obesity prevention: Current state of knowledge

B M Popkin 1

Introduction

In Europe and globally we have seen increases in obesity, particularly child obesity. This appears to be the decade when countries are finally beginning to take on major fiscal and regulatory efforts to address this problem. We are beginning to gain a much greater understanding of the rapid shifts in our diets, eating behaviors and the factors underlying these changes. While we also need healthy activity patterns and need to work on ways to improve physical activity, we have learned that we must shift toward much healthier eating patterns to prevent and even reduce obesity. But in all cases, we are at a very early stage of understanding for each type of action what works, what are the limitations and how can we improve our actions. I review what we know in the areas of fiscal actions, marketing controls, front-of-the-package profiling.

Methods

Use of an array of longitudinal commercial datasets on food purchases, food retail data, commercial sales, employment and price data along with self-collected in-depth data on each food product, including ingredients, nutrition facts panels, bar codes and much other data on each package. Longitudinal fixed and random effects statistical models based on counterfactual designs where we look at how policies shift trends[trajectories] of food purchases. Many other methods are also being used to look at overall food urchase pattner shifts. For fiscal evaluation this is combined with other sales, employment, price and demographic data. For marketing evaluations, commercial data on audiences and all TV shows are used to select representative samples of synthetic multiple weeks of TV viewing. For package characters and other claims, coding of all materials on packages is used. Cohorts of children in various ages are used to provide exposure to various TV shows to which they are linked for advertising exposure in addition to data on knowledge and attitude changes and ultimately dietary behavior.

Results

My review focuses more on current evaluations underway in Mexico, Chile, the US and limited work done in Europe. Other studies are just in the initial stages and discussed briefly. Fiscal actions appear now to be one of the most promising areas. We know that increased relative costs, especially if significant for that specific population, can reduce intake of the taxed product, be it sugary beverages or various categories of what we might term nonessential junk food. In the marketing area our knowledge of the inability of voluntary efforts to make any impact on behavior is great but we are only now learning about the effort of more comprehensive regulatory efforts, led by Chile. Similarly, in the front-of-the-package profiling area, knowledge is scarce, but several evaluations provide some sense of potentially effective options. All these efforts have focused at the large-scale level on limited aspects of what constitutes our overall food system. I discuss some of the gaps and how we need to begin to think about the next generation of interventions. We cannot limit ourselves to the three major clusters of current actions but must move far beyond. We have major gaps in food system interventions that require experimentation and major pushes. And we are far from learning how to create a culture of healthy eating.

Conclusion

While there is much to cheer, we must recognize we have many decades of major challenges ahead. We are in the very early stages of learning what works and must undertake thoughtful evaluations of what works as well as constantly learn of ways to address the industrial forces fighting against healthy dietary policies in the coming decades.

Obes Facts. 2018 May 26;11(Suppl 1):2–3.

PL7.1 The pink adipocyte

S Cinti 1

Introduction

Most of white and brown adipocytes, in spite of their well known different functions: i.e. storing energy (white) and thermogenesis (brown), are contained together in visceral and subcutaneous depots (adipose organ) in all mammals including humans (S Cinti The Adipose Organ, Kurtis Milan 1999, A Frontini et al Cell Metab 2010). A growing body of evidence suggests that the reason for this anatomical mixture could reside in the fact that adipocytes have peculiar plastic properties allowing them to convert directly each other under appropriate stimuli (S Cinti Am J Physiol EM 2009). Under chronic cold exposure white convert into brown to support the need for thermogenesis and under obesogenic diet brown convert into white to satisfy the need of energy storing. Adipocyte population in the mammary gland offers another striking example of adipocyte plasticity: during pregnancy and lactation adipocytes transdifferentiate into milk-producing epithelial cells (we propose to call them: pink adipocytes) and vice versa in the post-lactation period (Morroni M et al PNAS 2004, DeMatteis R et al Stem Cells 2009, Prokesch et al Stem Cells 2014). The white into brown transdifferentiation is of great medical interest because the brown phenotype of the adipose organ is associated with obesity resistance and drugs inducing the brown phenotype curb obesity and related disorders (Giordano et al Nature Rev Drug Discov 2016). We recently showed by transmission electron microscopy that in the post-lactating mammary gland interscapular multilocular adipocytes found close to the mammary alveoli contain milk protein granules. Lineage tracing system allowed showing that the involuting mammary gland of whey acidic protein-Cre/R26R mice, whose secretory alveolar cells express the lacZ gene during pregnancy, contains some X-Gal-stained and uncoupling protein 1 immunoreactive interscapular multilocular adipocytes. These data suggest that during mammary gland involution some milk- secreting epithelial cells in the anterior subcutaneous depot may transdifferentiate to brown adipocytes, highlighting a hitherto unappreciated feature of mouse adipose organ plasticity (Giordano et al Cell Physiol 2017).

Methods

Data have been obtained mainly with morphology, immunohistochemistry and lineage tracing techniques.

Results

We recently showed by transmission electron microscopy that in the post-lactating mammary gland interscapular multilocular adipocytes found close to the mammary alveoli contain milk protein granules. Lineage tracing system allowed showing that the involuting mammary gland of whey acidic protein-Cre/R26R mice, whose secretory alveolar cells express the lacZ gene during pregnancy, contains some X-Gal-stained and uncoupling protein 1 immunoreactive interscapular multilocular adipocytes. These data suggest that during mammary gland involution some milk- secreting epithelial cells in the anterior subcutaneous depot may transdifferentiate to brown adipocytes, highlighting a hitherto unappreciated feature of mouse adipose organ plasticity (Giordano et al Cell Physiol 2017).

Conclusion

In conclusion the plasticity of adipose organ is further supported by the reversible physiologic transdifferentiation of white to pink adipocytes and by pink to brown. These data open new avenues for future treatment of obesity-type 2 diabetes and allow a better understanding of mammary gland physiology.

Obes Facts. 2018 May 26;11(Suppl 1):3.

S1.1 Urbanization in China in Relation to Obesity: Diet, Omics, and Cardiometabolic Disease

P Gordon-Larsen 1

Introduction

Urbanization is associated with increased risk for obesity, diabetes, and other chronic diseases, yet we know little about the pathways through which urbanization bears its influence. Partially these gaps relate to lack of data across molecular to behavioural to environment levels.

Methods

We hypothesised that urbanization in China accompanies changes in the microbiome and metabolome, which in turn relate to dietary behaviours, obesity, and cardiometabolic diseases. In this study, we used data from the China Health and Nutrition Survey and compared the gut microbiome, plasma metabolome, dietary habits and health biomarkers of rural and urban people from a single Chinese province. We used 16S ribosomal RNA (rRNA) sequencing of faecal samples, as well as whole genome sequencing data to assess the gut microbial community of our subjects and plasma metabolomics to characterize circulating metabolites in the host bloodstream. We used 24-hour dietary recall data to characterize the dietary intake of the participants. We used pathway-based models to examine pathways from urbanization through diet behaviours to cardiometabolic disease and we used mixed linear models to examine differences in urban versus rural status with microbial and metabolite data.

Results

We found increases in many markers of Westernized diet across time and with urbanization, with strongest effects in individuals of low and moderate urbanization whereas individuals living in highly urbanized areas had slower pace of increase. Indirect pathways from urbanization through baseline and change in traditional and Western markers of diet as well as baseline occupational activity were associated with BMI at follow up. We identified significant differences in the microbiota and microbiota-related plasma metabolites in rural versus recently urban subjects from Hunan province, along with stronger similarity in microbes in the urban (versus rural) Chinese as individuals in the Human Microbiome Project cohort of American subjects. Furthermore, using whole metagenome sequencing, we found that urbanization was associated with a loss of microbial diversity along with increased gene diversity and antibiotic resistance and virulence strongly correlated with Escherichia and Shigella.

Conclusion

Urbanization in China is associated with changes in behaviours, weight status, and cardiometabolic diseases but at differences in pace of change across more and less urbanized areas and with different pathways to disease. Our data suggest that urbanization has produced convergent evolution of the gut microbial composition in American and urban Chinese populations, resulting in similar compositional patterns of abundant microbes through similar lifestyles on different continents.

Obes Facts. 2018 May 26;11(Suppl 1):3–4.

S1.2 Fast food restaurants and obesity: guilty as charged or falsely accused?

J R Speakman 1, M Mazidi 2

Introduction

In the USA the obesity epidemic has been mirrored by expansions in the numbers of, and portion sizes at, fast food restaurants (FFR), leading many to lay the blame for the epidemic at the door of the restaurant industry. If FFR do cause obesity, greater per capita densities of FFR should correlate with greater obesity levels.

Methods

We used county level data for obesity prevalence across the mainland USA in 2012 and matched this to county level per capita densities of FFR and FSR in the same year. Multiple linear regression was used to determine the relation between prevalence of obesity and densities of FFR and FSR after adjustment for confounding factors.

Results

Contrary to expectations obesity prevalence was highly significantly negatively related to the densities of both FFR and FSR (combined effect R2 = 0.195). This was principally because greater numbers of both FFR and FSR were located in areas where individuals were on average richer and more educated. When we normalised for these factors (and additional socioeconomic variables) the associations between restaurant densities and obesity effectively disappeared, (pooled R2 = 0.008). Estimates of the proportion of calories consumed out of the home indicate on average 15.9% of calories are consumed in FFR and FSR.

Conclusion

Variations in the density of FFR and FSR are not correlated with the prevalence of obesity in the USA. This is likely because food consumed in these establishments is responsible for less than a one fifth of total energy intake. This has implications for policy decisions regarding how we aim to tackle the obesity epidemic.

Obes Facts. 2018 May 26;11(Suppl 1):4.

S1.3 A comparative analysis of explicit weight bias in the UK and eight other countries

TK Kyle 1, J Nadglowski 2, X Ramos Salas 3, D Thomas 4, RM Puhl 5, K Watts 4

Introduction

Weight bias (WB) is an important source of harm to people with obesity (PwO) and a barrier to progress in reducing its health impact. Although WB has been documented in many different countries, few studies have examined the extent of WB and trends across multiple countries. The present research measured explicit attitudes about PwO and beliefs about the causes of obesity in 9 countries: Australia (AU), Brazil (BR), Canada (CA-En, CA-Fr), Germany (DE), Italy (IT), Mexico (MX), Sweden (SE), UK, and US.

Methods

Random samples of 90,573 adults completed anonymous, voluntary online surveys beginning in the fall of 2016. Participants indicated their agreement (using 5-point Likert scales) with 4 narratives regarding causes of obesity, as well as perceptions of blame, laziness, self-discipline, and social acceptance of PwO. Cumulative logit models were fit to each survey question within each category with responses on 5-point Likert scales as outcome variables. Explanatory variables for the models were gender, age intervals, and country and interaction terms.

Results

In all nine countries, respondents agreed with addiction to junk food and sugary drinks as an explanation for obesity, consistently rating it as high or higher than personal irresponsibility, environment, or medical narratives. BR, CA-Fr, and IT favored the addiction narrative over all other narratives. Only US and UK respondents expressed beliefs in irresponsibility as strong as their beliefs in other narratives. UK respondents tended to reject a medical narrative as a cause for obesity. MX respondents were likely to agree that PwO are lazy and deserve blame. AU respondents were likely to agree with blaming and socially rejecting PwO. Across all measures, UK respondents expressed harsh bias while CA-Fr respondents expressed less bias.

Conclusion

Patterns of explicit bias about obesity and PwO differ significantly among the countries studied. Even though food addiction remains a matter of scientific controversy, public opinion seems to favor this concept as an explanation for obesity. In some countries, such as the UK, bias appears to be an especially important factor to consider for advancing science-based approaches to reducing obesity. Continued tracking of these attitudes over time may offer important insights into cultural differences in weight bias and strategies to address this problem.

Obes Facts. 2018 May 26;11(Suppl 1):4.

S1.4 Personalized dietary management of obesity based on simple biomarkers

A Astrup 1

Introduction

Slimming diets produce variable responses, ranging from major weight loss, to almost no loss, or even weight gain. Efforts to identify responders based on pre-treatment biomarkers such as initial BMI, age, gender or hormones, have explained only a small percentage of the variability. However, novel insights suggest an interaction between diet composition and the individual obese patient’s glucose metabolism, opening up for prescription of personalized diets with a much greater success rate than previous “one diet fits all” concept.

Methods

We hypothesise that the acute satiating effect of carbohydrates depends on glucose uptake in insulin-dependent tissue (brain, muscle and liver), whilst the satiating effect of fat and protein depends more on the release of gastrointestinal hormones with neurohumoral signalling to the brain (CCK, GLP-1 and PYY). There is evidence that the “gluco-static concept” is an important regulator of satiation and determinant of spontaneous energy intake during meals. With increasing insulin resistance and failure to compensate with enhanced postprandial insulin secretion, the satiating effects of carbohydrates are attenuated due to reduced glucose uptake in the brain, and possibly in other tissues. Consequently, the satiating effect of carbohydrate is weakened in obese individuals with type 2 diabetes or pre-diabetics with low insulin secretion. Carbohydrate-rich diets are thus effective in normoglycemic obese individuals, but type 2 diabetics lose more weight on carbohydrate-restricted diets rich in protein and fat. We tested this hypothesis by reanalysing randomized controlled trials of diets for weight loss.

Results

In seven different trials we found that some pre-treatment indices for insulin resistance and secretion are powerful predictors of individual weight loss responsiveness to diets with different carbohydrate contents. For example, a randomized energy-restricted diet comparison of a low-fat, high-carbohydrate versus a low-carbohydrate, higher-fat diet (NUGENOB), found no difference in weight loss (7.5 kg in both arms). In a reanalysis, type 2 diabetics lost 2.0 kg more on the low-carbohydrate, higher-fat diet than on the low-fat, high-carbohydrate diet, whereas normoglycemic individuals lost a mean of 0.4 kg more on the low-fat, high-carbohydrate diet (group difference 2.5 kg). With diets high versus low in glycaemic load, fibre and whole grain, the difference between normoglycemic and prediabetic obese individuals in responsiveness is substantial. In the Diogenes trial prediabetic individuals regained a mean of 5.8 kg more on a high–glycaemic load diet than on a low–glycaemic load diet, whereas normoglycemic individuals regained only 1.4 kg more (group difference 4.4 kg). Responsiveness in prediabetic obese to high-fibre diets seems also to depend on microbiota, e.g. the ratio of Prevotella to bacteroides, which suggests that the production of short-chain fatty acids such as butyrate by certain bacteria may stimulate satiety, potentially through an insulin sensitizing mechanism.

Conclusion

Personalized diets matching macronutrient composition and fibre content of diets to glucose metabolism and microbiota can improve weight loss outcome.

Conflicts of Interest

Arne Astrup is co-inventor of patents owned by UCPH, and is co-owner of UCPH spin-out Personalized Weight Management Research Consortium/Gluco-diet.dk. He is advisor to & member of advisory board for Gelesis, USA. Recent research funded by Gelesis. Full disclosure on the NEXS, UCPH website.

Obes Facts. 2018 May 26;11(Suppl 1):4–5.

S1.5 Regulatory efforts in Mexico & Chile: impacts of taxation on obesity. Comparisons with taxation efforts in the US

S Barquera 1, A Colchero 1, K Sánchez-Bazán 1

Introduction

Fiscal policies have been used to reduce the consumption of goods with harmful effects on health such as tobacco, alcohol and, recently, sugar-sweetened beverages (SSB). In 2014, Mexico implemented an excise tax of a 1 peso per liter to all non-alcoholic beverages with added sugars. In 2014, Chile increased an existing tax to SSB from 13 to 18% for beverages with a sugar concentration of at least 6.25grms/100ml and those below that cut-off point decreased to 10%. In 2015, the city Berkeley in the USA implemented a one cent ($0.01) per ounce excise tax to all non-alcoholic beverages with caloric sweeteners added. The objective of the study was to compare taxes in Mexico, Chile and Berkeley and the documented impacts on consumption and other outcomes.

Methods

Literature review on existing taxes to SSB in Mexico, Chile and Berkeley, and on the associated changes in consumption and other outcomes.

Results

The magnitude and type of tax differed in each country/city (see table 1). Impact evaluations have been conducted in Mexico and Berkeley showing reductions in purchases of SSB. In Mexico, purchases of taxed beverages decreased on average by 7.6% two years after implementation of the tax. In Berkeley, SSB sales in stores decreased by 9.6% one year after implementation. Both evaluations showed increases of untaxed beverages. In Chile, impact evaluations have not been published but price elasticities estimate that SSB are price elastic. Regarding other outcomes, simulations have shown potential long run positive effects on health for Mexico as well as a recent study showing to negative effects on employment associated with the tax.

Conclusion

SSB taxes in Mexico and Berkeley have been effective at reducing SSB consumption. Impact evaluations in other countries that have recently implemented SSB taxes would contribute to the evidence on the effects on consumption and other relevant outcomes.

Conflicts of Interest

The authors declare that they currently have an unrestricted research grant from Bloomberg Philanthropies for the topics related to this abstract. The funder does not have any decision power regarding the studies’ design, results and/or publication.

Obes Facts. 2018 May 26;11(Suppl 1):5.

S2.1 Emotion regulation and eating behavior: Is comfort food actually comforting for high emotional eaters?

T Van Strien 1, LE Gibson 2, A Cebolla 3, R Baños 4, LHH Winkens 5

Introduction

Eating in response to negative emotions is perceived to be an emotion regulation strategy. However, there is as yet no conclusive experimental evidence that food intake actually helps high emotional eaters (HEE) to reduce their negative emotions beyond eating. Earlier studies suggest that the palatability of the test food offered and the timing of the measurement of negative affect may play a role, with only improvement in mood in HEE when the food offered is perceived as palatable and during but not after the food intake. However, no studies have systematically tested the effects of timing on mood improvement in HEE vs LEE, and whether the link between food-intake and mood improvement is mediated by the palatability of the test food offered, and whether this mediation effect depends on emotional eating status.

Methods

In two studies, female students (n = 58 and n = 29) that had been pre-selected on the basis of extremely high (HEE) or low (LEE) scores on an emotional eating questionnaire were offered food after a stress task. Mediation and moderated mediation was assessed with Hayes’ PROCESS macro in SPSS. Mood, tastiness (study 1), eating satisfaction (study 2) and emotional eating were all self-reported.

Results

In study 1, where negative mood was assessed during the food intake, we found significant moderated mediation, with a significant positive mediation effect of tastiness in the high emotional eaters, and a significant negative mediation effect of tastiness in the low emotional eaters on the change in negative affect. In study 2, where negative affect was assessed well after the food intake, the mediation effect of ‘eating satisfaction’ between food intake and mood improvement (decrease in sadness or increase in joy) showed only a robust significance in the low emotional eaters. In contrast, this mediation effect of eating satisfaction was not significant, or (depending on the confounders) showed a less strong mediation effect in the high emotional eaters.

Conclusion

Palatable food may only provide comfort during eating, i.e. when addressing the question whether comfort food actually is comforting for high emotional eaters, the timing of the measurement of negative affect should be evaluated.

Conflicts of Interest

Tatjana van Strien has a copyright and royalty interest in the Dutch Eating Behavior Questionnaire (DEBQ) and manual.

Obes Facts. 2018 May 26;11(Suppl 1):5.

S2.2 The Psychology and Neuroscience of Obesity: From laboratory to treatment

A Roefs 1

Our society is considered ‘obesifying’ because high-caloric foods are omnipresent. Yet, not everyone is overweight. Over the years a lot of research has been devoted to testing the hypothesis that high-caloric foods are more attractive for overweight than for healthy-weight people, causing overconsumption and therefore weight gain. A dominant view in the literature is that this increased attractiveness of high-caloric foods is reflected in the cognitive processing of food stimuli. That is, high-caloric foods—which are abundantly present in our obesogenic society—are thought to attract and keep overweight’s people attention and cause the reward-circuitry in their brains to be very responsive. Though some research indeed found evidence for increased reactivity of the neural reward circuit in overweight people upon viewing high-caloric food stimuli, a recent review concludes that “the pattern emerging from studies comparing obese individuals and binge-eaters with controls is most remarkable for its variability and inconsistency” (Ziauddeen et al., 2012, p. 283).

This lack of consistency in the literature may stem from the double-sided nature of high-caloric food perception: High-caloric foods often have a high hedonic value and at the same time these foods have a low health value because their overconsumption contributes to weight gain. In the cognitive processing of food stimuli, hedonic value does not necessarily take precedence. In the first part of this talk I propose it is a matter of mindset for any person. People’s mindset may alternate between focusing on hedonic versus health value, depending on for example their emotional or physiological state and the current situation or context. Importantly, mindset may vary—unbeknownst to the researcher—within and across participants as well as within and across studies, complicating the interpretation of findings from brain-imaging and attention bias studies.

In the second part of this talk, I will present the results of a RCT evaluating the effectiveness of Think Slim, a semi-tailored e-coach-intervention (6 weeks) for overweight people that was based on cognitive behavioral therapy (CBT). Semi-tailoring in Think Slim was attained by continuously monitoring eating behavior relevant variables (e.g., craving, emotions, cognitions) in daily life by means of an iPhone app. In addition, network analyses were performed on these data, to test whether predictive relationships between these variables and eating behavior changed from pre to post treatment.

At post-treatment, BMI, eating disorder psychopathology and self-liking improved in Think Slim and the control condition, with no significant advantage for Think Slim. Think Slim, as compared to the control condition, led to a greater reduction in dysfunctional cognitions related to food intake, emotional eating, and external eating. Higher dietary adherence was associated with greater BMI reduction. After the post-measurement, the control condition also received Think Slim, and all participants were measured at 3 mo. and 12 mo. follow-up. BMI reduction was maintained at follow-ups, and BMI-change between post-treatment and 3-mo follow up was correlated with measures of dysfunctional eating and cognitions.

Obes Facts. 2018 May 26;11(Suppl 1):6.

S2.3 Physiological and Cognitive Responses Associated with Successful Weight Loss Maintenance: A Cross-Sectional Study

L J Balter 1, JA Bosch 2, S Higgs 1

Introduction

While homeostatic and psychophysiological responses to food cues have historically received much attention, little is known if such responses may support weight-loss maintenance.

Methods

To assess this, 20 former obese weight-loss maintainers, 25 individuals with obesity, and 20 never-overweight lean individuals (mean age = 29.5, SD = 9.5; 61.5% females) completed a cue reactivity paradigm during which heart rate and saliva response were measured. To assess cognitive factors that can interfere or override controls of eating, participants completed cognitive tasks that determined motivation to obtain food/non-food reward and to avoid losing food/non-food and food-related cognitive control and attention biases.

Results

Upon presentation of the food cue (pizza) currently obese individuals showed heightened physiological reactivity (salivation and heart rate response) (p = .037), whereas successful weight loss maintainers showed the opposite effect (p = .034). Never-overweight lean individuals were unresponsive (p = .966). Weight loss maintainers were better in avoiding losing foods as compared to losing non-foods (money) (p = .013) or to winning food (p = .038). However, the type of reinforcement (food versus money) did not differentially impact performance of obese and lean individuals. Food- and non-food related cognitive control (Go/No-Go task and Reversal Learning) and attention towards food (Dot Probe task) did not differentiate between groups.

Conclusion

The current findings showed a marked difference in physiological reactivity to food depending on weight-loss history. Behaviorally, weight loss maintainers were specifically sensitive to losing food rewards (food punishment). Further longitudinal studies may help determine if reduced physiological response to palatable food and increased sensitivity to aversive outcomes of food may be predictive of individuals that successfully restrict food intake.

Obes Facts. 2018 May 26;11(Suppl 1):6.

S3.1 Stigma in the medical setting (does ICD stigmatise)?

D Durrer 1

Obesity stigmatization in healthcare setting: Durrer-Schutz D. EUROBESITAS Association, EASO Collaborative Center of Obesity Management (COM’s), Vevey, Switzerland

Introduction

These last decades many studies have pointed out that weight stigma is very frequent in healthcare setting, in general practitioners (GPs’) and even, paradoxically, in obesity specialists. This can have a very negative psychological impact on obese patients and the consequences are deleterious: damaged body image, very poor self-esteem, but also increased risk of depression, in some cases, leading to suicide. This occurs frequently in obese children and adolescents, who have a risk of suicidal ideation 4 times higher than in adulthood. Eating disorders and the general level of physical activity are jeopardized by stigmatization. Avoidance of exercise is commonly observed, further decreasing the total energy needs and ultimately leading to weigth gain, or weight regain. What is more worrying, is that these patients have the feeling of being dismissed by their doctor, so that they often cancel their consultation and, as a result, they fail to be treated. Ultimately, this will contribute to an increase in physical and psychological comorbidities.

Discussion

Can we moderate stigmatization in healthcare setting? There are a few studies showing success in decreasing stigmatization (Flint, 2015). These studies are based on educating healthcare professionals, medical students and doctors about the « uncontrolability » of obesity, as evidenced by the continuing rise in obesity prevalence in the world. The key message is that weight status and obesity are not under personal control. An education about avoiding stigmatization should already begin during the medical school and go on during postgraduate training and continuing education. The use of the motivational interviewing technique constitutes a possible approach to avoid stigma. Motivational inteviewing is a guided, patient-centered, non-judgmental and respectful counselling style approach which should be promoted to GPs’.

Conclusion

Weight-related bias and stigma has a substantial negative impact on the psychological, social and well-being of the obese patients. The stigmatization of obese patient by health professionals is unexpected since their role is to promote health, taking into account the psychological aspects of obesity. To increase education on this issue in healthcare professionals, medical students and doctors, constitutes a first logical and promising approach. Initiating this process early during the medical school and continuing it further during postgraduate education could lead to a decrease body weight-related bias and obesity stigmatization.

Obes Facts. 2018 May 26;11(Suppl 1):6.

S3.2 Discrimination in education

AJ Hill 1

Introduction

Anti-fat bias is becoming recognized in most areas of people’s lived experience. It is evident in how young and older children perceive those with obesity. Testimonies by youth victimised for fatness suggest a possible impact on academic engagement and achievement. Interest in educational outcomes was stimulated by observing lower maths and reading scores in US children with obesity from kindergarten age.

Methods

Reviewing the evidence around this time, Taras and Potts-Datema (2005) reported consistent findings of academic underachievement within the modest existing literature. But as evidence has accumulated then the association has become more uncertain. Caird et al (2011) included 29 studies in a systematic review, concluding that obesity was only weakly associated with lower educational attainment in children and young people. They noted that factors such as socio-economic status (SES) accounted for most of the observed association. In a recent update, Santana et al (2017) observed that only 15/34 studies found a significant negative relationship between obesity and academic performance. Again, controlling for SES, parental education, and physical activity led to the relationship being weakened or disappearing. Considering just longitudinal studies, Martin et al (2017) concluded that obesity was negatively associated only with adolescent girls’ maths performance. We still know little about whether change in obesity impacts on academic achievement. In addition, is academic underperformance is apparent in tertiary (post-18) college or university education?

Results

In terms of explanations of academic underperformance, distinction is made between direct and indirect mechanisms. Direct mechanisms include deficits in children’s motor coordination and cognitive abilities such as executive function. Indirect mechanisms link adverse physical and mental health with school absenteeism, and poor achievement with psychological distress (isolation, victimization by peers), poor sleep, and low levels of physical fitness/activity. Particularly, interesting are divergences in stakeholder views. For children and young people, academic achievement is mostly a function of attitude to school and affected by friendship issues with peers. Teachers are more likely to talk about a direct impact of weight on achievement through poor mental and emotional health.

Conclusion

Overall, our understanding is limited by the databases available, many of which do not have information on the potential causative or mediating factors identified by teachers and the young people themselves. Given that there is much stronger evidence for the indirect psychosocial challenges associated with obesity, intervention to support the educational experience of young people with obesity should be directed at these.

Obes Facts. 2018 May 26;11(Suppl 1):7.

S3.3 Discrimination in employment

SM Bevan 1

Introduction

All the evidence shows that obesity and overweight is an increasing concern for individuals, employers and society. In workplace settings, the implications of obesity are complex and potentially wide-ranging, including employee health and sickness absence, job design and working environment considerations, and, more recently, questions about legal responsibility and weight-based discrimination. This presentation will explore the current situation regarding obesity in European workplaces and how it is addressed: this is not just about the ways in which organisations are currently supporting employees to manage their weight, but also about the levels of stigma experienced or expressed relating to obesity, the problems obesity presents in the workplace (e.g. for design of the working environment, and job/work design) and any support provided to those managing obese employees. It will look at the history of the development of societal and organisational views on other ‘protected’ characteristics – including, mental health, disability, sexuality and race: examining where these characteristics have parallels with obesity and where these break down, in order to understand what lessons can be learnt for obesity as it starts out on this anti-stigma ‘journey’. The presentation will draw on data and research conducted in a number of EU member states and will also be informed by the results of a recent UK government review looking at the support needed by working age people living with obesity or overweight.

Methods

The author has reviewed the literature on stigma and discrimination at work faced by people living with and obesity and overweight and was an advisor to a review conducted for the UK government on the support needed to help accommodate obesity and overweight at work. The author has also conducted two studies of the health of the NHS workforce, both of which have collected self-reported data on weight and stigma. These data will be drawn upon in the presentation.

Results

The literature shows that there is considerable stigma both in workplaces and in the wider labour market towards people with obesity and overweight. This stigma affects recruitment, deployment, job retention, sickness absence, presenteeism, job design and vocational rehabilitation. Considerable difficulty is still experienced with regard to disclosure of co-morbid health conditions and the evidence also shows that both managers and co-workers have strong beliefs about the volitional nature of obesity and overweight which act as a barrier to both empathy and support. The literature has also estimated the direct and indirect costs of lost productivity as a result of obesity and overweight. The author will argue that these cost data should be used to highlight the benefits of investing in more inclusive and adaptive workplaces rather than framing obesity and overweight only as a drain on resources.

Conclusion

There is an argument for obesity to be considered a ‘protected characteristic’ in equalities law & that policy makers & employers should apply the same principles of equal treatment. Stigma at work reflects wider societal attitudes & the author argues that future workplaces will need to promote tolerance & empathy & provide a supportive psychsocial environment and public health setting for prevention.

Obes Facts. 2018 May 26;11(Suppl 1):7.

S4.1 Gut microbiome and obesity

T Hansen 1

Introduction

The gut microbiota in obesity, metabolic syndrome and T2D We are not alone. Recent findings have demonstrated that the gut microbiome complements our human genome with at least 100-fold more genes. In contrast to our Homo sapiens-derived genes, the microbiome is much more plastic, and its composition changes with age and diet, among other factors. An altered gut microbiota has been associated with several diseases, including obesity and diabetes, but the mechanisms involved remain elusive.

Methods

In order to understand the impact of gut microbes on human health and well-being we have described the Illumina-based metagenomic sequencing assembly and characterisation of 3.3 million non-redundant microbial genes from faecal samples of 124 European individuals. Nearly 10 million genes are now described in a recent updated gene catalogue. The extensive gene catalogue has enabled us to perform studies of association of the microbial genes with human metabolic phenotypes.

Results

Several studies have suggested that altered gut microbiota composition and function are associated with overt type 2 diabetes, obesity and atherosclerosis. However, in a recent study we questioned previously reported associations between gut microbiota and type 2 diabetes by demonstrating that metformin, the first-line of choice for treatment of hyperglycaemia in type 2 diabetes, confounds this relationship. Accordingly, although gut microbial signatures can be used with high accuracy to distinguish metformin-treated patients with type 2 diabetes from healthy controls, this is not the case when attempted in metformin-naïve patients indicating that drug treatment is an important factor to take into account when evaluating associations of microbiome composition to disease.

Conclusion

New data in treatment naïve individuals indicate that gut microbial signatures are altered in individuals with obesity, impaired glucose regulation and that low bacterial diversity is associated with elevated levels of biomarkers of poor metabolic health, including markers of glucose regulation, insulin resistance, inflammation, abdominal obesity, and dyslipidaemia.

Obes Facts. 2018 May 26;11(Suppl 1):7–8.

S4.2 The role of gut microbiota in obesity and mood: The MyNewGut project

Y Sanz 1

Dietary and lifestyle changes of Western societies are considered one of the main causes of the increased prevalence of obesity and the associated comorbidities. These included not only cardiometabolic diseases, but also behavioural and mood disorders. It is also hypothesized that the lifestyle changes (low fibre diets, stress, etc.) of modern societies have led to a disruption of the human-microbiome symbiosis that contributes to the cross-links between these pathologies. Although the underlying mechanisms are partly unknown, experimental studies in animal models and to a lesser extent in humans suggest that the obesity-associated microbiota may contribute to the endocrine, neurochemical and inflammatory alterations underlying obesity and its comorbidities. These include dysregulation of the hypothalamic pituitary adrenal axis with overproduction of glucocorticoids, alterations in the levels of neuroactive metabolites (e.g. neurotransmitters, short-chain fatty acids) and activation of a pro-inflammatory milieu that can cause neuro-inflammation. In the MyNewGut project (7th FP EU), we are deeply investigating the diet and microbiota-host cross-talk to progress in the identification of the bacteria and pathways involved in the regulation of the gut-brain axis and their effects in different organs and systems. To do so, we are applying a multidisciplinary research approach, using functional omics-technologies and systems biology, in well-controlled human studies and mouse models. This information will be used to determine to which extent the dietary risk for specific dieses is mediated by our gut microbiota and to design intervention strategies that help reduce the incidence of diet-related disorders.

Obes Facts. 2018 May 26;11(Suppl 1):8.

S4.3 How does bariatric surgery influence gut microbiota?

J Aron Wisnewsky 1

Introduction

The gut microbiota is recognized to have an important role in energy storage and the subsequent development of obesity and related-metabolic complications. Recent data in human shows that overweight or moderate obese individuals with metabolic alterations display a reduced gut microbial diversity as well as a profound dysbiosis both in microbiota composition as well as functions. Whether such is also the case or even worsened in morbid obesity (i.e. characterizing patient’s candidates to bariatric surgery) remains unknown yet.

Methods

Indeed, bariatric surgery (indicated for severe obesity) represents one of the most effective treatments that enables substantial and sustained weight loss as well as improved metabolic complications. Initial data, using 16S pyrosequencing, in humans and animal models have demonstrated that gut microbiota composition is modified after Roux-enY gastric bypass (RYGB).

Results

More recent studies using shotgun sequencing have also demonstrated gut microbiota function changes post-BS, potentially explaining some of the beneficial weight-loss and metabolic outcomes observed post-bariatric surgery. These changes occur as soon as three months but recent longer-term study has demonstrated that these changes are still observed nine years after-RYGB. Furthermore, some changes have also been evidenced post-sleeve gastrectomy, the actual most performed bariatric surgery worldwide.

Conclusion

Of course, bariatric surgery induced weight-loss could explain these observed changes in gut microbiota composition. However, it might not be the only responsible factor. Indeed, bariatric surgery not only improves hormonal and inflammatory status, but also induces numerous changes in the digestive tract that might account for the observed modifications of microbiota ecology and subsequent composition and functionality. Some questions still remains unanswered and will be the scope of future research. Does bariatric surgery modify or reverse this reduced bacterial diversity? Are gut microbiota changes post-BS similar after different surgery type (using different mechanisms)? Does microbiota derived circulating metabolites also change after bariatric surgery? In this lecture, we will address those questions.

Obes Facts. 2018 May 26;11(Suppl 1):8.

S5.2 Obesity paradox in chronic renal failure and kidney transplantation: myth or reality?

V Teplan 1

Introduction

In last decade, many studies have confirmed link between obesity and renal disease. There it could be direct effect due to obesity induced nephropathy or/and association with hypertension and diabetes. Exact mechanism of nephrons’ damage is yet not fully elucitaded, but no doubt, there are hemodynamic, metabolic and locally inflammation factors.

Methods

Different situation could be in some chronic renal failure patients when great majority of functioning nephrons was already destroyed (end-stage renal disease ESRD) and fat tissue can serve partially as energy source in catabolic processes in dialysis. In Obesity paradox studies, obesity measured as BMI index has been associated consistently with lover mortality rates in ESRD on (hemo)dialysis management. There was also evidence to suggest that higher adiposity, especially subcutaneous fat and muscle mass may be associated with better outcomes in ESRD mainly in very low short time expectancy with benefits from better nutritional status.

Results

The effect of obesity on renal transplantation may occcur in perioperative complications (accepted candidates for transplantation up to 35 kg/m2) and impairment of organ function. In our randomised study in 200 transplant patients, early regular exercise and modified diet led to decrease of BMI and body fat (P < 0.01) and adipocytokines (adiponectin and leptin P < 0.01, resistin P < 0.02 and visfatin P < 0.05) were influenced.

Conclusion

In conclusion, with exception of malnurish ESRD patients obesity represents also in renal failure high risk and should be effectively managed (diet, exercise, bariatry).

Obes Facts. 2018 May 26;11(Suppl 1):8.

S6.1 Control of integrative physiology by the melanocortin circuitry

H Fenselau 1

Proopiomelanocortin (POMC)- and agouti related peptide (AgRP)-expressing neurons in the arcuate nucleus of the hypothalamus represent key regulators of food intake and energy homeostasis. They rapidly integrate the energy state of the organism through sensing fuel availability via hormones, nutrient components and even sensory food perception. Importantly, they not only regulate feeding responses, but a whole plethora of autonomic responses including glucose and lipid metabolism, inflammation and blood pressure. The presentation will focus on the regulation of these neurons in control of integrative physiology, the identification of distinct neuronal circuitries targeted by these cells and finally on the broad range implications resulting from dysregulation of these circuits as a consequence of altered maternal metabolism.

Obes Facts. 2018 May 26;11(Suppl 1):8–9.

S6.2 Immunological characteristics in obesity: inflammation in fat as a trigger of metabolic complications

M Haluzik 1

Introduction

Adipose tissue lies at the crossroad of nutrition, metabolism, and immunity being among many other functions a huge reservoir of immunocompetent cells. Inflammation in adipose tissue, in particular in its visceral compartment, was proposed as a central mechanism connecting obesity with its metabolic and vascular complications. Resident immune cells constitute the second largest adipose tissue cellular component after adipocytes and play important roles in the maintenance of adipose tissue homeostasis.

Methods

The lecture will focus on the changes of the phenotype of immunocompetent cells in patients with obesity both with and without type 2 diabetes mellitus with particular focus on epicardial adipose tissue that possibly directly contributes to obesity-related heart diseases.

Results

Available data indicate that not only adipose tissue macrophages but also other immunocompetent cells could contribute to subclinical inflammation in obesity. Furthermore, there is an intensive interplay among circulating monocytes and adipose tissue macrophages and other immunocompetent cells in adipose tissue that is significantly and differentially affected by weight reduction.

Conclusion

Immunocompetent cells in adipose tissue importantly contribute to subclinical inflammation and obesity-related complications and the modulation of their proinflammatory phenotype could be used to attenuate long-term obesity complications.

Acknowledgement

Supported by RVO VFN 64135 and MH CZ - DRO („Institute for Clinical and Experimental Medicine – IKEM, IN 00023001”)

Obes Facts. 2018 May 26;11(Suppl 1):9.

S6.3Brain leptin reduces liver lipid content by increasing hepatic triglyceride secretion and reducing de novo lipogenesis in male rats

MT Hackl 1, C Schuh 1, M Krššák 1, A Freudenthaler 1, S Baumgartner-Parzer 1, C Buettner 2, C Fürnsinn 1, T Scherer 2

Introduction

Non-alcoholic fatty liver disease (NAFLD) is closely associated with obesity and type 2 diabetes. NAFLD develops when hepatic lipid influx and/or production exceed the ability of the liver to export/utilize triglycerides (TG) via the production of very low-density lipoproteins (VLDL). Therefore, TG secretion represents a key mechanism for the liver to dispose of excess lipids thereby preventing ectopic lipid deposition and lipotoxicity. The anorexic adipokine leptin is implicated in the regulation of hepatic lipid content. For example, leptin-deficient patients with lipodystrophy suffer from severe NAFLD, while leptin treatment ameliorates hepatic steatosis in these patients. The mechanism for this is unclear. Since leptin exerts its function mainly via signaling in the CNS, we hypothesized that brain leptin modulates hepatic TG secretion and thereby hepatic lipid content.

Methods

To study the effects of brain leptin in regulating hepatic TG flux we performed acute (4 hour) tyloxapol infusion studies in male Sprague Dawley rats in combination with isolated brain hyperleptinemia achieved by an intracerebroventricular (ICV) stereotaxic infusion. We complemented these studies with chronic ICV infusion studies, in which leptin or a leptin-receptor antagonist were infused continuously using osmotic mini-pumps over 4 weeks. Hepatic lipid content was then measured non-invasively using 1H-magnetic resonance spectroscopy. Finally, we combined selective hepatic vagotomy and sympathectomy with stereotaxic leptin infusion studies to assess via which branch of the autonomic nervous system leptin conveys its signals from the brain to the liver. Hepatic de novo lipogenesis was assessed in liver tissue lysates by measuring enzyme activity of fatty acid synthase, a rate limiting enzyme of lipogenesis.

Results

An acute ICV leptin infusion increased hepatic TG export (2.0 ± 0.19 vs 2.9 ± 0.13 μmol/kg/min; p = 0.0012; n ≥ 12 per group) compared to an ICV vehicle infused control group. In accordance with increased hepatic lipid export chronic leptin infusion reduced hepatic lipid content compared to weight-matched controls (0.61 ± 0.06 vs 0.42 ± 0.06% water signal; p = 0.038; n = 8 per group). Hepatic fatty acid synthase activity was reduced in livers of chronic (−44%) and acute (−32%) ICV leptin infused rats compared to weight-matched control animals. Conversely, blocking endogenous brain leptin signaling with a leptin-receptor antagonist resulted in hepatic steatosis. Brain leptin signaling preserved its ability to reduce hepatic TG content after selective liver sympathectomy. However, the anti-steatotic effect of brain leptin was abolished by selective hepatic vagotomy, but not by high fat diet feeding.

Conclusion

In conclusion, leptin signaling in the brain protects from ectopic lipid accumulation in the liver by stimulating hepatic TG secretion and reducing hepatic de novo lipogenesis. Therefore, increasing brain leptin signaling may be a potential future therapeutic drug target to ameliorate hepatic steatosis in patients with NAFLD, for which so far no clinically effective therapy exists.

Obes Facts. 2018 May 26;11(Suppl 1):9–10.

S6.4 Butyrate restores HFD induced adaptations in brain function and metabolism in mid-adult obese mice

IAC Arnoldussen 1, M Wiesmann 2, CE Pelgrim 2, BAa Franx 2, EM Wielemaker 2, W Van Duyvenvoorde 3, P Amaral Santos 4, L Verschuren 4, B Keijser 4, A Heerschap 5, R Kleemann 3, P Wielinga 3, AJ Kiliaan 2

Introduction

Midlife obesity increases the risk of cognitive impairment and dementia, besides the well known metabolic complications as diabetes mellitus type 2 and cardiovascular disease. Recent data suggest that intake of the short chain fatty acid, butyrate may improve memory function, and protect against diet-induced obesity by reducing body weight and adiposity. Butyrate is a natural product of bacterial fermentation of mainly undigested plant polysaccharides and resistant starch in the colon.

Methods

We examined the impact of a high-fat diet (HFD, D12451, Research Diets Inc., New Brunswick, USA) followed by intervention with 5% (w/w) dietary butyrate on metabolism, microbiota, brain function and structure in the low-density-lipoprotein receptor knockout Leiden (LDLr -/-) mouse model. The LDLr-/- mouse model was chosen for this study because of its high sensitivity to develop obesity and obesity-associated metabolic and vascular complications in multiple organs when fed HFD with modest fat content. We examined the effects of a HFD and a HFD enriched with butyrate (HFDB) in two age groups, mid- and late adulthood. In mid-adulthood, HFD feeding started at 3 months of age, and when the mice were 7 months old (m.o.) the butyrate intervention (HFDB) started. In late adulthood, exposure of the HFD started at 6 m.o., and at 10 months of age the mice were fed the HFDB. Cognitive and MRI experiments were performed when 9 m.o. in mid-adult mice, and in late adult mice at 12 m.o. Individual body weight and food intake (at cage level) were monitored over time. At the end of the experiment, all mice were sacrificed, organs (adipose tissue, liver and brain) harvested and used in immunohisto- and biochemical experiments.

Results

In mid-adult mice, 15 weeks of HFD-induced adiposity, liver fibrosis, and inflammatory processes in adipose tissue and hippocampus (Figure 1), increased systolic blood pressure, and decreased cerebral blood flow and functional connectivity assessed with neuroimaging. The subsequent 2 months butyrate intervention restored these detrimental effects to chow-fed control levels. Both HFD and HFDB intervention decreased variance in fecal microbiota composition. In late-adult mice, HFD showed similar detrimental effects and decreased cerebral white and gray matter integrity, whereas butyrate intervention attenuated only the metabolic parameters.

Fig. 1.

Fig. 1

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Quantification of activated microglia as visualized by IBA-1 immunhistochemistry (a–d). (a–c) Number of activated microglia within the hippocampus, cornu ammonis 1 (CA1) and thalamus in mid- (9 m.o.) and late (12 m.o.) adult mice. (d) Visualization (late-adult HFDB) of IBA-1 immunohistochemistry, positive for activated microglia, within the hippocampus at 5x and 40x magnification. Data are presented in mean ± s.e.m. *P≤0.050.

Conclusion

HFD induces detrimental effects in mid- and late-adult mice, which can be attenuated by butyrate intervention. These findings are consistent with reported associations between midlife obesity and cognitive impairment and dementia in humans. We suggest that butyrate may have potential in prevention and treatment of midlife obesity.

Obes Facts. 2018 May 26;11(Suppl 1):10.

S7.2 What do we know about digital food marketing and its impact?

E Boyland 1

Introduction

The marketing of foods high in fat, salt and sugar is hugely prevalent in most Western societies, and is increasingly occurring in other territories where a ‘nutrition transition’ from traditional diets to intake of heavily processed foods is underway. The influence of traditional food advertising over the food behaviours of children in particular is well documented, but the emergence of digital media and the marketing techniques it facilitates presents new challenges to researchers and policymakers alike. Partly because of methodological challenges, much less is known about digital food marketing including what this term truly encompasses, what evidence we have of its prevalence and nature, and what impact it has on eating behaviour.

Methods

Studies that have explored how digital food marketing affects eating behaviour will be summarised. The limitations of existing research and gaps in our knowledge will be identified.

Results

This session will contextualise food marketing as part of the obesogenic environment that is driving overconsumption and weight gain, and will illustrate what digital food marketing is and how widespread the practice is. It will also illustrate what evidence we have of its impact. Within this, evidence of engagement with digital media (most notably by young people) will be provided and consideration will be given to the extent to which digital media blurs the boundaries between food marketing and other types of content. An overview will be given of how the known effects of marketing on actual eating behaviour and determinants of eating behaviour (e.g. attitudes, preference) from traditional media may be magnified by the immersive, interactive and personalised nature of the offerings in the digital world.

Conclusion

The World Health Organization (WHO) Set of Recommendations on marketing of food to children (2010) called for comprehensive restrictions on unhealthy food promotion across all media but policies have tended to lag behind technological developments. The evidence base of digital food marketing and its effects is relatively limited to date, but new data are emerging frequently and this increasingly suggests that policy action is warranted in this area.

Obes Facts. 2018 May 26;11(Suppl 1):10.

S7.4 What’s next for food marketing policy?

T Lobstein 1

Introduction

The manufacture and sale of junk food is perfectly legal throughout Europe. Commercial operators producing soft drinks and fatty foods are fully entitled to bring their products to market. Equally, society has a responsibility to protect its citizens from preventable harm, and especially to work within the Convention on the Rights of the Child to protect children from harm and from inducements to harmful behaviour. In this context, governments have taken a variety of approaches to protect children from the promotion of junk food. A few have taken a rights-based approach to restrict the promotion of all products and services to children, on the grounds that children have a right to a commercial-free childhood. The great majority have taken a risk-based approach, with methods for assessing risk based on the nature of the products being promoted, the form of the promotion, the nature of the medium and extent of exposure of the child.

Methods

Using recent literature on food promotion, we identify some outstanding steps still to be addressed under a risk-based approach.

Results

Issues to be addressed include: (i) Digital marketing, including user-generated content, where the brand owner needs to be held accountable for the use of their brands and trademarked logos, and the need to use stronger age verification Methods; (ii) Broadcast marketing, including strengthening regulation during child and family viewing periods and time-shifted content; (iii) Point-of-sale promotion, including shop displays, café branding, menu promotions and supermarket placements; (iv) Product self-promotion and formulation, including package and labelling, and the use of ingredients and non-nutritive additives as inducements to encourage consumption.

Conclusion

Many issues remain to be addressed. Furthermore, whether the approach is rights-based or risk-based, we need to consider all vulnerable populations, not only children. Focusing on children is a political rather than a public-health decision.

Obes Facts. 2018 May 26;11(Suppl 1):10–11.

S8.1 Special age groups (adolescents). Integrating evidence-based pedometry for adolescents into the Physical Activity on Prescription (PAP) model in Sweden

A Raustorp 1

Introduction

In Swedish primary care, licensed professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the PAP method. In a randomised controlled trial, PAP significantly improved body composition and reduced metabolic risk factors. Since 2015 this model includes adolescents. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbook FYSS (www.fyss.se), the PAP model and the use of evidencebased pedometery.

Methods

In the improved understanding of the unique measurement and motivational proprieties of pedometers as behavior change tools, Tudor Locke et al (2009) outline an evidencebased model of hardware (i.e. scientifically validated pedometer) and software (i.e. researchbased indices to interpret data, as step/day recommendations, including BMI reference standards for pedometer determined steps/day.

Results

Previously published BMI reference standards indicate 12000 steps/day for young adults and 12000–15000 steps/day for children. By extrapolation, 12000 steps/day was decided for adolescents.

Conclusion

Preliminary positive feed back indicates the usefulness of expanding pedometry into adolescents in the Physical Activity on Prescription program Strength (individualised hands on method starting with baseline and goal to aim for) as well as limitations (how to interpret intensity and the step function in consumer devises) will be discussed.

Conflicts of Interest

Anders Raustorp has served as medical advisor for Keep Walking Scandinavia AB. KWS is a company in the wellness sector with online consulting, online distribution of literature and online distribution of pedometers of different brands including the Yamax.

Obes Facts. 2018 May 26;11(Suppl 1):11.

S8.2 Individualized prescription of physical activity: prevention to treatment. Special age groups (aging population)

B Ukropcova 1

Introduction

Sedentary lifestyle combined with excessive energy intake and ageing of the population provide a substrate for the development of sarcopenic obesity, frailty syndrome, as well as reduction of functional capacity, autonomy and quality of life. Physical inactivity substantially accelerates pathogenic processes leading to chronic diseases, including type 2 diabetes, cardiovascular and neurodegenerative diseases.

Methods

The aim of this talk is (i) to describe the impact of physical (in) activity on aging; (ii) to summarize the benefits of both short-term and long-term exercise physical activity programs on health and functional capacity of the elderly; (iii) to review the current recommendations for the individualized prescription of physical activity in the elderly, and simple methods for physical fitness and functional capacity testing.

Results

We and others have shown that relatively short-term training interventions (2–6 months) improve physical fitness, body composition and bring measurable health benefits to elderly with / without a chronic disease. It has been shown by many that the cardiometabolic risk factors are being favourably influenced by regular training, and the risk of type 2 diabetes, myocardial infarction and stroke is reduced in physically fit elderly individuals. It is important to note that even ageing-associated cognitive decline can be prevented or to some extent reversed by regular physical training. Various training interventions proved to be effective in the maintenance or improvement of cognitive functions in the elderly, with or without impaired glucose tolerance, subjective or mild cognitive impairment or early-stage Alzheimer’s disease. Design of individualized training intervention has many aspects which need to be addressed, including health limitations (comorbidities), a level of physical fitness, specific activity preferences and time schedule which can have a substantial impact on the training type, frequency, duration and intensity. The recommended dose of physical activity as well as the mode of delivery to elderly patients with/without obesity will be discussed.

Conclusion

Regular physical exercise enables to maintain high levels of physical fitness, functional capacity, autonomy and quality of life into advanced age. It is important to note that regular physical activity of sufficient intensity is an effective, readily available and physiological prevention and supportive treatment of many chronic diseases. Individualized prescription of physical activity as well as individually designed supervised intervention programs represent a cornerstone of complex lifestyle modification programs, aimed at promoting active lifestyle, reducing the disease risk & burden and the need for pharmacotherapy in the elderly population. Grant support: VEGA 2/0107/18, APVV 15/0253, APVV 15/0086, Ministry of Health of the Czech Republic16–33746A

Obes Facts. 2018 May 26;11(Suppl 1):11.

S8.3 Physical activity and obesity in special patient groups

J Oppert 1

Introduction

Physical activity is recognized as an important component in the prevention of weight gain as well as in the management of obese patients. Various patient groups can benefit from physical activity in the framework of a comprehensive obesity management program. Benefits of physical activity, as a whole, are many but their respective importance varies. The strategy for physical activity prescription will take into account the patient, treatment goal, resources available and the type of physical activity (lifestyle or structured).

Methods

Physical activity plays only a modest role in weight loss as such, compared to the effects of dietary changes. In terms of body composition, physical activity however has the potential to preserve fat free mass during weight loss. Weight maintenance after weight loss is considered as a major benefit brought about by physical activity. Physical activity, as part of an intensive lifestyle program, has been shown to substantially reduce some major health risks associated with obesity, the best example being the prevention of type 2 diabetes. Prescription of physical activity in patients will follow a sequence including detailed assessment of physical activity level, physical capacity, medical context, stage of change towards physical activity and motivation, and barriers (physical, individual/psychological, environmental) to physical activity.

Results

A major step in the prescription process will be to define the goal for a given patient at a given time for a given period in a given context. Different types of physical activity will indeed fulfill different treatment objectives. Endurance type of activity will help for cardiovascular prevention, resistance type of activity will help to maintain fat free mass, both types of activity combined could bring additional benefits for the metabolic and mechanical loads associated with obesity. Emerging evidence shows benefits of physical activity in specific patient groups, including obese persons undergoing bariatric surgery as well as patients with syndromic obesity.

Conclusion

Although its benefits should not be overlooked, it is important to emphasize that physical activity is and remains only one component of a global management strategy. An essential part of the Discussion brings to the issue of re-defining what the goal for physical activity is using a tailored approach for management of the obese patient.

Obes Facts. 2018 May 26;11(Suppl 1):11–12.

S9.1 How to select and prepare a patient for surgery

D Dicker 1

Introduction

Bariatric surgery (BS) is the most effective treatment of obesity and its associated comorbidities. Every year, about 500,000 bariatric surgeries are performed and about 60% of them preserve at least 20% total weight loss for more than 4 years. Yet 30%−50% of BS patients express long term weight regains and only 50% of BS patients express long term diabetes remission. Precision medicine is defined as medical care that is designed to optimise diagnostic efficiency or therapeutic benefit by targeting the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics.

Methods

Using Big-Data and Real Word Evidence we can develop scores like DIaReM and AD-DIaReM to predict diabetes remission, using Individualized Metabolic Surgery Score can help predict the best surgery for each patient.

Results

We will explore these tools and present the efforts that are being invested to establish precision medicine for bariatric medicine.

Conclusion

Due to the variability in the success of BS to treat obesity and its complications, there is a need for precision medicine to improve the prediction and decision-making tools available to the medical community.

Obes Facts. 2018 May 26;11(Suppl 1):12.

S9.3 How to decide the type of bariatric/metabolic procedure in the individual cases

R Peterli 1

Different bariatric/metabolic procedures vary in their effect regarding weight loss, reduction of co-morbidities, increase of life expectancy, increase of quality of life, complications (early and late), and possibly costs. The more effective an operation may be the more severe are certain side effects. Various predictors of outcome have been investigated but there is not one procedure ideally suited for all patients and there is no general consensus as to which patients needs which operation. Nevertheless, there are various potential patient associated factors that can be taken into account when selecting patients for a particular bariatric/metabolic operation: BMI, age, sex, eating habit/disorder, body composition, resting energy expenditure, type and severity of co-morbidity, pathologies of the upper gastro-intestinal tract, history of previous surgeries, socio-economic status and/or education, compliance, adherence, expected ability to cope with postoperative nutritional demands, and the patient’s wish. Other influencing factor may be associated to the bariatric/metabolic center: spectrum of procedures they are experienced to perform, how complete is their follow-up, how close do the patients live to the center etc. After interdisciplinary evaluation a patient can be selected and then prepared for bariatric/metabolic surgery. A number of different procedures have to be explained and offered to the patient enabling him to decide together with the responsible surgeon the one both believe is suited the best.

Obes Facts. 2018 May 26;11(Suppl 1):12.

S9.4 How to build an effective long-term follow-up

L Busetto 1

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. Bariatric patients may face new specific multifaceted clinical problems after surgery. Eating habits need to adapt to the new gastro-intestinal physiology, and nutritional deficits may arise according to the type of bariatric procedure. Management of obesity associated disease needs to be modulated according to weight loss taking into account the possibility of changes in drug pharmacokinetics. Specific problems may arise in women during pregnancy, and the patients may experience some psychological difficulties in adapting to the profound changes in eating behaviour and body image. Finally, weight regain can occur and should be prevented and managed.

Multidisciplinary long-term follow-up is recommended after bariatric surgery, and the provision of an adequate follow-up programme is mandatory for bariatric centres. However, giving the accumulating numbers of bariatric patients, follow-up should be at least in part transferred to primary care over time. Moreover, post-bariatric patients may confront obesity specialists, dieticians and nurses not specifically trained in bariatric medicine with thus far unknown problems in their professional activity. Referral to the bariatric centre is often necessary and should be possible, but there is a growing need for dissemination of first level knowledge in managing bariatric patients.

The basic notions needed to provide first-level adequate medical care to post-bariatric patients have been recently summarised in the “Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management” (Obesity Facts 2017;10:597–632).

Obes Facts. 2018 May 26;11(Suppl 1):12–13.

S10.1 The WCRF/ AICR Third Expert Report and the Updated Cancer Prevention Recommendations

M Leitzmann 1

Introduction

The Third Expert Report from the World Cancer Research Fund and the American Institute for Cancer Research provides a comprehensive analysis of the worldwide body of evidence on preventing and surviving cancer through diet, nutrition, maintaining a healthy weight and physical activity, and it presents the latest cancer prevention recommendations. These recommendations take the form of a comprehensive package to be used by individuals, families, health professionals, communities and policymakers, as well as the media.

Methods

A team at Imperial College London conducted systematic literature reviews of the current scientific evidence from around the world, which were peer reviewed by external reviewers. The International Agency for Research on Cancer provided expert reviews of the main hypotheses-related biologic mechanisms to support the epidemiological evidence. The Continuous Update Project (CUP) Expert Panel evaluated and interpreted the evidence, made judgements on the strength and directionality of the evidence, and made recommendations for the public based on its judgements. Members of the Secretariat managed the CUP and supported the Panel.

Results

The first recommendation is to be a healthy weight because greater body fatness is a cause of many cancers. The second recommendation is to be physically active as part of everyday life, such as walking more and sitting less. The third recommendation is to eat a diet rich in wholegrains, vegetables, fruit and beans by making these foods a major part of the usual daily diet. The fourth recommendation is to limit consumption of ‘fast foods’ and other processed foods high in fat, starches or sugars because they tend to be energy dense and are often consumed frequently and in large portions; thus, limiting these foods helps control calorie intake and maintain a healthy weight. The fifth recommendation is to limit consumption of red and processed meat, which means eating no more than moderate amounts of red meat, such as beef, pork and lamb, and eating little, if any, processed meat. The sixth recommendation is to limit consumption of sugar sweetened drinks and to drink mostly water and unsweetened drinks instead. The seventh recommendation is to limit alcohol consumption and to realize that for cancer prevention, it is best not to drink alcohol. The eighth recommendation is to not use supplements for cancer prevention but rather, aim to meet nutritional needs through diet alone. There are two special recommendations, one is for mothers to breastfeed their baby, if they can, because breastfeeding is good for both mother and baby. The other is for cancer survivors to follow the cancer prevention recommendations, if they can, and to check with their health professional what is right for them.

Conclusion

A comprehensive package of policies is needed to enable people to achieve and maintain a healthy weight, including policies that influence the food environment, food system, built environment and behaviour change communication across the life course. These policies can also help contribute to a sustainable ecological environment. Policymakers are encouraged to frame specific goals and actions according to their national context.

Obes Facts. 2018 May 26;11(Suppl 1):13.

S10.3 Translating Research into Policy. The WCRF/ AICR Third Expert Report on diet, nutrition, physical activity and cancer: Updated Recommendations, Underpinning Mechanisms and Policy Implications

G Mitrou 1

Introduction

With the global cancer burden continually increasing, global urgent action is needed. The environmental, economic, political and social dimensions are important upstream determinants of cancer risk and the prevention of cancer. Advancing the development and implementation of more effective policies worldwide to help people reduce their risk of cancer and other non-communicable diseases are crucial if we are to support people to follow a healthy dietary and lifestyle pattern based on our Third Expert Report (May 2018) and updated Cancer Prevention Recommendations.

This session will present the WCRF International’s NOURISHING framework which formalises a comprehensive package of policies to promote healthy diets and reduce overweight, obesity and diet-related non-communicable diseases. The framework outlines policy options allowing policymakers the flexibility to shape a response that is suitable and relevant for their national, regional and local contexts and target populations, and establishes a mechanism for reporting, categorising and monitoring policy actions around the world.

The session will also highlight why a whole-of-government, whole-of-society approach is necessary to create environments for people that are conducive to following the Cancer Prevention Recommendations, and to reduce the global burden of cancer.

Methods

The NOURISHING framework recognises the importance of three key policy domains where governments need to take action to promote healthy diets and prevent overweight, obesity and diet-related non-communicable diseases – the food environment, the food system and behavior change communication. The framework is accompanied by an extensive policy database which contains over 450 implemented government policies across 125 countries (more than half of all countries in the world) and five regional bodies (Caribbean Community (CARICOM), European Union, Gulf Cooperation Council, Mercosur and Nordic Cooperation Region), as well as over 90 policy evaluations.

One of NOURISHING’s strengths is the way it categorises the numerous policy options to promote healthy diets into ten overarching policy areas across the three policy domains, which enables policymakers, researchers and civil society organisations to advocate for and implement government policies to promote healthy diets. Building on the NOURISHING framework, the Public Health and Policy Implications section of the Third Expert Report presents a broad structured policy framework that addresses physical activity, alcohol consumption and breastfeeding - in addition to healthy diets - building on various other international policy frameworks, strategies and plans that exist and outline approaches and policy options to address these risk factors in a comprehensive way. By using NOURISHING as a lens to inform the development of an adapted policy framework, we offer an easily accessible overview of the key policy areas where action is needed.

Results

The adapted policy framework highlights common policy levers that can be used to promote healthy diets, physical activity, and breastfeeding, and reduce alcohol consumption. These policy measures broadly influence the availability, affordability, awareness and acceptability of healthy lifestyles relative to unhealthy lifestyles.

To address the four lifestyle factors of diet, physical activity, alcohol consumption and breastfeeding in the adapted policy framework, we have broadened NOURISHING’s three overarching policy domains to ‘health-enhancing environments’, ‘systems’ and ‘behaviour change communication’ – and modified and expanded NOURISHING’s ten policy areas to a total of eleven, to include ‘healthy urban design’ within the adapted framework.

We will present our latest policy brief, that accompanies the Third Expert Report, which sets out in more detail our ‘policy framework approach’ and adapted policy framework, with recent case studies from around the world across the four lifestyle factors. The Third Expert Report provides the latest scientific evidence on the links between diet, body weight, physical activity and cancer, which can help inform policy development which is needed to prevent cancer and other NCDs.

Conclusion

In order to curb the global cancer burden, urgent government action is needed in order to create environments that are conducive for people to make healthy lifestyle choices. The world is off track to meet the global voluntary NCD targets by 2025, with less than half the world’s countries having set targets to reduce their NCD burden. In order to advance the development and implementation of effective policies worldwide, World Cancer Research Fund International advocates for a comprehensive policy framework approach by policymakers in order to promote healthy diets, physical activity, and breastfeeding, and reduce alcohol consumption.

Obes Facts. 2018 May 26;11(Suppl 1):13–14.

S11.2 Pre- and post-operative deficiencies

B Ludvik 1

Introduction

Follwoing bariatric surgery, deficiencies in macro- and micronutrients are quite common, most likely due to restrictive and malabsorptive mechanisms. Occurence and extent of these deficiencies depend on the type of surgery and the respective malabsorptive component. However, despite overnutrition, obese subjects might exhibit deficiencies even before surgery, which increase the likelyhood of postoperative complications.

Methods

Sleeve gastrectomy primarily limits the volume of nutrients ingested and increases satiety. Gastric bypass and especially bilipancreatic diversion have an additional malabsorptive mode of action. While many studies investigated the prevalence of postperative nutritional deficiencies, respective evaluations regarding preoperative deficiencies are less frequent.

Results

Following sleeve gastrectomy, long-term data show primarily a decrease in ferritin, iron, vitamin D and folate and a consecutive increase in the rate of anaemia and metabolic bone disese. Gastric bypass and particularly biliopancreatic diversion show higher rates of these deficiencies and additionally low levels of vitamin B12 and albumin, which might be difficult to treat. In a recently published study we could demonstrate a high prevalence of preoperative micronutrient deficiencies, especially for folate and vitamin D, and to some extent of vitamin A and B12.

Conclusion

Depite increased food intake, patients with morbid obesity exhibit micronutrient deficiences even before bariatric surgery. This carries a high risk for aggravation and additional macronutrient deficits. The latter also depend on the type of surgery and the degree of malabsorption. Thus, a careful evaluation and appropriate nutritional counselling are needed, especially to identify patients at high risk for postoperative deficiencies. In selected patients, correction of preoperatvie nutritional deficits is mandatory to avoid postoperative complications. In that regard, a life long care is necessary in patients undergoing bariatric surgery, especially when malabsorptive methods are employed.

Obes Facts. 2018 May 26;11(Suppl 1):14.

S11.3 Post bariatric hypoglycaemia: diagnosis and medical solutions

A Pucci 1

Bariatric surgery is an effective treatment for severe obesity, inducing a sustainable weight loss and an amelioration of many obesity-related co-morbidities. One of the possible complication of those procedures is post-bariatric or reactive hypoglycaemia, especially after a Roux-en-Y Gastric Bypass (RYGB). This is a challenging medical problem even considering that estimates of incidence of hypoglycaemia differ, likely due to differences in definitions of hypoglycaemia, patient selection criteria, and duration of follow-up. To date, the pathogenesis of this condition has not been completely established. However, various factors and in particular increased postprandial glucagon-like peptide 1 secretion have been considered as crucial mediator. Hypoglycaemia, which typically occurs 1–3 h after a meal is associated with inappropriate hyperinsulinaemia. Many of the mechanisms involved in weight loss and diabetes resolution after bariatric surgery may be responsible, in genetically predisposed individuals, for the development of hypoglycaemia. Carbohydrate-rich foods is usually the trigger for hypoglycaemic symptoms and a dietary approach including carbohydrate restriction and avoidance of high glycaemic index foods is mandatory. Few patients require further medical intervention, such as medications. Acarbose, Diazoxide, Calcium-channel blockers and Octreotide are drugs commonly used but there are other emerging drugs to be considered. Selected patients may require surgery but pancreatectomy or RYGB reversal have to be evaluated carefully because of their severe complications like iatrogenic diabetes and weight regain. Clinical trials are needed to further determine the pathophysiology of this condition in order to better identify affected patients and to find specific medical and surgical treatments.

Obes Facts. 2018 May 26;11(Suppl 1):14.

S11.4 Abdominal pain after bariatric surgery: prevalence, evaluation, management

M Fried 1

The rising number of bariatric operations is directly associated with more frequently seen postroperative complications after bariatric surgery. In general, one of the important signs of potential serious postoperative complication in general surgery is abdominal pain. However, in obese population after bariatric surgery, pain is substantially less indicative, and may be difficult to diagnose because of the size of abdomen. In certain complications, such as resection line and/or anastomotic leaks it’s not uncommon to find clinically soft abdomen in morbidly obese patient with peritonitis.

There’s a different prevalence of conditions which may cause postoperative abdominal pain, as well as different prevalence of clinical manifestation of those conditions and associated abdominal pain.

According to large statistics and metaanalyses, the most frequently diagnosed causes of acute abdomen (associated with the highest morbidity and mortality) are leaks of GI tract anastomoses/resection lines (1%−5%), internal hernias (1%), lower rates of frequency and morbidity is seen after bleedings (1%), both intra and extra-lumenal.

More rare causes of acute abdominal pain may be linked ith stomal ulcerations, anastomotic strictures and/or gastric band outlet obstruction, mechanical and technical, or even with pulmonary embolism or blood sugar disturbances or nutritional deficiencies.

In general abdominal pain is mitigated or intermittent in frequency in obese patients, so non-specific signs such as tachycardia, leukocytosis, fever, CRP elevation, general feeling of unwellness/sickness are of important signs to pay attention to. On contrary, imaging methods may be falsely negative in serious conditions (i.e. around 20% of CT scans are negative in cases of internal herniations).

Large number of post-bariatric abdominal catastrophes and mortality may be prevented. Abdominal pain associated with abdominal emergencies in obese patients is of supportive, not decisive value and significance, however wide awareness of potential bariatric comlications and their clinical picture should help to mitigate and lower the detrimental results of late diagnosed and treated abdominal pain and emergencies.

Obes Facts. 2018 May 26;11(Suppl 1):14.

S12.1 Anorexia nervosa and food addiction – opposite sides of the same coin?

J Hebebrand 1

Introduction

Anorexia nervosa (AN) with the core symptoms underweight, body shape and weight concerns is one of the three major eating disorders. Patients restrict their energy intake to an extent that starvation related symptoms ensue. The disorder is thus characterized by the intertwining of the primary cognitions and behaviors and the somatic and mental sequelae of starvation. We contrast the disorder with the concept of food addiction as defined with the revised version of the Yale Food Addiction Scale.

Methods

The comparison will focus on anthropometric, psychological, genetic and endocrine aspects of both phenotypes. In addition, we address addiction as an overarching mechanism involved in both disorders.

Results

Body weight in AN is by definition low. In contrast, subjects with food addiction cluster in, but are not restricted to the overweight range. Interestingly, patients with AN frequently endorse particular items of the Yale Food Addiction Scale entailing a high rate of the ‘diagnosis’ food addiction. In psychological terms, addictive behavior plays a role in both AN and food addiction. Molecular genetic data indicate an overlap in the genetic predisposition to both underweight and AN.

Conclusion

Despite contrasting features there is no clear cut evidence that the two disorders represent the opposite ends of an underlying quantitative phenotype.

Obes Facts. 2018 May 26;11(Suppl 1):14–15.

S12.2. Addiction-like brain characteristics in obesity

P Smeets 1,2

There is ongoing debate on the definition and measurement of food addiction. Nevertheless, there is mounting data that some, but not all, obese individuals can be classified as food addicts. Functional neuroimaging techniques like functional MRI (fMRI) and to a lesser extent electroencephalography (EEG) have been used to study differences in brain function between normal-weight and obese individuals. Moreover, some have tried to compare these to the neural alterations seen in substance and behavioural addiction.

First, I will address the question in how far individuals might be classified as food addicts based on their brain activity or reactivity in response to food stimulation. Second, I will discuss in how far such (neural) classification can be helpful for steering obesity prevention or interventions aimed at weight loss and what would be the research needs to make this work.

Conflicts of Interest

I gratefully acknowledge support by the European Union Seventh Framework Programme (FP7/2007-2013) under Grant Agreements 266408 (Full4Health), 266044 (I. Family) and 607310 (Nudge-It).

Obes Facts. 2018 May 26;11(Suppl 1):15.

S12.3 Evaluation of Food Addiction in Diabetic Individuals

O Kucukerdonmez 1, S Seckiner 2, R Meseri 1, E Koksal 3

Introduction

Diabetes is one of the most common chronic diseases seen in all countries. Importance and prevalence continue to increase with decreasing physical activity and increasing obesity. In addition, obesity and diabetes can cause a variety of eating disorders. Healthy eating habits and drug treatment are the main components of diabetes management. The theory of food addiction has seen increasing popularity as a concept in recent years. This theory suggests that some processed foods (pizza, chocolate, sugary beverages etc.) can cause addiction and that obesity and eating disorders are the results of a response that causes addiction to these foods. This study was planned to evaluate food addiction status and the factors affecting in diabetic individuals.

Methods

This cross-sectional study was conducted with 400 individuals aged 19–64 (34.3% male, 65.7% female) with diabetes. Individual demographic variables and health information were questioned with a questionnaire. From anthropometric measurements, body weight and height were taken by the researchers in accordance with the technique. Body mass index (BMI) was calculated using the formula: weight (in kilograms)/height (in meters2) and classify according to WHO criteria. Eating addiction was assessed with “Yale Food Addiction Scale (YFAS)”. Statistical analyzes were performed in the SPSS program.

Results

Of the individuals, 19.3% were type 1 diabetics and 80.7% were type 2 diabetics. The mean age and BMI were 47.1 ± 13.06 years and 30.7 ± 7.32 kg / m2, respectively. 49.4% of individuals with type 1 diabetes and 62.8% of people with type 2 diabetes had food addiction. Patients with type 2 diabetes are 1.73 times more likely to be addicted to food than type 1 diabetics (p < 0.05). According to the BMI classification, food addiction was determined in 50% of normal individuals, 70.2% of overweight and 58.5% of obese diabetes (Figure 1.). The likelihood of food addiction in overweight / obese subjects was 1.71 times higher than in normal subjects (p 0.05).

Fig. 1.

Fig. 1

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Distribution of food addiction according to BMI and diabetes type.

Conclusion

In conclusion, our findings supports the high risks of obesity-related eating disorders due to the most Type 2 diabetic patients were obese. So, to achieve more success in nutritional management of the diabetic patients it is necessary to take into consideration these issues, as well. And early intervention of diabetes in the clinic may prevent this and other eating disorders.

Obes Facts. 2018 May 26;11(Suppl 1):15.

S12.4 Obesity stigma: Is the food addiction label feeding the problem?

E Boyland 1, H K Ruddock 1, R Ensell 1, K Boult 1, M Orwin 1, C A Hardman 1

Introduction

Obesity is often attributed to an ‘addiction’ to high-calorie foods, however the effect of ‘food addiction’ explanations of obesity on weight-related stigma remains unclear. The extent to which food addiction is viewed as a legitimate medical condition may also be important; a medically-diagnosed food addiction may yield less stigma than self-diagnosed food addiction because it implies that overeating is beyond personal control. To test this, the current study examined target-specific and general weight-based stigma following exposure to an individual with obesity with either self-perceived food addiction, medically-diagnosed food addiction, or no food addiction (control condition).

Methods

In an online study, participants (N = 439) were randomly allocated to one of three conditions (self-diagnosed, medical, or control). All participants read a short vignette which provided basic information about a target person (e.g. family, hobbies etc.) and described her as ‘very overweight’. In the self-diagnosed condition, the vignette also stated that the target believed herself to be a food addict. In the medical condition, the vignette stated that she had been diagnosed with food addiction by her doctor. There was no reference to food addiction in the control condition. Participants then completed a variety of questionnaires which assessed target-specific and general weight-based stigma.

Results

Relative to the control condition, participants in the self-diagnosed and medical conditions demonstrated increased target-specific stigma (ηp2 = 0.04). Target-specific stigma did not differ between the self-diagnosed and medical conditions. There was no effect of condition on general weight-based stigma.

Conclusion

These findings suggest that both medically-diagnosed and self-diagnosed food addiction may exacerbate stigmatising attitudes directed towards a specific individual with obesity. Future research should examine whether stigma towards food addiction is moderated by general beliefs about the controllability of addictive disorders, or by individual differences in addiction-like eating behaviour.

Obes Facts. 2018 May 26;11(Suppl 1):15–16.

S13.1 Lifestyle factors, overweight/obesity and related disorders over the life-course of children – observations of the IDEFICS/I. Family cohort

W Ahrens 1

Introduction

The pan-European IDEFICS/I. Family children cohort investigates the aetiology of overweight (OW), obesity (OB) and related disorders, and gives recommendations for their primary prevention.

Methods

The baseline examination (T0) of 16,229 boys and girls aged 2 to 9.9 years from eight European countries took place in 2007/08. Half of them were exposed to a community-oriented primary obesity prevention programme. Two years later 11,041 of the T0 children plus 2,555 newly recruited children participated in a follow-up (T1) examination followed by a third one (T3) in 2014/15. Parents reported socio-demographic, behavioural, medical, nutritional and lifestyle data for their small children and families while self-reports were collected from adolescents. Examinations included anthropometry, blood pressure, heel ultrasonography, physical fitness, accelerometry, DNA from saliva and physiological markers in blood and urine.

Results

Children were 6.0, 7.9 and 10.9 years at T0, T1 and T3, respectively. Lack of sleep and physical activity (PA), excessive TV exposure and unhealthy diet were associated with excess weight gain. Dietary patterns rich in vegetables, wholemeal cereals and fruit and low in animal products were associated with lower risk of OW/OB and less 2-year weight gain. Excess energy intake was longitudinally associated with increased BMI z-scores. Children from a lower socioeconomic background had persistently unhealthier dietary profiles. Sensory preference for sugary/fatty foods was associated with overweight/obesity. The proportion of children who met the recommended 60 min of moderate-to-vigorous PA (MVPA) per day ranged from 2.0% (Cyprus) to 14.7% (Sweden) in girls and 9.5% (Italy) to 34.1% (Belgium) in boys. Playground density and parks had a positive effect on objectively measured MVPA. MVPA was associated with an increased bone stiffness and it reduced the risk of becoming OW/OB. Nocturnal sleep duration differed substantially between countries, with shorter durations in Southern Europe. A dose-dependent inverse association between sleep duration and OW/OB was observed, particularly in primary school children. One-third failed to meet current screen time recommendations (< 2h/day). These were at increased risk of developing high blood pressure. Watching TV during meals, having a TV in the bedroom and watching TV for more than 1 h/day were associated with being OW/OB. BMI at birth, rates of BMI change during infancy (0 to < 9 months), early childhood (9 months to < 6 years) and later childhood (> = 6 years), as well as current BMI z-score were associated with the metabolic syndrome (MetS) at follow-up. Rapid BMI growth between 9 months to < 6 years increased metabolic risk in children. The 5-year incidence of OW/OB decreased from 20% in 3–4 year olds to 10.1% in 8–10 year olds while the 5-year spontaneous remission rate of OW/OB decreased from 33.3 in the youngest age group to 13.8% in 5–6 year olds and then increased again until the age of 8.

Conclusion

Risk factors for obesity are also relevant for other health outcomes like bone stiffness and MetS that also develops as a sequel of OW/OB in children. The age-dependent incidence and remission rates of OW/OB indicate sensitive time windows during which primary prevention efforts could be most effective.

Obes Facts. 2018 May 26;11(Suppl 1):16.

S13.2 The development, causes, and consequences of childhood obesity: exploring heterogeneity using multiple birth cohorts

W Johnson 1

Introduction

Large national surveys have been used to document the development of the paediatric obesity epidemic, and birth cohort studies have been used to help identify the causes and consequences of childhood obesity. Comparisons of different populations or sub-groups within a population have helped elucidate heterogeneity in the development, causes, and consequences of childhood obesity, but another powerful approach is to compare cohorts (from the same population) born at different points in time. Only then is it possible to understand how the age-related process of obesity development might have changed over time and what the causes and consequences of that secular trend might be, while also revealing the importance of contextual factors including the nutritional and behavioural landscape.

Methods

This talk will provide a narrative review of research which has used birth year as a proxy for the environment into which individuals are born and live in order to quantify heterogeneity in the development, causes, and consequences of childhood obesity. Research using data from the UK birth cohort studies and the Fels Longitudinal Study in the USA, which has a sequential birth cohort design, will be showcased.

Results

Children born into the obesity epidemic era tend to actually have lower BMI values during infancy compared to children born earlier in the 20th century, before experiencing an earlier adiposity rebound followed by steeper trajectories and increased risk of obesity. Using 273,843 BMI observations on 56,632 participants born in 1946, 1958, 1970, 1991, or 2001, we have previously demonstrated that by 10 years of age the prevalence of overweight or obesity in the UK was already 2–3 times greater for cohorts born after the 1980’s compared to those born before the 1980’s. Few publications have used data from multiple birth cohorts to explicitly quantify the causes and consequences of the pediatric obesity epidemic. We investigated how the relationship of infant weight gain (a key obesity risk factor) with adolescent BMI differed in two of the UK cohorts and, using decomposition analysis, found that a stronger positive association in the 2001 cohort compared to the 1946 cohort accounted for 20–30% of the difference (i.e., secular increase) in BMI. Evidence of a larger socio-economic inequality in adolescent BMI in the 2001 cohort compared to the 1946, 1958, 1970 cohorts also suggests that the secular increase in BMI has occurred greatest among lower social groups and contributed to the pediatric obesity epidemic. Evidence from the Fels Longitudinal Study also implicates a strengthening effect of genetic variants for obesity over the 21st century.

Conclusion

Shifts over time in BMI trajectories illustrate how younger generations of children are likely to accumulate greater exposure to obesity throughout their lives, but there is a dearth of knowledge on the causes and consequences of such secular trends from studies that have modelled data across multiple birth cohorts. Our findings implicate rapid infant weight gain, low socio-economic position, and high genetic susceptibility in the development of the paediatric obesity epidemic and suggest that the risk associated with these exposures may be more pronounced in obesogenic environments

Obes Facts. 2018 May 26;11(Suppl 1):16–17.

S13.3 Future lifetime costs of childhood obesity and overweight

K Balanda 1, IJ Perry 2, S Millar 2, A Dee 2, L Webber 3

Introduction

Systematic reviews demonstrate that childhood and adult obesity/overweight are associated with a range of diseases. The wider JANPA (www.janpa.eu) project and safefood (www.safefood.eu) project undertook to estimate the lifetime costs of childhood obesity and effects of reductions in childhood obesity in eight European countries. We present estimates for Ireland and Northern Ireland.

Methods

Estimates are based on a Closed Cohort Simulation Model which takes a representative virtual cohort of a country’s childhoood population, models their lifetime BMI trajectories, and records the direct healthcare costs and societal costs they are expected to experience over their lifetimes as a result of those BMI trajectories. Models are implemented in an adaptation of existing UK Health Forum microsimulation software. Comparisons of individuals who were obese/overweight as children to individuals who were of healthy weight as children are used to estimate attributable costs. Effects of 1% or 5% reductions in mean childhood BMI are estimated by comparing the attribuatble cost in the current childhood obesity scenario to those in the reduced childhood obesity scenario. All costs and effects are discounted to 2015 values using an annual discount rate of 5% pa.

Results

The total lifetime costs (in 2015 values) attributable to childhood obesity/overweight are €4,518m (€16,036 per person) in Ireland and €2,533.7m (€22,647 per person) in Northern Ireland. In both countries; lifetime productivity losses due to premature mortality were the greatest single cost item and lifetime societal costs accounted for the majority of the total lifetime costs. With a 5% reduction in mean childhood BMI, total lifetime savings were estimated to be over a billion euros in Ireland and almost €400m in Northern Ireland. Lifetime healthcare costs were expected to fall by €245.7m in Ireland and €100.1m in Northern Ireland. Total lifetime cost (and per person costs) attributable to childhood obesity/overweight were much higher for males than for females. Males incur higher total lifetime income losses and productivity losses due to premature mortality while females incur higher lifetime healthcare costs and productivity losses due to absenteeism. These differences may be explained in part by higher risk of premature mortality and higher average incomes amongst males and the greater tendency to seek care and respond to care amongst females.

Conclusion

Our findings are brodly consistent with other studies although comparisons are very diffiicult because of methodological differences. Irish estimates highlight the staggering costs of childhood obesity/overweight in Ireland amd Northern Ireland and the substantial savings that could follow from modest changes In mean childhood BMI. Estimates from the other JANPA WP4 countries are under review. Across the eight countries, availability of required data varied greatly and further work is needed to improve the co-ordination, quality and analysis of European health information; particularly in the surveillance of obesity and obesity-related diseases and healthcare costs. The biggest gap iin the JANPA costing model relates to the psychosocial consequences of childhood obesity and their implications for human capital and the economy.

Obes Facts. 2018 May 26;11(Suppl 1):17.

S14.2 How to create a sustainable food system with affordable, accessible, and available health promoting food – a policy perspective

K Schindler 1

Background

Austria has promoted a Health in All Policies approach stipulated in the intersectoral process of Gesundheitsziele Österreich [1], the Austrian health targets. To provide access to a healthy diet for all is among the targets of this policy. Access to a healthy diet, however, is determined by a long chain of factors ranging from the producers, manufacturers and retailers to the consumers of foods and therefore involves many sectors and stakeholders. Austria wants to use the EU Council Presidency second half of 2018 to advance this topic and activities in this area.

The food system is a critical determinant of health. The European food system experienced dramatic changes during the last century. After the Second World War ensuring access to appropriate energy intake and fighting undernutrition was a priority of European nutrition and agriculture policies. Successful policies resulted also in increased production, availability and affordability of low cost energy dense, high in fat, trans-fats and sugar processed foods.

The past few decades have also been characterized by an alarming rise of overweight, obesity and NCD prevalence rates. High prevalence rates are associated with negative impact on citizens’ health, quality of life and life expectancy, but also with reduced labour force and increased health care expenditures in MS and the EU.

To tackle this problem and mitigate against the rising incidence of overweight, obesity and NCDs a move from a “silo” to a “collaborative and systemic approach” is needed. Well-being and health are the common goal for joint action.

Multifaceted, sometimes new or customized, policies, (research) strategies and actions are needed to support provision and access to a sustainable, diversified healthy diet. These policies encompass the entire food system and the sectors along the food value chain: agricultural production, food storage, transport and trade, food transformation, retail and provisioning and empower European citizens to make the healthy choice. Consequently interventions can be undertaken by a.) one sector alone or b.) multi- and cross sectoral cooperation, all including considerations about not posing barriers to internal trade and impact on public health (“health in all policies”) simultaneously.

Aims

The overarching aim is to contribute to a sustainable food system with affordable, accessible, and available food that can accommodate the aims of the different sectors involved including health, agriculture, environment and trade.

To this end the Austrian EU Presidency shall pursue the following Objectives:

– Facilitating dialogue and collaboration between different government departments having a stake in sustainable food systems

– Identifying co-benefits of health for other sectors

– Identifying market failures, governance failures, unwanted trade-offs and deficiencies

– Presenting policy options for all relevant sectors to harness these co-benefits

– Identifying potential entry points into the regulatory frameworks to facilitate development of a sustainable, equitable and health promoting food system within an effective functioning internal market

Reference

Obes Facts. 2018 May 26;11(Suppl 1):17.

S15.1 How to improve communication with children with overweight/obesity and their parents

I Lissau 1,2

Communication with overweight or obese children and their patients may be very important for the outcome of consultations with families. Interventions against overweight/obesity vary in many aspects. Some interventions include both parents and the child while others only include the parents. The number of papers on treatment of children with overweight or obesity has increased dramatically in the latest decade. The Cochrane systematic review has therefore divided the latest update into six separate reviews. Three reviews concern diet, physical activity, and behavioural interventions and are divided age groups 0−5, 6−11, and 12−17 years, respectively. One review concerns parents only intervention, and the fifth and six review concern drugs and bariatric surgery.

The purpose with this presentation is to give an view on how its possible to improve the communication with children and their parents. In order to improve the communication with the families, we need to ask our clients to evaluate the consultations and use the information next time we see the client. In every consultation, is it very important to clarify the client’s purpose of the consultation. With our questions, we support the patient verbally in expressing his/her purpose of the consultation. Data from consultations with children and their parents will be shown.

In solution-based brief therapy it is well known that the therapeutic alliance is crucial. The therapeutic alliance is measured by the client(s) by using four questions which are answered using Visual Analogue Scales. The better the therapeutic alliance, the more probable it is that the client comes back to the next session. Also, the therapeutic alliance is a strong predictor for the outcome of therapeutic interventions.

In conclusion, in order to improve our communication in psycho-therapeutic sessions it is necessary to include and use the clients’ evaluations.

Obes Facts. 2018 May 26;11(Suppl 1):17–18.

S15.2 Growth and body composition. An intriguing duet

A Pietrobelli 1,2, L Pecoraro 1

Introduction

Growth and development are key characteristics of childhood and sensitive markers of health status and adequate nutrition. Body composition measurements in children are quite challenging, due to rapid growth-related changes in fat mass and fat free mass, both in the short- and long-term period. Poor growth in early life influences the acquisition of lean tissue, while compensatory “catch-up” growth could drive fat mass deposition. On the other hand, the link between growth and developmental plasticity, could drive size at birth, maturation, and physiological function in adulthood.

Methods

Aim of our presentation is an overview on body composition assessment in order to understand and appreciate the difference in body composition during growth.

Discussion: Starting from pregnancy, at birth, and during early life, body composition measurements are crucial to monitor the baby’s growth. Body composition during infancy is important, because it is a critical period for obesity risk development, thus, valid tools are needed to accurately, precisely, and quickly determine fat mass and fat free mass. The early years are the time of immense change when fundamental behaviors, including those around eating, sleeping, and physical activity, are established, Understanding the changes in body composition that occurs during the first years of age, and how they may be related, may help inform evidence-based practice during childhood. Normative data on body composition will be reported in order to characterize at the day-by-day clinical work, variables useful to detect as earlier possible, any early life trajectory to later obesity that starts with rapid infancy gains in weight, length, and fat and lean mass.

Conclusion

Better understanding metabolic, behavioral and body composition correlates with growth trajectory will help to monitor nutrition and to develop preventive strategies against obesity and related metabolic disorders.

Obes Facts. 2018 May 26;11(Suppl 1):18.

S15.3 Understanding and preventing childhood obesity: The European experience

LA Moreno 1

Obesity in children and adolescents is the most prevalent nutrition-related condition, both in developed and developing countries. Genetic susceptibility determines around 60% of the variability in the body mass index or the fat mass index, the most widely used indicators of obesity. However, currently known genetic factors are able to explain their variability but just at about 4%. Perinatal factors are also important determinants of the development of obesity being the most important, maternal gestational weight gain, rapid infant’s growth and high protein consumption before two years of age. Later during childhood and adolescence, high energy-diets, including high free sugars intake and low levels of physical activity and an excess of time spent watching TV are the main drivers of the condition.

To tackle childhood obesity, the most adequate strategy is to try to prevent its development. The most efficient behavioural changes can be achieved by increasing fruits and water intake, increasing physical activity and reducing sedentary behaviours. The efficacy of the interventions is positive in terms of body mass index or prevalence of obesity; however, it is modest in terms of clinical relevance. New strategies to improve the efficacy of the interventions should be incorporated in the intervention programs, such as delivery of healthy foods, the implementation of social marketing strategies, the use of comprehensive strategies considering all the steps in the implementation of the intervention activities, the use of social networks to interact with the children and the families and the implementation of healthy policies at the level of the community environment.

Obes Facts. 2018 May 26;11(Suppl 1):18.

S15.4 Treatment of overweight children as a prevention of future childhood obesity

C-E Flodmark 1

Introduction

Childhood obesity is difficult to prevent. A common public health action is based on pedagogical methods using information to initiate behavioural change in individuals of a population. This is mainly chosen as an effective method for scaling up the interventions. However, it might also be possible to use a more individual approach using different kinds of treatment interventions. In this way treatment of childhood overweight could prevent the development of future childhood obesity.

Methods

A systematic review of the literature was undertaken. Two hundred nine studies were identified. Through additional cross referencing two more studies were found. In total abstracts from 211 studies were read by two independent researchers. A selection of 39 studies were read in full text. Of these 13 studies were found to be relevant.

Results

Studies from Germany, Italy, the Netherlands, Portugal and Brazil were identified. In most studies, there was a significant reduction of Δ BMI SDS but also other parameters such as waist circumference and body fat%.

Conclusion

To conclude, the knowledge regarding treatment of overweight children as a way of preventing obesity is limited. A treatment that works on obesity also seems to be efficient against overweight. However, there also seems to be specific programs that could be effective on overweight but not obesity.

Obes Facts. 2018 May 26;11(Suppl 1):18.

S15.5 The Viennese Obesity Prevention Project EDDY

K Widhalm 1, E Malina-Altzinger 1, S Czernin 1, T Knopf 1

Introduction

Obesity in children and adolescents is a worldwide major health problem with dramatic sequelae for the next generation, treatment is widely unsuccessful. Therefore prevention is the most important measure to tackle this problem. This is also the main goal of WHO.

Objectives

The “EDDY” study as an interventional cohort study with a two-year lifestyle intervention aimed to affect the lifestyle and nutrition habits of 8 – 11 year old children by intervention with nutritional training and sports programs.

Methods

2 Viennese schools were cluster-randomized into an intervention group and a control group. A total of 160 pupils aged 8 − 11 were included. The intervention group received a comprehensive, age-appropriate training on nutrition and lifestyle exercise intervention for 12 months. Before and after intervention and at two follow-ups, subjects were physically measured. In addition, knowledge of nutritional issues and eating habits were measured with questionnaires.

Results

The data imply an improvement of nutrition knowledge, a significant reduction in the consumption of junk food (p = 0.01), sweets (p.001) and salty snacks (p < 0.001) as well as a slight improvement of physical performance after intervention.

Conclusion

An age- adjusted lifestyle intervention based on dietary training and exercise can improve the nutritional knowledge, eating habits of school children, body composition and physical performance. In regard to body composition it could be shown that in the intervention group muscle mass increased in all weight groups (p < 0,05) whereas there was no change in the contest group.

Moreover, children who underwent intervention showed significant increases in physical performance, whereas the control group did not change.

Obes Facts. 2018 May 26;11(Suppl 1):19.

S17.1 Research Update: what is the story in personalised nutrition?

E Blaak 1

Which diet is optimal for weight loss an maintenance in obese individuals as well as which diet is optimal for preventing obesity-related metabolic complications remains controversial and implies that no diet fits all patients. Overall, energy restriction is the major factor producing a negative energy balance and weight loss. Nevertheless, it is increasingly understood that the cellular, molecular and physiological processes induced by distinct macronutrients may have consequences for energy yield and satiety, also depending on the genotype and phenotype of individuals. A recent study has shown that elevated fasting plasma glucose before treatment indicates success with dietary weight loss and maintenance among overweight patients consuming diets with a low glycemic load or with large amounts of fiber and whole grains Additionally, despite being compliant to lifestyle advices, the metabolic flexibility (defined as the ability to adapt substrate oxidation to substrate availabilityto certain dietary and/or lifestyle pattern may vary between individuals, resulting in differential effects on blood glucose homeostasis. Recent evidence indicates that metabolic inflexibility and insulin resistance may develop separately in different organs, representing different aetiologies towards diabetes and cardio-metabolic risk. Interestingly, the insulin-resistant metabolically inflexible phenotype (being predominant in muscle or liver) has been shown to interact with the type of diet to determine changes in metabolic outcome. Finally, recent data showed that dietary habits, anthropometrics, physical activity, and gut microbiota can accurately predict personalized glycemic and metabolic responses The above studies illustrate that the response to an intervention depends on a variety of factors including overall diet composition (ie protein, carbohydrate, fat and dietary fiber), food products, the physiological metabolic phenotype and microbial profile as well as lifestyle factors including sleep, stress and physical activity, and which each cannot be isolated from their context. Thus, the advances in systems biology and – omics methodologies and methodologies for quantifying dietary intake and lifestyle factors may yield new possibilities for more personalized or subgroup-based dietary strategies, although implementation in public health and clinical implementation and general consensus is still more remote.

Obes Facts. 2018 May 26;11(Suppl 1):19.

S17.2 Is there a practice-based future for personalised nutrition?

E Govers 1

Introduction

To improve the quality of prevention and management of obesity it is important that health professionals use evidence based guidelines. Dietitians in an European survey carried out by the European Specialist Dietetic Network (ESDN) on Obesity reported to work according to national guidelines in 76.7% of the cases; 84% of those guidelines were multi-disciplinary. On the other hand, working according to guidelines may improve quality of obesity care but does not guarantee successful weight loss (table 1).

Although these guidelines are of great importance, in dietary management the dietary diagnosis that is assessed, is leading in the choice for an intervention. Recently individualised diets have been accepted for Irritable Bowel Syndrome, the FODMAPS diet. In obesity and type 2 diabetes many patients are treated with diets that are not according to general food guidelines, leading to significant weight loss and improvement of glucose levels in patients that would otherwise not have been met. The objective of this presentation is to show that personalised nutrition may lead to more success in conservative weight loss treatment if the right approach is taken.

Methods

Based on the weight loss results from our own study we compared different diets for weight loss on their composition: hypo caloric diet; low fat diet; low carbohydrate/high protein diet, low GI diet and Mediterranean diet. We carried out a literature search on obesity guidelines to find high quality evidence for the effect of weight loss diets. We also used data on the use of dietary interventions from an online questionnaire we sent to European dietitians specialised in obesity management.

Results

We found that 65% of dietitians treats patients with an individually assessed diet; 28% prescribes a Meditterranean diet; 13.5% a low carbohydrate/high protein diet. Weight loss objective should be 5–15% in one year. Any diet can lead to weight loss, but not for every patient. Less weight loss may indicate that the diet used is not fit for the patient. Patients that suffer from insulin resistance are more successful with low carbohydrate/high protein diets. Protein content of the diet determinates percentage weight loss. Mediterranean diet is very helpful in weight maintenance. Low GI diets can induce weight loss, especially if they are also high protein.

Conclusion

Patients are best served with an individually designed diet, tailor made to fit their genetic, physical, psycological and social possibilities. Until research has solved the problem of perfectly matching an individual to a diet, flexibility in choosing among many diets with measurement of intended outcomes in individual patients should be recommended.

Table 1.

Weight loss related to diet after 6 months*

>5% weight loss
 <3% or no weight loss
Hypo caloric diet 29.1% RGV 34.2%** Low fat diet 28.6% Low carb/high protein diet 46.1%
 Hypo caloric diet 41.7% RGV 35.9% Low fat diet 28.8% Low carb/high protein diet 28.8%
>5% loss of waist circumference
 <3% loss of waist circumference
Hypo caloric diet 40% RGV 38% Low fat diet 25% Low carb/high protein diet 57%
 Hypo caloric diet 37.9% RGV 35.8% Low fat diet 62% Low carb/high protein diet 42.8%
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*

57% comorbidities

**

Dutch National Dietary guidelines

Reference

  • 1.Govers, et al. 2008.
Obes Facts. 2018 May 26;11(Suppl 1):19–20.

S17.3 Weight loss as part of a healthy lifestyle

T Handjieva-Darlenska 1

In almost every overweight and obese patient the diet must be adjusted to reduce energy intake. Dietary therapy consists of instructing patients as to how to modify their dietary intake to achieve a decrease in energy intake while maintaining a nutritionally adequate diet. The desirable rate of weight loss for most people is 0.5–1 kg per week after the first month of dieting. With higher rates of loss there may be excessive loss of lean tissue. During the first month weight loss will be more rapid because of the loss of water associated with glycogen. There is evidence to support the idea that differences in diet composition exert some effects on energy absorption and energy expenditure, but these differences have less clinical importance compared with the major goal to reduce total energy intake. Initially the target of a weight loss programme should be to decrease body weight by 5–10%. Once this is achieved a new target can be set. Patients will generally want to lose more weight, but it should be remembered that even a 5% weight reduction improves risk factors and risk-comorbidities. Several factors should be taken into consideration, e.g. the patient’s degree of obesity, previous weight loss attempts, risk factors, co-morbidities, and personal and social capacity to undertake the necessary lifestyle changes. Therapeutic obesity diets distinguish between several recognized weight reduction regiments. Low-energy diets (LED) and very low energy diets (VLED) replace normal foods. Ad libitum low fat diets do not restrict energy intake directly. A recent study shows that choosing between low-fat and low-carbohydrate diets for weight loss isn’t helped by taking patients’ genetics or insulin-secretion patterns into account. Predictors of weight loss could be a powerful tool in the daily practice.

Therapeutic obesity diets distinguish between several recognized weight reduction regiments. Low-energy diets (LED) and very low energy diets (VLED) replace normal foods. Ad libitum low fat diets do not restrict energy intake directly. A recent study shows that choosing between low-fat and low-carbohydrate diets for weight loss isn’t helped by taking patients’ genetics or insulin-secretion patterns into account. Predictors of weight loss could be a powerful tool in the daily practice.

Changing lifestyle factors remain the most effective long-term treatment and although the clinician can help with this is still the responsibility of the patient to maintain changes and achievd the desired healthy outcome.

Obes Facts. 2018 May 26;11(Suppl 1):20.

S17.4 Management of obesity related conditions through weight

S Polovina 1

Introduction

Weight loss in obese people achieved by lifestyle intervention, pharmacotherapy, or bariatric surgery, is a primary strategy in prevention and treatment of type 2 diabetes (T2DM) and obesity related commorbidities.

Methods

A lot of meta-analyses have shown benefitial effect of weight loss in overweight and obese subjects on metabolic commorbidities of obesity.

Results

In patients with prediabetes and metabolic syndrome, weight loss efficiently prevents progression to type T2DM and decrease cardiovascular risk factors. The main underlying mechanism of these benefits may be improvement in insulin resistance. In patients with overt T2DM, weight loss improves blood glucose and reduces the need for glucose-lowering drugs. In nondiabetic and diabetic subjects, calorie restriction produces improvement in insulin sensitivity due to mechanism that correlates with the loss of total body fat. Cardiovascular risk (CV) becomes lower after weight loss due to improve in serum lipids, proinflammatory cytokines and low grade inflammation. Restored GLP-1 secretion after substantial weight loss is one more mechanism which leads to decrease in vascular stiffnes. Blood pressure decreases proportionally to the weight loss. OSAS and PCOS as common obesity commorbidities, also rapidly improve after weight loss. Different dietary regiments have more or less success in CV risk reduction. After bariatic surgery ovulation is established and fertility rate is increased as well as decreased androgen hyperproduction and following metabolic disorders.

Conclusion

Dieraty treatment and lifestyle changes are a primary and long-term therapeutic approaches which with pharmacotherapy for obesity have positive impact on some obesity related commorbidities. Bariatric surgery is the most efficient therapy with durable effect on obesity and obesity related commorbidities.

Obes Facts. 2018 May 26;11(Suppl 1):20.

S18.1 Body composition as a tool to monitor overweight and obesity: the role of nuclear techniques

V Owino 1, C Loechl 1

The sharp rise in the global prevalence of overweight and obesity over the past few decades has contributed significantly to the high burden of non-communicable diseases, which according to the World Health Organization (WHO), were associated with over 70% of global deaths in 2015. The high number of overweight and obese children is particularly worrisome as the adverse outcomes are lifelong. The ability to diagnose the risk factors for obesity can facilitate the design of mitigating policies and interventions. Body mass index (BMI) has been used routinely as the main parameter to classify individuals as obese. However, BMI is only an index of body size and a surrogate indicator of obesity. BMI represents excess weight for height and does not distinguish the excess weight between fat, fat free mass, body water or bone. The relationship between BMI and body fat is also affected by factors such as hydration, maturation, and ethnicity, making it a weak indicator of adiposity. The assessment of body composition, not BMI alone, is vital to understanding the mechanisms of obesity and reducing its role in the global burden of NCDs. The International Atomic Energy Agency (IAEA), through its ‘Atoms for Peace and Development’ initiative fosters the application of non-radioactive nuclear techniques for assessing body composition and nutritional status in its Member States (MS). Stable isotope techniques play an important role in understanding the mechanisms of all forms of malnutrition from wasting to obesity, and as reliable tools in designing and evaluating the impact of nutrition interventions due to their high specificity and sensitivity compared to conventional Methods. The techniques are applicable in the assessment of body composition (fat and fat-free mass), energy expenditure, breastfeeding patterns, vitamin A body stores, and factors affecting absorption and retention of essential minerals such as iron and zinc in the body. Body composition by deuterium dilution is being used as a tool to monitor obesity in an IAEA regional project aiming to prevent adolescent obesity in 10 European countries (Albania, Bosnia and Herzegovina, Greece, Hungary, Macedonia, Moldova, Montenegro, Latvia, Portugal and Ukraine). All countries are already involved in the World Health Organization led Childhood Obesity Surveillance Initiative (COSI) which showed that the prevalence of overweight and obesity in primary school children was 20.5 – 37.9%. Data will be generated on body composition using deuterium dilution, physical activity levels using accelerometery and cardio-vascular risk factors of school children 8–10 years old. Information generated from this project will contribute to formulation of policies and interventions to halt the obesity menace in Europe and beyond in line with Sustainable Development Goals and World Health Assembly nutrition targets.

Obes Facts. 2018 May 26;11(Suppl 1):20–21.

S18.3 How do parents identify childhood obesity and can we help them to correctly categorise their child’s weight status?

AR Jones 1, L Cutler 1, KN Parkinson 1, M Tovee 2, MS Pearce 1, KD Mann 2, LJ Ells 3, V Araujo-Soares 1, J Harris 4, AJ Adamson 1

Introduction

Research suggests that parents tend not to classify their child as overweight (OW) even when they are according to clinical criteria. It is hypothesised that parental ability to correctly recognise when their child is OW or obese is fundamental to its prevention, acting as a potential barrier to parental action to improve their child’s health related behaviours and/or help seeking. We have completed a programme of work exploring parental identification of childhood OW and, using these data, have developed and tested an intervention to improve parental recognition of childhood OW.

Methods

Six focus groups with 27 parents were completed to explore parental views of childhood OW. Using the information generated we developed the MapMe intervention to improve parental recognition and understanding of childhood OW in two formats (paper- and web-based). MapMe included body image scales of known weight status, developed using 3D surface body scanning technology, as well as information on childhood OW and improving health related behaviours. The impact of MapMe on parental recognition of childhood OW and longer term child weight outcomes was tested in a three arm randomised control trial which recruited 2933 parents of 4–5 and 10–11 year old children from 15 regions across England.

Results

During focus groups parents used various methods to identify childhood OW and tended to use visual assessments and comparisons with other children. The MapMe intervention had no impact on the percentage of parents correctly categorising their child as OW. However, MapMe was associated with significantly greater reductions in child body mass index z-score 12 months post intervention (p = 0.022).

Conclusion

Parents tend not to use objective measures to determine their child’s weight status, rather they look at their child and compare them with others. Findings from the trial testing the MapMe intervention suggest that parents may be unwilling to label their child as OW, rather than being unable to recognise it, and that MapMe can help weight outcomes in children with OW. Further research is needed to replicate these findings, explore mechanisms of action and to test the feasibility of using such tools in other European countries. On-going work is developing and testing MapMe body image scales for use with Spanish families. The intervention has potential to be used to improve feedback to parents from national child measurement programmes and to be used in web-based intervention programmes for both prevention and treatment of childhood OW and obesity.

Funding

The National Prevention Research Initiative (NPRI), Gateshead Council; Newcastle City Council; North Tyneside Council; Redcar & Cleveland Borough Council; Sunderland City Council

Obes Facts. 2018 May 26;11(Suppl 1):21.

S18.4 Applying Nuclear Techniques to Design and Evaluate Interventions to Prevent and Control Obesity in Adolescents in Latvia

I Siksna 1, I Lazda 1, I Pudule 2

Latvia has successfully participated in WHO European Childhood Obesity Surveillance Initiative (COSI) since 2007 conducting survey for four times. Survey data include anthropometric measures (weight, height, waist and hip circumference) for 7 and 9-year-old school children as well as data about healthy school environment. 21,7% of 7-year olds in Latvia are obese or overweight. However, the previous data does not provide any information on the body composition of Latvian children, which could help to distinguish children with normal body weight but excess fat mass and low muscle mass. The deuterium dilution technique is the “gold standard” to assess body composition and it can be used to validate the previously used Methods, which has never been done previously in Latvia. Latvia is a participant of the IAEA regional project and it has provided opportunity for participants to master techniques of assessing body composition in training courses in Albania, Montenegro and Glasgow, as well as participate in International Childhood obesity conference in Lisbon in 2017. The objective of the participation in the project is to conduct a pilot study which aims to use stable isotope (deuterium dilution) technique to determine body composition (fat and lean mass) and physical activity levels and dietary intake patterns among school children (7–9 years). Planned study sample is 100 7–9- year old school children. The intervention will be performed in schools with a prior consent form of the participants’ parents received. There are planned informative meetings with parents and school representatives about safety of deuterium as this is currently one of main burdens of project. The Approval of the Research Ethics Committee of the Institute of Food Safety, Animal Health and Environment “BIOR” has already been received (No. 3/11/1/2018). The body composition of the children will be assessed using scales and height gauge, waist and neck circumference measurements, skinfold thickness measurements using a skinfold caliper, bioelectrical impedance and measurements of TBW using the deuterium dilution technique. TBW will be assessed based on deuterium analysis by Fourier Transform Infrared spectrometry (FTIR) in the saliva samples of the participants. Dietary intake patterns will be assessed using 24 h food diaries, food-frequency questionnaires and questionnaires on family dietary habits. Physical activity levels will be assessed using accelerometers, activity diaries and physical activity questionnaires (PAQ-C). All methods are chosen based on IAEA methodology (IAEA Health Series, No. 12). It is expected that the results will validate and give more accurate results on obesity prevalence in children in Latvia.

Obes Facts. 2018 May 26;11(Suppl 1):21–22.

S18.5 Applying Nuclear Techniques to Design and Evaluate Interventions to Prevent and Control Obesity in Adolescents in Bosnia and Herzegovina

AF Hadžiomeragić 1, VR Grujić 2

Changes in dietary habits and lifestyle have led to rising rates of obesity and related non-communicable diseases in countries throughout the Europe. Rates are particularly high in middle-income countries of Eastern and South-Eastern Europe. In both entities of Bosnia and Herzegovina cardiovascular diseases represent the biggest cause of mortality and 60% of adults suffer from overweight or obesity. The rate of overweight and obesity among children under five and adolesecents in the Federation of Bosnia and Herzegovina is 17,5% of and 22,3%, respectively. Similarly, 20% of under fives and 21,4% of adolescents in the Republic of Srpska are overweight and obese. Accurate information on overwieght and obesity for development of strategies to counteract obesity and related health risks in South-Eastern Europe and to evaluate existing strategies are needed and regional project on application of nuclear techniques supproted by IAEA has been initiated.

Bosnia and Herzegovina was among first to join the project and in 2016 hosted first regional coordination meeting organised by IAEA and State Regulatory Agency for Radiation and Nuclear Safety where representatives of ten member states WHO and EASO participated. In 2017 serious of regional trainings for participating countries have been organised by IAEA including training on assessment of body composition using deuterium dilution technique based on deuterium analysis by Transform Infrared spectrometry (FTIR) and on bioelectrical impedance technique; training on assessment of physical activity using accelerometers and questionnaires as well as scientific visit on use of stable isotope techniques in nutritional status assessment in context of overweight and obesity and quality control and assurance. Regional training on data management and data evaluation and training on data analysis are planned as well.

Pilot studies in pariticipating countries to familiarise with body composition assessment methods and physcial activity assessment methods are planned and all neccesary equipment has been provided by IAEA. In Bosnia and Herzegovina pilot study is planned for the second half of 2018 and accqusition of ethical approval is in proggress. Study will be conducted in two pediatric nutriton counceling centers in Mostar and Bjeljina and 30–60 children aged 8−10 years will be included. Saliva samples will be collected and analysed using FTIR and measurement of bioelectrical impedance and anthropometric measurements will be made. Questionnaires and accelerometers to assess physical activity levels and questoinnaires on food consumption and on knowledge attitude and behaviour will be used as well.

Built capacity for assesment of body composition and physical activity levels will help country in gethering accurate information on overweight and obesity and contribute to improvement of interventions on conter-acting obesity particularly ones aimed to school children as well as to evaluation and improvement of existing programmes in the country.

Obes Facts. 2018 May 26;11(Suppl 1):22.

S19.2 The ‘Can Cook’ intervention

R Davison 1

Introduction

Since 2008 the UK economy has been challenged by austere economic output which has produced a massive reduction in welfare benefits, stagnating workforce wages, reduced public services and increased food prices. Politically Neo-Liberal in its design, the results of austerity mean that deprived communities are now places that host levels of poverty not seen for decades; places where peoples access to food and the mechanisms of good diet have been stripped away. These circumstances of decline have been rapid and for those communities affected the response is based on a food aid system that circulates only ultra-processed foodstuffs that could accurately be branded a system of poor-food-for-poor-people.

Methods

Responding to the conditions food poverty and the system of poor-food-for-poor-people, Can Cook a food enterprise based in Liverpool (UK) have undertaken 5 years of research and delivery including facilitating 3 conferences and a review of international food aid systems with a particular focus on North America. These methods engaged over 165 frontline organisations as well as teaching over 10,000 people to cook and distributing over 35,000 free fresh meals to people in food poverty. All of the methods were/are predicated on finding a solution to hunger and in particular establishing good food services in deprived areas.

Results

Practitioner led, the intervention discussed will demonstrate how after 5 years researching and a further 5 years of working in deprived areas, Can Cook is now in a position to roll out an innovative/viable solution called Good Food Areas (GFA). GFA contains solutions to poor-diet and a linked solution to food poverty. The delivery elements of GFA already exist with deprived communities. What GFA will do is arrange and improve these elements to ensure only good food is distributed. GFA is a solution that could be scaled up to improve diets and wellbeing in any inner-city area.

Conclusion

Without a move towards good food solutions for people of low or no economic standing. In the UK, a public health crisis will blight communities and have a severe impact on the prospects of future generations. GFA’s has the potential to add significant social and economic benefits and establish good food options in every tier of community based food delivery; improving diets and stopping food poverty.

Obes Facts. 2018 May 26;11(Suppl 1):22.

S19.3 School-based intervention in low income communities

LS Elinder 1

Introduction

The cumulated evidence shows that for prevention of childhood obesity to be effective, it should be performed in schools, involve multiple components and include the home environment. In Sweden, when children start school at the age of 6, they have their first visit to the school health services together with their parents. This is an outstanding opportunity to meet all families and boost parents’ knowledge and skills regarding health promoting practices at an important stage of the child’s life. However, evidence-based programmes to promote health and prevent obesity within this setting are lacking. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent overweight and obesity in children through parental support in disadvantaged areas that have increased health needs, delivered by teachers and school nurses. Two previous trials have been performed with encouraging results regarding dietary habits and transient effects on body weight development.

Methods

This intervention is based on Social Cognitive Theory and builds on experiences from two previous rounds of process and outcome evaluations. In this study, another component has been added, the focus on parenting practices and family interplay has been enhanced, and all intervention components are now carried out by school staff and/or parents. The intervention comprises four components: 1) A health information brochure to parents; 2) one or two MI sessions with parents according to family needs, performed by the school nurse; 3) nine classroom activities performed by teachers with home assignments to be completed by children together with their parents; and new 4) a web-based self-test of T2D risk for parents with feedback concerning their level of risk. A characteristic feature of this intervention is that the components allow for tailoring to the special needs of the families. The study will be conducted as a cluster-randomised parallel trial with randomisation at school level, with a wait-list control group.

Results

Seventeen schools are participating in the study with 350 children and their parents. The intervention started in December 2017 and runs for 6 months. School nurses have been trained in Motivational Interviewing and teachers have been instructed how to perform the classroom component. Baseline measurements have been performed and new measurements will be done in April-May 2018 and again at a 1 year follow-up. The baseline data, intervention components and the programme theory will be discussed including hypothetical mechanisms of change based on Social Cognitive Theory.

Conclusion

Preventive universal interventions are not expected to yield large effect sizes in the short term. But because children from all socio-economic levels can be reached by school staff over an extended period of time, the programme has the potential for beneficial long-term effects with measurable effects at the population level. External support for large-scale implementation of this programme is limited to training of school nurses in Motivational Interviewing, since all materials and instructions for teachers are available from the project’s website.

Obes Facts. 2018 May 26;11(Suppl 1):22–23.

S20.1 Drive, Inhibition and Choice in an Appetite Control System – a dynamic interaction between Biology and the Environment

JE Blundell 1

Appetite is concerned with eating, hunger, food behaviour and energy intake; and is essential for understanding the aetiology and management of obesity. Food Intake is perceived as a major cause of obesity and as an obstacle to its treatment. In consumer societies it can be assumed that no one is trying to get fat; weight gain happens passively. It is neither intended nor wanted. The biological system is asymmetrical and involves tonic and episodic processes; fat gain is readily permitted whilst the system strongly defends against weight loss. Moreover as fat mass increases appetite control appears to weaken. It can also be inferred that no one is trying to deliberately overeat; overconsumption is passive – it can happen with minimal awareness and without volitional action. Can foods be used strategically to counter this?

Human appetite is reflected in two issues: what to eat, and how much to eat. Humans are omnivores; everything can be eaten and food behaviour has to be adaptive. Food choice is a priority. Since foods vary enormously in physical and nutrient composition, appetite cannot be separated from the food supply. Energy density (ED) of foods is a major influence on energy intake; ED is dominated by fat and leads to passive overconsumption via satiation.

Homeostatic appetite refers to the stimulation and inhibition of eating. Eating behaviour shows high individual variability; it is quite volatile and not strictly regulated. Research is often focussed on satiety and satiation – processes reflecting an inhibition of eating. Satiety varies substantially between individuals; high and low satiety phenotypes (LSP) can be identified. Is this heterogeneity important for understanding appetite control? What techniques are available to help the LSP? How strong are food-based mechanisms? If the biological signal is strong enough (eg drug-induced action at GLP1 receptors) then appetite can be effectively suppressed.

The drive for food is strong, persistent and can be denied only under exceptional circumstances. Why is it so difficult to inhibit the drive to eat? Recent work has drawn attention to the importance of energy expenditure (EE) in the Drive to eat. Energy is required to maintain the integrity and function of vital organs and constitutes a metabolic need reflected in the Resting Metabolic Rate (RMR), now regarded as a ‘major determinant of energy intake’ (AJCN editorial September 2017). Additional research has demonstrated how the EE of physical activity can improve the sensitivity of the appetite system – including an augmentation of satiety. Sedentariness can weaken appetite and energy intake is not independent of energy expenditure. New avenues of research on human appetite are now open; but is research is going in the right direction?

Obes Facts. 2018 May 26;11(Suppl 1):23.

S20.2 Cell walls as barriers to lipid bioaccessibility in plants – implications of metabolisable energy for appetite control

M Grundy 1, P Ellis 2

Introduction

Diets containing foods high in fat are considered to be detrimental to health; however, studies have shown that the consumption of almond seeds (comprising ~50% lipid) is associated with beneficial health effects, in particular reduced cardiometabolic risks and body weight. To be digested, lipids are required to be released from the cells of plant tissue and emulsified. However, a great proportion of lipids in some plant food matrices, such as almonds, remains undisturbed after mastication and the subsequent digestion processes. On this basis, it is proposed that by encapsulating intracellular nutrients, almond cell walls may act as a physical barrier to digestion in the upper gastrointestinal tract, thereby limiting lipid bioaccessibility.

Methods

The role played by almond cell walls in the regulation of lipid bioaccessibility and digestion kinetics was investigated using a combination of in vivo and in vitro Methods. First, the extent of lipid release and the microstructural changes occurring in almond tissue during mastication were examined. Then, the effects of digestion on cell walls structure and lipid content, in almond products with various degree of complexity, was determined in ileostomy subjects as well as using in vitro digestion models. Finally, the potential penetration of lipase(s) through the cell wall matrix was investigated using notably confocal microscopy.

Results

The findings of this project indicated that following mastication and gastrointestinal digestion of whole almonds, only a small proportion of lipid was released from ruptured cells. Depending on the almond structure and degree of processing, the amount of lipid released from the food matrix and fatty acids produced from lipolysis varied substantially.

Conclusion

This work demonstrated that by manipulating the structure of almonds the lipid bioaccessibility can be controlled. On this basis, it is proposed that by encapsulating intracellular nutrients, almond cell walls may act as a physical barrier to digestion in the upper gastrointestinal tract, thereby limiting lipid bioaccessibility with implications for appetite.”

Obes Facts. 2018 May 26;11(Suppl 1):23.

S20.3 Could the use of ‘omics’ contribute to a better understanding of satiety?

M Bulló 1,2

The control of satiety involves a complex interplay between a multitude of processes regulated by various signaling molecules (i.e. hormones) and learnt behaviors, classically orchestrated from brain systems that are involved in the control of appetite, but also include enzymes that control how efficiently energy is harvested from the food we eat. However, there is increasing evidence suggesting that the regulation of satiety and consequently body weight may also be influenced by other actors as gut microbiota or cellular regulators such as miRNA. Collectively, these novel multidisciplinary approaches to satiety control and body weight regulation highlight the need to use high-throughput methodologies that collectively characterize and quantify pools of molecules at multiple sites that translate into function and the inter-organ crosstalk. Metagenomics allows us to investigate thousands of low-abundance gut bacteria species.

Modern metabolomics platforms afford profiling of hundreds of metabolites in parallel and in several biological fluids or tissues. In addition, genomics, transcriptomics, proteomics, are different links within the same integrated biological system with promising roles for a better comprehension of the satiety cascade and the regulation of body weight. Although the use of these technologies has not yet strongly influenced this area of human research, cognitive and hedonic responses to meal ingestion can be envisaged to correlate with changes in a panel of circulating metabolites that could be considered as objective biomarkers of perception. Similarly, preliminary non-published results from our group suggest that different circulating metabolic profiles discriminate between subjects who are more satiated after a specific meal compared to those that become less satiated.

The question of whether differences in satiety after a meal can be related to a specific “omic” profile and to what extent this response can be predicted, remains to be answered by further research.

Obes Facts. 2018 May 26;11(Suppl 1):23–24.

S20.4 Appetitive Sensations: Questions about Measurement and Function

RD Mattes 1

Appetitive sensations contribute to decisions regarding food choice and energy intake. However questions about to what degree and how reliably have not been adequately characterized. Consequently, the utility of appetite measurement is uncertain. One issue is how they are measured. A limited set of indices has been identified and defined in the scientific community, but it is not clear individuals being measured understand and differentiate these concepts. Thus, responses are often non-specific and highly correlated when, because they purportedly have different biological mechanisms underlying them and serve different purposes, there is little reason for this to be true. Moreover, even under tightly controlled conditions, they are susceptible to trivial manipulations of the stimulus or judge. In an attempt to validate, objectify and understand the mechanisms underlying appetitive sensations, considerable work has focused on endocrine function. While supra-physiological concentrations of selected hormones may alter feeding patterns and, sometimes, total energy intake, the relationship between concentrations of these signaling compounds and appetite under more realistic conditions has not been robust. Whether due to measurement shortcomings or other factors, the preponderance of evidence also indicates appetitive sensations are only weakly correlated with ingestion. In part, this likely stems from a lack of clarity of which sensation should be evaluated under a given set of conditions and for a specified outcome. Rather, a shotgun approach is typically applied leading to confusing outcomes. It must also be recognized that ingestive decisions are based on many factors in addition to appetitive sensations. Collectively, the non-appetite contributors likely overwhelm appetite-related input. The existence of appetitive sensations and their potential behavioral and health implications are undeniable, but how we measure and use them will require new thinking.

Obes Facts. 2018 May 26;11(Suppl 1):24.

S22.1 Brown adipose tissue: The body’s own mechanism to combat obesity?

MR Boon 1,2, PCN Rensen 1,2

Activated brown adipose tissue (BAT) combusts high amounts of intracellular lipids into heat. In the past few years, we have investigated the consequences of BAT activation for lipoprotein metabolism and cardiometabolic health. Initially, we showed that South Asians, a population characterized by dyslipidemia and prone to develop type 2 diabetes and cardiovascular disease compared to white Caucasians, have low BAT activity correlating with low energy expenditure. In search for pharmacological strategies to activate BAT, we set out to understand the physiology of BAT. Using preclinical models we elucidated that BAT activation enhances selective uptake of lipoprotein-triglyceride-derived fatty acids by BAT thereby generating lipoprotein remnants that are taken up by the liver. Next, we discovered novel pharmacological targets that modulate BAT activity with respect to uptake of plasma triglyceride-derived fatty acids, both directly and via neural control. We showed that BAT activation improves dyslipidemia and reduces atherosclerosis, accompanied by lowered (V)LDL levels and increased HDL turnover and reverse cholesterol transport. Based on these collective data, we recently started human intervention studies in prediabetic individuals from South Asian vs white Caucasians origin aimed to activate BAT activity and improve cardiometabolic health. Moreover, we currently search for biomarkers and optimize a novel and less invasive visualization method to assess BAT activity based on triglyceride content via MRI.

Obes Facts. 2018 May 26;11(Suppl 1):24.

S22.2 The Mitochondrial Lipid Cardiolipin Governs Systemic Energy Homeostasis through Thermogenic Fat

EG Sustarsic 1, MD Lynes 2, T Ma 1, M Larsen 3, M Lundh 1, K Plucinska 1, NZ Jespersen 1, B Kramar 1, K Qvortrup 3, T Hansen 1, B Emanuelli 1, N Grarup 1, C Scheele 1, Y-H Tseng 2, Z Gerhart-Hines 1

Introduction

The inducible energy-expending capacity of brown and beige adipocytes is positively associated with metabolic health. The dynamic process that activates the energy consumption capacity of thermogenic adipose tissue is poorly understood. Here we report that the mitochondrial phospholipid cardiolipin is indispensable for thermogenic fat function and regulates whole-body energy homeostasis.

Material and Methods:

Proteomic and lipidomic analyses were used to identify novel factors involved in BAT activation. With this dual-platform, we discovered that increased cardiolipins (CLs) and expression of the CL synthesis enzyme CRLS1, is a key signature of activated thermogenic fat. Loss and gain-of-function studies were performed in primary adipocytes. Human adipose tissue biopsies were used to assess translational potential of our findings. With Exome chip genotyping data, we examined the association of CRLS1 variants with metabolic disease. Finally, a floxed Crls1 mouse was generated and used to determine the role of adipose tissue Crls1 in thermogenesis and whole-body metabolic homeostasis.

Results

Cardiolipin synthesis is robustly induced in both brown and beige adipose upon cold or genetic activation. Overexpression of the cardiolipin synthase, Crls1, enhances energy consumption in mouse and human adipocytes. Conversely, loss of Crls1 in adipose severely disrupts mitochondrial structure and bioenergetics and alters fat tissue architecture. Cardiolipin is essential for adipose-driven thermogenesis and glucose uptake. Fat-specific Crls1 knockout mice display reduced metabolic flexibility and are strikingly insulin resistant. In humans, CRLS1 mutation and decreased CRLS1 levels in fat are linked to insulin resistance.

Conclusion

Adipose cardiolipin is a powerful regulator of organismal energy homeostasis through thermogenic fat bioenergetics.

Obes Facts. 2018 May 26;11(Suppl 1):24.

S22.3 Too hot to eat? A brown fat mediated gut-brain circuit regulates satiation

Y Li *, K Braun *, S-M Gabler 1,2,3, A Bast 1,2,3, F Bolze 1,2,3, M Klingenspor 1,2,3

Introduction

Brown adipose tissue (BAT) harbors a remarkable capacity to evoke energy expenditure through uncoupling protein 1 (UCP1) dependent thermogenesis, making it a potential therapeutic target against obesity and diabetes. Two types of thermogenesis, cold-induced thermogenesis (CIT) and diet/meal-induced thermogenesis (DIT/MIT), have been proposed to be mediated by BAT. While the former type is well established and indisputable, the latter type is still a matter of debate, especially pertaining to the identity of molecular mediators and the functional significance.

Methods

We reasoned that gut hormones released postprandially are potential evokers of MIT. We profiled the gut hormone receptors expressed in BAT using RNA-seq data obtained from BAT samples of mice. We further tested whether ligands of BAT-expressed gut hormone receptor could activate thermogenesis both in vitro and in vivo. The physiological significance of thermogenesis evoked by endogenous gut hormone was explored.

Results

We found that the receptor of the gut hormone secretin (SCTR) is highly expressed in BAT. By binding to this receptor, secretin (SCT) activates UCP1-dependent thermogenesis both in vitro and in vivo. We demonstrate that SCT induced thermogenesis inhibits food intake in fasted mice in an UCP1-dependent manner not invoking adrenergic receptors. Blocking of endogenous secretin activity through neutralizing antibodies decreases BAT temperature and increases food intake in response to feeding.

Conclusion

Our results not only revealed secretin as a novel non-adrenergic activator of BAT but also establish a gut-secretin-brown fat-brain axis in mammals that constitutes the physiological basis of meal-induced thermogenesis in the control of satiation.

Obes Facts. 2018 May 26;11(Suppl 1):24–25.

S22.4 No macrophage infiltration into brown and brite/beige adipose tissues during cold-induced recruitment

N Boulet 1,2, B Cannon 1, J Nedergaard 1

Introduction

The role of macrophages in brown and brite/beige adipose tissues has recently received high interest. Despite the relatively well described involvement of macrophages in the development of insulin resistance in white adipose tissue, their physiological role in cold-induced thermogenesis is still debated. To address this question, we determined the macrophage infiltration into brown, brite/beige and white adipose tissues following different housing temperatures.

Methods

Lean and obese (HFD 45% for 12 weeks) C57BL/6J male mice were single-caged and housed at thermoneutrality (30 °C), standard (22 °C) and cold (4 °C) conditions during 4 weeks. Interscapular brown, inguinal (brite/beige, lymph nodes removed) and epididymal (white) adipose tissues were collected. The proportion of macrophages in the stromal-vascular fraction (SVF) was determined by flow cytometry, and the inflammatory status of the tissues was determined by RT-qPCR analyses.

Results

Following cold exposure of lean mice, the number and percentage of macrophages in the SVF were unchanged in brown and white fats, and decreased in brite/beige fat. Most of the pro- and anti-inflammatory markers studied by RT-qPCR (such as Arg1, IL10, Mrc1, iNOS and TNFa) were decreased in brown fat, while they were unchanged in brite/beige and white depots. Following cold exposure of obese mice, the total number of macrophages per depot was reduced by half in the three adipose tissues studied, while the number of macrophages per mg of tissue was not affected. However, macrophage percentage in the SVF was reduced in brown and white depots, but not in brite/beige fat. Both pro- and anti-inflammatory marker gene expressions were decreased in brown fat but not really affected in white and brite/beige depots.

Our results show that, in lean mice, cold exposure does not increase the amount of macrophages in brown and brite/beige adipose tissues. Surprisingly, the inflammatory status of the brite/beige fat remains basically unchanged, while both anti- and pro-inflammatory markers decrease in brown fat following cold exposure. In already obese mice, cold exposure leads to a reduction in macrophage content in brown and white fat depots, which is associated with a decrease of fat mass. However, the brite/beige fat macrophages seem insensitive to the effect of cold and/or weight loss.

Conclusion

In conclusion, our results indicate that there is no macrophage infiltration into cold-activated brown and brite/beige adipose tissues and therefore raise the question of the physiological relevance of macrophage involvement in cold-induced thermogenesis.

Obes Facts. 2018 May 26;11(Suppl 1):25.

S23.1 Interactions between metabolic, reward and cognitive processes in appetite control

S Higgs 1, MS Spetter 1, P Rotshtein 1, JM Thomas 2, M Lee 3, M Hallschmid 4, CT Dourish 5

Introduction

Many current models of appetite emphasise the importance of cross talk between metabolic and hedonic systems in the control of food intake. For example, it is well recognised that gut hormones, such as leptin, ghrelin, GLP-1 and PYY can act on food reward circuits in the brain to alter hedonic responding to food. There is also now ample evidence that higher level cognitive functions such as learning, memory and attention play an important role in everyday appetite control, as well as an emerging literature documenting the effects of metabolic signals on higher level cognitive processes.

Methods

We review recent evidence on the relationship between metabolic, reward and cognitive processes in appetite control and present data from experiments in healthy volunteers that examined the effects of satiation on behavioural measures of reward responsiveness and cognition as well as neural activity assessed by fMRI.

Results

We find that natural satiation reduces food reward-related responding and that this is related to increased activity in cognitive control areas of the brain.

Conclusion

These data are consistent with the suggestion that some effects of metabolic signals on eating may be mediated by their effects on cognition and that appetite control involves integration of cognitive, homeostatic and reward mechanisms.

This work was supported by the Biotechnology and Biological Sciences Research Council (BBSRC) grant number: BB/N008847/1.

Obes Facts. 2018 May 26;11(Suppl 1):25.

S23.2 Decreased leptin signaling during dieting and its role in neural circuits regulating thermogenesis and food reward

RAH Adan 1, V de Vrind 1, R Pandit 1, K de Git 1, A Omrani 1

Introduction

Weight loss in obesity is hampered by counter regulatory mechanisms such as reduced thermogenesis and increased craving for palatable food that can be reversed by injecting leptin peripherally. The neural circuits mediating these effects are poorly understood. We here aimed to understand which neural circuits mediate leptin’s effect on these counter-regulatory mechanisms.

Methods

In rats, injections with leptin, viral-vector-mediated overexpression of a leptin receptor antagonist and withdrawal from a high-fat high sucrose choice diet were used to determine leptin receptor signaling in the dorsomedial hypothalamus (DMH) and the role of thermogenesis (assessed using telemetry) in a novel dieting model. Leptin receptor cre mice and chemogenetics were used to determine the role of leptin receptor expressing neurons in lateral hypothalamus (LH) and ventral tegmental area (VTA) in the effect of leptin on the motivation to press lever to obtain a palatable food reward.

Results

We discovered that restoring leptin signaling in the dorsomedial hypothalamic nucleus (DMH) is sufficient to normalize the reduced thermogenesis caused by withdrawal from an obesogenic diet. In support of this, inhibition of leptin signaling in the DMH reduces thermogenesis and promotes adiposity independent of food intake. We find that leptin receptor expressing neurons in lateral hypothalamus (LH) modulate the activity of VTA dopamine neurons during food seeking.

Conclusion

These studies collectively demonstrate that a state of relative leptin deficiency during dieting reduces leptin signaling in the DMH resulting in reduced thermogenesis and provides a mechanistic explanation for preservation of adiposity despite lowered caloric intake during dieting. Leptin indirectly inhibits activity of VTA dopamine neurons to reduce the motivation to obtain a food reward.

Supported by EC grant Nudge-it

Obes Facts. 2018 May 26;11(Suppl 1):25–26.

S23.3 Influence of food intake, and altered appetitive gut hormone signalling, on human reward processing and addictive behaviours

AP Goldstone 1

Introduction

There is evidence from pre-clinical studies that food intake and appetitive gut hormones, including glucagon-like peptide-1 (GLP-1), not only alter appetite, but also food and non-food reward processing, as well as addictive behaviours influencing eating behaviour such as emotional reactivity. There is more limited evidence from human studies. This talk will review our human studies using multi-modal phenotyping, including functional MRI, to study the food-gut-brain axis in eating and addictive behaviours.

Methods

A platform of fMRI paradigms including picture evaluation task (to assess cue reactivity or anticipatory reward) [Scholtz et al. Gut 2014; Goldstone et al. AJCN 2014; Goldstone AP et al. JCEM 2016], monetary incentive delay task (anticipatory non-food reward), and viewing of unpleasant images (negative emotional reactivity) [McGonigle et al. J Psychopharmacol. 2017], we studied the effects of food intake, Roux-en-Y gastric bypass (RYGB) or gastric banding surgery for obesity, acute pharmacological suppression of satiety gut hormones, and infusion of GLP-1 analogue, Exenatide.

Results

Food intake suppressed negative emotional reactivity, and anticipatory monetary reward responses in amygdala. Patients after RYGB had lower reward system activation during food evaluation, and lower high-energy food appeal, than patients after gastric banding. Anticipatory high-energy food reward responses correlated with consummatory food reward (taste pleasantness). The degree of suppression of GLP-1 and PYY by Octreotide correlated with increased reward system responses after bariatric surgery. Longitudinally, RYGB surgery reduced high-energy food appeal, which correlated with reduced orbitofrontal cortex and amygdala activation. RYGB also reduced amygdala activation to unpleasant pictures which correlated with reducted emotional eating. In recent preliminary findings from our Gut Hormone in Addiction (GHADD) study, Exenatide reduced the appeal of and brain responses to alcohol pictures in dieting subjects with obesity.

Conclusion

Food intake and RYGB surgery can reduced anticipatory reward responses to food, anticipatory monetary reward and/or negative emotional reactivity. Appetitive gut hormones such as GLP-1 suppress anticipatory reward responses to food, and potentially also alcohol and other drugs of abuse, suggesting the potential for gut hormone based therapies not only for obesity but also addiction.

Disclosure:

Supported by Medical Research Council, Wellcome Trust, Imperial College Healthcare Charity, NIHR

Obes Facts. 2018 May 26;11(Suppl 1):26.

S23.4 Central administration of ghrelin induces conditioned avoidance in rodents

SL Dickson 1,2, C Cook 1,2, M Le May 1,2, T Bake 1,2, SM Luckman 1,2, E Schéle 1,2

Introduction

Feelings of hunger carry a negative-valence (emotion) signal that appears to be conveyed through agouti-related peptide (AgRP) neurons in the hypothalamic arcuate nucleus. The circulating hunger hormone, ghrelin, activates these neurons although it remains unclear whether it also carries a negative-valence signal. Given that ghrelin also activates pathways in the midbrain that are important for reward, it remains possible that ghrelin could act as a positive reinforcer and hence, carry a positive-valence signal. The aim of the present study was to determine whether brain delivery of ghrelin to rats carries a negative or a positive valence signal.

Methods

We used condition preference/avoidance tests (for a place or for a flavor) to explore the reinforcing/aversive properties of ghrelin, delivered by intracerebroventricular (ICV) injection (2μg/injection once a day for 4 days).

Results

We found that ICV ghrelin conditioned an avoidance, both in a conditioned place preference/avoidance test (CPP/CPA, in which the animals avoid a chamber previously paired to ghrelin injection) and in a conditioned flavor preference/avoidance test (CFP/CFA, in which the animals consume/avoid a taste previously paired to ghrelin injection). The effects of ghrelin to induce a CPA were observed when conditioning to ghrelin occurred in the absence or presence of food. We did not find evidence, however, that brain ghrelin delivery to rats induces malaise (in the pica test).

Conclusion

Our data indicate that ICV ghrelin carries a negative-valence signal consistent with its role as a circulating hunger hormone and with its effects to activate AgRP neurones.

Disclosuer

Supported by EC grants NeuroFAST, Full4Health, Nudge-it, by BBSRC (UK) and by the Swedish Research Council for Medicine.

Obes Facts. 2018 May 26;11(Suppl 1):26.

S23.5 Understanding the role of dietary fibre and short chain fatty acids in central appetite regulation

G Frost 1

Introduction

Obesity is a major health problem therefore the prevention of weight gain is an important target. Much of appetite regulation is driven centrally. In animals fermentable dietary fibres protect against the weight gain induced by high fat diet. Here we explore the impact of fermentable fibres and it’s metabolites on central appetite regulation.

Methods

To get an overarching view of the impact of dietary fibre and short chain fatty acids (SCFA) on appetite regulation and weight gain a literature review was undertaken using PubMed search the years 1980 to the present. We used the search terms “dietary fibre”, “short chain fatty acids” and “appetite” giving 144 peer reviewed publications

Results

The effects of dietary fibre on appetite regulation only occur when large amounts of dietary fibre are consumed in humans, this is equivalent to consuming over 50g dietary fibre per day. Appetite regulation appears to be related to the fermentation of dietary fibre to short chain fatty acids. There are multiple reported mechanisms by which SCFA impacts on central appetite regulation. These include stimulation of the gastrointestinal anorectic peptides GLP-1 and PYY through the SCFA receptor FFAR2. Direct vagal stimulation through the SCFA receptor FFAR3. Stimulation of gastrointestinal gluconeogenesis and vagal stimulation. Stimulation of adipocytes to produce leptin.

There is also mounting evidence SCFA, particularly acetate, having a direct effect on hypothalamic neuronal signalling and activation on POMC. With recent evidence pointing to acetate effecting epigenetic modification in GABA neurones. Also there is evidence of SCFA influencing the reward areas in the brain

Conclusion

Dietary fibre and the fermentable products short chain fatty acids effect appetite regulation through multiple

Obes Facts. 2018 May 26;11(Suppl 1):26–27.

S24.1 Treating the ticking time bomb: childhood obesity

L J Ells 1, K Rees 2, T Brown 1, E Mead 1, G McGeechan 1, N Farpour-Lambert 3, L Al-Kudairy 4, H Clements 1, E Loveman 5, L Baur 6, P Rayco-Solon 7, A Demaio 8, L Azevedo 1

Introduction

Children and adolescents with overweight and obesity are a global health concern. Obesity in childhood and adolescence is associated with various serious cardio-metabolic, muscular-skeletal, respiratory and psychological conditions. Childhood obesity is also likely to track into adulthood, thus increasing the risks associated with obesity related ill health later in life. Effective treatment regimens are paramount in preventing the exacerbation of obesity and associated co-morbidities in these populations. We summarize the findings from an overview of Cochrane systematic reviews, which collectively provide an up-to-date synthesis of evidence from randomized controlled trials examining the effects of different interventions for the management of overweight and obesity in children and adolescents.

Methods

Six Cochrane reviews examining pediatric weight management were included, and assessed in an overview of reviews. Data from each review was extracted and each review independently quality assessed by one author and checked by a second. The primary outcomes of interest were changes in body mass index (BMI) or BMI-z score, with results extracted from relevant meta-analyses alongside secondary outcomes as reported in the summary of findings tables. The review authors’ Cochrane ‘risk of bias’ assessment and GRADE assessments were also recorded.

Results

The six included reviews were of high quality and provided evidence on the effects of surgery (n = 1 trial), drugs (n = 21 trials), and lifestyle modification interventions conducted in children < 6 y (n = 7 trials), 6–11 y (n = 70 trials), and adolescents 12–17 y (n = 44 trials) and interventions that target parents only (n = 20 trials). Most of the evidence derived from high-income countries and was published after 2000. The collective evidence from the lifestyle modification reviews suggested that multi-component behavior changing interventions may be beneficial in achieving small reductions in body weight status in children of all ages, with few adverse events, where reported. Authors were unable to ascertain the long term sustainability of the observed effects, particularly in children aged 6–11 years. The evidence from the surgical and drug interventions was too limited to draw robust Conclusions about use and safety, and adverse events were a serious consideration.

Conclusion

The evidence provides a comprehensive update on the effects of overweight and obesity treatments interventions for children aged 2–17 years. Despite a significant expansion in the evidence base, the results remain similar to those presented in 2009: whilst multi-component lifestyle interventions continue to deliver small positive changes in weight status, there is limited evidence to determine what are the effective components and delivery modes. The use of RCT alone without consideration of other study designs, poses practical considerations for policy making, where findings should be interpreted with the context of local political and health systems, and population need, and outcomes and adverse events carefully evaluated.

Conflicts of Interest

Dr Pura Rayco-Solon and Dr Alessandro Demaio are full-time staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the official position, decisions, policy or views of the World Health Organization.

Obes Facts. 2018 May 26;11(Suppl 1):27.

S25.1 Obesity and female reproduction

R Pasquali 1

We are facing a worldwide public health emergency due to the increasing epidemic of obesity and related disorders. The price of obesity is represented by a long list of co-morbidities and social, psychological and demographic problems. Obese women are characterized by similar co-morbidities to men, particularly type 2 diabetes and cardiovascular diseases. In parallel, there is evidence that infertility is growing in parallel with the obesity epidemic, in both males and females. The evolutionary perspective may be of importance in understanding the link between body composition, specifically body fat amount and topography and fertility processes. It can be expected that natural selection probably increased this differentiation. The association between excess body fat and infertility was described many centuries ago by Hippocrates: in the “Essay to the Scynthians“ he wrote that «… . the girls get amazingly flabby and podgy fatness and flabbiness are to blame. The womb is unable to receive the semen and they menstruate infrequently and little ». At present, we know that obesity may affect infertility and reproduction in women in different ways: (i) by affecting menses cycles and ovulatory function, (ii) by interfering with assisted reproductive technology (ART) efficiency and outcomes, (iii) by altering endometrial receptivity and by increasing rates of miscarriages, (iv) by worsening the physiological processes of pregnancy and therefore the maternal-fetal environment and, finally, (v) by altering the delivery processes. The relationship between excess body fat and reproductive disorders appears to be stronger for early-onset obesity particularly during the adolescent age. In addition, available data support the concept that visceral fatness is associated with a decreasing chance of conception more negatively than total body fat. The paradigm of PCOS exemplifies the negative effects of obesity on fertility and reproduction. Mechanisms by which obesity influences the pathophysiology and clinical expression of PCOS are complex, however a key responsibility of androgen excess and insulin resistance, has been outlined. Other than ovulatory dysfunctions, obese PCOS women are characterized by blunted responsiveness to pharmacological treatments to induce ovulation, recurrent miscarriages, more frequent early pregnancy loss and a reduced incidence of pregnancy. Obesity can also impair the outcome of ART, whereas it has been shown that the reduction of BMI by life style intervention and particularly bariatric surgery significantly increases the chance of pregnancy and live-birth. Therefore a closer collaboration between different specialists in order to improve the medical approach and treatment of infertility in both obese women and men is warranted.

Obes Facts. 2018 May 26;11(Suppl 1):27–28.

S25.2 Obesity and male reproduction

I Huhtaniemi 1

Introduction

Impaired male reproductive function has been demonstrated to belong to the health hazards associated with obesity. It most clearly inhibits the function of the hypothalamic-pituitary-testicular (HPT) axis at the central level causing hypogonadotropic hypogonadism [low or inappropriately normal luteinizing hormone (LH) and low testosterone (T)], leading to suppressed sexual function and other less specific physical and psychological complaints.

Methods

The presentation is based on findings of the European Male Ageing Study (EMAS), a multicentre study on aging related finding in a population of 3369 men of 40–79 yeas of age, from 8 Europqan countries (see e.hg. Wu et al. J Clin Endocrinol Metab 2008;93:2737).

Results

Suppressed serum T (< 11 nmol/L) is relatively common, 17%, in the general population of 40–80 year-old men, but the aging-related male hypogonadism, so-called late-onset hypogonadism (LOH), when defined using strict criteria (specific symptoms and low T), is a relatively rare finding, 2.1%. It is associated in 75% of patients with overweight and obesity, and only 25% being purely due to chronological aging. While the mechanism of obesity-related hypogonadism is not completely understood, it is likely due to inhibitory effect of adipose tissue-derived pro-inflammatory cytokines (e.g. TNFa and IL-2), central insulin resistance, and suppressing effect of hyperinsulinemia and elevated lipids on gonadotropin secretion. The long-held theory about adipose-tissue-produced estrogens as inhibitors of gonadotropin secretion does not hold true in light of more recent findings, because men only with extreme obesity have high estrogen levels. Obesity-related low T is a reversible phenomenon, because testicular T production recovers after weight loss. The clinical significance of obesity-associated low T has to be evaluated in connection with the simultaneous decrease of sex-hormone-binding globulin (SHBG), which reduced the impact of obesity on free T, which represents the biologically active fraction of this hormone. Besides effects of endocrine function of the HPT axis also suppressed sperm production has been reported in obese men. While the impact of obesity on male fertility cannot be evaluated on the basis of these figures, obesity may contribute to the documented worldwide trend of declining sperm counts.

Conclusion

The mechanisms, functional consequences and clinical significance of obesity in male reproductive functions will be discussed in this presentation.

Obes Facts. 2018 May 26;11(Suppl 1):28.

S25.3 Obesity and pregnancy: Obstetrical challenges and opportunities for intervention

B Martinez De Tejada 1

Introduction

Obesity is a global non-infectious epidemic and its prevalence is steadily increasing, especially in children under 5 years of age. Genetic predispositions in association with modifications of the environment and lifestyle contribute to excessive weight gain, in particular in populations with low socio-economic status, and leads to the early development of non-communicable diseases (NCDs). During pregnancy, obesity and excessive weight gain increases the risk of maternal complications (gestational hypertension or diabetes, thromboembolism, preeclampsia and death) and fetal complications (malformations, preterm delivery, in-utero death) by 2 to 6 times. The rate of caesarean section and related complications, as well as epidural analgesia failure are also high in this population. Maternal obesity and excessive weight gain during pregnancy also predispose to large for gestational age newborn (macrosomia), as well as childhood obesity, early development of NCDs, and premature death. In Europe, obesity already affects 20% of pregnant women and its prevalence may reach 37% in 2020. In June 2016 we initiated the program “Contrepoids Maternity”. This program aims to: 1) Develop a multidisciplinary program to improve the quality of care for pregnant women with obesity and prevent complications during pregnancy, childbirth, postpartum and between pregnancies; 2) To reduce the risk of developing early childhood obesity by improving the family lifestyle and parenting skills, in collaboration with the network of health care professionals in Geneva.

Methods

This project joins human resources and infrastructures of the Service of Obstetrics and the Service of Therapeutic Education for Chronic Diseases of HUG. It includes the following components: 1) A review of the evidence and the development of recommendations for weight gain, diet and physical activity during pregnancy and breastfeeding, as well as the adaptation of birth preparation and post-natal courses; 2) The creation of a clinical protocol and specialized multidisciplinary consultations for pregnant women with obesity; 3) The development of adapted physical activity classes, and nutritional and cooking workshops; 4) The evaluation of the knowledge, attitudes and representations of health care professionals taking care of pregnant women and their children in our hospital, and the set-up of a postgraduate and continuing training program; 5) The establishment of a longitudinal mother-child clinical follow-up with parental guidance; AND 6) The creation of a mother-child cohort study in order to evaluate the impact of the program on the quality of care of the mother and child at short, medium and long term.

Results

In 2017 at the maternity unit of HUG, 22% of pregnant women were overweight (BMI 25–29) and 12.5% were suffering from obesity (BMI> 30), which represents an average of 70 obese female who consult each month

Conclusion

This oral presentation will focus on the review of the evidence, clinical recommendations, challenges and opportunities for intervention in this population and the implementation of the program “Contrepoids Maternity”.

Funding

The Private Foundation of the University Hospitals of Geneva, Switzerland

Obes Facts. 2018 May 26;11(Suppl 1):28.

S26.1 Obesogenic Environments and INFORMAS

T Lobstein 1

Introduction

National authorities and international agencies have developed a wide range of policies to prevent the increase in the prevalence of obesity. Evaluation of success can be measured by the improvements in the prevalence of overweight and obesity in the population, but such improvements may be years after the policies are implemented. Indicators are needed to show that the policies are affecting the drivers of obesity, and that the policies are themselves being implemented.

Methods

A network of academic, civil society and public health institutions known as INFORMAS (the International Network for Food, Obesity and non-communicable diseases Research, Monitoring and Action Support) have developed a suite of tools for monitoring obesogenic environments in a range of settings. These also include tools for monitoring the development and implementation of policies by national authorities and by commercial actors. The tools can be freely downloaded and adapted for local situations, from the INFORMAS website https://www.fmhs.auckland.ac.nz/en/soph/global-health/projects/informas.html

Results

At the time of this abstract, 22 countries had used one or more of the INFORMAS monitoring tools, including 17 countries using the government policy assessment tool, and 8 countries using the commercial sector assessment tool. Three countries in Africa, seven in Latin America and six in Asia have used one or more of the INFORMAS tools.

Conclusion

Within five years, the INFORMAS tools have become widely accepted and valued as a means of assessing obesogenic environments and assessing the policies being put into place to moderate them. As the tools become more widely used and a core body of peer-reviewed literature develops, the INFORMAS approach will come to play a valuable role in holding governments and private enterprises to account for their effects on public health.

Obes Facts. 2018 May 26;11(Suppl 1):28–29.

S26.2 Lessons from taxation in Hungary: the need for ongoing political support

E Martos 1

Introduction

Hungarian public health data, including the high prevalence of nutrition related diseases are very unfavourable. National public health measures promoting a healthy diet, therefore, have high priority on the political agenda. In the recent years diverse governmental regulatory actions- such as restriction of trans fatty acids in food or healthy public catering- have been initiated in order to prevent nutrition-related NCDs.

Methods

As a fiscal measure, a public health product tax (PHPT) was introduced in 2011. The rationale behind it’s Introduction was the limited success of voluntary food reformulation and the increasing cost of the nutrition related disease burden. The objectives of the PHPT Introduction were to encourage food reformulation, reduce consumption of products that carry proven health risks when consumed and create revenue for financing public health services and programs. The specific excise tax on a per unit measure (kg, liter) is levied on non-staple pre-packaged foodstuffs, if their sugar, salt or methyl-xantine content exceed a certain threshold level. These threshold values were developed on the basis of objective measurements of the affected ingredients in different goods and on consumption data of these foods. The categories of products impacted by the tax are soft drinks, energy drinks, confectionery, salted snacks, condiments, flavoured alcohol and other alcohol products and fruit jams.

Results

Following the Introduction of the tax, an increased reformulation activity was observed from the food industry side, primarily affecting the energy drink sector, to avoid tax paying. Due to this, and because of the need of broadening the scope of the tax, it has been modified five times. The results of the impact assessments (2012, 2014) supported by the WHO Regional Office for Europe had shown that the tax reached it’s public health goals by reducing the supply of foodstuffs with unhealthy components, by reaching the consumers to decrease consumption of products from the affected food categories. The tax was successful from the economic point of view, as the planned tax revenues were realized. Moreover, the economic situation of the major tax payer companies had not been adversely altered. The PHPT has had also a long-term impact, the health literacy of consumers had improved over that in the first impact assessment. Most of those who made substitutions chose a healthier alternative. Weight and socioeconomic status had a strong effect on consumption change. Since the Introduction of the PHPT, €200 million have been generated, those made it possible to raise the wages of 95 000 health care workers. The stakeholders of the food industry have been arguing that the tax is discriminative, regressive, ineffective, does not solve the problem of obesity, prevents innovation and overall negatively affects the competitiveness of companies and they would like to reach the abolishment of taxation.

Conclusion

One of the key points of the success is the strong political commitment adjusted to the prevention of NCDs.

Obes Facts. 2018 May 26;11(Suppl 1):29.

S26.3 SIPCAN: how was it established?

F Hoppichler 1

Introduction

Cardiovascular diseases are affected by diet and can be approached, at least in part, from a nutritional point of view, as can the increasing “epidemic” of obesity. In preventing nutrition-related chronic diseases, programmes must address the need for change at the individual level (“behavioural interventions”) as well as the modifications in the environment (“environmental interventions”) to make healthier choices accessible and preferable, for example in schools and workplaces. The school environment presents an ideal location for health promotion interventions, because school children spend nearly half of their waking hours in school. This does also apply for adults in workplaces.

Methods

In 2005, SIPCAN (Special Institute for Preventive Cardiology And Nutrition) was founded and is a non-profit association which is supported by national scientific experts such as physicians, public health experts, and nutritionists. The priorities are health promotion, prevention, and research. The programmes include “behavioural interventions” on the one hand and “environmental interventions” on the other hand. The school-based programmes as pilot projects were funded by national grants and the nationwide implementation was financed by private sponsors and companies but without having an impact on design, conduct, data collection, analysis, or interpretation, and on publications. Two examples are the “drinking and snack licence”, which is a 5-week nutrition education programme conducted by teachers and integrated in the existing curriculum in the fifth-grade and the “vending machine check”, which enhances the offer in beverage vending machines towards healthier choices.

Results

Since the implementation of the programmes in 2007, in total, 993 schools or 227.454 school children, respectively, have already participated in at least one of them. The aim of these programmes is to provide a complete package of education and modification in the environment for healthy choices to increase nutrition-related knowledge and to decrease the consumption of unhealthy food while using the skills of the respective school and teachers. This approach is easy for teachers to use, has the ability to reach an appropriate proportion of school children, and it requires a minimum of money per school children, as no personnel is needed on site.

Conclusion

SIPCAN is an Austrian non-profit association and provides interventions in changing the individual level as well as the modifications in the environment to make healthier choices accessible and preferable especially in schools while using the skills of the teachers. Another key factor for success is to collaborate closely with decision-makers such as school physicians, parents, teachers, as well as, the educational board.

Conflicts of Interest

The SIPCAN programmes as pilot projects were initially financed by national funds and ongoing projects are financed by national subsidies as well as private sponsors and companies.

Obes Facts. 2018 May 26;11(Suppl 1):29.

S27.1 Self-regulation and emotion regulation in weight loss maintenance – working towards a consensus: The H2020 NoHoW Project

Obesity and associated disease place severe burdens on healthcare systems. Behavioural interventions for weight loss (WL) are subject to high attrition and weight regain. Management of longer-term WLM is currently and empty and fragmented space on the horizon of obesity research and practice, and consensus is needed in the area. Despite the massive public health importance of obesity on long-term management is lacking and largely constrained to select clinical or registry samples. Cognitive self-management of eating and activity behaviours in the general population can significantly enhance WLM, and may be improved by self-management of stress and emotions. The NoHoW project has now established a rigorous evidence-base of how weight is lost and maintained in European citizens through representative samples of 2000 adults in 3 European countries who are engaged in weight management attempts, 2000 successful weight loss maintainers, the weight histories and psychometric profiles of 1600 participants of the NoHoW trial and qualitative examination of the habits and behaviours associated with WL and WLM.

The first results of the NoHoW project have determined the role of self-regulation/motivation and emotion-regulation/stress management in the lives of European populations struggling to manage their weight. These results will provide new insights that will inform the development of the next generation of WLM trials and influence practice in longer-term weight management for decades to come. The current symposium provides the world’s first overview of the conceptually linked and thematically integrated findings covering the journey for initial WL to successful WLM. We identify research priorities and possible innovations in practice that will change the agenda shaping programmes and consensus for modification of energy balance behaviours and long-term management of obesity as a chronic relapsing condition.

Obes Facts. 2018 May 26;11(Suppl 1):30.

O1.1 Changes in visceral fat and cardio metabolic risk factors in trans persons during cross-sex hormonal therapy: Results from a multicenter prospective study

M Klaver 1, C Wiepjes 1, C De Blok 1, N Nota 1, J Defreyne 2, T Schneider 3, A Fisher 4, G T’Sjoen 2, M Den Heijer 1, R De Mutsert 5

Introduction

Visceral adipose tissue (VAT) is strongly related to multiple cardiometabolic risk factors, such as dyslipidemia and insulin resistance. Cross-sex hormonal therapy (CHT) in trans persons affects total body fat and body fat distribution, but little is known about the effects of CHT on VAT and cardiometabolic risk factors. The aim of our study was to investigate the changes in VAT and to examine the relation of changes in total body fat and VAT with changes in total cholesterol, triglycerides, and insulin resistance after one year of CHT.

Methods

In a multicenter prospective study at two university hospitals, 179 male-to-female trans persons (transwomen) and 162 female-to-male trans persons (transmen) underwent whole body dual-energy X-ray absorptiometry (Hologic Discovery A, Hologic Inc., USA) and laboratory measurements before and after one year of CHT. Linear mixed models were performed to estimate changes over time and linear regression was used to examine the relation between changes in total body fat and VAT with changes in cardiometabolic risk factors. Change in insulin resistance was assessed using the homeostatic model assessment (HOMA-IR) and expressed as a relative change.

Results

In transwomen, total body fat increased with 4.4 kg (95% CI 3.7;5.1, standard deviation (SD): 4.5), and VAT increased with 10 grams (range −289 to 251 grams, SD: 87). In transmen, total body fat decreased with 2.6 kg (95% CI −3.5;−2.0, SD: 4.3), and VAT increased with 6 grams (range −331 to 179 grams, SD: 83). In transwomen, each SD change in total body fat was associated with a change of 0.2 mmol/l (95% CI 0.1;0.3) in total cholesterol, 0.1 mmol/l (95% CI 0.0;0.2) in triglycerides, and with a 1.4-fold increase in HOMA-IR (95% CI 0.9;2.2). After adjustment for change in total body fat, coefficients per SD change in VAT were 0.2 mmol/l (95% CI 0.1;0.3) in total cholesterol, 0.1 mmol/l (95% CI 0.1;0.2) in triglycerides, and 1.0 (95% CI 0.7;1.5) in HOMA-IR. In transmen, one SD increase in TBF was related to a change of 0.1 mmol/l (95%CI −0.0;0.2) in triglycerides, no change in cholesterol (0.0 mmol/l, 95% CI −0.1;0.2), and a 1.5-fold increase in HOMA-IR (95%CI 0.2;10.7). After adjustment for change in total body fat, coefficients per SD change in VAT were 0.0 mmol/l (95% CI −0.1;0.1) in total cholesterol, 0.1 mmol/l (95% CI −0.1;0.2) in triglycerides, and 0.9 (95% CI 0.3;3.0) in HOMA-IR.

Conclusion

One year of CHT resulted in large changes in TBF, but in small mean changes in VAT, with a large inter-individual range in both transwomen and transmen. In transwomen, an increase in both TBF and VAT was associated to small increases in total cholesterol and triglycerides, but not in HOMA-IR. These associations were not seen in transmen.

Obes Facts. 2018 May 26;11(Suppl 1):30.

O1.2 Anthropometric measurements and metabolic syndrome in relation to glucocorticoid receptor polymorphisms in (local) corticosteroid users

M Savas 1, VL Wester 2, AM Iyer 2, E L T Van Den Akker 3, E F C Van Rossum 2

Introduction

Synthetic glucocorticoids, also known as corticosteroids, are amongst the most prescribed drugs. Use of corticosteroids has been linked to cardiometabolic adverse events including weight gain and abdominal adiposity. We previously showed that users of local or systemic forms were also more likely to have the metabolic syndrome (MetS). Since an essential role in the pathway of glucocorticoid (GC) action is reserved for the glucocorticoid receptor (GR), it could be proposed that GC sensitivity altering polymorphisms could affect the vulnerability for these adverse effects. We therefore assessed the relationships between functional GR polymorphisms with anthropometric measurements and MetS in users of corticosteroids.

Methods

We included 10,619 adult participants in the population-based Lifelines cohort study. Subjects were systematically evaluated for drug use, body mass index (BMI), waist circumference (WC), blood pressure, and fasting biochemical parameters (HDL-cholesterol, triglycerides, glucose) at first wave. Genotyping was performed for GR polymorphisms associated with a relatively increased (BclI and N363S) or decreased (ER22/23EK and 9β) GC sensitivity. All included subjects had complete information on MetS components according the harmonized criteria, and were classified as wild type (WT) (2 wild type alleles), GC hypersensitive (1 or 2 copies BclI and/or N363S), or GC resistants (1 or 2 copies ER22/23EK and/or 9β). Analyses were performed between nonusers (genotypes combined) and users (specified) and were adjusted for age, sex, education, smoking, and physical activity.

Results

Overall corticosteroids use was associated with a significantly higher BMI and WC in GC hypersensitive users (BMI: mean difference +0.67 kg/m2 (95% CI, 0.32–1.02); WC: +2.09 cm (1.16–3.02), both P < 0.001), in WT users (BMI: +0.57 kg/m2 (0.04–1.11), P = 0.04; WC: +1.90 cm (0.48–3.31), P < 0.01) but not in GC resistant users. Of the main corticosteroid administration forms, specifically the use of inhaled corticosteroids was associated with similar findings in GC hypersensitive users (BMI: +1.68 kg/m2 (1.15–2.20); WC: +4.72 cm (3.33–6.10), both P < 0.001), and WT users (BMI: +1.07 kg/m2 (0.25–1.89), P = 0.01; WC: +3.53 cm (1.35–5.70), P < 0.01). In regard to MetS, again only GC hypersensitive users (odds ratio (OR) 1.23 (95% CI, 1.01–1.50)) and WT users (OR 1.43 (1.06–1.93)) were more likely to have MetS in comparison to nonusers. This was especially the case with users of only inhaled corticosteroids (GC hypersensitive users, OR 1.44 (1.08–1.91); WT users, OR 1.64 (1.05–2.54)).

Conclusion

Corticosteroid users, in particular of inhaled corticosteroids, have an increased BMI, WC and more often MetS in comparison to nonusers. These relationships are significantly evident in carriers of GR genotypes associated with GC hypersensitivity or the wild type genotype, but not in users harboring GR resistant polymorphisms.

Obes Facts. 2018 May 26;11(Suppl 1):31.

O1.3 Compensatory responses to weight loss and long-term relapse: Is there a link?

S Nymo 1, SR Coutinho 2, J Rehfeld 3, H Truby 4, B Kulseng 5, C Martins 2

Introduction

Weight loss maintenance (WLM) remains the biggest challenge in obesity management. Research over the last decades has shown that strong compensatory mechanisms are activated with weight loss (WL), with a significant increase in appetite despite reduced total energy expenditure. It has been systematically suggested that these mechanisms drive long-term relapse, but evidence supporting it is missing. Therefore, the aim of this study was to explore the potential association between WLM and the compensatory mechanisms activated with WL (both at level of energy expenditure (EE) and appetite).

Methods

36 (26 men) adults (age: 41 ± 10 years) with obesity (BMI: 37 ± 4 kg/m2) underwent 8 weeks VLCD, followed by 4 weeks of refeeding (W13) and 1-year (1Y) maintenance program. Body weight and composition (BodPod), resting metabolic rate (RMR), respiratory quotient, and skeletal muscle efficiency (graded cycle ergometry at 10, 25, and 50 watts of power) (all by indirect calorimetry), and subjective feelings of appetite (hunger, fullness, desire to eat, and prospective food consumption, using VAS) and appetite-related hormones (active ghrelin (AG), active GLP-1, total PYY, CCK, and insulin) both in fasting and postprandially were measured at baseline, W13 and 1Y. Correlation analysis was performed between WLM and changes in all the EE and appetite variables measured, as a result of WL (W13-baseline). Multiple regression analysis was also performed using WLM as outcome variable and changes in RMR, basal AG, and fasting hunger as potential predictors.

Results

No significant correlations were found between WLM and changes in any of the EE or appetite variables studied. The regression analysis model showed that only changes in basal AG were significant (P = 0.009) in predicting relapse, with the model with three predictors explaining 24% of the variation in WLM.

Conclusion

No significant association seems to exist between compensatory mechanisms activated with WL and WLM. Larger studies are needed to further investigate the role of physiological adaptations to WL in modulating long-term relapse.

Obes Facts. 2018 May 26;11(Suppl 1):31.

O1.4 Predictors of fasting and postprandial appetite-related peptide response after supervised exercise

C Gibbons 1, J Blundell 1, A Myers 2, M Dalton 3, G Finlayson 1

Introduction

Exercise is often promoted as a method of weight control for obese people, but the variability in weight loss is large. Mechanisms behind these changes could be due to changes in appetite related peptides. The response of fasting and postprandial peptides to supervised aerobic exercise is not well understood. We examined psychological and physiological predictors of changes in fasting and postprandial responses of leptin, insulin, ghrelin, GLP-1 and PYY in two independent cohorts.

Methods

Two 12-wk supervised exercise interventions (2500kcal/wk) were conducted in study 1: 32 (M:11, F:21; Age 43yrs; BMI 31kg/m2) and study 2: 26 (F:26; Age 41yrs; BMI 31kg/m2) overweight/obese individuals. Leptin, insulin, ghrelin, GLP-1 and PYY were measured in a fasted and postprandial state. Fasting results were combined whereas postprandial responses were dealt with separately due to differing test meal methodologies. Baseline and change in body composition, cardiovascular fitness and eating behaviour trait characteristics were examined as predictors of peptide responses in both cohorts.

Results

Fasting leptin and insulin significantly decreased, whilst GLP-1 and PYY significantly increased (all p < 0.05) over the 12 weeks exercise; ghrelin increased, but not significantly (p = 0.064). When change in fasting peptides was controlled for, postprandial peptides showed sensitivity to the preload meals provided, but they did not change over the 12 week exercise period in either of the two studies (all p > 0.05). Change in weight appeared to be a major predictor of changes in fasting peptide levels, with insulin showing a decrease independent of weight change. No other predictors were identified.

Conclusion

In two independent cohorts of overweight/obese individuals, fasting peptides changed significantly, with leptin and insulin decreasing and GLP-1 and PYY increasing. Once these changes in fasting levels were accounted for, the direct postprandial response to food did not change after supervised exercise in either cohort. Nevertheless, the changes in fasting levels still mean the concentrations of peptides after food is lower or higher (dependent on the change in fasting levels), and this can be considered as beneficial. Weight loss appears to be the main contributor to changes in fasting peptide levels, with the exception of insulin which shows an independent effect from the exercise.

Obes Facts. 2018 May 26;11(Suppl 1):31–32.

O1.5 Regular exercise, glucose metabolism and cognitive functions in elderly individuals

M Schon 1, L Slobodova 2, V Tirpáková 3, P Krumpolec 4, M Vajda 5, S Vallová 2, S Šutovský 6, Z Košutzká 7, P Turčáni 6, I Straka 7, W Bogner 8, U Dydak 9, P Valkovič 7, M Sedliak 10, J Ukropec 11, B Ukropcova 12

Introduction

Substantial evidence indicates that sedentary lifestyle and low physical fitness may impair glucose metabolism and accelerate cognitive decline. Regular exercise represents an effective way of preventing both age-related metabolic and cognitive decline. Our aim was (i) to evaluate cognitive functions in seniors with/without prediabetes & type 2 diabetes (T2D); (ii) to evaluate associations of physical fitness and cognitive functions; (iii) to determine effects of long-term aerobic-strength training on body composition, glucose metabolism and cognitive functions.

Methods

Study population (n = 52; M/F = 21/31; BMI = 27.1 ± 4.1 kg/m2; 68.3 ± 7.9yrs) included individuals with prediabetes/T2D (n = 16/4), normal glucose tolerance (n = 32) and mild cognitive impairment (MCI, n = 29). Cognitive functions were determined by the battery of cognitive tests (Addenbrook’s test, ACE-R; Mini Mental State Examination, MMSE; Montreal Cognitive Assessment, MoCA; computerized tests CogState). Body composition (bioimpedance), glucose tolerance (oGTT), the volume of hippocampus & amygdala (MRI), muscle strength (hand grip, knee extension dynamometry) and physical fitness (10m walk test by preferred and maximal speed, Chair stand test, Rockport 1 mile Walk Test) were assessed. Long-term supervised aerobic-strength training (~12 months, 2×1h/week, brisk walking/Nordic walking/stationary bicycling of 60–70% VO2max; resistance training of major muscle groups) was performed in a subpopulation (n = 16).

Results

Individuals with prediabetes&T2D had lower scores in cognitive tests than NGT controls (MMSE/MoCA/ACE-R p = 0.002/0.026/0.004). Performance in cognitive tests MMSE, MoCA, ACE-R (R = −0.46, p = 0.002; R = −0.39, p = 0.027; R = −0.43, p = 0.005) as well as the gait speed (R = − 0.57, p = 0.021) were negatively associated with 2h glycaemia. Interestingly, the gait speed was positively correlated with a cognitive test score (R = 0.50, p = 0.05). Attention correlated positively and reaction time negatively with the volume of amygdala & hippocampus (Cogstate; p≤0.01). Muscle strength was positively associated with executive functions (Cogstate; R = 0.41, p = 0.015) and the volume of amygdala (R = 0.41, p = 0.049) & hippocampus (R = 0.38, p = 0.074). Importantly, supervised long-term aerobic-strength training improved cognitive performance in seniors with MCI (n = 11, MMSE, p = 0.021; ACE-R, p = 0.012), without concomitant changes in body weight and composition (p > 0.1 both).

Conclusion

Impaired glucose metabolism and low muscle functional capacity were associated with impaired cognitive functions in seniors, supporting a role of active lifestyle in prevention of age-associated cognitive and metabolic decline. Long-term regular physical activity has a potential to improve cognitive functions in seniors with mild cognitive impairment. Grant support: SAS–NSC Joint Research Cooperation grant 2013/17, VEGA 2/0107/18, APVV 15–0253

Obes Facts. 2018 May 26;11(Suppl 1):32.

O1.6 Utility of Transient Elastography for assessment of NAFLD in morbidly obese patients in a real life setting

M Eilenberg 1, M Arikan 2, F Winkler 2, J Stift 3, M Trauner 4, P Munda 4, A Ferlitsch 4, F Langer 5, G Prager 5, K Staufer 6

Introduction

Up to 90% of patients with obesity suffer from non-alcoholic fatty liver disease (NAFLD) including the risk of liver fibrosis, cirrhosis and liver cancer. Transient elastography (TE) has shown reliable performance for the detection of advanced fibrosis and cirrhosis, but was not independently validated in patients with morbid obesity. The aim of this study was to determine TE’s accuracy in comparison to liver biopsy obtained from patients undergoing bariatric-metabolic surgery.

Methods

173 consecutive patients scheduled for bariatric-metabolic surgery between 07/2014 and 11/2017 who underwent preoperative TE (XL-probe) and intraoperative liver biopsy were retrospectively analyzed. The ability of TE including controlled attenuation parameter (CAP) to detect significant and advanced fibrosis and steatosis was compared to liver histology using area under receiver operative characteristics curves (AUC). TE was performed during preoperative evaluation for assessment of either in a primary care or in an out-patient hospital setting. Liver histology was graded according to SAF score.

Results

Of 173 patients (64.7% female, median age [IQR]:42.0y [33.5;50.5], median BMI [IQR]: 44.1kg/m2 [41.3;47.7]), 60.7% (n = 105) presented with non-alcoholic steatohepatitis (NASH), 27.2% with (n = 47) non-alcoholic fatty liver, and 12.1% (n = 21) with a normal liver according to histology. The degree of fibrosis was F0–1 in 78.0% (n = 135), whereas F2, F3 or F4 was diagnosed in 13.3% (n = 23), 5.8% (n = 10), and 2.9% (n = 5) of patients, respectively. TE delivered reliable results in 86.1%. The AUC of TE for significant fibrosis (≥F2) and advanced fibrosis (≥F3) was 0.692 and 0.659, respectively. CAP was available in 145 of 173 patients. The AUC for the detection of moderate steatosis (≥ S2), and advanced steatosis (S3) was 0.643, and 0.640, respectively.

Conclusion

TE including CAP showed only low to moderate accuracy for the detection of significant to advanced fibrosis or steatosis in a real life setting. Therefore we cannot recommend TE as a tool for routine screening in morbidly obese patients.

Obes Facts. 2018 May 26;11(Suppl 1):32–33.

O2.1 Cross-sectional associations between weight misperception and symptoms of anxiety/depression and life satisfaction in overweight/obese adolescent from two cohorts in Norway – The HUNT Study

K Kvaløy 1, E Sandsgård 2, TT Eik-Nes 2

Introduction

This study aims to explore the cross-sectional associations between misperception of weight (considering oneself normal or underweight) and symptoms of anxiety/depression and life satisfaction among youth (aged 13–19 years) with overweight or obesity in two cohorts participating 11 years apart in the population based Health Study of Nord-Trøndelag (HUNT) of Norway. Underestimating one’s weight may prevent attempts of weight loss with further associated unfavorable health outcomes. Even so, recent findings show that misperception of weight in individuals with overweight and obesity may have beneficial outcomes especially related to mental health.

Methods

Logistic multivariable regression models were used to examine cross-sectional associations between underestimation of weight and symptoms of anxiety and depression (SCL-5) and life satisfaction. Study participants included from the adolescent part of HUNT were 1338 overweight/obese adolescents (659 boys and 679 girls) from the Young-HUNT1 (1995–1997) survey: whereof 450 (34%) underestimated their weight and 1799 overweight/obese adolescents (951 boys and 848 girls) from the Young-HUNT3 (2006–08) survey whereof 848 (47%) underestimated their weight.

Results

Within the overweight/obese study samples, the proportion of obese individuals had increased significantly from 1995–97 to 2006–08 from 17.3% to 24.8% in boys and 16.8% to 21.1% in girls. Similarly, a significant increase in anxiety and depression symptoms were observed; 10% to 13.4% in boys and 21.4% to 32.0% in girls. In girls, life dissatisfaction increased from 27.7% to 37.9%. A significant increase in the number of individuals who underestimated their weight was observed in both boys (from 45.4% to 57.1%) and girls (from 22.2% to 36.0%), Young-HUNT1 and Young-HUNT3 respectively. Interestingly, the proportions were higher in boys compared to girls in both cohorts. In all the regression models, underestimation of weight was protectively associated to anxiety and depression in both surveys; OR: 0.40 (0.27–0.59), p < 0.001 in Young-HUNT1 and OR: 0.43 (0.33–0.55), p < 0.001 in Young-HUNT3 (sex and age adjusted). Likewise, underestimation of weight was also protectively associated with life dissatisfaction in both surveys; OR: 0.41 (0.30–0.57), p < 0.001 in Young-HUNT1 and OR: 0.43 (0.34–0.54), p < 0.001 in Young-HUNT3 (sex and age adjusted).

Conclusion

The proportion of overweight/obese individuals who underestimated their weight had in both boys and girls increased significantly from 1995–97 to 2006–08. Underestimation of weight was protectively associated with anxiety/depression symptoms and life dissatisfaction in both cohorts and therefore beneficial with regard to mental health and well-being.

Obes Facts. 2018 May 26;11(Suppl 1):33.

O2.2 Energy intake, appetite and food reward responses to High Intensity Interval Exercise might depend on the degree of obesity in adolescents

M Miguet 1, A Fillon 1, J Masurier 2, M Khammassi 1, V Julian 1, Y Boirie 3, M Duclos 1, J Blundell 4, G Finlayson 5, D Thivel 6

Introduction

High-Intensity Interval Exercise (HIIE) has been lately described as an efficient exercise modality to improve their body composition and metabolic profile. Studies conducted in overweight adults also suggest that HIIE might have beneficial effects on appetite control, decreasing implicit wanting for low and high fat food as well as for sweet and savory tastes (Alkahtani et al., 2014). Recently food intake and macronutrient preferences have been shown unchanged after a 22-minute HIIE session in 10 years old lean children (Morris et al., 2018). To our knowledge, there is so far no study that has questioned the effect of HIIE on subsequent energy intake and appetite feelings in obese children and adolescents. The present study questioned the effect of a single HIIE session on subsequent energy intake, macronutrient consumption, appetite feelings and food reward in adolescents with obesity. We also questioned whether these post-exercise nutritional adaptations could be influenced by the adolescents’ degree of obesity.

Methods

Thirty three obese adolescents (12–15 years old, 12 boys, Tanner stage 3–4)) were included (Ethics: CPP Sud Est VI). Maximal aerobic capacities (maximal aerobic test) and body composition (DXA) were assessed. They were then asked to complete a food preference questionnaire and the Three-Factor-Eating-Questionnaire R21. Adolescents were then randomly assigned to two experimental sessions (one week apart): i) control condition without exercise (CON); ii) HIIE condition (HIIE). On the 2 occasions, participants received a standardized breakfast (08:30am) and started one of the two experimental conditions at 11:15am (rest or exercise). Thirty minutes after the end of the experimental conditions (exercise or rest), participants had to complete the Leeds Food Preference Questionnaire (LFPQ) before being served with an ad libitum buffet-style meal. They had to complete the LFPQ once more after the meal. Diner energy intake was also assessed using an ad libitum buffet-style meal. Their appetite feelings were assessed at regular intervals through the day.

Results

Participants’ body weight was 93.2 ± 13.0 kg; BMI: 35.0 ± 4.3 kg/m2; z-BMI: 2.3 ± 0.2; fat mass: 37.6 ± 3.5% and fat free mass: 55.9 ± 7.3 kg. Absolute energy intake at lunch was significantly lower (7%) after HIIE than after CON (respectively 1102 ± 276 kcal and 1222 ± 310 kcal; p < 0.05), as well as total daily energy intake (p < 0.05). Relative energy intake was also lower on HIIE compared with CON (1005 ± 274 kcal and 1172 ± 306 kcal; p < 0.01). Lunch time and whole day protein (p < 0.01) and fat (p < 0.05) intake (in grams) were significantly lower on HIIE. Daily appetite feelings and food reward were not different between conditions. Adolescents with the lower BMI and FM% (using tertiles) showed significantly greater energy intake reductions after HIIE (p < 0.05) without difference between FFM tertiles.

Conclusion

While HIIE appears as a time-efficient exercise modality, favoring low perceived exertion in adolescents with obesity, it also seems to reduce subsequent absolute and relative energy intake in adolescents with obesity. Our results also suggest that these post-exercise nutritional adaptations might depend on the degree of Fat Mass but not Fat Free Mass in such a population.

Obes Facts. 2018 May 26;11(Suppl 1):33.

O2.3 From upset to calm but overweight in 3 steps: is food to calm early on related to the development of overeating and overweight in the preschool years?

E Jansen 1, R Byrne 1, K Mallan 2, L Daniels 3

Introduction

Parental feeding practices that do not recognise and respond appropriately to a child’s hunger cues may interfere with their ability to self-regulate energy intake. An example is the use of food to calm a distressed child, also called ‘emotional feeding’. Early feeding for non-nutritive reasons (e.g. to calm rather than in response to hunger) has been hypothesised to foster emotional eating behaviours, which in turn have been implicated in the development of obesity in children. Longitudinal data and evidence to confirm these relationships are scarce. This study aimed to first examine differences in the use of food calm between feeding mode (% feeds via bottle) to explore the potential role of calming through breastfeeding. The second aim was to examine longitudinal relationships between use of food to calm, child eating behaviours (i.e. satiety and food responsiveness, emotional overeating) and child BMI. It was also investigated if child eating behaviours are a mediator through which using food to calm relates to child BMI.

Methods

This secondary analysis used data from the NOURISH randomised controlled trial. The first aim used baseline data (n = 317) when children were 4 months of age. Mothers reported their use of food to calm via the Infant Feeding Questionnaire (Baughcum et al., 2001). The second aim used data at child age 2 years (n = 346) including maternal report of child eating behaviour via the Child Eating Behaviour Questionnaire (Wardle et al., 2001) and child BMI z-scores calculated using researcher measured weight and height.

Results

Percentage of feeds via bottle was negatively (rho = −0.23, p < 0.001) correlated with using food to calm and formula feeding mothers (100% bottle usage) used food to calm less often than breast or mixed feeding mothers (p < 0.001). Using food to calm was positively associated with satiety responsiveness (β = 0.159, p = 0.014) but not food responsiveness, emotional overeating or BMI z-score (p > 0.05). Although satiety responsiveness was negatively associated with BMI z-score, the mediation/intervening effect was not significant (Sobel test p = 0.11).

Conclusion

While using food to calm was more likely to be associated with breastfeeding in this sample, no prospective relationships with child overeating or overweight were found. Indeed, using food to calm was associated with increased child satiety responsiveness 20 months later. These results provide preliminary data to suggest that the hypothesised associations between using food to calm and adverse infant appetite and weight outcomes are not evident in the context of breastfeeding. Larger studies that allow separate examination by feeding mode need to verify these findings. These relationships also need to be assessed in older children when solids, such as discretionary foods, are used to calm instead of milk.

Obes Facts. 2018 May 26;11(Suppl 1):34.

O2.4 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):34.

O2.5 An ad a day doesn’t keep the pounds away

C Thomas 1, L Hooper 1, F Thomas 2, G Rosenberg 3, L Bauld 4, J Vohra 5

Introduction

Obesity is the largest preventable risk factor for cancer after smoking, associated with approximately 18,100 cases a year in the UK (5% of all cancer cases). It is related to 13 types of cancers, including two of the most common (breast, bowel) and one of the hardest to treat (womb). Children who are overweight or obese are significantly more likely to go on to become overweight or obese adults and are therefore at higher risk of developing obesity-related cancers. Although the causes of obesity are complex, evidence has linked advertising and marketing exposure with overweight and obesity. This study examines the relationship between exposure to marketing and food and soft drink consumption behaviours among young people (11- 19 yrs) in the UK.

Methods

Two studies were undertaken to investigate the link between HFSS marketing and consumption. Firstly, a qualitative scoping study to explore young people’s perceptions of marketing, and mechanisms linking this with dietary choices. Secondly, a nationally representative cross-sectional survey, based on these findings, was designed to further establish the link between marketing and high calorie diets/weight outcomes. Data from 3,348 11–19 year olds was collected.

Results

Exposure to broadcast media was strongly associated with the marketing of foods high in salt sugar and fat (HFSS). The qualitative research found that all young people could recall a favourite HFSS television advert; and were particularly influenced by adverts that were fun, targeted, age appropriate or catchy. results from national survey found the links between screen time, engagement with HFSS marketing and HFSS consumption were high. On average, young people watched 21hrs of TV, with just over half viewed on streaming platforms. Obese participants watched significantly more (26hrs, p < 0.000). HFSS products accounted for 7,000 calories consumed/week −40−50% of this age group’s guideline total amount. Logistic regression modelling associated commercial TV screen time with an increased risk of high junk food consumption (OR 1.8, p = 0.002). This was true for both traditional TV and streaming mediums. Further, recalling one extra broadcast advert predicted a significant increase in HFSS consumption, approximately 18,000 extra calories/person/year.

Conclusion

This is the largest survey of its kind in the UK, and the first to study online TV viewing in such a systematic fashion. It shows that there is a link between viewing adverts for HFSS foods and their consumption in young people. Both TV time and advert recall were associated with large and consistent increased in the consumption of HFSS foods. This suggests that HFSS food marketing may be an important contributor to childhood overweight and obesity in the UK and, in the longer term, cancer risk.

Obes Facts. 2018 May 26;11(Suppl 1):34.

O2.6 Does social media food marketing influence children’s food intake and preferences?

A Coates 1, E Boyland 1

Introduction

Previous studies of television advertising have shown that celebrity endorsement affects children’s food intake and preferences. However, children are increasingly exposed to marketing through digital avenues and the impact of promotional paid for advertising by video bloggers (vloggers) on these outcomes is not known. The objective of the current study was to examine the influence of vlogger endorsement of snack foods (healthy and unhealthy), via social media (Instagram), on children’s ad libitum snack intake and food preferences.

Methods

In a between-subjects design, 176 children (9–11 years, mean 10.5 ± 0.7 years) were randomised to view still images of the Instagram pages of YouTube vloggers which featured images of the vlogger with either unhealthy snacks (n = 58), healthy snacks (n = 59), or non-food products (n = 59). Subsequently, participants’ food preferences and ad libitum intake of unhealthy snacks and healthy snacks were measured.

Results

Children in the unhealthy Instagram condition consumed 19% more kcals (448.3) compared to children in the non-food Instagram condition (357.1). Children in the unhealthy Instagram condition consumed 32% more kcals from unhealthy snacks (384.8), compared to children in the non-food Instagram condition (292.2). Children in the healthy Instagram condition did not significantly increase their healthy snack intake (69.5), compared to children in the non-food Instagram condition (64.9). No effect of vlogger endorsement on food preferences was found.

Conclusion

Children regularly watch vlogs and follow vloggers on social media. As a result they are exposed to foods that are high in fat salt and sugar. The results of this study have shown that exposure to these foods does increase energy intake in children. Children require further protection from online food marketing, especially on social media where it is difficult to differentiate an advert from genuine user-generated content.

Obes Facts. 2018 May 26;11(Suppl 1):34–35.

O3.1 Adaptive thermogenesis, leptin and gut hormones during dietary induced weight loss: impact on long-term weight loss maintenance

G Thom 1, N Brosnahan 2, Y Al-Gindan 3, SU Dombrowski 4, ME Lean 1, D Malkova 1

Introduction

Dietary induced weight loss is accompanied by a decline in resting metabolic rate (RMR) and adaptive thermogenesis, defined as reduction in RMR beyond what would be expected for change in body composition. In addition, it increases drive to eat through alterations in appetite regulating hormones. Taken together, these factors offer a plausible explanation for why many individuals regain lost weight over time. In this study, we document changes in RMR and body composition before and after weight loss, and evaluate presence of adaptive thermogenesis, plasma concentration of leptin, PYY and GLP-1 and how these factors impact on long-term weight loss maintenance.

Methods

Twelve women, aged 48.1 ± 7.3 years with BMI of 39.3 ± 4.5 kg/m2 (mean ± SD) followed a total diet replacement (825–853 kcal/d) weight loss intervention for 12–20 weeks. Fat mass and fat-free mass were quantified by whole body magnetic resonance imaging and RMR by indirect calorimetry, before and after dietary intervention. Adaptive thermogenesis was calculated as measured-predicted RMR after weight loss. Predicted RMR was determined by regression equation using initial body composition data and age. Fasting plasma leptin, PYY and GLP-1 concentrations were measured in blood samples before and after maximal weight loss using commercially available ELISA kits.

Results

Weight loss (14.2 ± 7.0 kg) and fat-free mass loss (4.6 ± 3.3 kg) were significant (P < 0.05), but muscle mass was preserved, with only marginal reduction (−0.3 ± −1.0 kg). After weight loss, measured RMR was significantly (P < 0.001) lower than at baseline (Before, 1796 ± 325 kcal/d; After 1505 ± 235 kcals/d) and difference from predicted RMR was small (−38 ± 146 kcals/d) and not significant. However, closer investigation revealed that there was large inter-individual variability in direction and extent of adaptive thermogenesis: 7/12 subjects displayed reductions in RMR beyond what was expected for the change in body composition (range: −78 to −282 kcals) and 5/12 subjects had higher than expected RMR (range: +76 to +200 kcals). Dietary intervention induced significant (P < 0.001) reduction in fasting plasma concentrations of leptin (Before, 64.6 ± 12.6 ng/ml; After, 40.6 ± 40.6 ng/ml) and GLP-1 (Before, 47.7 ± 22.6 pmol/L; After, 32.5 ± 13.2 pmol/L) but had no significant impact on PYY concentration (Before, 69.4 ± 37.2 pg/ml; After, 87.2 ± 28.3 pg/ml). Body weight, measured at approximately 2 years, increased by 6.3 ± 7.6 kg (P < 0.05). The increase in body weight significantly negatively correlated with GLP-1 concentrations measured before dietary intervention (r = −0.61, P < 0.05) and at the point of maximal body weight loss (r = −0.65, P < 0.05). Correlations between increases in body weight during follow-up, and adaptive thermogenesis, rate of initial weight loss, RMR, leptin and PYY before and after dietary intervention, were not significant.

Conclusion

Higher fasting GLP-1 concentrations before and after weight loss can be expected to benefit long term weight loss maintenance. The extent and direction of adaptive thermogenesis, change in RMR, plasma concentrations of leptin and PYY are not related to future weight change after successful weight loss.

Obes Facts. 2018 May 26;11(Suppl 1):35.

O3.2 Association of brown adipose tissue, skeletal muscle glucose uptake and supraclavicular skin temperature, with cold-induced thermogenesis and nutrient oxidation rates

G Sanchez-Delgado 1, Y Garcia-Rivero 2, L Rodriguez-Perez 3, B Martinez-Tellez 3, JM Alcantara 3, FJ Amaro-Gahete 3, E Merchan 3, WD Martinez-Avila 3, V Muñoz-Hernandez 3, MJ Arias-Tellez 3, A Ramirez-Navarro 2, JR Ruiz 3

Introduction

Cold induced thermogenesis (CIT) in humans results from a combination of both brown adipose tissue (BAT) and skeletal muscle thermogenic activity. The relative contribution of both tissues to non-shivering thermogenesis, as well as its impact on cold induced nutrient oxidation rates (CI-NUTox) remains to be elucidated. Supraclavicular skin temperature seems to be an indirect marker of BAT activity, although its relation to CIT and CI-NUTox is not clear. We investigated the association of cold-induced BAT and skeletal muscle glucose uptake, and supraclavicular skin temperature, with CIT and CI-NUTox in adults.

Methods

A total 44 young healthy adults (22.2 ± 2.2 years old; 25.6 ± 5.3 kg/m2; 29 women) participated in the present study. BAT and skeletal muscle metabolic activity was assessed by means of a 18F fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) scan preceded by a personalized cold stimulation. Cold exposure consisted in 2 hours in a mild cold room at 19.5–20°C wearing a water perfused cooling vest set a 4°C above the individual shivering threshold. On a separate day, CIT and CI-NUTox were estimated by indirect calorimetry under fasting conditions during one hour of cold exposure.

Results

Neither BAT volume or activity, nor muscle metabolic activity, were associated with CIT or CI-NUTox (All P > 0.2). Cold-induced supraclavicular skin temperature change was marginally associated with CIT (β = 3.634; R2 = 0.087; P = 0.076), and significantly associated with cold-induced fat oxidation rate (β = 91.846; R2 = 0.347; P = 0.027) and cold-induced carbohydrate oxidation rate (β = −20.924; R2 = 0.439; P = 0.017). The results persisted after controlling for sex, time of the day when CIT was assessed, or date when CIT was assessed. The association between cold-induced supraclavicular temperature change and CIT, reached significance after adjusting by date when CIT was assessed (β = 5.516; R2 = 0.217; P = 0.010).

Conclusion

BAT and muscle cold-induced 18F-FDG uptake is not associated with CIT or CI-NUTox. Inherent limitations of the available radiotracers for BAT detection and muscle activity quantification may explain why we failed to detect a physiologically plausible association. Nonetheless, cold-induced 18F-FDG PET/CT is currently considered the method of choice for BAT assessment. On the other hand, we found that cold-induced supraclavicular temperature change is a strong predictor of CI-NUTox, and a weak predictor of CIT. Cold-induced supraclavicular temperature change is likely the result of a combination of BAT and cervical muscles activity, and it is not biased by cellular substrate preference, as it is PET/CT. Therefore, cold-induced supraclavicular temperature change seems to be a non-invasive, cheap and easy way of predicting non-shivering thermogenesis.

Obes Facts. 2018 May 26;11(Suppl 1):35–36.

O3.3 Relationship between White Matter Microstructure Patterns and Reward Sensitivity in Normal Weight and Overweight Chilean Young Adults

S Reyes 1, P Peirano 2, CM Rimkus 3, B Lozoff 4, S Gahagan 5, BB Biswal 6, C Algarin 2

Introduction

Little is known regarding the association between white matter (WM) integrity and reward sensitivity in the obesity domain. The aim of this study was to compare the relationship of WM microstructure patterns and reward sensitivity between normal weight (NW) and overweight (OW) young adults.

Methods

Participants were part of a cohort followed since infancy who underwent magnetic resonance imaging studies in early adulthood. Diffusion tensor imaging sequence was performed to obtain parameters of WM microstructure patterns [fractional anisotropy (FA), mean, axial and radial (RD) diffusivities]. Reward sensitivity was assessed by an Eye Tracking task, an oculomotor test of inhibitory control. Participants were instructed to avoid looking at visual stimuli of trials appearing on the screen and look in the opposite location (correct response). Each trial began with an image indicating the possibility of reward, loss avoidance or neutral. Error percentage was estimated for each trial type. Body mass index was categorized as NW (≥18.5 to < 25.0 kg/m2) and OW (≥ 25.0 kg/m2) groups. The relationship of WM microstructure patterns and error percentage in trial types were compared between groups using Tract Based Spatial Statistics (TBSS). Threshold-free cluster enhancement was applied to correct for multiple comparisons. Slopes differences between groups were compared with linear regression analysis.

Results

Twenty-six participants were NW (61% female and 21.4 ± 0.4y) and forty-two were OW (50% female and 21.4 ± 0.3y). Compared to OW, NW exhibited lower error percentage for loss avoidance trials (22.6 vs. 33.4%, p < 0.05). No differences were found for reward and neutral trials between the two groups. Differences in the relationship between WM patterns (FA and RD values) and reward sensitivity (error percentage in loss avoidance trials) were apparent between groups (p = 0.08), specifically in both right superior corona radiata and posterior limb of internal capsule. In these brain regions, increased FA (β = −0.599, p = 0.001) and decreased RD (β = 0.610, p = 0.001) were related to lower error percentage in the NW group. Non-significant results were shown for OW group.

Conclusion

Our results show that greater WM integrity (FA increase and RD decrease) is related to better performance on a rewarding task (lower error percentage) only in NW participants. This provides support about alterations in white matter integrity in OW participants, suggesting that this characteristic could be related with reward sensitivity. Support: Fondecyt 11160671 and Fondecyt 1110513 / NIH HD33487 and NIH HL088530 grants.

Obes Facts. 2018 May 26;11(Suppl 1):36.

O3.4 Effect of a 4-week exercise programme in gut appetite hormones and faecal short-chain fatty acids in overweight women

E Rizou 1, K Gerasimidis 1, S Do Carmo 1, R E Vizuete Martinez 1, K Lundberg 1, D Malkova 1

Introduction

Faecal short-chain fatty acids (SCFAs), the major products of bacterial fermentation of dietary fibre in the colon, are involved in appetite regulation (1). It has been reported that production of SCFAs (2) and gut appetite hormones (3) are modified by exercise. Thus, concentrations of SCFAs can be among predictors of gut appetite hormone changes induced by exercise. This study investigated the impact of a 4-week moderate intensity exercise programme on plasma concentrations of gut appetite hormones and faecal concentrations of SCFAs in overweight females and explore whether the production of SCFAs is associated with satiety hormone changes induced by exercise.

Methods

Thirty healthy overweight women aged 25.9 ± 4.9 years, with BMI of 29.3 ± 3.6 kg/m2 (values are Means ± SD) were allocated to Exercise (EX, n = 21) or Control (CON, n = 9) groups. The EX group underwent a 4-week supervised exercise training while the CON group for the similar duration continued with habitual life style. Participants of both groups underwent two 7-hour trials; one before and another after 4 weeks of the interventions. During the 7-hour trials blood samples were collected and appetite scores measured before and after consumption of standardised breakfast and lunch. Prior to the first 7-hour trial, participants recorded their diet for 3 days and replicate this intake prior to the second 7-hour trial. On the second or third day of either the food recording or replication, participants provided a fresh stool sample. ELISA kits were used to measure plasma concentration of PYY and GLP-1. Faecal SCFAs were assessed by gas chromatography.

Results

Body weight and BMI changes were not significant (P > 0.05) in EX group but significantly increased (P < 0.05) in CON group. Time averaged plasma concentrations of PYY and GLP-1 and concentrations of faecal SCFAs did not change in the EX or CON group (Table1). Further investigation revealed large individual variability in changes of PYY and GLP-1 in EX group (Fig. 1) while inter-individual variability in CON group was lower. In EX group, changes in plasma PYY and GLP-1 concentrations were not significantly (P > 0.05) correlated to SCFA changes or to SCFA concentrations measured at week 0 and week 4.

Fig. 1.

Fig. 1

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Conclusion

On average, exercise programme had no impact on either gut appetite hormone or SCFA concentrations but the extent and direction of gut appetite hormone and SCFA changes varied among individuals. Changes in gut appetite hormones were not related to changes in SCFA concentrations or SCFA concentrations measured prior to and at the end of exercise programme.

Tab. 1.

Mean ± SD time averaged plasma PYY and GLP-1, and faecal SCFA concentrations before (week 0) and after (week 4) interventions. In both groups P > 0.05 for all measures

 EX group
CON group
Week 0
 Week 4
 Week 0
 Week 4
Appetite Hormones
PYY (pg/ml) 114 ± 53 110 ± 50 127 ± 38 134 ± 47
GLP-1 (pmol/L) 27 ± 14 26 ± 15 40 ± 9 42 ± 8
SCFA (µmol/g)
Acetate 385 ± 185 412 ± 170 476 ± 142 415 ± 187
Butyrate 78 ± 80 90 ± 70 117 ± 81 102 ± 118
Propionate 76 ± 71 80 ± 59 93 ± 52 84 ± 70
Total 568 ± 317 613 ± 290 715 ± 260 628 ± 352
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References

Obes Facts. 2018 May 26;11(Suppl 1):36.

O3.5 Determination of underlying genetic variations in an obese cohort of more than 1000 patients and the effect of bariatric surgery

M I Cooiman 1, L Kleinendorst 2, EO Aarts 3, IMc Janssen 1, FJ Berends 1, EJ Hazebroek 3, HK Ploos Van Amstel 4, B Van Der Zwaag 4, MM Van Haelst 2

Introduction: Introduction

A number of monogenic causes of obesity have been identified in humans. The most common cause of monogenic obesity is a mutation in the melanocortin-4 receptor gene (MC4R), which is part of the leptin-melanocortin pathway. Mutations in this pathway can lead to an imbalance in energy homeostasis and therefore obesity. Next generation sequencing (NGS) techniques can be used for determination of underlying genetic variations. Even so, with more knowledge on obesity associated genes and their possible influence on weight loss after bariatric surgery, it could be possible to further personalize treatment.

Methods

methods A custom NGS-assay aimed at enrichment of 255 known obesity genes or putative obesity candidate genes was developed. Analysis of 52 obesity associated genes was performed as a diagnostic gene panel-test by the genome diagnostics laboratory of the UMC Utrecht. Patient inclusion criteria were: redo-surgery for insufficient weight loss, BMI > 50kg/m2 or childhood age of onset of obesity. Genomic DNA of 1014 patients was sequenced at > 100X median coverage, yielding a 15X horizontal gene panel coverage of >95%.

Results

results Multiple known pathogenic mutations and genetic variants of uncertain clinical significance (VUS) were identified. Nine patients showed a mutation in MC4R; six of these patients underwent Roux-en-Y Gastric Bypass surgery. After two years, mean %Total Body Weight Loss (%TBWL) of 26.6 (± 12.9) was achieved, compared to %TBWL of 32.6(± 9.9) (p = 0.421) in 102 patients without mutations on the gene panel matched for age and BMI.

Conclusion

Conclusion Follow-up of the patients with a MC4R mutation is necessary to assess the long term effect of bariatric procedures. In parallel, analysis of all identified pathogenic mutations and VUS of the 52 obesity associated genes with their effect on weight loss will be performed. Analysis of the 203 (candidate) obesity associated genes could uncover novel genetic causes of obesity. results from these studies can potentially be used to develop personalized treatment options in patients with morbidly obesity.

Obes Facts. 2018 May 26;11(Suppl 1):37.

O3.6 The effect of exercise intensity on circulating hepatokine concentrations in healthy men

SA Willis 1, JA Sargeant 1, DJ Stensel 1, JA King 1

Introduction

Hepatokines such as fibroblast growth factor 21 (FGF21), follistatin and leukocyte cell-derived chemotaxin 2 (LECT2) are liver-derived proteins which contribute to the regulation of whole-body glucose and lipid metabolism. Acute shifts in energy balance, through means such as exercise, modulate circulating concentrations of these hepatokines; however the influence of exercise intensity has not been fully explored. This study examined the effect of exercise intensity on circulating hepatokine concentrations in healthy men.

Methods

In a randomized, crossover design, 10 healthy men (see Table 1 for participant characteristics) completed three experimental trials, commencing with either a moderate-intensity run (55% peak oxygen uptake (VO2 peak); MOD), high-intensity run (75% VO2 peak; HIGH) or control period (rest; CON). The duration of MOD and HIGH differed (mean ± SD: 57 ± 8 vs 42 ± 6 min, respectively) so that total energy expenditure was matched (target 600 kcal). After exercise, participants rested for 7 h, with standardised meals consumed at 2 and 6 h post-exercise. Venous blood samples were taken before exercise and at 0, 1, 2, 4 and 7 h post-exercise for measurement of plasma FGF21, follistatin and LECT2 concentrations (ELISA).

Results

Total energy expenditure was similar between the two exercise trials (MOD vs HIGH: 591 ± 17 vs 595 ± 14 kcal; P = 0.46). Two-way ANOVA revealed a significant trial main effect and trial-time interaction for FGF21 (both P < 0.001), indicating a greater increase in plasma FGF21 concentrations at 1, 2 and 4 h after HIGH compared to MOD (all P < 0.03; Figure 1A). A significant trial main effect and trial-time interaction for follistatin was also observed, indicating elevated plasma follistatin concentrations at 4 and 7 h after both MOD and HIGH vs CON (all P < 0.01; Figure 1B); however the response was similar between the two exercise trials. A significant trial-time interaction was found for LECT2, indicating an increase in plasma LECT2 concentrations immediately after MOD and HIGH vs CON (both P < 0.05; Figure 1C); however there were no differences between the two exercise trials.

Conclusion

The present study demonstrates that acute bouts of exercise transiently increase circulating concentrations of the hepatokines FGF21, follistatin and LECT2. Furthermore, the magnitude of the post-exercise increase in circulating FGF21 may be dependent on the intensity of the exercise, while responses in the other hepatokines appear to be independent of exercise intensity.

Conflicts of Interest

The research was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre.

Fig. 1.

Fig. 1

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Tab. 1.

Participant characteristics (n = 10)

 Mean ± SD
Age (years) 26 ± 2
Height (m) 1.77 ± 0.07
Body mass (kg) 80.2 ± 6.2
BMI (kg•m-2) 25.6 ± 1.7
Waist circumference (cm) 83.7 ± 4.1
Body fat (%) 15.4 ± 4.4
VO2 peak (ml•kg-1•min•1) 49.8 ± 5.3
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Obes Facts. 2018 May 26;11(Suppl 1):37.

O4.1 Sleep efficiency and duration assessed with metabolic holter: Associate with anthropometric measurements and body composition

N Acar Tek 1, S Navruz Varlı 1, MS Karacil Ermumcu 1, Y Ertaş Öztürk 1

Introduction

Sleep problems such as insufficient sleep (short sleep duration and poor sleep quality) have been extensively reported in modern societies during recent years. Changes in mean sleep duration, quality, and efficiency are associated with many health problems. Short sleep duration is associated with weight gain and obesity, diabetes, cardiovascular disease, psychiatric illness, performance deficits and total mortality. This study was planned to determine the associations between sleep duration, efficiency, quality with anthropometric measurements and body composition in adults.

Methods

This cross-sectional study was conducted with young adults aged 19–30 years. Sleep duration and efficiency were assessed with Metabolic Holter. Sleep quality was assessed with Pittsburgh Sleep Quality Scale. Body composition was analyzed with Bioelectric Impedance Analysis.

Results

Body fat mass, body fat percent, waist circumference, and waist/hip ratio was found higher in females with poor sleep efficiency, and decreased sleep efficiency correlated with increased waist/hip ratio (r = −0.324; p = 0.054). Being female gender and decreased fat mass were shown as major predictors for increased sleep efficiency according to regression analyses. Also, in females with poor sleep quality had higher percentage of body fat mass and body mass index than females with good sleep quality (p < 0.05). The body mass index and waist/hip ratio were found higher in males with sleep duration < 7 hours. Decreased sleep efficiency correlates with increased body fat mass and the body fat percent in males (p < 0.05).

Conclusion

Poor sleep efficiency and short sleep duration in males and poor sleep efficiency in females is associated with increased obesity indicators.

Obes Facts. 2018 May 26;11(Suppl 1):38.

O4.2 Effectiveness of a physical activity program on cardiovascular disease risk in adult with overweight and obesity: the “Pas-a-Pas” community intervention trial

V Arija Val 1, F V Martinez 1, R Pedret Llaberia 2, A Vinuesa Fernández 2, D Jovani 2, A Reche 2, T Basora Gallisà 2, J Basora Gallisà 2

Introduction

Physical activity is a major, modifiable, risk factor for cardiovascular disease (CVD) that contributes to the prevention and management of CVD. The aim of this study was to assess the effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults with overweight and obesity.

Methods

Multicentered, randomized, controlled community intervention involving 249 patients with overweight (44.6%) and obesity (55.4%) in four primary care centers. The participants were randomly assigned to a Control Group (CG = 81) or Intervention Group (IG = 168); mean age 65.57 years; 73.5% women. The intervention consisted of 120 min/week walking (396 METs/min/week) and sociocultural activities once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, triglycerides, total cholesterol, LDL- and HDL-cholesterol) and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data.

Results

At baseline and at the end of the intervention period, there were no differences in the dietary intake of participants. At the end of the intervention period, In the IG compared to the CG group, there was a significant increase in physical activity (540.51 METs/min/week), a significant decrease in systolic blood pressure (5.53 mmHg), weight (1.45 Kg), BMI (0.48 Kg/m2) and LDL-cholesterol (7.17 mg/dL) after adjustment for potential confounders (socio-demographic, lifestyle, morbidity and anthropometric measures).

Conclusion

This community-based physical activity program improved cardiovascular health and promoted regular physical activity in Spanish adults with overweight and obesity.

Obes Facts. 2018 May 26;11(Suppl 1):38.

O4.3 Simple functional tests for screening sarcopenia in adult females with obesity

M El Ghoch 1, A Rossi 2, S Calugi 1, S Rubele 2, F Soave 1, M Zamboni 2, E Chignola 1, G Mazzali 1, P Bazzani 1, R Dalle Grave 1

Introduction

The coexistence of sarcopenia with obesity has been termed as sarcopenic obesity (SO), and recent studies have reported that, together, these conditions synergistically increase their effects on comorbidities and mortality. We aimed to assess both the prevalence of sarcopenia in adult females with obesity and the reliability of simple tools for screening SO in this population.

Methods

Dual-energy X-ray absorptiometry (DXA) body composition assessment was used to categorise 147 female participants with obesity as with or without sarcopenia according to the new definition of SO proposed by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Participants were also administered muscle strength and physical performance tests, and receiver operating characteristic (ROC) curve analysis was used to establish the ability of the latter to discriminate between patients with and without SO.

Results

Ninety-three participants (63.3%) met the criteria for SO. After controlling for age, BMI and site, patients with SO displayed significantly higher 4-metre gait-speed scores and lower six-minute walking test and handgrip-strength scores than those without; the discriminating cutoff points of these tests were found to be 470 metres, 3.30 seconds (gait speed = 1.2 m/sec) and 23.5 kg respectively; the 4-metre gait-speed test seems to provide the best balance of sensitivity and specificity, and the greatest discriminatory power at 90% sensitivity.

Conclusion

Treatment-seeking adult females with obesity display a high prevalence of sarcopenia. The 4-metre gait-speed test seems to be the most accurate functional test for screening this condition in that population.

Obes Facts. 2018 May 26;11(Suppl 1):38.

O4.4 Child physical activity levels and sedentary time are associated with body composition at 5 years of age: Findings from the ROLO Kids Study

AA Geraghty 1, EC O’Brien 1, MK Horan 1, E Larkin 1, J Donnelly 1, FM McAuliffe 1

Introduction

With childhood obesity reaching epidemic proportions world-wide, identifying modifiable factors to address this has become vital. Adverse child behaviour, in terms of low physical activity and high sedentary time, has increased alongside rates of over-weight and obesity. However, research on these aspects of physical health is limited in young children.

Methods

Analysis was carried out on 275 5-year-old children from the ROLO Kids study. Parental-reported measures of physical activity was collected using the CLASS questionnaire along with information on screen time. Child anthropometry including height, weight, circumferences and skinfold thickness were collected, along with heart rate and blood pressure. T-tests, Mann-Whitney U, and Chi-square tests were used to compare the participants and linear regression models were used to control for confounders.

Results

Males spent more time in vigorous physical activity and in front of a screen than females (P < 0.05). 37.5% of the cohort were not meeting the WHO physical activity guidelines of more than one hour per day and 73.4% were exceeding the AAP guidelines for screen time of less than one hour per day. After controlling for confounders, vigorous physical activity was positively associated with child weight and BMI, while screen time was positively associated with waist to height ratio (P < 0.05). Those meeting the guidelines for screen time also had reduced waist to height ratio (P < 0.05).

Conclusion

With three quarters of the cohort exceeding recommendations for screen time, these findings indicate that this could have a detrimental impact on body composition. Further research is required in this area to expand on the importance of physical activity and screen time in 5-year old children.

Obes Facts. 2018 May 26;11(Suppl 1):39.

O4.5 Self-efficacy toward eating and physical activity – predictors for sustained weight loss and health related quality of life after vertical sleeve gastrectomy for severe obesity?

T N Flølo 1, JR Andersen 2, A Aasprang 3, RL Kolotkin 4, GS Tell 5, V Våge 6, KO Hufthammer 7

Introduction

Between 30 and 40% of vertical sleeve gastrectomy (VSG) patients regain weight after surgery. Identification of factors that can impact long-term weight management after surgery is needed. Self-efficacy has been identified as a target for behavioral change in non-surgical interventions, but to a limited extent been subject for research after bariatric surgery. We explored whether self-efficacy in eating and physical activity were associated with weight-loss and health related quality of life (HRQL) after VSG.

Methods

Data were collected prospectively with a mean follow-up of 16 and 48 months. Self-efficacy was measured by the Weight efficacy lifestyle questionnaire Short form (WEL-SF) and the Self-efficacy for physical activity scale (SEPA). We performed separate multiple regression analysis with 48 months values of excess BMI-loss (%EBMIL) and summary scores from two HRQL-questionnaires; The Impact of weight on quality of life – lite (IWQOL-lite) and Short Form-36 (SF-36); physical (PCS) and mental (MCS) component scores as dependent variables.

Results

Of the 114 patients included, 91 (80%) and 83 (73%) were available at 16 and 48 months follow-up. Mean %EBMIL from baseline to 16 and 48 months was 76 ± 19 and 67 ± 22.4, respectively. WEL-SF and SEPA scores improved significantly (both at 16 and 48 months) after VSG (p < 0.001). Preoperative scores of WEL-SF and SEPA did not predict postoperative %EBMIL, PCS, MCS or IWQOL-lite, adjusted for age, gender, preoperative values of BMI and the dependent variable. When change-scores (0–4 years) on WEL-SF and SEPA was added to the models, higher WEL-SF was significantly associated with higher %EBMIL (β = 0.36, p < 0.001), improvement in PCS (β = 0.23, p = 0.044), MCS (β = 0.28, p = 0.017) and IWQOL (β = 0.48, p < 0.001) after VSG. Higher change-scores on SEPA showed no associations with any of the outcomes (p = 0.88).

Conclusion

VSG contributed to significant and sustained improvement in self-efficacy for eating and physical activity 4 years after surgery. Patients with greater improvements in their self-efficacy toward eating, but not physical activity, experienced significantly greater weight-loss and HRQOL. Preoperative self-efficacy did not predict postoperative weight change or HRQL.

Obes Facts. 2018 May 26;11(Suppl 1):39.

O4.6 Dietary patterns modify the association between FTO genetic variations and changes in obesity phenotypes

F Hosseini-Esfahani 1, G Koochakpoor 2, MS Daneshpour 3, P Mirmiran 1, F Azizi 4

Introduction

Few studies specifically examined the modulatory effect of dietary pattern on the associations of the fat mass and the obesity-associated gene (FTO) risk alleles with obesity. The aim of this study was to investigate whether the dietary patterns could interact with FTO polymorphisms in relation to changes in body mass index (BMI) and waist circumference (WC) over 3.6 years follow-up.

Methods

Subjects of this cohort study were selected from among adult participants of the Tehran Lipid and Glucose Study (n = 4292, 43.2% male). Dietary data were collected using a valid and reliable semi-quantitative food frequency questionnaire (FFQ). Dietary patterns were determined using factor analysis on 25 foods groups. Selected polymorphisms (rs1421085, rs1121980, rs17817449, rs8050136, rs9939973, and rs3751812) were genotyped. Genetic risk score (GRS) were calculated using the weighted method.

Results

The mean ages of participants were 42.6 ± 14 and 40.4 ± 13 in men and women respectively. Two dietary patterns (DP) were extracted. The healthy DP was loaded heavily on vegetables, legumes, low fat dairy, whole grains, liquid oils and fruits. The western DP consisted of a high intake of soft drinks, fast foods, sweets, solid oils, red meats, salty snacks, refined grains and high fat dairy. The larger increase in BMI was observed among participants with higher adherence to western DP and risk allele carriers of rs1421085, rs1121980, rs17817449, rs8050136, rs3751812 (P interaction < 0.05). As adherence to western DP decreased, WC change was predicted to decrease in risk allele carriers of rs1121980 and rs3751812 (P interaction < 0.05). The increase in BMI (mean change: Q1 = 1.04 ± 0.34 vs. Q4 = 2.26 ± 0.36) and WC (mean change: Q1 = 0.47 ± 0.32 vs. Q4 = 0.95 ± 0.34) was found in individuals with higher GRS (≥ median) across four categories of adhering to western DP. No significant differences between FTO genotypes were seen among high consumers of healthy DP.

Conclusion

These results suggest that individuals with higher FTO genetic predisposition to obesity could be more susceptible to harmful effect of western DP adhesion. Our results emphasize reducing consumption of unhealthy foods for prevention of obesity.

Obes Facts. 2018 May 26;11(Suppl 1):39–40.

O5.1 The hidden role of histone deacetylases inhibition during β-adrenergic receptor stimulated Ucp1 expression

A Yuliana 1, HF Jheng 1, S Kawarasaki 1, W Nomura 1, H Takahashi 1, T Ara 1, T Kawada 1, T Goto 1

Introduction

Chromatin was built by packing DNA using special protein called histone which prone to the epigenetic modification. Acetylation in specific histone activation marks loosen the interaction with DNA, followed by an “opened” chromatin structure, thus promotes gene expression. In the opposite, deacetylation of histone suppresses them. Accordingly, inhibition of histone deacetylases (HDACs) may be one possible way to enhance gene expression. Indeed, class I HDAC inhibitor (MS275) has been reported to boost Ucp1, a signature of browning. Brown adipose tissue (BAT) has been targeted for its high thermogenic capacity to treat obesity. β-adrenergic receptors (β-ARs) stimulation activates BAT, while also induces browning on certain depots of white adipocytes (WAT), termed as beige adipocytes. Interestingly, β-ARs agonist was found to increase histone acetylation in Ucp1 promotor of BAT, which may indicate HDAC inhibition activity. However, the detail mechanism is still unclear in beige adipocytes.

Methods

HDAC inhibition was first investigated by measuring 1) HDAC activity and 2) acetylation in histone 3 lysine 27 (H3K27ac) during β-ARs stimulation in beige adipocytes. Chromatin immunoprecipitation (ChIP) assay was further performed to measure H3K27ac in specific Ucp1 promotor region in immortalized beige adipocytes. Finally, HDAC inhibition was elaborated using specific HDAC inhibitor and small interfering RNA (siRNA), and their effects on H3K27ac and Ucp1 expression was inspected.

Results

We found that β-ARs agonist-induced Ucp1 expression mildly decreased HDAC activity in beige adipocytes, compared to MS275. Further investigation using protein kinase A (PKA) inhibitor showed a complete recovery of HDAC inhibition caused by β-ARs agonist, implying the dependence on PKA pathway. Later, β-ARs agonist-reduced HDAC activity was likely resolved by the downregulation of Hdac 3 and 8 mRNA levels, while slightly disrupting Hdac 3 recruitment to Ucp1 promotor region. Consistently, H3K27ac was also elevated in Ucp1 enhancer and proximal region upon β-ARs agonist stimulation, suggesting a direct involvement of HDAC inhibition pathway to promote Ucp1 expression. The importance of HDAC inhibition was further confirmed by enhanced Ucp1 expression when β-ARs agonist was co-treated with Hdac 3 or/and 8 inhibitors. Nonetheless, Hdac 3 inhibitor showed higher H3K27ac than Hdac 8 inhibitor and only Hdac 3 siRNA displayed upregulated Ucp1, corroborating Hdac 3 as the largest benefactor.

Conclusion

These findings highlight the hidden pathway of HDACs inhibition on promoting Ucp1 expression that may become a potential target for obesity.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):40.

O5.2 Biophysical Characterization and Diagnosis of Obesity from Adipose Tissue by Fourier Transform Infrared (FTIR) Spectroscopy and Imaging

F Kucuk Baloglu 1, G Brockmann 2, F Severcan 3

Introduction

Obesity is a heterogeneous disorder originating from the enlargement of visceral (VAT) and subcutaneous (SCAT) adipose tissue mass in the body and this process usually results in disturbed glucose and lipid metabolism. In current study, we firstly aimed to characterize and differentiate SCAT and VAT considering biomolecular content and investigate transdifferentiation between white and brown adipocytes by using Fourier Transform Infrared (FTIR) microspectroscopy. Secondly, our purpose was to investigate gender-based differences by comparing male and female samples. Finally, it was aimed to propose an obesity related spectral biomarker in SCAT and VAT using the diagnostic potential of ATR-FTIR spectroscopy.

Methods

In harmony with our first and second purposes, characterization and differentiation experiments were performed to determine obesity-induced differences in VAT and SCAT bu using FTIR microspectroscopy. UCP1 immunohistological staining was used to compare the appearance of brown and white adipocytes in transdifferentiation experiments. For third purpose, ATR-FTIR spectroscopy coupled with hierarchical cluster analysis (HCA) and principal component analysis (PCA) was performed to the spectra at different regions including triglyceride band located at 1770–1720 cm-1 spectral region as a diagnostic tool in the discrimination of the obese and control samples for both SCAT and VAT.

Results

In characterization and trans-differentiation experiments, our results indicated a remarkable increase in the lipid/protein ratio, accompanied with a decrease of UCP1 protein content which might be due to the trans-differentiation of brown to white adipocytes in obese groups. The results also revealed that SCAT was more prone to obesity-induced structural changes than VAT. The gender-based comparative studies revealed that the effects of obesity on compositional structure of adipose tissues were more significant for male groups in VAT and for female groups in SCAT. UCP1 staining results indicated that VAT samples have more UCP1 protein in females in comparison to males. A successful differentiation between control, obesity related insulin resistant and obese groups was achieved with high sensitivity and specificity in the triglyceride spectral region of the adipose tissue samples. This reveals that ATR-FTIR spectroscopy can be used a rapid, low-cost, operator independent sensitive novel approach in diagnosis of obesity.

Conclusion

The current study clearly revealed the power of FTIR microspectroscopy in the precise determination of spectral variations in adipose tissue components of obese mice models. Since understanding how structure and composition of adipose tissue differ by gender can enable personalized and gender-based treatments. Gender-based alterations were able to be determined by comparing biomolecular composition of adipose tissue samples of male and female mice. Additionally, the internal diagnosis of obesity which was achieved by FTIR spectroscopy coupled with chemometrics can be used in biopsies and bariatric interventions. Since SCAT is more accessible than the VAT and it is closely correlated with the VAT in regard to metabolic effects of obesity such as insulin resistance, this tissue can be preferred in medical operations.

Obes Facts. 2018 May 26;11(Suppl 1):41.

O5.3 A distinct molecular signature of adipose tissue in constitutional thinness

N Gheldof 1, Y Ling 2, C Canto 3, B Galusca 2, N Germain 2, B Estour 2, J Hager 1

Introduction

Most studies in the obesity field have focused on metabolic changes occurring in obese populations, but less is known about people on the other side of the weight spectrum. Constitutional Thinness (CT) is a state of extremely low but stable body mass index (BMI, generally lower than 18 kg/m2) despite normal feeding, exercise and psychological profile. The goal of the present study is to gain understanding in the mechanism of this strong resistance to weight gain in CT. In particular, given the importance of adipose tissue in the obesity etiology, we present here our integrative analyses on the molecular characterization of adipose tissue in those people.

Methods

We conducted a clinical study on 30 CT and 30 normal weight individuals matched for gender and age (including 15 women and 15 men per group). Standard clinical variables were measured, and subcutaneous adipose tissue biopsies were taken. Adipocyte size was evaluated by histology, and transcriptomic profiling was performed by RNAseq and validated by Nanostring technology. In addition, mitochondrial function was analyzed by Oroboros high-resolution respirometry, and mitochondrial DNA content evaluated by Taqman qPCR.

Results

Adipocytes were markedly smaller in CT compared to the controls, and males had smaller adipocytes than their female counterparts. Respiration assays did not show any difference in uncoupling, suggesting that there is not more brown/beige-like activity of the subcutaneous adipose tissue in CT. However, we observed a significant higher mitochondrial complex II activity in both male and female CT, resulting in higher electron transport chain activity. This higher activity was in line with the mitochondrial DNA content, which appeared to be higher in CT. Gene expression profiling demonstrated a distinct transcriptomic signature in CT adipose tissue samples. Pathway analyses revealed an increase in fatty acid oxidation pathways, but also triglyceride biosynthesis. This suggests the presence of a different futile fuel cycling, potentially associated with the observed increased mitochondrial activity.

Conclusion

In summary, despite the fact that CT individuals had smaller adipocytes, the mitochondrial content of adipose tissue from these people was higher, resulting in higher mitochondrial activity. We propose that this increased mitochondrial function could be a mechanism by which CT people maintain their lower weight.

Obes Facts. 2018 May 26;11(Suppl 1):41.

O5.4 FAM46A a new regulator of leptin secretion in adipocytes

J Hager 1, J Carayol 1, C Chabert 1, A Valsesia 1, P Descombes 1, N Viguerie 2, D Langin 2, A Astrup 3, W Saris 4

Introduction

Leptin plays a key role in body weight regulation. Low leptin levels suggest low fat stores and lead to increased food intake both in rodents and humans. Most obese individuals have higher leptin levels than normal weight individuals despite high fat content, having lead to the concept of leptin resistance. Another problem in obesity is that during weight loss leptin levels decrease and low leptin levels at the end of a caloric restriction period increase the risk of overfeeding and weight regain. However, the levels to which leptin decreases during weight loss vary significantly between subjects and little is known how leptin secretion from adipocytes is controlled.

Methods

We designed a large-scale protein quantitative trait locus (pQTL) analysis on 1,129 proteins from 494 obese subjects before and after a weight loss intervention. Sequencing libraries were prepared from adipose tissue RNA using the Illumina TruSeq Kit. 498, 233 SNPs were genotyped and imputation was performed using a 1000 Genomes reference panel. pQTLs were mapped using a linear mixed model (LMM) with GCTA software. Silencing of the FAM46A gene in SGBS adipocytes was achieved by RNA interference, overexpression by introducing full length FAM46A cDNA into the SGBS.

Results

We identified 55 BMI-associated cis- and trans-pQTL’s at baseline and 3 trans-pQTLs after the intervention. Of 42 proteins associated to BMI both at baseline and during the LCD, only leptin displayed a pQTL signal during LCD. Two tightly linked SNPs on chromosome 6 were associated with leptin protein expression changes. Surrounding genes included BCKDHB involved in the catabolism of branched chain amino acids (BCAAs) and FAM46A, a SMAD signalling pathway related protein involved in TGF-β signaling. Using expression data obtained from fat biopsies, we performed an eQTL analysis in a 5 Mbase interval surrounding the pQTL signal. Only the FAM46A gene expression displayed association with SNPs in the pQTL region. To evaluate if FAM46A levels directly influenced leptin levels, we performed FAM46A knockdown and overexpression studies in the SGBS human adipocyte cell line. Transfection with siRNA resulted in a 71% reduction of FAM46A gene expression and a 33% reduction of protein. FAM46A knockdown had no influence on leptin gene expression and did not show any effect on markers of adipocyte differentiation PPARγ and CEBPα. Conversely, FAM46A knockdown resulted in a highly significant 49% increase of leptin secretion from the adipocytes (p = 0.0002). Overexpression of FAM46A resulted in a 21-fold increase of FAM46A expression. FAM46A overexpression resulted in a significant 28% reduction of leptin release (P = 0.034). Overexpression did not influence PPARγ or CEBPα gene expression. To evaluate if the observed effects on leptin were specific the secretion of other adipokines was tested. Secretion of adiponectin and IL6 were not effected by the knockdown or overexpression of FAM46A.

Conclusion

In conclusion we performed the first large scale pQTL study in obesity. Using data from a dietary intervention study in obese patients we identified multiple cis- and trans-pQTL signals associated with BMI at baseline and after the intervention. Finally we provide the first evidence for FAM46A being a new negative regulator of leptin in human adipose tissue.

Conflicts of Interest

Research Scientist at Nestlé

Obes Facts. 2018 May 26;11(Suppl 1):41–42.

O5.5 Human brite adipogenesis: Generation and characterization of cell models

F Volat 1, P Bercier 1, J Zachayus 1, C Déon 1, M Bock 1, G Thil 1, D Debono 1, G Boldina 1, P Paul 1, M Didier 1, A Kannt 2, V Mikol 1, J Guillemot 1, A Bouloumié 3

Introduction

Stimulation of brite (brown in white) adipogenesis is an attractive therapeutic strategy to fight against obesity-associated metabolic disorders. Various approaches aimed at stimulating brite adipocyte appearance and function in murine models showed an improvement in metabolic parameters. In mice, brite adipocytes are thought to originate either from direct conversion of mature white adipocytes or from de novo differentiation of resident progenitor cells. In human, due to the lack of appropriate cell model, the brite adipogenesis process remains to be defined. In human subcutaneous adipose tissue, among native progenitor cells (CD45-, CD34+, CD31- cells), we identified a small population positive for MSCA1 and CD36 as bipotent white and brite preadipocytes displaying the highest adipogenic potential (Estève et al., 2015; Gao and Volat et al., 2017, Stem cells). Thus, our aim was to immortalize these human progenitors to develop cell models with demonstrated brite adipogenic capacities.

Methods

Cells (CD45-,CD34+,CD31-,MSCA1+,CD36+) were isolated by cell sorting from the stroma-vascular fraction of human subcutaneous adipose tissues. Freshly immunoselected cells were lentivirally transduced with HPV16 E6/E7 oncogenes and the human telomerase reverse transcriptase (hTERT) and further subcloned. Adipogenic capacity of derived clones was tested in defined adipogenic culture conditions by their capacity to generate lipid-laden cells and to express white/brite specific genes (RT-qPCR). Brite phenotype was sustained by the detection of UCP1 protein in enriched mitochondria preparation (Western-blot and Mass Spectrometry) and further characterized by RNA-Seq analyses. Brite function was then assessed by mitochondrial respiration analyses.

Results

Several clones accumulating lipid droplets and expressing common adipogenic markers (e.g. FABP4, PLIN1) under adipogenic culture conditions were obtained. Based on brite-specific genes expression (e.g. UCP1, CIDEA) clones were clustered and expression of UCP1 protein in mitochondria was confirmed on several selected clones. Finally, a significant induction of the mitochondrial proton leak was observed in UCP1 positive clones in response to lipolytic agents including Forskolin or β-adrenergic agonist.

Conclusion

Taken together, our results show that several clones originating from (CD45-,CD34+,CD31,MSCA1+,CD36+) human cells exhibit brite phenotype and function. Such brite progenitor clones provide an original cell model to define the brite adipogenic process. Focusing on specific enriched pathways revealed by the RNA sequencing on UCP1 clones will help us to identify key molecular pathways involved in human brite adipogenesis but also in brite adipocyte function.

Conflicts of Interest

This work is financially supported by Sanofi R&D and the INSERM. The majority of authors are Sanofi employees. The authors indicate that the content of this work was not influenced by the employers and declare no potential conflict of interest.

Obes Facts. 2018 May 26;11(Suppl 1):42.

O5.6 Vitamin D and adipose tissue insulin sensitivity in overweight and obese humans

A Pramono 1, JWE Jocken 1, Y Essers 1, GH Goossens 1, EE Blaak 1

Introduction

Data on the relationship between circulating vitamin D 25OHD3, 1,25OH2D3, 1,25OH2D3/25OHD3 ratio and tissue-specific insulin sensitivity in obese humans is limited. In addition, a recent study showed that adipose tissue (AT) Vitamin D Receptor (VDR) mRNA expression is higher in AT from morbidly obese as compared to lean individuals. Here, we investigated (1) the determinants of plasma vitamin D metabolites and (2) the relation between vitamin D metabolites and AT VDR mRNA expression with adipose tissue insulin sensitivity (AT insulin sensitivity) in overweight and obese individuals.

Methods

This cross-sectional analysis included 92 adult overweight and obese (BMI range 25–35 kg/m2, age range: 19–69) men (n = 72) and women (n = 20). A 2-step hyperinsulinemic-euglycemic clamp was performed to determine AT insulin sensitivity, measured by the % suppression of plasma free fatty acid (FFA) concentrations during the clamp. Abdominal subcutaneous AT mRNA expression of genes involved in vitamin D metabolism (VDR, CYP) was determined by standard PCR techniques. Liquid chromatography mass spectrophotometry (LC-MS) was used to quantify plasma 25OHD3 and 1.25OH2D3 concentrations.

Results

Univariate model analyses including age, BMI, sex as covariates showed that age and BMI are determinants of plasma 25OHD3 concentration (std ß = 0.321, P = 0.012; std ß = −0.274, P = 0.011; respectively). Waist circumference is strongly associated with AT VDR expression (std ß for WC = 0.460, P = 0.005) independent of BMI. Univariate model analyses including age, sex, BMI, plasma vitamin D metabolites and 1,25OH2D3/25OHD3 ratio as covariates showed that only AT VDR mRNA was negatively associated with AT insulin sensitivity (std ß = −0.200, P = 0.039) Additionally, AT CYP2J2, CYP27A1, CYP27B1 and CYP24A1 expression were associated with AT VDR mRNA (P < 0.05 for all) but not with plasma vitamin D metabolites nor AT insulin sensitivity.

Conclusion

The present findings indicate that age and BMI may affect circulating vitamin D concentrations. Secondly, plasma vitamin D concentration and 1,25OH2D3/25OHD3 ratio are not associated with AT insulin sensitivity in overweight and obese humans. However, AT VDR expression is negatively associated with AT insulin sensitivity, independent of plasma vitamin D concentrations. The underlying mechanism for this association needs to be investigated in more detail in future studies.

Obes Facts. 2018 May 26;11(Suppl 1):42–43.

O6.1 The LiveLighter healthy weight and lifestyle campaign: Evaluation and policy advocacy

J Martin 1, B Morley 2, A McAleese 3, P Niven 2, H Dixon 2, M Wakefield 2, M Swanson 4, M Szybiak 4, T Shilton 4, IS Pratt 5, T Slevin 5

Introduction

The Australian LiveLighter healthy weight and lifestyle campaign graphically illustrates negative health effects of overweight and recommends alternatives to obesogenic behaviours. With paid television advertising as a centrepiece, it comprises communication and social marketing activities as well as policy advocacy efforts, to influence behavioural choices and promote public policies favourable to reducing obesity. LiveLighter addresses a range of nutrition and physical activity messages with a recent focus on sugary drinks. It was developed and launched in Western Australia (WA) in 2012 and launched in Victoria in 2014.

Methods

The WA impact evaluation employed a pre-post design, with cross-sectional tracking surveys (n~1,000) across three Phases of the campaign: ‘Toxic Fat’, ‘Sugary Drinks’ and ‘Junk Food’. The Victorian evaluation employed a pre-post evaluation design with a control group (South Australia) for Phases one and two (n~700 per condition per survey).

Results

Impact evaluation of the paid television campaign showed Phase one was associated with increased knowledge of the health consequences of overweight in WA and Victoria (p < 0.05). Following Phase two, the message about reducing sugary drink consumption impacted frequent consumers in WA (p < 0.05) and Victoria (p < 0.01). In WA, cross-sectional trends also show consumption of sugary drinks (p < 0.001) and fast food (p < 0.05) have reduced significantly since the campaign launched. Phase three showed increased public support in WA for environmental and policy initiatives to encourage healthy lifestyles, including improved nutrition labelling and sugary drink taxes (p < 0.05). Importantly, the campaign minimises adverse consequences with no increased negative perceptions of overweight individuals. The LiveLighter campaign employs a comprehensive mix of strategies in addition to paid media, including public relations and communications, professional engagement such as policy and professional development, and stakeholder engagement.

Conclusion

The first phase of LiveLighter set the agenda and succeeded in promoting awareness and motivation for achieving a healthy weight and lifestyle. The second phase showed evidence of behaviour change with reduced SSB consumption. At Phase three LiveLighter was associated with increased support for public policies favourable to reducing obesity. Overall, these results show LiveLighter delivers a comprehensive program with advertising aired at sufficient intensity to achieve change. A long-term commitment to communication and policy efforts will be required to successfully tackle the international rise in obesity. LiveLighter serves as an action oriented example of leading edge efforts to improve diets and to address obesity.

Obes Facts. 2018 May 26;11(Suppl 1):43.

O6.2 Plant-based diet and longitudinal adiposity: the Rotterdam Study

Z Chen 1, OH Franco 1, JD Schoufour 1, T Voortman 1

Introduction

Vegan or vegetarian diets have been suggested to help prevent obesity. However, not much is known about whether variation in the degree of having a plant-based versus animal-based diet may be beneficial for adiposity. Furthermore, it is largely unclear if and how the variation is associated with fat mass, and fat-free mass in middle-aged and elderly populations — those usually with aging-related body composition change, fat distribution, and muscle mass lose. Therefore, we explored whether adherence to a diet high in plant-based foods and low in animal-based foods was associated with longitudinal body mass index (BMI), waist circumference (WC), fat mass index (FMI), fat-free mass index (FFMI), and body fat percentage (BF%) in middle-aged and elderly populations.

Methods

We included 9641 participants (mean age 64.2 ± 8.7 years) from three sub-cohorts of the Rotterdam Study, a prospective cohort study in the Netherlands. Dietary data were collected using a semi-quantitative food frequency questionnaire at baseline of each of the three sub-cohorts (1989–93, 2000–01, and 2006–08). Using these data, we created an overall plant-based diet index to assess variation in the degree of having a plant-based versus animal-based diet, where intake of plant foods received positive scores, while intake of animal foods received reverse scores. We collected longitudinal data of height, weight, waist circumference, fat mass and fat-free mass (obtained using dual energy X-ray absorptiometry (DXA)) from follow-up examinations every 3–5 years. We used linear mixed models to analyze associations between adherence to the plant-based diet index with longitudinal BMI, WC, FMI, FFMI, and BF%.

Results

In multivariable-adjusted analyses, a higher score on overall plant-based diet index was associated with lower longitudinal BMI, which was explained mainly by a lower FMI, but also a slightly lower FFMI, (per 10 scores increase for BMI: β = −0.64 95%CI(−0.75; −0.53), for FMI: β = −0.57 95%CI(−0.68; −0.46), for FFMI: β = −0.13 95%CI(−0.19; −0.07)). In line with this, a higher score on overall plant-based diet index was also associated with a lower WC and BF%, (for WC: −1.82 (−2.12; −1.52), for BF%: −0.99 (−1.20; −0.77). Associations with BMI, WC, and BF% were stronger in middle-aged participants (45–65 years) than elderly (>65 years).

Conclusion

Our study suggests that a more plant-based and less animal-based diet beyond strict adherence to a vegetarian or vegan diet, may be beneficial for prevention of adiposity in middle-aged and elderly populations. This supports current recommendations to shift to diets rich in plant foods, with low in consumption of animal foods.

Obes Facts. 2018 May 26;11(Suppl 1):43.

O6.3 Roadmap towards a pan-European surveillance of obesity, obesity-related lifestyle behaviours and their determinants in infants, children and adolescents

A Hebestreit 1, B Thumann 1, M Wolters 1, J Bucksch 2, I Huybrechts 3, J Inchley 4, C Lange 5, N Lien 6, K Manz 5, N Slimani 3, HP Van Der Ploeg 7, W Ahrens 1

Introduction

An inventory of existing (pan-)European surveillance systems identified gaps in health reporting, particularly with regard to the assessment of obesity-related lifestyle behaviours in youth. Based on this inventory we developed a roadmap towards a harmonised pan-European surveillance system measuring core indicators of health behaviours and their determinants.

Methods

Five European surveillance systems (the WHO European Childhood Obesity Surveillance Initiative, the Health Behaviour in School-aged Children: WHO Collaborative Cross-National survey, EU Menu, the European Health Interview Survey (EHIS) and the Nordic Monitoring of Diet, Physical Activity and Overweight) were selected as key initiatives and the German KiGGS study served as a model for the implementation of objective assessment Methods. These initiatives contributed to the roadmap through a structured workshop in 2016.

Results

A conceptual framework for this roadmap was developed to guide a stepwise approach towards cross-country harmonisation. The starting point is the identification of key indicators of dietary intake, dietary behaviour, physical activity, sedentary behaviour and their determinants in children and adolescents. Second, short screening instruments ideally may be included in existing surveillance systems to assess key indicators. Then, optional supplementary modules could be administered for obtaining more in-depth or objective data such as e.g. provided by physical activity monitors. This would allow mutual calibration and improvement of existing instruments which should lead to the replacement of those currently used by more comparable measurement tools. Last, establishment of a competence platform is envisaged for coordinating and guiding methodological studies to achieve the different steps.

Conclusion

The proposed roadmap towards a harmonised pan-European surveillance system builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends, and − once in place − will provide an evidence basis for the evaluation of policy interventions.

Obes Facts. 2018 May 26;11(Suppl 1):43–44.

O6.4 Trends in the prevalence of childhood obesity and morbid obesity in the Republic of Ireland – The Childhood Obesity Surveillance Initiative in 2008, 2010, 2012 and 2015

S Bel-Serrat 1, MM Heinen 1, G O’Malley 2, J Mehegan 1, CM Murrin 1, CC Kelleher 1

Introduction

Although childhood obesity and morbid obesity are associated with immediate and long-term serious health problems, there is a lack of data on the extent of the problem. Therefore, we aimed to investigate the prevalence of obesity and morbid obesity in Irish schoolchildren aged 6–7 years old.

Methods

A nationally representative cross-sectional sample of 7,650 children (52.5% girls), mean age 7.2 (± 0.4SD) years that participated in each of the four rounds (2008, 2010, 2012 or 2015) of the Irish Childhood Obesity Surveillance Initiative (COSI) were included. Height and weight were objectively measured by trained nutritionists following the WHO COSI protocol. The 1990 United Kingdom (UK 1990) growth reference charts were used to compute age and sex-specific body mass index (BMI). Prevalence of obesity was defined as either obesity (BMI≥UK 1990 98thcentile) or morbid obesity (BMI≥UK 1990 99.83th centile for boys and 99.76th centile for girls) according to Cole et al. cut-offs. Prevalence was computed by sex, school location (urban vs. rural) and school socioeconomic status (disadvantaged vs. non-disadvantaged). Differences in prevalence between groups and over time were examined using chi-squared tests and p-trend analyses.

Results

Overall, the rates of obesity and morbid obesity in this sample were 4.8% and 1.7%, respectively. The prevalence of obesity was 5.4% in 2008 and 4.5% in 2010, 2012 and 2015. Morbid obesity was found in 2.0% of children in 2008, in 1.7% in 2010 and in 1.5% in both 2012 and 2015. Although both obesity and morbid obesity seemed to be stabilising over time, no significant trends were observed across rounds. Obesity was significantly more prevalent in disadvantaged schools than in non-disadvantaged schools (7.1% vs. 4.6%, p = 0.002) and in urban schools (5.1% vs 3.5%, p = 0.012). Prevalence of morbid obesity was significantly higher in disadvantaged schools (1.6% vs 3.2%, p = 0.002) whereas no significant differences were observed between urban (1.6%) and rural (2.2%) schools (p = 0.141). Obesity and morbid obesity rates did not differ between sexes.

Conclusion

Obesity and morbid obesity rates could be plateauing among Irish school-aged children. However, both types of obesity were more prevalent in disadvantaged and in urban schools. These findings should raise awareness of the scale of the problem and of the population groups at a higher risk of obesity and of morbid obesity. The implementation of interventions to prevent progression to obesity and morbid obesity should be supported and in addition, interventions to treat both types of obesity are warranted such that childhood comorbidities can be reduced.

Obes Facts. 2018 May 26;11(Suppl 1):44.

O6.5 No evidence for a causal association between liver fat and (sub)clinical disease outcomes, including insulin resistance, type 2 diabetes, and coronary artery disease

R AJ Smit 1, S Trompet 2, R Noordam 2, T Christen 3, JB Van Klinken 4, K Willems Van Dijk 4, M Den Heijer 5, S Le Cessie 3, PCN Rensen 2, JW Jukema 6, FR Rosendaal 1, R De Mutsert 1

Introduction

Observational studies have shown strong associations between non-alcoholic fatty liver disease (NAFLD) with risk of type 2 diabetes (T2D) and cardiovascular disease (CVD). However, these designs cannot rule out residual confounding or reverse causation. Using Mendelian randomization (MR), we aimed to test the hypothesis that NAFLD is causally related to (sub)clinical measures of T2D and CVD.

Methods

We selected nine lead SNPs for loci known to associate with diagnosis of NAFLD in recent literature, but without known pleiotropic effects on glucose-metabolism pathways (LYPLAL1, FDFT1, COL13A1, LTBP3, EFCAB4B, NCAN, PDGFA, TM6SF2, PNPLA3). We examined the combined effects of these variants using an unweighted genetic risk score (i.e. possible range 0–18), against hepatic triglyceride content (n = 1,818), ALT and AST levels, fasting glucose, HOMA-IR, intima-media thickness, and pulse wave velocity (n = 2,161) in 5,711 individuals aged 45–65 years from the Netherlands Epidemiology of Obesity study, and against incident CVD, incident T2D, and mortality outcomes in 5,804 individuals aged 70–82 years from the PROspective study of Pravastatin in the Elderly at Risk. In addition, using external weights from a large-scale GWAS on CT-measured liver fat for three of the genetic instruments (LYPLAL1, NCAN, PNPLA3), we calculated inverse-variance weighted (IVW) MR estimators using publically available GWAS data from the MAGIC (fasted glucose, HOMA-IR, n = 46,186), DIAGRAM (T2D, n = 69,033), and CARDIoGRAM+C4D (coronary artery disease (CAD), n = 184,305) consortia.

Results

The NAFLD-GRS was associated with increased liver triglyceride content (1.05 (95%CI: 1.02, 1.09) relative change per-allele), higher ALT (0.32 (0.13, 0.50) mmol/L per-allele) and AST (0.12 (0.00, 0.25) mmol/L per-allele), but not with fasting glucose (0.00 (−0.01, 0.02) mmol/L per-allele) or HOMA-IR (1.00 (0.99, 1.02) relative change per-allele). In addition, we did not observe evidence of associations with subclinical or clinically overt CVD outcomes, T2D, or mortality. Findings from large-scale GWAS consortia were in line with these Results, as the IVW-MR estimators did not show clear evidence of associations with fasting glucose (0.02 (−0.04, 0.08) mmol/L per unit increase in genetically raised liver fat), HOMA-IR (0.03 (−0.04, 0.10)), T2D (odds ratio (OR) 1.28 (0.71, 2.31), or CAD (OR 0.94 (0.74, 1.19).

Conclusion

Based on our selection of genetic instruments, our findings suggest that the previously observed associations between NAFLD and liver fat with high risk of T2D and CVD in observational studies might not be causal.

Obes Facts. 2018 May 26;11(Suppl 1):44–45.

O6.6 The Impact of Body Mass Index on Mortality after Infection: Cohort study of 18,167 patients hospitalized in Denmark

S B Gribsholt 1, L Pedersen 1, B Richelsen 2, HT Sørensen 1, RW Thomsen 1

Introduction

The association between body mass index (BMI) and mortality remains controversial. From an evolutionary perspective, obesity and associated proinflammatory defenses may protect against death from infections. We examined the impact of BMI on outcome after any acute incident hospital admission for infection in a population-based study.

Methods

We identified 18,167 persons with an incident acute medical or surgical inpatient admission for an infectious disease during 2011–2015 in the Central Denmark Region. We examined risk of death within 90 days after discharge date in association with underweight, overweight and obesity, versus normal weight as reference. We adjusted for potential confounding factors, and examined the influence of recent weight change, comorbidities, cancer, and tobacco smoking on the association between BMI and mortality.

Results

Compared with patients of normal weight, the adjusted 90-day hazard ratio (aHR) of death following infection was substantially increased in patients with underweight: 2.2 [95% confidence interval (CI); 1.8–2.8]. However, no mortality increase was observed among patients with stable underweight, i.e., no recent weight loss [aHR = 1.1 (0.5–2.3)]. In contrast, the aHRs of death were clearly decreased in patients with overweight [0.6 (95% CI; 0.5–0.6)] and in patients with obesity [0.5 (95% CI; 0.4–0.6]. Among patients with obesity, presence or absence of recent weight changes, comorbidities, cancer, or smoking had little impact on the association with decreased mortality.

Conclusion

Overweight and obesity were associated with substantially reduced 90-day mortality following incident hospital admission for infection. An association between underweight and increased mortality was confined to patients with recent weight loss, suggesting confounding by occult disease.

Obes Facts. 2018 May 26;11(Suppl 1):45.

O7.1 Genetic susceptibility helps to predict type 2 diabetes remission after bariatric surgery

A Lecube 1, R Simo 2, A Ciudin 2, S Pich 3, N Vilarrasa 4, A Caixàs 5, E Sánchez 1, A Simó 4, L Gutiérrez 6, E Salas 3, I Ortega 3, K Guillem 3, O Casagran 3, M Rigla 5, JA Baena 7, JM Fort 8, A Luna 5, P Rebasa 5, JM Balibrea 8, E Fidilio 9, M Bueno 1, C Hernandez 2

Introduction

Obesity and its comorbidities, specially type 2 diabetes (T2D), are a major public health problem. The disappointing result of dietary treatment and the scarce of drugs have led to increased bariatric surgery (BS). However, not all obese patients with T2D who undergo BS achieve diabetes remission. We aimed (1) to develop an improved genetic scoring system for predicting T2D remission following BS, and (2) to compare our results with the DiaRem prediction score that uses HbA1c, age and diabetes medications.

Methods

We used a retrospective Spanish cohort (n = 585) that included 139 individuals with T2D followed at least 18 months after BS (79 Y-de-Roux gastric bypass and 60 sleeve gastrectomy). DNA was extracted from saliva samples and processed using Nutri inCode test (NiC, Ferrer inCode) based on 6 genetic predisposition risk scores (GPS). Each GPS consists of several SNPs which were shown to be implicated in appetite regulation, response to exercise, response to hypocaloric diet, response to lyfe style intervention, response to BS, and SNPs related to the presence of metabolic syndrome or T2D. Multivariate logistic regression was used for adding several GPS to DiaRem score creating new scores, to predicting the event of interest (T2D remission). The calibration of the adequacy of the different models was determined by Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC) was used for evaluating the prediction performance for each score.

Results

In patients underwent BS, the new test significantly predicted T2D remission. In addition, the addition of the new test improved the AUC compared with DiaRem alone in patients underwent sleeve gastrectomy [0.816 (95% IC: 0.701–0.932) vs 0.718 (0.576–0.861), p = 0.024]; however, the improvement in patients underwent gastric bypass was no significant [0.657 (95% IC: 0.534–0.779) vs. 0.582 (0.454–0.710), p = 0.201).

Conclusion

To identify subjects with an inadequate response before surgery is a challenge, both for the doctor and for the Administration. Thus, it is critical to develop methods for predicting outcomes that are applicable for clinical practice. Adding genetic information to clinical data helps to better predict diabetes remission following BS. Aknowledgement: PERIS 2016 SLT002/16/00497

Obes Facts. 2018 May 26;11(Suppl 1):45.

O7.2 Genetic determinants of weight loss after bariatric surgery

M Aasbrenn 1, TM Schnurr 2, CT Have 2, M Svendstrup 3, DL Hansen 4, D Worm 5, M Balslev-Harder 2, M Hollensted 6, N Grarup 2, KS Burgdorf 7, H Vestergaard 2, TIA Sørensen 6, M Fenger 8, S Madsbad 9, T Hansen 2, O Pedersen 2

Introduction

The responses to weight loss interventions is partly heritable; yet, genetic determinants of weight loss are largely unknown. The aims of this study were to examine the effect of two genetic risk scores (GRS7, GRS3) earlier shown to be associated with excess body mass index loss (EBMIL) following bariatric surgery (1), and to examine the effect of 77 GWAS identified BMI susceptibility SNPs and ten weight loss associated SNPs (1, 2) on EBMIL in patients having undergone bariatric surgery.

Methods

578 patients (74% females; mean age: 45 years (SD 10); mean BMI: 44 kg/m2 (SD 5)) were included. Weight was measured prior and 2–3 years following Roux-en-Y Gastric Bypass surgery, and EBMIL was calculated as ΔBMI / (Initial BMI – 25). A LASSO regression corrected for age and gender was performed on SNPs related to BMI or EBMIL (1, 2). Through summing up of genotype dosage information for the alleles (1), two genetic risk scores were calculated, comprising seven BMI SNPs (GRS7) and three waist-hip ratio SNPs (GRS3), respectively. Associations between EBMILand the two GRSs were evaluated by linear regression corrected for age, gender and recruitment centre.

Results

Three of the GWAS-identified BMI susceptibility SNPs (rs17001654 (NUP54/SCARB2), rs657452 (AGBL4) and rs7903146 (TC-F7L2) associated with EBMIL. The GRS3 associated with EBMIL (B = 0.02 EBMIL per risk decreasing allele [95% CI: 0.00–0.04], p = 0.021), whereas no association was observed for GRS7 (B = 0.00 EBMIL per risk decreasing allele [95% CI: −0.01–0.01], p = 0.98).

Conclusion

Three BMI susceptibility SNPs discovered in European subjects in a recent GWAS (2) associated with EMBIL following bariatric surgery. One of two earlier presented gene risk scores for weight loss after bariatric surgery (1) can be replicated in this independent Danish cohort. Findings of genetic determinants of BMI loss after bariatric surgery should be replicated in larger cohorts. 1. Bandstein M, Voisin S, Nilsson EK, Schultes B, Ernst B, Thurnheer M, et al. A Genetic Risk Score Is Associated with Weight Loss Following Roux-en Y Gastric Bypass Surgery. Obesity surgery. 2016;26(9):2183–9. 2. Locke AE, Kahali B, Berndt SI, Justice AE, Pers TH, Day FR, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015;518(7538):197–206.

Obes Facts. 2018 May 26;11(Suppl 1):46.

O7.3 Effect of Calcium citrate versus Calcium carbonate on elevated PTH following Roux-en-Y gastric bypass. A Double-blinded Randomized Study

L R Madsen 1, R Espersen 2, L Rejnmark 2, B Richelsen 2

Introduction

Following Roux-en-Y gastric bypass (RYGB), elevated PTH levels are commonly noted and may be attributable to inadequate vitamin D and calcium supplementation. In patients with preserved gastrointestinal tract, calcium citrate is absorbed more efficiently than calcium carbonate. Moreover, hypochlorhydria, which in theory could be induced by RYGB, also reduce absorption of calcium carbonate. Based on these facts, calcium citrate is recommended over calcium carbonate as supplementation to RYGB operated. In this long-term, clinical, double-blinded randomized controlled trial, we investigated the impact of either calcium carbonate or calcium citrate in patients with elevated PTH after RYGB.

Methods

We enrolled 39 RYGB operated with elevated PTH levels (PTH>6.9 pmol/l), vitamin D levels>50 nmol/l, and normocalcemia despite following the Danish recommendations of supplementation with calcium and vitamin D (800 mg elementary calcium plus 38 μg vitamin D/daily) in a 12-week double-blinded randomized controlled trial of either calcium carbonate or calcium citrate (1200 mg elementary calcium/daily). We collected data on everyday diet focusing on calcium and vitamin D intake, alcohol and smoking habits, use of medications and vitamins, history of weight, travel activity, physical activity, and sun exposure. Blood and urine samples were obtained at baseline and 12 weeks.

Results

All patients (80% females) completed the intervention. Median age was 49.5 years (IQR: 42.9; 56.0), and the participants had RYGB 6.2 years (IQR: 5.5; 6.9) prior to study inclusion. Pre surgery BMI was 48.9 kg/m2 (IQR: 44.1; 54.6), and median weight loss was 53 kg (IQR: 44; 63). In the total cohort, mean PTH levels at 12 weeks, 7.78 (95% CI: 7.05; 8.52) pmol/l, were not significantly lower than at baseline, 7.96 (95% CI: 7.25; 8.67, p-value: 0.517). Changes in PTH levels was comparable between the two intervention groups (p-value: 0.838). Calcium, magnesium-, and phosphate levels did not change. P1NP, osteocalcin, and CTX decreased to a greater extent in the citrate-treated group, meanwhile, when adjusting for baseline values, the difference in ΔCTX rendered insignificant, while the difference in Δosteocalcin (p-value: 0.008) and ΔP1NP (p-value: 0.047) stayed significant. We found no difference in urinary excretions, except lower phosphate secretion in the citrate group.

Conclusion

Increasing the dose of calcium supplementation in RYGB operated patients with elevated PTH levels does not seem to normalize PTH levels, regardless of the type of supplement (calcium citrate or calcium carbonate). Compared to calcium carbonate, calcium citrate reduced bone formation markers, but not to a level of clinical relevance. Based on our Results, there is no evidence for recommending the more expensive calcium citrate supplementation over calcium carbonate.

Obes Facts. 2018 May 26;11(Suppl 1):46.

O7.4 Changes in bone mineral density due to omega-loop gastric bypass induced weight loss in patients with vitamin D supplementation over 12 months

M Luger 1, R Kruschitz 2, E Winzer 1, I Grabovac 1, K Schindler 2, M Krebs 2, F Hoppichler 3, B Ludvik 4

Introduction

Little is known about bone mineral density (BMD) during surgically induced weight loss after omega-loop gastric bypass (OLGB). The role of vitamin D deficiency in postoperative bone loss is not fully understood, nor has use of supplements been proven to reverse this process. We evaluated BMD after OLGB as a function of vitamin D status and assessed a minimum 25-hydroxy vitamin D [25(OH)D] concentration or threshold, which should be obtained by supplementation to decelerate bone loss in the first year.

Methods

A total of 50 bariatric patients who were recruited for a randomized controlled trial of vitamin D supplementation were included in this analysis. They were divided in patients who revealed serum 25(OH)D concentrations ≥50 nmol/l at 6 (T6) and 12 months (T12) postoperatively (adequate vitamin D group; AVD) and in those < 50 nmol/l at T6 and/ or T12 (inadequate vitamin D group; IVD). The patients underwent BMD, anthropometric, and laboratory measurements (bone turnover markers: C-telopeptide, osteocalcin, alkaline phosphatase, procollagen type 1 N-terminal propeptide, 25(OH)D, intact parathyroid hormone iPTH) before surgery, at T6 and T12.

Results

A 25(OH)D concentration ≥50 nmol/l postoperatively (AVD group) had a significant effect on changes in lumbar spine, left hip, forearm, and total body BMD, compared to the IVD group (< 50 nmol/l) in the first year (Figure 1). The relative declines in BMD were lower in the AVD compared to the IVD group. OLGB resulted in a large reduction in body weight by 35% in morbidly obese patients with a decrease in total body fat and an increase in fat-free mass. In total, a significant decrease in BMD was seen in lumbar spine by 7%, left hip by 13%, and in total body by 1%, but not in the forearm. Bone turnover markers increased significantly but all patients demonstrated normal iPTH concentrations. Weight loss was not associated with changes in BMD. However, lower bone loss in the left hip showed a strong correlation with a higher increase in 25(OH)D (r = 0.635, p = 0.003).

Conclusion

These findings support a dose effect of vitamin D supplementation on bone health and suggest that 25(OH)D at least need to be above 50 nmol/l during the first postoperative year to decelerate bone loss in patients undergoing OLGB.

Conflicts of Interest

This study was partly supported by the Austrian Biobanking and BioMolecular resources Research Infrastructure funded by the Austrian Federal Ministry of Science, Research and Economy (GZ 10.470/0016-II/3/2013) and by SIPCAN (Special Institute for Preventive Cardiology And Nutrition; Salzburg) for personnel costs.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):47.

O7.5 Do elderly obese patients benefit less from bariatric surgery? Lessons from morbidity and mortality rates: The Israeli Bariatric Surgery Registry

D Dicker 1, O Romano-Zelekh 2, N Sakran 3, T Shohat 4, I Raz 2

Introduction

Bariatric surgery (BS) is effective treatment to reduce morbidity and mortality in obese patients, yet the effects on elderly obese patients are still uncertain. Recent systemic review reported higher complications and mortality rates and less weight loss for laparoscopic Roux-en-Y Gastric Bypass (RYGB) in obese patients ≥60 years than in younger obese patients.

Methods

Data were obtained from the National Registry of BS, initiated in 06/ 2013. 13 hospitals that perform BS in Israel submit data on a monthly basis. Data are collected according to a structured electronic questionnaire, and subject to routine quality controls. Data collected for this study included age, gender, BMI, comorbidities, operative data and mortality. All patients who underwent BS in Israel between 06/2013 − 12/2016 were included in the study.

Results

The respective data for patients < 65 years (31,645) and ≥65 years (994) were: male (32.3%, 42.8% p < 0.001), mean age (41.1+11.9 years, 67.7+2.4 years, p < 0.001), baseline mean BMI (42.3+5.3kg/m2, 42.1+5.6kg/m2 p < 0.423); 7.9%, 9.2% had Gastric Band; 74.5%, 68.9% Sleeve Gastrectomy, 16.4%, 21% RYGB; 12.2%,14.8% (p < 0.023) had redo surgery. Length of follow up was 1.87 and 1.75 years, respectively. % Estimated Weight Loss 1-year post-operative was 76.1+38.9, 63.7+24.8, respectively (p < 0.001). In a multivariate linear regression model, age ≥65 years, high baseline BMI and number of comorbidities correlated with lower weight loss. Complication during hospitalization rates were 3.7% and 5.9%, respectively. In Multivariate Logistic regression the odds ratio for complications was higher for males (1.24, 95% CI, 1.10–1.48, p < 0.001), more comorbidities (1.33, 95% CI, 1.19–1.49, p < 0.001), and lower for married (0.84, 95% CI, 0.72–0.97, p < 0.02) patients, with reported good health (0.76, 95% CI, 0.64–0.911, p < 0.002) and after laparoscopy (0.123, 95% CI, 0.08–0.177, p < 0.001). Length of hospital stay was 2.8 + 3.2, and 3.1+2.6 days, respectively (p < 0.007). Mortality.105 (0.33%) and 20 (2.0%) deaths were documented, respectively. In Multivariate logistic regression Odds ratio for mortality was higher for age ≥65 years (4.35, 95% CI, 2.34–8.06, p < 0.001), males (1.60, 95% CI, 1.02–2.52, p < 0.039), higher baseline BMI (1.07, 95% CI, 1.02–1.11, p < 0.001), more comorbidities (1.80, 95% CI, 1.27–2.57, p < 0.001) and diabetes (1.79,95% CI, 1.05–3.05, p < 0.001); and lower for patients who were married (0.40, 95% CI, 0.23–0.67, p < 0.001), reported high energy level (0.31, 95% CI, 0.30–0.94, p < 0.031), and underwent laparoscopy (0.39, 95% CI, 0.08–0.93, p < 0.039). Cause of death. Deaths considered directly caused by the surgery were 27 (26%) and 3 (15%), respectively and included leaks (12.4%, 5.0%), infections (2.95%, 5.0%) and cardiac causes (3.8%, 0%). Deaths caused indirectly by the surgery included malignancies (21.9%, 35.0%), late cardiac causes (9.5%, 10.0%), suicide (5.7%, 0%), late infections (4.8%, 10%), thrombosis (2.9%, 0%), and renal disease (1.9%, 0%).

Conclusion

BS in elderly obese patients leads to less weight loss and higher complications and mortality rates than in younger obese patients. Nevertheless, age was not a significant cause for in hospital post BS complication and 85% of the death cause in the elderly was not directly related to the BS.

Obes Facts. 2018 May 26;11(Suppl 1):47–48.

O7.6 Bariatric surgery reduces malignant melanoma incidence in the Swedish Obese Subjects study

M Taube 1, M Peltonen 2, K Sjöholm 1, Å Anveden 1, JC Assarsson 1, P Jacobson 1, M Bergö 3, L M Carlsson 1

Introduction

Obesity is an established cancer risk factor and some studies indicate that intentional weight loss sometimes reduces the risk. However, evidence for a link between obesity, weight loss, and malignant melanoma is limited. Here, we used data from the matched Swedish Obese Subjects (SOS) study – a prospective controlled intervention trial examining bariatric surgery outcomes – to analyze the impact of weight loss on melanoma incidence.

Methods

The SOS study (ClinicalTrials.gov, identifier: NCT01479452) is an ongoing, prospective, and matched intervention trial comparing bariatric surgery with conventional obesity treatment In brief, the surgery group consists of 2010 subjects who chose surgical treatment, and the control group consists of 2037 individuals matched for 18 variables. To analyze malignant melanma incidence, Kaplan-Meier estimates of cumulative incidence rates were used to compare time to first melanoma cancer diagnosis between the different treatment groups. Furthermore, Cox proportional hazards models were used to calculate hazard ratios between the surgery and control groups.

Results

We found that bariatric surgery markedly reduced the risk of melanoma With a median follow-up time of 18.1 years (interquartile range 14.8–20.9 years, maximum 26 years) we observed a reduced risk of malignant melanoma (HR = 0.39; 95% CI 0.20–0.78; p = 0.008; median follow-up = 18.1 years) by bariatric surgery; and a reduced the risk of skin cancer in general (hazard ratio (HR = 0.58; 95% CI 0.34–0.99; p = 0.044).

Conclusion

In this long-term study, bariatric surgery reduced the risk of malignant melanoma. This finding supports the idea that obesity is a melanoma risk factor, and indicates that weight loss in individuals with obesity can reduce the risk of a deadly cancer form that has increased steadily over several decades.

Conflicts of Interest

MOB has received speaker fees from Baxter Medical and LEO Pharma; LMSC has recieved lecture fees from AstraZeneca, Johnson & Johnson and Merck Sharpe & Dohme. The other authors declare no conflict of interest.

Obes Facts. 2018 May 26;11(Suppl 1):48.

A Randomised, Phase 2, Placebo- and Active-Controlled Dose-Ranging Study of Semaglutide For Treatment of Obesity in Subjects Without Diabetes

J Wilding 1, AL Birkenfeld 2, B McGowan 3, O Mosenzon 4, SD Pedersen 5, S Wharton 6, M Kabisch 7, CG Carson 7, PM O’Neil 8

Introduction

The global rise in the prevalence of obesity and its comorbidities is a major public health challenge. The incretin GLP-1 regulates both insulin secretion and appetite, and significant weight loss has been observed among subjects treated with the GLP-1 receptor agonists liraglutide (LIRA) and semaglutide (SEMA). The use of SEMA for treatment of obesity without diabetes was evaluated in a Phase 2 clinical trial.

Methods

This was a multinational, randomised, double-blinded, dose-ranging study (NCT02453711) of SEMA versus placebo (PBO) and an active LIRA control (3 mg), each with dietary and physical activity counselling. Eligible subjects were adults with obesity (BMI ≥30 kg/m2) without diabetes and with at least one previous non-surgical attempt at weight loss. Participants were randomised to receive PBO or active treatment with either once-daily subcutaneous SEMA at doses of 0.05, 0.1, 0.2, 0.3, or 0.4 mg (starting at 0.05 mg and escalating every 4 weeks to target dose) or with once-daily subcutaneous LIRA 3 mg (weekly escalation from 0.6 mg), in a 6:1 active: PBO ratio. Each active group had a PBO counterpart of matching injection volume and escalation schedule; all PBO groups were pooled for analysis. Two additional faster-escalation SEMA groups are not presented here. The primary endpoint was change in body weight (%) from baseline (BL) to week 52 (ANCOVA model; region, sex, and BL body weight as covariates).

Results

A total of 957 subjects (35% male) were randomised and treated (102–103 per active arm; 136 pooled PBO). Mean (range) BL characteristics were: age 47 (18–86) years, weight 111 (70–244) kg, and BMI 39 (30–80) kg/m2. Overall, 93% (892/957) had body weight data at Week 52 (81% on drug, 12% discontinued). Estimated mean weight losses from BL to Week 52 were –2.3% (PBO) and –7.8% (LIRA 3 mg), vs –6.0% (0.05 mg; P = 0.001 vs PBO), –8.6% (0.1 mg), –11.6% (0.2 mg), –11.2% (0.3 mg) and –13.8% (0.4 mg; P < 0.0001 vs PBO for 0.1–0.4 mg). All comparisons remained significant after adjustment for multiple testing. Mean weight loss for 0.2–0.4 mg were all P < 0.01 (unadjusted) vs LIRA 3 mg. Weight loss ≥5% occurred in an estimated 23% (PBO) and 66% (LIRA 3 mg) vs 54% (0.05 mg), 67% (0.1 mg), 75% (0.2 mg), 81% (0.3 mg), and 83% (0.4 mg) of subjects (all P < 0.0001 vs PBO). Weight loss ≥10% occurred in an estimated 10% (PBO) and 34% (LIRA 3 mg) vs 19% (SEMA 0.05 mg; P = NS vs PBO), 37% (0.1 mg), 56% (0.2 mg), 58% (0.3 mg), and 65% (0.4 mg) of subjects (P < 0.0001 vs PBO for 0.1–0.4 mg). All SEMA doses were generally tolerated; there were no new safety concerns observed. The most common adverse events on SEMA were dose-related gastrointestinal events as seen previously with GLP-1 receptor agonists.

Conclusion

In combination with dietary and physical activity counselling, all SEMA doses from 0.05 to 0.4 mg daily were tolerated and resulted in dose-related reductions in body weight that were superior to PBO among people with obesity without diabetes.

Conflicts of Interest

Novo Nordisk advisory board members (AB), research investigators/grants (RI), speakers (SP), consultants (CN), or employees (EM): JW and SDP (AB, RI, SP, CN); ALB and PMO’N (AB, RI); BM (AB, RI, lectures); OM and SW (AB, RI, SP); MK and CGC (EM).

Obes Facts. 2018 May 26;11(Suppl 1):48.

O8.2 Weight Loss and Alteration in Dietary Preferences in Humans Due To Reduction of Smell By A Novel Nasal Device Varies With Age

D Dicker 1, D Marcovicu 1, A Markel 2, S Mazzawi 2, E Greenberg 3, A Beck 3

Introduction

The role of olfaction in regulating appetite, food intake, and body weight has been studied extensively, but is so complex that we have only begun to understand this system. Exposure to food odors increases food intake and loss of smell reduces food intake. Smell is reduced in overweight/obesity, but obese people have a greater stimulation of appetite when exposed to food odors. Of particular note, olfaction declines starting about age 50. No studies have deliberately reduced smell and assessed weight loss in human beings.

Methods

The objectives of this pilot study were to determine if a nasal insert would reduce the ability to smell, reduce body weight, alter dietary preferences, and improve metabolic dysfunction. A randomized, single blind, controlled study of adults suffering from obesity. Experimental subjects wore a soft silicone nasal insert for 5–12 hours per day and control subjects inserted two drops of normal saline into each nostril daily. Follow up visits occurred every two weeks. All subjects were given a −500 kcal/d diet. Weight, olfactory sensitivity, and glucose, insulin, and lipid assays were performed at baseline and end of study.

Results

Sixty five subjects completed the study: 37 in the study group 28 in control; The nasal device reduced smell significantly (p < 0.001) while saline drops did not change olfaction. All subjects lost weight, but the primary outcome of weight loss showed no significant difference between device and control in the whole population. However, a secondary analysis by age above or below 50 years showed significant weight loss in the < 50 age group compared to control (7.7% ± 4.2% vs 4.1% ± 2.9%, p < 0.02). Dietary preferences for sugar, sweet beverages and artificial sweeteners were significantly reduced in the < 50 group but not in the older group. Insulin results in the < 50 group showed a trend (−1.7 ± 3.8 vs. 2.0 ± 6.0, p = 0.069). Systolic blood pressure was significantly reduced in the < 50 group (−16.5 ± 12.9 vs. −4.2 ± 14.0, p = 0.03) but not in above 50. No serious adverse events occurred.

Conclusion

A novel self-administrated nasal device that reduces smell caused weight loss and reduced dietary preference for sweets in subjects < 50 years. Further studies should be conducted to explore this new option and to determine the role of this device for treatment of obesity and diabetes.

Conflicts of Interest

Beck Medical Funded the study. Adva Beck is the entrepreneur and main share holder in Beck Medical ltd. Dr. Elhanan Greenberg serves as advisory to Beck Medical, E.N.T Head and Neck Surgery Specialist and is a small share holder.

Obes Facts. 2018 May 26;11(Suppl 1):49.

O8.3 Virtual Follow-Up (FU) program enhances weight-loss results post Elipse balloon: An innovative, digital patient-friendly approach.

R Ienca 1, C Giardiello 2, R Schiano 2

Introduction

Elipse is a novel, procedureless intragastric balloon that is swallowed and is spontaneously excreted after a 4-month gastric residence. Intragastric balloons are effective for weight-loss, but weight-loss maintenance after balloon removal or passage is challenging. Literature suggests inadequate follow-up as an important cause for weight regain. The aim of our study was to evaluate an innovative, digital follow-up program developed for the Elipse balloon.

Methods

This prospective, randomized controlled study followed 20 Elipse patients every 2 weeks for 8 months following device excretion. Group A (10 pts) received virtual FU that allowed us to be in contact with them as needed, while Group B (10 pts) did not and were used as controls. Every patient received a weighing scale that connected via Bluetooth to their mobile phone in order to share their weight and body composition with us. This virtual FU platform also offered an exercise and eating plan with nutritional advice. Diet adherence was evaluated by means of a 3-day alimentary diary, and obesity related disability was measured using the TSD-OC at time 0 (Elipse placement), at T1 (Elipse excretion), and at T2 (12 months post-placement).

Results

20 Patients (5M/15F) with average age 36y were followed for 12 months post Elipse placement. During the 4-month treatment their mean BMI decreased from 36.6 to 31.6 (5 points) and mean weight decreased from 99.4kg to 83.4kg (16kg). After 8 months of follow up, in Group A 12% had lost additional weight, 69% maintained their weight loss, and 19% regained weight, and in Group B none lost additional weight, 62% maintained their weight loss, and 38% regained weight. The average obesity related disability score decreased from 67% to 38% during Elipse treatment, with a further reduction to 29% in Group A and a stabilization to 41% in group B at the end of the 8-month FU period. Adherence to a Mediterranean diet was maintained in all 10 in Group A and only 7 in Group B.

Conclusion

This pilot study demonstrates, for the first time, enhancement and maintenance of weight-loss results by utilizing an innovative digital virtual follow-up program after Elipse Balloon placement. This also resulted in a decrease in obesity related disability score. In an era of widespread use of digital technology, this may lead to new applications in obesity management.

Fig. 1.

Fig. 1

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Tab. 1.

TSD-OC Score at 4 Months and 12 Months After Elipse Placement

 Group A
 Group B
 p Value
TSD-OC score
T0 Elipse placement 67% 67%
T1 Elipse excretion 38% 38%
T2 12 months post placement 29% 41% p < 0.05
Weight profile during follow up
Lost additional weight 12% 0
Maintained weight 69% 62%
Re-gained weight 19% 38% p = 0.02
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Obes Facts. 2018 May 26;11(Suppl 1):49.

O8.4 Prevotella-to-Bacteroides ratio predicts body weight and fat loss success on 24-week diets varying in macronutrient composition and dietary fiber

M F Hjorth 1, T Blædel 1, LQ Bendtsen 1, JK Lorenzen 1, LH Larsen 1, JB Holm 2, P Kiilerich 2, K Kristiansen 2, HM Roager 3, A Astrup 1

Introduction

Individuals with high pre-treatment microbial Prevotella-to-Bacteroides (P/B) ratio have been reported to lose more body weight on diets high in fiber than subjects with a low P/B ratio. Therefore, the aim of the present study was to examine potential differences in dietary weight loss responses between participants with low and high P/B.

Methods

Eighty overweight participants were randomized (52 completed) to a 500 kcal/d energy deficit diet with a macronutrient composition of 30 energy percentage (E%) fat, 52 E% carbohydrate and 18 E% protein either high (≈1500 mg calcium/day) or low (≤600 mg calcium/day) in dairy products for 24 weeks. Body weight, body fat (by DXA), and dietary intake (by 7-day dietary records) were determined. Individuals were dichotomized according to their pre-treatment P/B ratio derived from 16S rRNA gene sequencing of collected fecal samples in order to test the potential modification of dietary effects using linear mixed models.

Results

Independent of the randomized diets, individuals with high P/B lost 3.8 kg (95%CI, 1.8,5.8; P < 0.001) more body weight and 3.8 kg (95% CI, 1.1, 6.5; P = 0.005) more body fat compared to individuals with low P/B. Using median split of self-reported dietary intake, individuals with high P/B lost more body weight when consuming a diet high in dietary fiber [6.8 kg (95% CI, 3.5, 10.0; P < 0.001)], carbohydrate [6.8 kg (95% CI, 4.1, 9.5; P < 0.001)], protein [6.2 kg (95% CI, 2.9, 9.5; P < 0.001)], and low in fat [3.1 kg (95% CI, 0.1, 6.2; P = 0.042)]. No differences were found among individuals with low P/B (0.3–1.0 kg; P ≥ 0.35). Weight loss among individuals with no detectable Prevotella (n = 8) also differend according to self-reported dietary intake (See table 1).

Conclusion

Individuals with high P/B lost more body weight and body fat compared to individuals with low P/B, confirming that individuals with a high P/B are more susceptible to weight loss on a diet rich in fiber, carbohydrate, and protein as well as low in fat.

Conflicts of Interest

MFH and AA are co-inventers on a pending provisional patent application on the use of biomarkers for prediction of weight loss responses. The present stratified analysis was supported by a grant from Gelesis Inc. AA is consultant for Gelesis Inc.

Obes Facts. 2018 May 26;11(Suppl 1):50.

O8.5 Enrichment of health-associated gut bacteria after a short-term dietary intervention in elderly obese subjects

R Cancello 1, S Turroni 2, L Cattani 3, S Cattaldo 4, S Mai 4, R Vietti 4, M Scacchi 5, P Brigidi 2, C Invitti 1

Introduction

Preservation of gut microbiota homeostasis during aging may possibly support health maintenance. The risk of morbidity is particularly high in obese elderly patients whose gut microbiota composition has not been thoroughly characterized. We compared the intestinal microbiota of elderly obese with that of elderly non obese individuals and examined the effect of a short term balanced Mediterranean hypocaloric diet in modifying gut microbiota composition.

Methods

In 26 obese patients, mean age 78.9 yrs, BMI 40.5 ± 6 kg/m2, fecal samples for microbiota assessment were collected 1–2 days before the admission at the Istituto Auxologico Italiano for a weight loss intervention (T0), 15 days after a balanced Mediterranean hypocaloric diet (mean caloric intake 1600 ± 120.9 Kcal/die) (T1) and after the following 15 days during which the diet was associated with one daily supplementation of a probiotic mixture (VSL#3). T0 samples were compared with those of a group of non-obese elderly individuals (mean age 72.5 yrs). Fecal microbiota was characterized by Illumina sequencing of the V3–V4 region of the bacterial 16S rRNA gene.

Results

Elderly obese patients showed typical alterations of the microbiota found in obesity and related complications, with an increase, compared to non-obese elderly subjects, in potential pro-inflammatory components, such as Collinsella andStreptococcus, and Lactobacillus, and a decrease in health-promoting, short-chain fatty acid producers. The supplementation with VSL#3 did not substantially modify the changes in the microbiota observed with the only diet. Gut microbiome biodiversity decreased with BMI increase. 15 days of diet induced a 2.4% weight loss and were able to modulate the microbiota dysbiosis, counteracting the rise of pro-inflammatory species and resulting in an increase of Methanobacteriaceae and Akkermansia, a mucin-degrading bacterium typically related to BMI reduction and improved metabolic profile. The following 15 days of diet+VSL#3 induced a further 1.4% decrease in weight and improvement in oxidative stress parameters but did not substantially modify the changes in the microbiota observed with the diet alone.

Conclusion

The recovery of a health-promoting gut microbial configuration may be rapidly obtained in obese elderly subjects by a short-term balanced Mediterranean hypocaloric diet. This finding underlines the relevance of a correct dietetic approach to counteract the increased risk of morbidity of these patients.

Obes Facts. 2018 May 26;11(Suppl 1):50.

O8.6 Early achievement of significant weight loss with naltrexone/bupropion is associated with additional weight loss and improved glycemic control at 1 year in patients with type 2 diabetes

L Acevedo 1, A Halseth 1, K Gilder 2, R Plodkowski 3, P Hollander 4

Introduction

Prolonged-release naltrexone 32 mg/bupropion 360 mg (NB) is approved for chronic weight management as an adjunct to diet and physical activity. A phase 3 study in participants with type 2 diabetes mellitus (T2DM) demonstrated significantly greater weight loss with NB versus placebo (PBO). As early response to treatment predicts long-term weight loss, the current analysis was performed to evaluate weight loss and glycemic effects in early responders, which is defined as participants who achieve 35% weight loss at Week 16.

Methods

Efficacy analyses were performed on the full analysis set (FAS), defined as randomized participants with at least one post-baseline weight measurement while on study drug.

Results

Baseline characteristics (BL) in the FAS (N = 265 NB, N = 159 PBO) were similar between treatment groups: 54% female, with mean BL age of 54 years, BMI of 36.6 kg/m2, HbA1c of 8.0%, and fasting plasma glucose (FPG) of 161 mg/dL. Weight loss of 35% at Week 16 was achieved in 41% of NB participants and 13% of PBO participants. 88% of NB early responders (NB-Responders) completed 56 weeks of treatment. In NB-Responders, mean (SE)% weight loss at Week 16 was 8.5 (0.2)%, and at Week 56 it was reduced by 9.1 (0.5)% from BL. At Week 56 NB-Responders exhibited a least squares (LS) mean (SE) change of −1.01 (0.09)% in HbA1c versus PBO 0.14 (0.09)%; FPG decreased 19.5 (3.6) mg/dL in NB-Responders versus 4.0 (3.4) mg/dL in PBO. Change in HDL cholesterol in NB-Responders was 5.4 (0.8) mg/dL versus −0.3 (0.6) mg/dL in PBO. The most common reason for the discontinuation of study drug was due to adverse events (NB 29%, PBO 15%). The safety profile has been previously published and was similar to that of Phase 3 study participants without T2DM.

Conclusion

Participants treated with NB that achieved 35% weight loss by Week 16 exhibited additional weight loss and improved glycemic parameters at 1 year, and the majority continued treatment to study end, supporting the use of the Week 16 criteria to predict longer term outcomes in patients with T2DM.

Conflicts of Interest

L. Acevedo, A. Halseth, and K. Gilder are employees and stockholders of Orexigen Therapeutics. R. Plodkowski and P. Hollander are consultants for Orexigen Therapeutics.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):51.

O9.1 Predictors of weight loss maintenance after clinically significant weight loss: a 12-month longitudinal study

E H Evans 1, K Sainsbury 2, C Duarte 3, BL Heitmann 4, L Lähteenmäki 5, M Matos 6, PJ Teixeira 7, RJ Stubbs 3, FF Sniehotta 2

Introduction

Longitudinal studies of weight loss maintenance (WLM) are few. Most evidence regarding the determinants of successful WLM comes from select samples (clinical weight-loss trial follow-up or national registries). Understanding WLM in the general population may facilitate development of wider, effective interventions for WLM beyond research or clinical contexts. This observational longitudinal study examined predictors of successful WLM amongst individuals attempting to maintain clinically significant weight loss.

Methods

1803 adults attempting WLM after reaching their individually-chosen goal weight were recruited from a UK commercial weight loss provider’s mailing list: the provider had no further involvement with the study. Inclusion criteria were pre-weight loss BMI of ≥25kg/m2 and objectively-verified weight loss of ≥5% within the preceding 12 months. Participants completed an online survey at baseline, 6 and 12 months, assessing WLM motivation, planning, habits, health behaviours and lapses, emotional dysregulation, affect and adherence to weight management strategies. Objectively-measured retrospective and prospective weight records were provided by the weight loss provider’s in-group data acquisition systems. Predictors of 12-month WLM (residualised change score from baseline to 12 months) were examined using multiple regression analyses, controlling for baseline demographics and pre-weight loss BMI.

Results

Mean (SD) weight loss at baseline was 14.8 ± 9.2 kg (17 ± 8%), and BMI was 24.5 ± 2.4 kg/m2. Mean (SD) weight regain was 0.7 ± 2.9 kg by 6 months and 1.5 ± 3.0 kg by 12 months. At 12 months, 90% of participants remained ≥5% below their start weight. Individuals with more successful WLM at 12 months had lower baseline emotion dysregulation and, between baseline and 12 months, showed increases in action planning, increased intrinsic motivation for WLM and increased automaticity of healthy eating, and deviated less frequently from their healthy eating and physical activity plans. In the final model, these predictors accounted for 28% of variance in WLM (all β values had p < 0.01). Time since goal weight was achieved, and proportion of body weight initially lost, did not predict degree of WLM.

Conclusion

Lower initial emotion dysregulation and increases over time in several key behavioural variables significantly increased the likelihood of WLM after large and clinically-significant weight loss in individuals with initial overweight or obesity. WLM interventions might profitably target these variables, which included emotion regulation, planning, making healthy eating a habit, avoiding behavioural lapses and developing intrinsic motivations. This project (NoHoW: Evidence-based ICT solutions for weight loss maintenance) has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement No. 643309.

Obes Facts. 2018 May 26;11(Suppl 1):51.

O9.2 The relationship between dietary restraint and weight trajectories in successful weight-loss maintainers

M De Zwaan 1, M Neumann 1, A Hilbert 2, A Müller 1

Introduction

Dietary restraint has a complex relationship with weight trajectories.

Methods

We measured dietary restraint using the restraint scale of the German version of the Dutch Eating Behavior Questionnaire (DEBQ) in 494 weight loss maintainers (WLM) of the German Weight Control Registry (GWCR). Baseline values were compared with a representative sample of the German population (n = 2513). In addition, the WLM of the GWCR were followed-up for 2 years and were divided into 2 groups: those with stable weight (SW, n = 280) and those with unstable weight (USW, n = 160) defined as weight regain of more than 5% compared to baseline weight and/or weight cycling of more than 5 kg in the 2-year follow-up period.

Results

At baseline participants of the GWCR reported significantly higher values of restrained eating compared to the general population sample with an OR of 5.5 (95%CI: 4.7–6.5), even after controlling for differences in sociodemographic variables. Also, participants with unstable weight trajectories reported significantly higher restrainede eating scores compared to participants with stable weight trajectories. Restrained eating scores decreased significantly during the 2-year follow-up period in both groups. However the decrease was markedly steeper in the group with unstable weight and at the 2-year assessment point the scores did not differ any more between the weight trajectory groups.

Conclusion

Higher dietary restraint seems to be necessary to maintain weight loss especially if it is associated with constant monitoring and vigilance. The strong decrease in dietary restraint in GWCR participants with unstable weight trajectories can be interpreted in 2 ways. When individuals who restrain their intake consume food that is inconsistent with their dietary restraint goal and gain weight, this might produce a disinhibited state followed by a breakdown in self-regulation including dietary restraint. However, it has repeatedly been shown that elevated dietary restraint efforts are usually observed as a response to unsuccessful weight management. On the other hand, some individuals with high dietary restraint might not be able to keep it up over an extended period of time.

Obes Facts. 2018 May 26;11(Suppl 1):51–52.

O9.3 Impact of bariatric surgery on relationship status: Results from two Swedish cohort studies

P Svensson 1, G Bruze 2, T Holmin 1, M Peltonen 3, J Ottosson 4, K Sjöholm 1, I Näslund 4, M Neovius 5, LM Carlsson 1

Introduction

Bariatric surgery is an effective treatment for obesity that results in durable weight-loss. However, while the effects of bariatric surgery on many disease outcomes are well documented, information about the psychosocial impact of bariatric surgery is more limited and very little is known about its effects on interpersonal relationships. The aim of this study was to investigate if relationship status is altered after bariatric surgery.

Methods

Changes in relationship status after bariatric surgery were examined in two cohorts: (1) the prospective Swedish Obese Subjects (SOS) study in which bariatric surgery is compared with matched obese controls receiving usual care (recruitment 1987–2001, median follow-up 10 years, 1958 bariatric surgery patients and 1912 controls); and (2) participants from the Scandinavian Obesity Surgery Registry (SOReg; a prospective, electronically captured register, recruitment 2007–2012, median follow-up 2.9 years, 29234 gastric bypass surgery patients) and 283748 matched comparators from the general population (matched on age, sex and place of residence). In the SOS study, information on relationship status was obtained from questionnaires. In the SOReg/general population cohort, information on marriage and divorce was obtained from the Swedish Total Population Registry.

Results

In the SOS study, bariatric surgery was associated with increased incidence of divorce/separation compared to controls for those in a relationship (adjusted hazard ratio [adjHR] = 1.28 [95%CI, 1.03–1.60], P = 0.03) and increased incidence of marriage or new relationship (adjHR = 2.03 [95%CI, 1.52–2.71], P < 0.001) in those who were unmarried/single at baseline. In the SOReg/general population cohort, gastric bypass was associated with increased incidence of divorce compared to the general population in married participants (adjHR = 1.41 [95%CI, 1.33–1.49], P < 0.001) and increased incidence of marriage in those who were unmarried at baseline (adjHR = 1.35 [95%CI, 1.28–1.42], P < 0.001). Within the surgery groups, changes in relationship status were greater in those with larger weight-loss.

Conclusion

In addition to its effects on obesity co-morbidities, bariatric surgery-induced weight-loss is also associated with changes in relationship status.

Conflicts of Interest

Dr Carlsson has obtained lecture fees from AstraZeneca, Johnson&Johnson, and MSD. Dr Näslund has obtained personal fees for speeches and consultation from Baricol Bariatrics AB, Sweden. No other disclosures were reported.

Obes Facts. 2018 May 26;11(Suppl 1):52.

O9.4 Perception of self and body image impacts vulnerability to type 2 diabetes

A Volkmann 1, L Hesseldal 2, M Bagger 2, D Napier 3

Introduction

Today, 650 million people globally are obese, and almost two billion overweight.1 Because the most significant modifiable driver of type 2 diabetes (T2D) is excess body weight, reducing weight must also be part of diabetes prevention and management at population and individual levels. Lifestyle modification and interventions have shown to be effective in weight reduction and diabetes prevention, but they are significantly influenced by environmental, social, and cultural factors. The way a person integrates oneself into the social environment and comparatively evaluates what is normative can create explicit vulnerability to T2D. When normative body images change, so does the perception of what a ‘healthy body’ might look like. In a setting where large body size is accepted as normal or even desirable, such a view can have a significant negative effect on biological risk factors for T2D as it normalises overweight. Conversely, stigma and shame are anchored in perceptions of one’s own body in comparison to others.

Methods

Vulnerability Assessments2 were carried out in Copenhagen, Houston, Mexico City, Shanghai, Tianjin to understand what makes certain people vulnerable to T2D by identifying relevant environmental, social and cultural factors. In total, 740 individual semi-structured interviews were conducted as part of the assessments which also included ethnographic and demographic data collection. The research was part of Cities Changing Diabetes created in partnership between Novo Nordisk, Steno Diabetes Center Copenhagen, University College London and local partners.

Results

The research identified a set of social factors and cultural determinants relevant to T2D vulnerability. Those factors were shared across cities but manifested in different ways locally. A key determinant regarding overweight, obesity and diabetes was ‘Perception of Self and Other.’ We identified multiple ways in which this determinant contributed to a person’s understanding of self in relation to others and how it impacted health. Participants made reference to other individuals in their environment and wider society to define themselves through differentiation. Mexico City: current body image and dietary behaviours were impacted by demographic, epidemiologic and nutritional transitions and an overall shift towards a new normative larger body size. Houston: comparing one’s own large body size favourably to others created a scenario where weight change was perceived as unnecessary. Several obese participants referred to body size of others in a negative manner (which they perceived to be excessive), in order to ‘normalise’ their own overweight. Copenhagen: some obese people did not go to gyms and fitness clubs because they perceived themselves as ‘bigger than average’ and felt uncomfortable. Shanghai and Tianjin: recent memory of hunger and food scarcity created an obesogenic environment where larger body sizes were perceived as desirable and signalling good health.

Conclusion

‘Perception of Self and Other’ impacts vulnerability to T2D. Awareness of this determinant and insights on how it manifests locally should inform and guide local tailor-made interventions.

Conflicts of Interest

I am an employee and stock/shareholder of Novo Nordisk.

References

  • 1. WHO: Obesity and overweight Fact sheet 311. 2015.
  • 1. Napier: Diabetes vulnerability assessment tool. UCL 2014.
Obes Facts. 2018 May 26;11(Suppl 1):52–53.

O9.5 Pre- and postbariatric subtypes and their predictive value for long-term surgery outcomes

L Schäfer 1, C Hübner 1, T Carus 2, B Herbig 3, F Seyfried 4, S Kaiser 5, A Dietrich 1, A Hilbert 1

Introduction

Bariatric surgery is the most effective treatment for severe obesity. However, 20–30% of patients achieve insufficient postbariatric weight loss and only minor psychosocial improvements in the long term. Differences in surgery outcomes may be influenced by heterogeneous psychological profiles in bariatric patients regarding impulsivity, emotion dysregulation, and disinhibited eating. The present study aimed to subtype patients based on these aspects before and two years after bariatric surgery and tested the predictive value of the identified pre- and postbariatric subtypes for health-related outcomes assessed three years after surgery.

Methods

N = 229 bariatric patients were examined before, two and three years after bariatric surgery via clinical interviews and self-report questionnaires within a prospective multicenter patient registry. Using latent profile analyses, pre- and postbariatric subtypes were differentiated by temperament, emotion dysregulation, and disinhibited eating. The subtypes were externally validated with general and eating disorder psychopathology. The predictive value of the pre- and postbariatric subtypes for surgery outcomes measured three years after surgery was tested via linear regression analyses.

Results

Latent profile analyses resulted in five prebariatric and three postbariatric subtypes with distinct characteristics regarding self-control, emotion regulation, and disinhibited eating that were significantly associated with different levels of general and eating disorder psychopathology. Post- versus prebariatric subtypes explained more variance regarding eating disorder psychopathology, depression, and quality of life assessed three years after surgery. Neither pre- nor postbariatric subtypes predicted weight loss three years after surgery.

Conclusion

The present study emphasized the superiority of postbariatric over prebariatric subtypes in predicting health-related outcomes three years after bariatric surgery. Accordingly, a re-evaluation of patients’ psychological status after bariatric surgery is recommended in order to detect postbariatric patients with potential risk for adverse surgery outcomes in the long term due to their deficits in self- and emotion regulation.

Obes Facts. 2018 May 26;11(Suppl 1):53.

O9.6 Self-regulation and eating behaviour traits in preschool children

L Afonso 1, S Torres 2

Introduction

Self-regulation in eating is known as the ability to start and stop eating in accordance with the maintenance of energy balance. Poorer eating self-regulation has been associated with higher food intake and weight status, during childhood. This study aims to evaluate the association between self-regulation in eating and eating behaviour traits, namely food approach and avoidance.

Methods

A pilot study was conducted with 35 parents of preschool children in Portugal. Parents completed two self-report measures: a) ‘Children’s Self-regulation in Eating Questionnaire’, that evaluates self-regulation in eating; b) ‘Children’s Eating Behaviour Questionnaire’, that measures eating behaviors traits of food approach (subscales of food responsiveness, emotional overeating, enjoyment of food and desire to drink) and food avoidance (subscales of slowness in eating, food fussiness, emotional undereating and satiety responsiveness). Correlations between subscales were determined using Pearson’s correlation coefficient.

Results

Children’s self-regulation in eating was negatively correlated with food approach traits, namely food responsiveness (r = −0.655; p < 0.001), enjoyment of food (r = −0.461; p < 0.001) and desire to drink (r = −0.356; p = 0.04). Regarding food avoidance traits, it showed to be positively correlated with satiety responsiveness (r = −0.376; p = 0.03). No correlation was found with slowness in eating (r = 0.010; p = 0.95), food fussiness (r = −0.210; p = 0.23), emotional overeating (r = −0.229; p = 0.19) and emotional undereating (r = −0.152; p = 0.39).

Conclusion

Children with higher food approach traits shown to have poor self-regulation in eating, what may help clarify behavioral pathways to obesity.

Obes Facts. 2018 May 26;11(Suppl 1):53.

O10.1 How sugary beverages are positioned as better-for-you through their labels

A Brownbill 1, C Miller 1, L Smithers 2, A Braunack-Mayer 2

Introduction

Sugary beverages are a notable contributor to free sugars in the diet and are consequently attracting increased attention from health agencies interested in curbing obesity and associated non-communicable diseases. To combat increasing consumer concerns regarding the health effects of sugar, market research has predicted an increase in the sale of beverages portrayed as ‘better for you’. This has previously been demonstrated by other sections of the food industry, with product labelling being one way in which this message is communicated to consumers.

Methods

This study aimed to examine the ways in which sugary beverages are being portrayed as better-for-you via product labels. During September to November 2016 we undertook an audit of beverage labels within 17 South Australian stores from leading supermarket chains. We content analysed the labels of 945 sugar containing beverages for explicit and implicit features positioning these beverages as healthy or ‘better-for-you’.

Results

Beverages had a high mean sugar content of 8.3g/100ml and most (87.7%) had features on the labels that positioning the beverages as better-for-you. Common features that positioned beverages as better-for-you included associating the product with being natural (76.8%), having a reduced energy or sugar content (48.4%) and suggesting that the beverage contributes to meeting the bodily requirements for nutrition (38.5%) or health (15.1%). Features that positioned beverages as better-for-you were more common on the labels of coconut water, iced tea, sports drink, and juice beverages.

Conclusion

Despite existing regulations of nutrition and health claims on food and beverage products in Australia, beverages high in sugar use features on their labels that position them as healthy or better-for-you. Current regulations should be revised to include a wider range of terminology that is being used to position sugary products as healthy or better-for-you. Health promotion on sugary beverages should also address the sugar content of beverages being positioned in this way.

Obes Facts. 2018 May 26;11(Suppl 1):53–54.

O10.2 An assessment of the legal compliance and consumer understanding of nutrition and health claims used on commercially available ‘meal replacement for weight control’ products

S Rymill 1, WL Hall 1, KL Johnston 2

Introduction

Due to their simplicity and convenience, the use of meal replacement products (MRP) is an important strategy in facilitating both weight loss and maintenance and there is evidence of significant reductions in body weight and improvements in health outcomes when MRP are used as part of a weight loss/management regime1,2 MRP are specially-formulated foodstuffs; the ingredients, compositional criteria, labelling, and use of nutrition and health (NH) claims for which are governed by specific pieces of EU legislation. Whilst there is some evidence that dieters are more likely to make active use of claims on pack due to their ‘health goals’3 there is a paucity of data with regards to both the role of on-label claims in influencing consumers’ evaluation and choice when purchasing products for weight loss, and their overall understanding of these.

Methods

A marketplace assessment enabled the identification of all commercially available MRP shakes sold in the UK. On-pack information for each eligible brand was analysed to assess its compliance for composition, labelling and NH claims in line with relevant EU regulations. To gauge consumers understanding of on-pack NH claims, an internet-based questionnaire was used.

Results

Of the 50 MRP shakes identified, only three brands met all of the relevant compositional and labelling requirements. Furthermore, 79% of all NH claims made were not compliant with the EU Nutrition and Health Claims regulation. A total of 240 respondents (44 male) completed the questionnaire of which 57% reported to be currently on a diet, or had been on one in the last 6 months. In brief, the NH claims reported to be the most understood by this cohort were ‘low fat’ (95%), ‘low calorie (95%)’ and ‘high protein (94%). The least understood NH claims were ‘protects against chronic diseases’ (48%) and ‘Low GI’ (53%). 25% of respondents indicated they understood the meaning of the claim ‘healthy’ and despite a high reported understanding of NH claims by this cohort, the majority of on-pack claims were perceived by respondents as not being true.

Conclusion

Provision of adequate nutrition via the use of MRP as part of a weight loss strategy is necessary to maintain overall nutrient intake. Data obtained from this analysis of commercially available MRP shakes within the UK highlights the need for tighter regulation of MRP with regards to both their composition and labelling but also to prevent the use of unsubstantiated NH claims on-pack, so as to protect consumers and ensure fair market competition.

Conflicts of Interest

Kelly Johnston is employed by LighterLife UK Ltd

References

  • 1.Noakes M, Foster PR, Keogh JB, Clifton PM. Meal replacements are as effective as structured weight-loss diets for treating obesity in adults with features of metabolic syndrome. J Nutr. 2004;134:1894–1899. doi: 10.1093/jn/134.8.1894. [DOI] [PubMed] [Google Scholar]
  • 2.Emily Brindal, Hendrie Gilly A., Taylor Pennie, Freyne Jill, Noakes Manny. Cohort Analysis of a 24-Week Randomized Controlled Trial to Assess the Efficacy of a Novel, Partial Meal Replacement Program Targeting Weight Loss and Risk Factor Reduction in Overweight/Obese Adults Nutrients. 2016 May;8((5)):265. doi: 10.3390/nu8050265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Bialkova S., Sasse L., Fenko A. ‘The role of nutrition labels and advertising claims in altering consumers’ evaluation and choice’. Appetite. (2016);1((96)):pp.38–46. doi: 10.1016/j.appet.2015.08.030. [DOI] [PubMed] [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):54.

O10.3 Reduction of added sugar intake through a nutrition education program in Viennese school children

E Winzer 1, M Luger 1, M Schätzer 2, N Moser 2, J Schätzer 2, C Putzhammer 2, L Angelmaier 3, M Lechleitner 4, A Rieder 1, F Hoppichler 2

Introduction

Preventive health strategies in children, particularly in school children, can help to prevent nutrition-related chronic diseases. Due to the existing infrastructure, school staff, facilities, policies, and environments, the school setting provides a logical choice as a context for implementing interventions. It is postulated that lifestyle interventions can reduce the risk of becoming overweight when incorporated into the curriculum. Therefore, this secondary analysis of a randomized controlled study examined the effects a 5-week nutrition education program on the sugar consumption in fifth-grade school children in Austria.

Methods

A randomized controlled study (pre-post design) from seven secondary schools in Vienna was tested on program efficacy. Twelve intervention classes received the nutrition education program, which was conducted by teachers, and six control classes followed their usual curriculum. Using a semi-quantitative Food Frequency Questionnaire, the intake of added sugars was assessed and the BMI was self-reported.

Results

In 344 children, aged 10.4 (0.8) years, 4% were obese and 14% overweight. At baseline, the intervention group (IG; n = 240) consumed 70.8 (41.7) g or 13.4 (7.8) energy-% of added sugars and the control group (CG; n = 104) 73.3 (44.1) g or 13.8 (8.2) energy-% per day, respectively, (p = 0.619 or p = 0.659; Figure 1). After the intervention a significant added sugars reduction of 13% in the IG and 6% in the CG (p = 0.001) could be observed. By using one-way ANCOVA, a significant difference in the estimated mean reduction of added sugars in grams and energy-% was found between the groups: −10.1 (95%-CI −18.8, −1.5; p = 0.021) g and −2.0 (95%-CI −3.6, −0.4; p = 0.015) energy-% (adjusted for age, sex, school, BMI, migration background, and baseline value). Accordingly, the school nutrition education program lead to a mean reduction of 50 g of added sugars per school week and child. Following food groups contributed to this reduction: sweets & pastries (IG: −23% vs. CG: −1%; p = 0.001) and soft drinks (IG: −31% vs. CG: −13%; p = 0.030).

Conclusion

Through the school nutrition education program, the intake of added sugars has been increasingly reduced. By combining this with modifications of the school environment, this effect might be further enhanced e.g. by optimizing the offer at the school cafeteria.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):54.

O10.4 Healthier diets for families with toddlers: a cluster randomized pilot trial in Finnish child health clinics

S Lehtinen-Jacksy 1, P Kyttälä 1, M Erkkola 2, P Lindfors 1, C Kronberg-Kippilä 3, M Lahti-Koski 4, T Hakulinen 5, SM Räsänen 6, SM Virtanen 3

Introduction

In Finland, the national universal child health clinic (CHC) services provide an excellent arena for promoting healthy lifestyle of families with young children. The services are free of charge and most families visit the CHCs at regular intervals. We piloted a theory-based, enhanced, family-centered and tailored dietary counselling intervention conducted by public health nurses (PHN) as part of their routine work at the CHCs.

Methods

We used a cluster-randomized controlled trial design with a complex intervention. Trained PHNs recruited families visiting eight CHCs in Southern Finland for a child’s standard 6-, 8-, 12- and 18-month health check-ups and delivered the intervention to them. The families in the intervention group (I) received enhanced dietary counselling at the 8- and 12-month visits. The Smart Family (SF) counselling method based on motivational interviewing techniques and developed by the Finnish Heart Association was complemented by information leaflets on children’s diet. The control families (C) received the usual care (health checks and customary lifestyle counselling). We assessed feasibility and acceptability of the intervention by mixed Methods: quantitative analysis of recruitment and participation, realization of the dietary intervention and data collection, and qualitative analysis of audio-recordings of Discussions during the CHC visits.

Results

Participant flow and availability of data for feasibility and acceptability analyses are shown in the Figure. Recruitment of families took 7 vs. planned 4 months. Challenges identified included few PHNs giving consent to the audio-recordings; the counselling not always occurring according to the SF method; unforeseen changes taking place in the national and communal regulations, and in the CHC personnel. The PHNs and families found the topic important and the intervention acceptable. No adverse events or side effects were observed.

Conclusion

Balancing strengths and weaknesses, the intervention embedded in the routine CHC services is feasible, but the study protocol needs to be refined together with PHNs and families in the target population.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):55.

O10.5 Real World Data On The Reversibility Of Beta Cell Function In Uncontrolled Type Two Diabetic Patients Multi Daily Injections of insulin At Glycemia Clinic In Kuwait For A Better Glycemic Control

A Shaghouli 1, R Aranky 2

Introduction

Type 2 diabetes is described as a progressive loss of beta-cell function throughout the course of the disease linearly with time, and after 10 years more than 50% of individuals require insulin therapy. Overall, there is strong evidence that type 2 diabetes is inevitably progressive, with a high likelihood of insulin therapy being eventually required to maintain good glycemic control. Current guidelines offers no recommendation for the treatment of patients who failed Multi Daily Injections of insulin (MDI) treatment.

Methods

A retrospective case study was done on 64 patients with type two diabetes who are uncontrolled on MDI, with an HbA1c of more than 6.5% and attended Glycemia Clinic for a better glycemic control. Their treatment was changed from MDI to a Glucagon-like Peptide-1 Receptor (GLP-1R), agonist, sodium/glucose-cotransporter 2 (SGLT2) inhibitors and other oral hypoglycemic agent, with or without basal insulin for better glycemic and metabolic control. Their HbA1c and other parameters were compared in 3 months as intervals follow-up.

Results

Patients had overall better glycemic and metabolic control after changing their medication from MDI: The average ΔHbA1c reduction was around 1.6% Average Δ weight reduction from baseline was 11% of total body weight. Some patients were able to stop their insulin dose completely. Average (TDD) was = 72 Units/Day at baseline.

Conclusion

Despite long duration of diabetes, average of 23 years, Beta cell function could still be reversible by adding GLP-1R, SGLT2 Inhibitors and other oral hypoglycemic agents (OHA) with a better glycemic and metabolic control and weight reduction. Giving the fact that some patients were able to stop their MDI completely.

Obes Facts. 2018 May 26;11(Suppl 1):55.

O10.6 The effect of sugar-sweetened beverage front-of-pack labels on drink selection, health knowledge and awareness: An online Randomised Controlled Trial

A Peeters 1, N Billich 1, M Blake 1, K Backholer 1, M Cobcroft 2, V Li 2

Introduction

Sugar-sweetened beverages (SSB) consumption is high globally and associated with health risks. One strategy aimed at reducing SSB consumption involves the use of front-of-pack (FOP) labels identifying the risks associated with SSB consumption. This study aimed to determine whether FOP labels with a graphic warning, text warning, sugar information (with the number of teaspoons of added sugar) or health star rating (HSR) reduces intended choice of a SSB in an online choice experiment with young Australian adults.

Methods

994 young adult (18–35y) participants were recruited and completed an online choice experiment. In each scenario, participants were asked to imagine they were entering a convenience store, take away café or approaching a vending machine to buy a pre-packaged drink. Participants were then presented with 15 cold non-alcoholic drink alternatives (both SSBs and non-SSBs). Drink display order was varied using computerised randomisation, so that participants were exposed to only one of the five label conditions. Participants all saw the same 15 drink types and the label type (or no label for the control group) varied depending on the group they were allocated to. Participants were asked which drink they would choose from the selection of drinks and could also select “no drink” if they no longer intended to purchase a drink. Randomised groups included: control group (no labels), a graphic warning label on all SSBs, a text warning label on all SSBs, a sugar information label on all SSBs and a health star rating label on all drinks.

Results

Compared to the control group who were not exposed to a label, the graphic warning, text warning, sugar information and HSR labels all reduced selection of a SSB in the online choice experiment. The effect was greatest for the graphic warning label (RR 0.45, 95% CI 0.35–0.58). Compared to the control group, the HSR label, but not other labels, increased selection of the drinks with higher Health Star ratings (RR 1.41, 95% CI 1.05–1.90).

Conclusion

Front of pack labels, particularly those with graphic warnings, have the potential to reduce intended SSB purchases. Labels that also identify healthier alternatives may influence consumers to substitute SSBs with healthier drinks.

Obes Facts. 2018 May 26;11(Suppl 1):55–56.

O11.1 Higher body mass index (BMI) and overweight/obesity in children with intrauterine smoke exposure

F Falahi 1, LK Kupers 1, E Corpeleijn 1, H Snieder 1

Introduction

Childhood overweight/obesity is a serious public health concern since it is often a predecessor of metabolic disorders in adulthood. According to the Developmental Origins of Health and Disease (DoHAD) hypothesis, such metabolic disturbances may have their origin in fetal life as a result of adverse intrauterine exposures. One deleterious exposure in fetal life is maternal smoking exposure, which occurs in more than 1 in 10 pregnant women in Europe. Therefore, we hypothesized that intrauterine smoke exposure is associated with increased BMI in children at age 6.

Methods

To study the association between intrauterine smoke exposure and increased BMI at age 6, a prospective cohort study design was employed in GECKO Drenthe, a Dutch population-based birth cohort. Maternal smoking during pregnancy was retrieved from questionnaires. BMI was calculated as weight/height2. Age- and gender-specific BMI Z-scores were computed using the growth analyzer; reference population: the Netherlands 1977. Obese/overweight, and normal weight children were categorized using the BMI cut-offs defined by the International Obesity Task Force guideline. The association between intrauterine smoke exposure and primary outcome (BMI Z-score at age 6) or secondary outcome (overweight/obese at age 6) was tested in 1890 children using regression analysis while adjusting for potential confounders including offspring’s gender, gestational age, mother’s age at birth, pre-pregnancy maternal BMI, socio-economic status, breast feeding, and standardized birthweight for parity, gender, and gestational age.

Results

Intrauterine smoke exposure was present in 388 children (13.9% of our cohort) and was associated with higher BMI in 6 year old children exposed to smoking during their fetal lives in comparison with unexposed children (B = 0.3; CI95 = 0.2–0.4). This association was adjusted for potential confounders. From these, gestational age, pre-pregnancy maternal BMI, and standardized birthweight showed a significant positive association with BMI Z-score at age 6. Additionally, children with intrauterine smoke exposure were 2.5 times more likely to be overweight/obese (OR = 2.5, CI95 = 1.7–3.6) compared with unexposed children.

Conclusion

Our study clearly shows a higher BMI in children that were exposed to maternal smoking in the womb. Potential mechanisms that may explain this association require further investigation.

Obes Facts. 2018 May 26;11(Suppl 1):56.

O11.2 Combined effects of smoking during pregnancy, maternal and child genetic profile on childhood overweight

C S Morgen 1, TM Schnurr 2, L Ängquist 3, EA Nøhr 4, CT Have 2, T Hansen 2, TIA Sørensen 5

Introduction

Environmental and genetic factors play a role in the development of childhood overweight, and especially the pre- and postnatal periods are critical time windows. Maternal smoking during pregnancy is a well-established risk factor for childhood obesity, but research is needed to investigate whether genetic predisposition to obesity of the mother and her child interacts with maternal smoking during pregnancy in their influence on child overweight at age 7 years.

Methods

From the Danish National Birth Cohort (n = 100 418), in a case-cohort design, the following mother-child pairs with genotypes were available: 1) Randomly selected women and their children (n = 510) 2) Obese women and their children (n = 431) A maternal genetic risk score (comprising 77 genetic variants shown to associate with adult BMI) and a child Genetic risk score (comprising 15 genetic variants shown to associate with childhood BMI) were created and divided into respective tertiles (low, medium, high). The risk of child overweight according to the interactions of maternal genetic risk score*maternal smoking (yes/no) and child genetic risk score*maternal smoking was assessed using logistic regression analyses.

Results

Compared to nonsmoking mothers and low maternal genetic risk score/low child genetic risk score, the OR for overweight for a child with a high genetic risk score and a mother who had been smoking during pregnancy was 7.37 (95% CI: 2.86–19.01), and 2.02 (95% CI: 0.87–4.66) for a child with a mother with a high genetic risk score who had been smoking during pregnancy. The effects of maternal smoking*maternal genetic risk score were additive (p-value interaction = 0.8) and the effects of maternal smoking*child genetic risk score were multiplicative (p-value interaction = 0.006).

Conclusion

The study confirms that smoking and child genetic predisposition to obesity strongly affect the risk of childhood overweight and that maternal genetic predisposition, has a weaker effect. The study adds that there appears to be no synergy effect of maternal genetic risk score and maternal smoking but there appears to be a synergy effect of child genetic risk score and maternal smoking on child overweight.

Obes Facts. 2018 May 26;11(Suppl 1):56.

O11.3 Association of bright liver with I148M variant of the PNPLA3 gene in healthy toddlers

G Bedogni 1, G De Matteis 1, A Alisi 1, A Crudele 1, F Pizzolante 1, F Signore 1, V Nobili 1, M Manco 1

Introduction

Given the epidemic obesity in the pediatric population, non-alcoholic fatty liver disease (NAFLD) has become the first cause of liver disease in young patients. Both genetics and in utero metabolic programming seem to influence the onset and the progression of the disease in young patients. Aim of the study was to identify early determinants of bright liver in toddlers and explore the interaction between common genetic variants and perinatal factors associated with increased risk of non-alcoholic fatty liver disease.

Methods

Cohort study of 505 mother-newborn dyads. Maternal intake of fatty acids during the pregnancy was estimated by profiling fatty acids on maternal erythrocytes at the end of pregnancy and on cord blood. Patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 C>G and transmembrane 6 superfamily member 2 (TM6SF2) rs58542926 C>T single nucleotide polymorphisms were genotyped. At 1 year of age, bright liver (BL+ v.s. BL-), thickness of subcutaneous (SAT) and epicardial adipose tissue (EAT) were estimated by ultrasonography.

Results

At 1 year, 505 toddlers underwent the follow-up visit. Genetic data were available in 391 out of 505 toddlers (77.4%); 374 of them were BL- and 17 BL+ . Body weight (p < 0.01) and body mass index (BMI) (p < 0.05) were higher in BL+ than in BL- children and the same was true for the pregnancy weight gain of their mothers (p < 0.05). No difference was found in birth weight, SAT and EAT values between BL+ and BL-children. No difference was found, as well, in maternal and fetal lipid profile on erythrocyte membranes. The odds of having the more severe PNPLA3 allele (GG vs. CG vs. CC) was higher among BL+ than BL- children (OR = 2.41, exact 95%CI 1.14 to 5.07, exact mid-p-value = 0.027, ordinal logistic regression). The odds of having the more severe TM6SF2 allele (CC vs. CT vs. TT) was similar among BL+ and BL- children (OR = 1.35, exact 95%CI 0.35 to 3.75, exact mid-p-value = 0.669, ordinal logistic regression).

Conclusion

Findings of the study demonstrates that liver brightness occurs in toddlers and carriers of the PNPLA3 I148M variant have an increased risk of presenting with this feature. BL+ toddlers had significantly higher body weight and body mass index than BL- toddlers. BL+ toddlers were born from mothers who gained significantly greater body weight during gestation.

Obes Facts. 2018 May 26;11(Suppl 1):57.

O11.4 Childhood body mass index and risk of intracerebral hemorrhage among women and men

L K Gjærde 1, TC Truelsen 2, TIA Sørensen 1, JL Baker 1

Introduction

Childhood overweight and obesity are associated with increased risks of cardiovascular disease, including ischemic stroke. For intracerebral hemorrhage (ICH), which accounts for about 15% of all cases of strokes, the association with adult body mass index (BMI) is U-shaped. However, few studies investigating the association of childhood BMI with risks of ICH showed either no association or a positive association. We investigated associations of BMI during childhood with risks of adult ICH in a large cohort of children.

Methods

We used data on annually measured height and weight to calculate childhood BMI (kg/m2) at age 7–13 years on 311,033 Danish schoolchildren, born 1930–1988, who were included in the Copenhagen School Health Records Register. Information on birth weight was reported by their parents at school entry. By using a unique identification number at birth, we were able to get information on vital status and occurrence of ICH (ICD-8 code 431 or ICD-10 code I61) in adulthood by linkages with national registers. We followed the children from age 25 years until first ICH event, emigration, death, loss to follow up, or 31 December 2013, whichever came first. We used Cox regressions to calculate hazard ratios (HRs) and confidence intervals (CIs) for the association between childhood BMI and risks of ICH in women and men separately. Additionally, we investigated the effect of birth weight on the associations.

Results

During the study period 1,282 women and 1,744 men experienced an ICH. In women, childhood BMI was not associated with risks of ICH. In men, we observed a non-linear association, where men with a childhood BMI below average had increased risks of ICH, whereas men who had a childhood BMI above average showed no, or a slightly increased not statistically significant association with later risks of ICH. The association was stronger at higher childhood ages, and at age 13 years a BMI z-score of -1 was associated with a HR of 1.14 (95% CI, 1.05–1.24), and a BMI z-score of -2 with a HR of 1.39 (95% CI, 1.15–1.67). Birth weight itself was linearly and inversely associated with risks of ICH among men (HR = 0.88 [95% CI, 0.83–0.93]) per 500 grams birth weight), whereas no association was seen in women. Birth weight and BMI at all childhood ages did not interact in their respective associations with risks of ICH (all p-values >0.3). The associations did not change with age at diagnosis and were stable across birth cohorts.

Conclusion

In men, a BMI below average in childhood is associated with increased risks of ICH, independent of birth weight, whereas in women childhood BMI is not associated with risks of ICH.

Obes Facts. 2018 May 26;11(Suppl 1):57.

O11.5 BMI change during puberty and the risk of heart failure

J Kindblom 1, M Bygdell 1, A Sondén 2, J Célind 1, A Rosengren 1, C Ohlsson 1

Introduction

Elevated body weight is associated with increased risk of cardiovascular disease (CVD), with concerns that a sustained obesity epidemic may counterbalance the current trend of declining cardiovascular mortality rates with public health consequences such as reduced life expectancy as a possible result. Heart failure is a severe disorder with a prognosis worse than that of many common forms of cancer. Heart failure may, for unknown reasons, be on the rise among young adults, coinciding with the obesity epidemic. A high body mass index (BMI) in middle-aged men and women is a well-documented risk factor for heart failure. There is also recent evidence of an association between a high BMI in young adulthood and risk of adult heart failure in men. For pre-pubertal childhood BMI however, there is no clear evidence of an association with adult risk of heart failure, and the effect of childhood BMI and BMI change during puberty, independent of each other, on adult risk of heart failure has not been investigated. The aim of the present study was to evaluate the association between childhood BMI (Body Mass Index) and BMI change during puberty for risk of adult heart failure in men.

Methods

Using the BMI Epidemiology Study (BEST), a population-based study in Gothenburg, Sweden, we collected information on childhood BMI at age 8 years and BMI change during puberty (BMI at age 20 – BMI at 8) for men born 1945–1961, followed until December 2013 (n = 37,670). BMI was collected from pediatric growth charts and mandatory military conscription tests. Information on heart failure was retrieved from high quality national registers (342 first hospitalisations for heart failure).

Results

BMI change during puberty was independently of childhood BMI associated with risk of heart failure in a non-linear J-shaped manner. Subjects in the upper quartile of BMI change during puberty (Q4) had more than twofold increased risk of heart failure compared with subjects in Q1 (HR [Hazard Ratio] = 2.29, 95% CI [Confidence Interval] 1.68–3.12). Childhood BMI was not independently associated with risk of heart failure. Boys developing overweight during puberty (HR 3.14; 95% CI 2.25–4.38) but not boys with childhood overweight that normalized during puberty (HR 1.12, 95% CI 0.63–2.00) had increased risk of heart failure compared with boys without childhood or young adult overweight.

Conclusion

BMI change during puberty is a novel risk factor for adult heart failure in men.

Obes Facts. 2018 May 26;11(Suppl 1):57–58.

O11.6 BMI at 8 years of age is associated with the risk of colon cancer

J Célind 1, C Ohlsson 1, M Bygdell 2, M Nethander 1, J Kindblom 1

Introduction

Colorectal cancer is the third most common cancer in adults worldwide. A previous study has demonstrated an association between BMI during childhood and risk of colon cancer, but the association between childhood BMI and colon cancer independent of BMI change during puberty is not known. The objective with this study was to evaluate the contribution of pre-pubertal childhood BMI and BMI change during puberty, two distinct developmental BMI parameters, for risk of adult colorectal cancer in men.

Methods

In this population-based study in Gothenburg, Sweden, men born 1945–1961 with information on both childhood BMI at age 8 and BMI change through puberty and adolescence (BMI at age 20 − BMI at age 8) were followed until December 2013 (n = 37,663). Information on colorectal cancer was retrieved from high quality national registers (257 cases of colon cancer, 159 cases of rectal cancer).

Results

Childhood BMI at 8 years of age was associated with the risk of a colon cancer diagnosis (HR [Hazard Ratio] 1.19 per SD, 95% CI [Confidence Interval] 1.06–1.33), but BMI change during puberty (BMI at age 20 − BMI at age 8) was not directly associated with the risk of colon cancer (HR 1.02 per SD BMI change; 95% CI 0.90–1.15). Because we found a significant interaction between childhood BMI and BMI change during puberty for the risk of colon cancer (p < 0.001), we stratified the analyses by splitting the cohort at the median according to BMI change during puberty. No interaction between childhood BMI and BMI change during puberty was detected within strata. Interestingly, childhood BMI was associated with risk of colon cancer only in individuals with a BMI change during puberty above the median, (HR = 1.48 per SD, 95% CI 1.26–1.74), but not below (HR = 0.95 per SD, 95% CI 0.80–1.12). This association was independent of BMI change during puberty. BMI change during puberty in itself was not associated with the risk of colon cancer in either stratum. Childhood BMI or BMI change during puberty did not demonstrate a significant association with rectal cancer.

Conclusion

High childhood BMI is associated with increased risk of colon cancer in individuals with a BMI change during puberty above the median.

Obes Facts. 2018 May 26;11(Suppl 1):58.

O12.1 Novel Methods for simulating BMI and obesity trajectories during childhood: a life course model from Australia

A Hayes 1, T Lung 2, A Tan 1

Introduction

Over the last 40 years, age standardized body mass index (BMI) among children has increased globally. This has been accompanied by unprecedented increases in child overweight and obesity in high income countries. In Australia, one in 5 children is already affected by overweight or obesity by the time they start school, and among adolescents the prevalence of overweight and obesity is currently 25%. The WHO Commission on Ending Childhood Obesity has emphasized the need for greater evidence in informing policy and actions targeted at reducing overweight and obesity in children. One of the challenges in evaluating interventions in childhood is knowing how obesity progression may change long term, as a result of policies and interventions. Life course modelling approaches may contribute to evaluating both the effectiveness and the cost-effectiveness of obesity preventive programmes over a longer and more policy relevant timeframe. The aim of this study is to develop and validate a micro-simulation model for progression of obesity over the child and adolescent life course, based on national level Australian data.

Methods

We use an individual–level (microsimulation) method to model the epidemiological progression of obesity from early childhood to late adolescence. In this context, our approach is unique because it accounts for the full distribution of BMI and simulates individual BMI trajectories over childhood. Equations for weight (BMI) gain underpinning our model were derived from the population-representative Australian study, the Longitudinal Study of Australian Children (LSAC). As a first step to validate the epidemiological predictions of the model, we simulated BMI and obesity trajectories until adolescence using individual level input data on children aged 4 years. Projected BMI and obesity prevalence based on WHO growth standards were compared with observed data from the LSAC.

Results

Simulated BMI trajectories for boys and girls were verified by the observed data (Figure 1).

Conclusion

The model is epidemiologically sound in its prediction of both BMI trajectories and prevalence of obesity for boys and girls. Further development of economic aspects will enable its use as a framework to aid decision makers in allocating resources to obesity prevention programs during childhood. The ultimate aim is to evaluate a range of interventions that have different delivery modes, e.g at school, in early childhood settings, in community settings or through TV or internet. The model will help answer: when is it best to intervene in childhood what are the most cost-effective approaches and which population groups will benefit most from interventions.

Fig. 1.

Fig. 1

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Modelled average BMI trajectories for boys and girls, starting with an input population representing over 700,000 children aged 4 years; black circles = data from LSAC; dashed line = modelled trajectory with 95% error band. The model projected prevalence of obesity to increase from 8.5% to 13.4% (boys) and from 6% to 12.7% (girls) between age 4 and 14 years. These projections were consistent with the data from the LSAC of 13.1% (95% CI 10.6–16.0) for boys and 11.5% (95% CI 9.0–14.3) for girls by age 14 years.

Obes Facts. 2018 May 26;11(Suppl 1):58.

O12.2 Prevention of obesity in toddlers: the PROBIT trial

A Morandi 1, M Tommasi 1, E Fornari 1, F Tomasselli 1, C Maffeis 1

Introduction

The PROBIT trial (clinicaltrials.gov registration number: NCT03131284) aimed to decrease the prevalence of overweight/obesity at two years of life, in a group of toddlers whose parents were provided with an intensive standardized educational intervention from their child’s birth onwards (intervention arm), compared to a group of toddlers whose parents were not provided with any additional intervention besides the usual care and follow-up provided by their paediatrician (control arm).

Methods

The target population of the trial consisted of healthy newborns from Verona, Italy, whose parents or guardians accepted to participate in the study at the time of the first newborn well visit, by informed consent. Parents were assigned to the control or intervention group according to which group their paediatrician was randomly assigned to. In the intervention arm, parents were provided, at the well visits of the first two years of the newborn’s life, with oral and written information on behaviours to adopt for their child to be protected from obesity: breast feeding, feeding on demand, responsive feeding, correct time of Introduction of complementary feeding, portions shaped on the child’s appetite, avoiding added sugar and beverages other than milk and water, practicing active game with the child, alternating protein sources correctly and avoiding protein excess. All the information and the tips were resumed in 12 A5 size sheets to be inserted in the regional follow-up loose-leaf notebook all parents are provided with, at the time of the neonatal well visit. The “control paediatricians” were just asked to provide the newborns’ parents with usual care and follow-up according to the well visits calendar. Overweight and obesity at two years of age were defined as a BMI above the 85th and the 95th percentile according to the CDC growth charts, respectively. Overweight at one year of age was defined as a BMI above the 85th percentile according to the WHO growth charts. Rates of overweight/obesity and average BMI were compared across the two arms by Chi Squared test and ANOVA respectively. Moreover, a binary logistic model and a general linear model were run, with overweight/obesity or BMI as dependent variables, and arm, parental BMI and parental socio-economic status as independent variables, respectively.

Results

Twenty-two paediatricians (eleven for arm) recruited 469 newborns overall, of whom only one dropped-out from the intervention arm. Two hundreds and sixteen “control” children were compared to 252 “intervention” children. At two year of age, the groups did not differ significantly in the percentage of overweight or obesity and in the average BMI (all p > 0.05). Among children from at least one obese parent (24 control vs 29 intervention subjects), the control group had a significant higher prevalence of obesity at two years of age, compared with the intervention group (12% vs 0%, p = 0.03).

Conclusion

The PROBIT trial was not effective in decreasing the prevalence of obesity at two years of age in the general population. However, it highlighted that an early educational intervention could be effective in infants with obese parents, suggesting. If confirmed, this result will support strategies of obesity prevention based on selective intervention in at risk infants.

Obes Facts. 2018 May 26;11(Suppl 1):59.

O12.3 Childhood BMI is inversely associated with pubertal timing in normal weight, but not in overweight boys

M Bygdell 1, J Kindblom 1, J Célind 1, M Nethander 1, C Ohlsson 1

Introduction

A negative association between childhood body mass index (BMI) and pubertal timing is well established for girls. Among boys, there has been both positive and negative associations reported. To determine the association between childhood BMI and age at peak height velocity (PHV) as an assessment of pubertal timing in boys, we used the well-powered population-based BMI Epidemiology Study (BEST cohort).

Methods

To adequately calculate age at PHV in an unbiased manner, height measurements before, during, and after the pubertal period is required. The BEST cohort is the first large-scale study with this information available for boys. We collected heights and weights between 6.5 and 22 years of age in boys born 1945–1961 (= original cohort; n = 31,971; childhood BMI mean ± SD 15.7 ± 1.4 kg/m2; age at PHV 14.1 ± 1.1 years) and 1981–1996 (= replication cohort; n = 1,465; childhood BMI 16.5 ± 2.0 kg/m2; age at PHV 13.7 ± 1.1 years) attending schools in Gothenburg, Sweden, and examined at mandatory military conscription. Age at PHV was obtained from curve-fitting of measured heights using a modified Infancy-Childhood-Puberty model.

Results

In the original cohort, childhood BMI was inversely associated with age at PHV (p < 0.001) and non-linearity of this association (p < 0.001) was revealed by a significant quadratic term for childhood BMI. Using a piecewise linear regression model, we identified a threshold for the association at childhood BMI 18.24 kg/m2. A significant inverse association was observed below (ß = −0.17 years/BMI unit; 95% confidence interval (CI) −0.16; −0.18) but not above (ß = 0.03; 95%CI −0.02; 0.08) this childhood BMI threshold. For every unit increase in childhood BMI, age at PHV was 2.1 months earlier up to the childhood BMI threshold. Above the threshold additional increase of childhood BMI did not result in further decrease in age at PHV. Similar results were observed in the replication cohort, demonstrating a significant inverse association below (ß = −0.17; 95%CI −0.22; −0.12) but not above (ß = −0.02; 95%CI −0.11; 0.07) the childhood BMI threshold. The identified threshold was close to the cutoffs for overweight at 8 years of age and childhood BMI was inversely associated with age at PHV below but not above the overweight cutoffs. The observed associations were unaltered after adjustment for birth year and country of birth.

Conclusion

The present findings establish an inverse association between childhood BMI and pubertal timing in normal weight but not in overweight boys. We speculate that lean mass rather than fat mass drives the inverse association between childhood BMI and pubertal timing in normal weight boys.

Obes Facts. 2018 May 26;11(Suppl 1):59.

O12.4 Median BMI as a stable reference point for establishing BMI thresholds in childhood

C M Wright 1, TJ Cole 2

Introduction

While the healthy upper limit for BMI is well established in Northern European adults, it is ill-defined for children, and historically BMI centiles have been used instead to set upper thresholds. When compared to the original reference sample, centiles identify a fixed percentage of children at all ages as being above the normal range. However it is unlikely that the prevalence of obesity has ever been constant across childhood. As the variability of BMI increases markedly with age, this means that a young child with a raised BMI may be classified as obese while an older child with a similarly raised BMI is classified as normal. We hypothesise that the upper range of BMI increases with increasing economic development and availability of cheap (unhealthy) food and will thus vary over time and between countries, but that median BMI is relatively invariant and could be used to adjust for age and gender and define a healthy BMI range.

Methods

We studied three BMI references (WHO 2006/7, CDC 2000 and British 1990 [UK90]) and the data underlying the IOTF cut-offs, collected in six countries over 30 years, and compared the variability of their median curves to the variability of their +2 SD curves. Using the UK90 we then expressed the +2 SD threshold at age 2 years as % of the median at that age, and defined the threshold up to age 18 years as this same % of the median at different ages.

Results

The CDC +2 SD line was 3.4–3.6 kg/m2 higher than both UK90 and WHO at age 12, and the WHO +2 SD line was >1 kg/m2 higher than UK90 for age 15–19. In contrast the median curves were all very similar, varying by no more than 0.9 kg/m2. The six IOTF dataset median curves varied by < 1 kg in mid-childhood and < 2 kg in later teenage, while the overweight and obese thresholds varied by >4 and >6 kg/m2. For the merged IOTF surveys the coefficient of variation (CV) for BMI was < 8% until age 4 but then rose steeply to 13% at age 12, with a tenfold increase in the CV variance. The UK90 +2 SD line at age 2 was 19% greater than median BMI for both sexes. This line extrapolated 19% above the median for age, rises much more gradually than the +2 SD (98th centile) line, and at age 18 corresponds almost exactly to 25 kg/m2 for both genders (see figure).

Conclusion

The median BMI curve varies little over time or between cultures. The BMI range increases rapidly after age 3–4, but before that it is narrow and near normally distributed, suggesting that most young children are still within the healthy BMI range. The +2 SD upper limit at age 2, expressed as a % of the median and extrapolated to age 18 could be used as a healthy upper limit for BMI throughout childhood.

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Obes Facts. 2018 May 26;11(Suppl 1):59–60.

O12.5 Maintenance Interventions in Overweight or Obese Children: a Systematic Review and Meta-Analysis

L B Van Der Heijden 1, EJM Feskens 2, AJ Janse 1

Introduction

Childhood obesity is associated with significant health consequences. Although several intervention programs for children result in weight-loss or stabilisation in the short term, preventing relapse after treatment remains an important challenge. This systematic review summarises the evidence about maintenance interventions after treatment in childhood obesity.

Methods

Studies were identified by searching PubMed, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, CINAHL, and SocINDEX. Randomised controlled trials (RCTs) and cohort studies about maintenance interventions for children and adolescents with overweight or obesity were selected. The primary outcome measure for this review was body mass index standard deviation score (BMI-Z-score). Three independent reviewers performed the eligibility assessment and critically appraised the methodological quality of the studies. When information was not or unclearly reported, authors were contacted for further information. Data were pooled using quality effect models. Statistical heterogeneity was quantified using the I2 test.

Results

Eleven studies (1532 participants, age 2–18 years) were included, covering a wide range of maintenance approaches. Included studies varied widely in methodological quality. Pooled analysis showed that the BMI-Z-score of maintenance intervention participants remained stable (weighted mean difference [WMD] −0.02, 95% confidence interval [CI] −0.09 to 0.05, I2 = 55%), whereas control participants experienced a slight increase in BMI-Z-score during the weight maintenance period (WMD 0.09, 95% CI 0.00 to 0.18, I2 = 0%). No differences were observed regarding intensity and duration of therapy. A slight preference for ‘face-to-face’ versus ‘on distance’ interventions was shown. Generally, the attrition rate was high in the included studies.

Conclusion

This review shows that, although there is limited quality data to recommend one maintenance intervention over another, continued treatment does have a stabilizing effect on BMI-Z-score. Considering the magnitude of the problem of childhood obesity, this is an important finding that highlights the need for further research on weight loss maintenance.

Obes Facts. 2018 May 26;11(Suppl 1):60.

O12.6 Utility values for childhood obesity interventions: a systematic review and meta-analysis of the evidence for use in economic evaluation

V Brown 1, EJ Tan 2, A Hayes 2, S Petrou 3, M Moodie 4

Introduction

Rigorous economic evaluation of childhood obesity prevention and treatment interventions is a useful tool for priority-setting, particularly given the high prevalence of overweight and obesity in children globally. Cost-utility analysis is a form of economic evaluation that compares the costs of an intervention with the benefits gained, incorporating intervention impact on both the quality and quantity of life. Preference-based health-related quality of life is incorporated using health utilities that are indexed on a cardinal scale where 0 represents death and 1 represents perfect health. Rigorous estimates of preference-based utilities are important inputs into economic evaluations of childhood obesity interventions, yet no published review currently exists examining utility by weight status in paediatric populations.

Methods

A comprehensive systematic literature review and meta-analysis was undertaken based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (Figure 1), pooling data on preference-based health state utilities by weight status in children aged ≤18 years. Meta-analysis was undertaken with the Microsoft Excel add-in MetaXL version 5.3 using a random effects model. Mean utility values for healthy weight, overweight, obese and overweight/obese states were estimated. Studies reporting mean utility values for both healthy weight and overweight/obese participants were also pooled to estimate the weighted mean difference in utility values. Cohen’s d effect sizes were estimated, where approximately 0.2, 0.5 and 0.8 are respectively considered small, moderate and large. Tests for heterogeneity were performed and publication bias was assessed.

Results

Of 3,434 potentially relevant studies identified, eleven met our eligibility criteria. Estimates of Cohen’s d statistic suggested a small effect of weight status on preference-based utilities. Mean utility values were estimated as 0.85 (95% UI 0.84–0.87), 0.83 (95% UI 0.81–0.85), 0.82 (95% UI 0.79–0.84) and 0.83 (95% UI 0.80–0.86) for healthy weight, overweight, obese and overweight/obese states respectively. Meta-analysis of studies reporting utility values for both healthy weight and overweight/obese participants found a statistically significant weighted mean difference (0.015, 95% UI 0.003–0.026)(Table 1). A small but statistically significant difference was also estimated between healthy weight and overweight participants (0.011, 95% UI 0.004–0.018).

Conclusion

This study represents the first systematic review and meta-analysis of utility values by weight status for childhood populations. To date, very few economic evaluations of obesity interventions incorporating health-related quality of life benefits to children and adolescents have been published. This potentially results in under-estimation of the cost-effectiveness of obesity interventions in children and adolescents. Study findings demonstrate higher preference-based utility values in healthy weight as compared to overweight or obese children and adolescents, but more evidence is required to improve the rigour and reliability of these estimates.

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Tab. 1.

Pooled estimates of WMD in health-related quality of life in children and adolescents, by weight status

Analysis
 n
 Pooled estimate WMD (95% CI)
 Cochran’s Q (p)
 I2 (95% CI)
 Risk of publication bias (LFK Index)
 Cohen’s d (95% CI)
Healthy weight and overweight/obese 8 0.015* (0.003–0.026) 7.71 (0.36) 9%(0–71%) Major (3.91) 0.14 (0.04–0.24)
Healthy weight and overweight 7 0.011* (0.004–0.018) 1.61 (0.95) 0%(0–0%) Major (3.46) 0.07 (0.02–0.11)
Healthy weight and obese 7 0.024*(0.009–0.039) 15.06 (0.02) 60% (9–83%) Major (6.42) 0.16 (0.06–0.26)
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*

p < 0.05. LFK Index = Luis Furuya-Kanamori Index. N = number of included estimates. WMD = weighted mean difference. 95% CI = 95% confidence interval.

Obes Facts. 2018 May 26;11(Suppl 1):61.

O13.1 How do local authorities in England tackle the wider determinants of health surrounding obesity?

J Nobles 1, A Christensen 2, W Lameck-Marwa 2, D Radley 2, K Pickering 2, J Saunders 1, C Weir 1, M Butler 1, P Sahota 2, P Gately 1

Introduction

In 2007, the Foresight Tackling Obesities Report outlined the complex aetiology of obesity, identifying 108 causal factors with over 300 interlinkages. This report, and others, advocate an equally comprehensive approach to prevent and tackle obesity. This approach would acknowledge that obesity is for many a consequence of living in the modern world, and action should therefore be taken at the individual-, community-, societal-, and political- levels. Action must be taken by all stakeholders operating within the obesity system, not solely that of the health sector. In the UK, local government organisations (Local Authorities; LAs) are responsible for tackling obesity, and this paper aims to understand how their current actions counter the myriad causes of obesity.

Methods

Ten LAs were invited to document their current actions on obesity. Each LA completed a standardised data collection pro-forma, which ascertained detail associated with the actions undertaken. These actions were systematically mapped against an adapted version of Dahlgren and Whitehead’s (1991) model on the wider determinants of health (levels: biological factors [BF]; individual lifestyle factors [ILF]; social and community factors [SCF]; living and working conditions [LWC]; and wider conditions [WC]). This mapping process was independently completed by three researchers, with any inconsistencies discussed and resolved. Four LAs also completed an exercise to identify the local causes of obesity. These causes, alongside the 108 noted by Foresight, were also mapped against the wider determinants of health model – thus juxtaposed against the actions.

Results

A total of 283 actions were listed across the 10 LAs, with a mean of 28 actions per authority (range: 16 − 40). As for unique causes, 127 were identified by the four LAs akin to the 108 Foresight causes. Preliminary results indicate that almost two thirds of causes lie in the LWC (31%) and the WC (33%) as opposed to 15% in the ILF. In contrast, 61% of LA actions are targeted at ILF, with approximately one in three actions targeted at LWC (21%) and WC (9%). Numerous actions were delivered by multiple LAs, for example: weight management programmes, breastfeeding support, the NCMP, cycle infrastructure, and the Healthy School programme. Figure 1 demonstrates that current actions are largely focused on the downstream determinants of health, with the causes predominantly residing upstream.

Conclusion

This paper documents how LA action on obesity relates to the wider determinants of health. A stark disconnect is evident, with the lion’s share of actions targeting individual lifestyle factors despite almost two thirds of causes classified within the LWC and WC. This disconnect reinforces the need for a whole systems approach to obesity (both locally and nationally); many sectors and organisations are required to address the spread of interconnected causal factors mediating and moderating population-wide weight status. An upstream approach would have many benefits across local systems, not just upon obesity.

Conflicts of Interest

This work is associated with the Public Health England commissioned Whole Systems Obesity project.

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Obes Facts. 2018 May 26;11(Suppl 1):61–62.

O13.2 Morbid obesity projections in the UK to 2035

L Keaver 1, B Xu 2, A Jaccard 2, L Webber 2

Introduction

The prevalence of morbid obesity is increasing worldwide with numbers doubling in the past 20 years. Morbid obesity (Body mass index of ≥40kg/m2) carries a high risk of non-communicable disease such as type 2 diabetes, coronary heart disease, stroke, mental illness and some cancers and increased all-cause mortality rates. In addition, morbid obesity is associated with more complex health issues and challenges in the health care system than having a lower BMI. While overweight and obesity trends have been projected to 2035 for these countries, no work has been carried out looking at recent and likely future trends in morbid obesity specifically. Aim To project trends in morbid obesity to 2035 in male and female adults in Scotland, Wales and England.

Methods

Modelling projection study. BMI prevalence by group (healthy weight, overweight, obesity, morbid obesity) was obtained from the Health Survey for England, Welsh Health Survey and the Scottish Health Survey, from 2004 to 2014 were collected for males and females aged 15+ (in five-year age groups). A categorical multi-variate nonlinear regression model was fitted to the data to project BMI trends.

Results

Morbid obesity prevalence was predicted to increase to a prevalence of 5%, 8% and 11% in Scotland, England and Wales respectively by 2035. When exploring the data by age group, English males aged 55–64 years have the highest projected prevalence at 16%. In total, over 4 million people will be classified as morbidly obese across the three countries in 2035.

Conclusion

The prevalence of morbid obesity is predicted to increase to 2035 across the three UK countries, with Wales projected to have the highest rates, followed by England then Scotland. This is likely to have serious health and financial implications for society and the health system.

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Tab. 1.

(%) of morbid obesity in Scotland, Wales and England in 2035, by gender and age group

Age (Years)
 Scotland % prevalence Males
 Scotland % prevalence Females
 Wales % prevalence Males
 Wales % prevalence Females
 England % prevalence Males
 England % prevalence Females
Total 6 5 13 9 7 8
15–19 0 2 6 2 6 6
20–24 0 2 6 2 6 6
25–29 4 10 5 2 7 8
30–34 4 9.5 5 2 7 8
35–39 1 3.5 9 5 12 10
40–44 1 3.5 9 5 12 10
45–49 1 5 6 7 10 10
50–54 1 5 6 6 10 10
55–59 4 5 4 10 16 8
60–64 3 5 4 10 16 8
65–69 2 2 4 6 5 12
70–74 2 2 4 7 5 12
75+ * 6 * 5 9 8
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*

unable to determine reliable projections for these groups due to small sample sizes and a lack of data

Acknowledgement

The authors would like to acknowledge the Staff Capacity Fund and the CRISP research group in Institute of Technology, Sligo who generously provided funding to allow LK to attend this event.

Obes Facts. 2018 May 26;11(Suppl 1):62.

O13.3 Moving towards consensus on weight bias reduction messages and strategies

X Ramos Salas 1, E Cameron 2, A Alberga 3, M Forhan 4, S Kirk 5, S Russell-Mayhew 6, AM Sharma 7

Introduction

Weight bias is defined as negative attitudes toward and beliefs about others because of their weight. Weight bias is manifested through stereotypes and/or prejudice toward people with overweight and obesity. Ultimately, the enactment of weight bias attitudes and prejudice against people with obesity that can cause exclusion, marginalization, and lead to health and social inequities. Under the umbrella of the Canadian Obesity Network (CON), the EveryBODY Matters Collaborative works to advance weight bias research and action in Canada. In May 2016, this interdisciplinary collaborative worked with stakeholders including individuals living with obesity, researchers studying weight bias, health professionals and knowledge translation experts to host the 3rd Canadian Weight Bias Summit. Unlike previous summits, which focused on raising awareness about weight bias (2011) and identifying research gaps (2015), the 3rd summit (2016) took a more practical, action-oriented approach to reduce weight bias in healthcare, education and public policy.

Methods

Using a brokered dialogue method, the summit explored the following questions: 1) How? (Explanation): How is weight bias experienced, addressed and contested by individuals living with obesity, health professionals and other obesity stakeholders? 2) What? (Description): What are some weight bias reduction interventions and resources available in Canada? 3) So What? (Synthesis): What are some common messages, strategies, principles and language used from existing weight bias research that we can all agree will advance changes in practice and policy? 4) Now What? (Action): How can we incorporate these messages, strategies, principles and language into future weight bias reduction interventions?

Results

The summit deliverables included: a) An inventory of weight bias reduction interventions and approaches available in Canada; b) A set of common messages and strategies from existing weight bias interventions that can be used/evaluated in future research and knowledge translation initiatives by stakeholders; and c) A clear plan of action for stakeholders to tailor these common messages and implement them into future weight bias interventions in practice and policy.

Conclusion

In this presentation, we will share the outcomes of the 3rd Canadian Weight Bias Summit and generate a Discussion about the generalizability of these common weight bias reduction messages and strategies in the field of obesity internationally.

Obes Facts. 2018 May 26;11(Suppl 1):62.

O13.4 Health-related costs in a sample of premenopausal non-diabetic overweight and obese females in Antwerp region – a cost-of-illness analysis

W Hens 1, D Vissers 1, L Annemans 2, J Gielen 3, L Van Gaal 1, J Taeymans 4, N Verhaeghe 2

Introduction

Background

People with overweight are at increased risk for disease later in life which cause important health costs. The aim of this analysis was to estimate the health status and the corresponding costs in a sample of females with overweight which were participating in an effectiveness study (RCT design) of lifestyle habits changes on ectopic adipose tissue.

Methods

Sixty-two non-diabetic premenopausal “metabolically healthy overweight” females were recruited among patients visiting endocrinologists at the obesity clinic of the University Hospital of Antwerp and the University of Antwerp.

A RCT embedded cost-of-illness approach with societal perspective, based on self-reported questionnaires and cost diaries (3 months recall) was applied to estimate the prevalence of different comorbidities and the related direct and indirect costs in this sample of overweight females. The European Quality-of-Life-5D questionnaire was used to define the health state and the corresponding utility index of the participants.

Results

The average direct health costs and health utilities observed in this sample were comparable with the general Flemish female population. This may partially be explained by the inclusion criteria of the RCT (i.e. “metabolically healthy overweight”). However, 15% of the participants had five or more comorbidities resulting in higher average costs and lower average health utility as compared to the general population. In this sub-sample productivity was low due to high average absenteeism, yielding important total costs for the society.

Conclusion

Secondary prevention to avoid health deterioration in “healthy overweight” females is needed to contain long-term health care costs.

Obes Facts. 2018 May 26;11(Suppl 1):63.

O13.5 Minimum Nutritional Standards for Catering for Staff and Visitors in Health and Social Care, for staff and visitors across all catering, retail and vending facilities

JCF Da Silva 1, J Casey 2

Introduction

Obesity rates in Northern Ireland (NI) are similar to other parts of the UK, with 63% adults and 25% children aged 2–15 years overweight or obese in 2016. The NI obesity prevention strategy, A Fitter Future for All 2012–2022, outlines key outcomes to be achieved in this timeframe. Delivery of these outcomes are coordinated by the Regional Obesity Prevention Implementation Group (ROPIG). A key objective of this strategy is that ‘nutritional standards are in place for staff and visitors in Health and Social Care (HSC) settings and across local government.’ Through ROPIG, the Food Standards Agency (FSA), safefood and the Public Health Agency (PHA) led the development of Minimum Nutritional Standards (MNS) for Catering for Staff and Visitors in HSC settings in NI. The National Diet and Nutrition Survey data for NI highlights the population consumes too much saturated fat, sugar and salt and not enough fruit, vegetables, oily fish or fibre compared to Government recommendations. The significant role of the workplace and employers in promoting healthier lifestyles and supporting staff with better nutritional and other choices is increasingly recognised. The issue of food served within Health Care settings has been highlighted as a key area for development both in terms of the overall health impact to staff and visitors and in leading system change and modelling good practice to improve standards and shift the norm of food offerings to become healthier.

Methods

A review was undertaken of the work done in the other areas of the UK where nutritional standards have been successfully introduced in Health Service catering. This included the Government Buying Standards for Food and Catering Services and the supporting Healthier Catering Toolkit in England, the Scottish Government and NHS Health Scotland’s healthy living award and the Welsh voluntary guidance on healthy food and drink choices for staff and visitors and the Corporate Health Standard award. These were considered by the Working Group in conjunction with dietetic, catering and procurement specialists and adapted for use in NI. These food-based standards are developed around the Eatwell Guide.

Results

The MNS1 received endorsement from the British Dietetic Association (BDA) and the Hospital Caterers Association (HCA) and were published by safefood, the FSA and PHA on 16th June 2017 with a foreword by the NI Chief Medical Officer. The three agencies secured funding for a dietitian/nutritionist to lead the implementation of the standards. The Innovation Lab (Department of Finance NI) are supporting the implementation through research on behaviour change. The steering group have received a request from the Health Service Executive in the Republic of Ireland to adapt the standards for their use. The steering group has also received interest from other public sector organisations to use these standards.

Conclusion

The tripartite project achieved a key objective of A Fitter Future for All 2012–2022 obesity prevention strategy. The MNS fulfilled a vacuum felt in relation to the lack of relevant guidance for catering within the public sector in NI and highlighted the advantages of working in partnership. 1. Minimum nutritional standards for catering in health and social care; PHA, safefood, FSA,2017

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Obes Facts. 2018 May 26;11(Suppl 1):63.

O13.6 A scoping review and systematic mapping of existing health interventions, including those with a focus on obesity, in Islamic religious settings in the UK

KK Rai 1, S Abid Dogra 2, S Barber 2, P Adab 1, C D Summerbell 3

Introduction

We aimed to identify health interventions, particularly those with a focus on tackling obesity, in Islamic religious settings (IRS) in the UK. IRS were defined as mosques, madrassas (Islamic schools for children), and men’s or women’s circles which focused on Islamic studies. We planned to describe the content, implementation and evaluation of these interventions.

Methods

We conducted a scoping review and systematic mapping of the evidence, using methods adapted from previously published literature1,2. We searched bibliographic databases (published literature), search engines and websites (grey literature). We also searched for grey information (which is recorded only on paper or in a person’s memory) in the 10 areas in the UK with the highest Pakistani and Bangladeshi population. All of these areas were in England, and so we also selected the top area in Scotland, Northern Ireland and Wales. In these 13 areas, we contacted Muslim charity organisations and networks, local councils, mosques and health agencies. Four responses from 160 email requests sent, and 26 responses from 74 phone calls made, provided the source of grey information for this review.

Results

Fifty-five interventions were identified; 2 from bibliographic databases (both of which reported an evaluation), 4 from Google (one of which reported an evaluation), 9 from health websites (all 9 were contained in one report3), and 40 from the grey information (mostly identified from people’s memories). Contacting organisations or individuals in IRS by phone was much more successful compared with emails. Contacting a named person, particularly by somebody known to them, was particularly successful. Interventions were identified in all 13 geographical areas that we studied. 25 of the 55 interventions focused on physical activity, and three focused on diet. Most of the interventions were instigated and led by members of the congregation (often health professionals) acting as health champions and volunteers; this approach was considered a normal expectation with IRS communities. The choice of intervention used was often based on the personal experiences of the congregation and their needs and desires. Most of the interventions identified were not associated with any external funding. Most of the interventions were poorly described in terms of content and implementation, and rarely evaluated. The few interventions which were described in detail and evaluated were externally funded, and suggest that using faith leaders to deliver the intervention results in a relatively high reach (response and retention rate).

Conclusion

Interventions to tackle obesity, particularly those which promote physical activity, are common place in IRS in the UK. Most of these interventions are instigated and led by volunteers from within the congregation, receive no external funding, and are only recorded in people’s memories. Given the potential benefit which these interventions may have on reducing inequalities in obesity in South Asian Muslim communities, further research is warranted.

References

Obes Facts. 2018 May 26;11(Suppl 1):64.

O14.1 An unique phenotype found in obese mice exposed to hypoxia: amelioration of hyperglycaemia despite worsening of insulin resistance

S Abu Eid 1, MT Hackl 1, M Kaplanian 1, M Winter 2, A Luger 1, T Scherer 1, C Fürnsinn 1

Introduction

The prevalence of obesity and diabetes is lower in mountain than lowland dwellers, which could in part be due to the lower partial oxygen pressure at high altitude. Although mountain ascents and experimental hypoxia are known to reduce food intake, no study in humans or animals has yet convincingly dissected, if and to what extent metabolic benefits ascribed to a hypoxic environment reach beyond the mere consequences of a spoilt appetite.

Methods

Four groups of male C57BL/6J mice were maintained under the following conditions for 3 months: free access to conventional chow diet (n = 8); free access to high fat diet (HFD; 60% of calories as fat; n = 8); free access to HFD under continuous normobaric hypoxia (10% oxygen; n = 12); restricted access to HFD so to obtain a weight curve as in found in the hypoxia treated mice (n = 12). Body weight and food intake were documented at least twice a week. Glycaemia and body composition, as well as glucose and insulin tolerance were determined at the end of the study, before the animals were killed for the collection of plasma and tissue samples.

Results

As compared to chow diet, HFD induced weight gain and the typically associated metabolic derangements. Exposure to hypoxia reversed most of the HFD induced increase in calorie consumption (with chow ad lib = 100%: HFD ad lib, 131%; HFD+hypoxia, 102%) with according effects on body weight and metabolic parameters. Providing the same amount of HFD to control mice as consumed by their hypoxic counterparts resulted in parallel weight curves, indicating that hypoxia did not affect energy expenditure or food efficiency. Comparable body weight as induced by hypoxia vs. food restriction went along with similar body composition (% body fat: HFD+hypoxia, 29+/-2; HFD restricted, 29+/-3; ns), plasma insulin (nmol/l: HFD+hypoxia, 0.24+/-0.04; HFD restricted, 0.25+/-0.03; ns) and plasma leptin (nmol/l: HFD+hypoxia, 1.29+/-0.22; HFD restricted, 1.20+/-0.16; ns). While the effects of hypoxia on the above parameters thus seem to be secondary to blunted appetite and weight gain, hypoxia improved basal glycaemia and glucose tolerance beyond the extent observed in weight matched controls (basal glycaemia, mmol/l: chow ad lib, 6.2+/-0.2; HFD ad lib, 10.2+/-0.7; HFD+hypoxia, 6.8+/-0.2; HFD restricted, 8.0+/-0.3; hypoxia vs. food restricted: p = 0.006). Weight independent amelioration of hyperglycaemia was accompanied by a reduced ratio of hepatic lipid content (mg/g) per total fat mass (g), suggesting that hypoxia shifted lipid disposition from liver to adipose tissue (HFD+hypoxia, 4.0+/−0.2; HFD restricted, 5.6+/−0.3; p = 0.0004). Such direct beneficial actions of hypoxia were accompanied by seemingly counterintuitive results from the insulin tolerance test, indicating that hypoxia caused insulin desensitisation (decremental area over the curve, min*mmol/l: HFD+hypoxia, 140+/−17; HFD restricted, 221+/−15; p = 0.003).

Conclusion

In mice fed HFD, continuous exposure to hypoxia markedly reduced food consumption resulting in amelioration of obesity and associated metabolic derangements. Beyond the indirect metabolic changes via blunted appetite and weight gain, hypoxia directly triggered an unique phenotype characterised by amelioration of hyperglycaemia along with impairment of insulin sensitivity.

Obes Facts. 2018 May 26;11(Suppl 1):64.

O14.2 Enhanced metabolic flexibility to glucose excess is accompanied by impaired metabolic flexibility to glucose deprivation in healthy young males

J E Galgani 1, P Olmos 1, R Fernandez 1, M Castro 2, JL Santos 2

Introduction

Metabolic flexibility (MetFlex) is the capacity to adapt fuel oxidation to fuel availability. A mismatch between availability and oxidation of energy substrates might induce insulin resistance. Accordingly, MetFlex assessed under conditions of glucose excess (e.g. euglycemic-hiperinsulinemic clamp) directly relates to insulin sensitivity. Whether MetFlex assessed under conditions of glucose deprivation (e.g. prolonged fasting) follows the same pattern is unknown. We hypothesized that: i) enhanced MetFlex to glucose excess during an euglycemic-hiperinsulinemic clamp was accompanied by enhanced MetFlex to glucose deprivation during prolonged fasting; and ii) enhanced MetFlex during prolonged fasting will associate with high insulin sensitivity.

Methods

Fourteen healthy, weight-stable males (age = 22.1 ± 1.7 [mean ± SD] y old; BMI = 21.8 ± 1.4 kg/m2) were evaluated during glucose clamp conditions (85 mg/dL, 2 mU insulin/kg/min, for 2 hours) and during prolonged fasting (only water allowed, minimal physical activity, for 20 h). Clamp and fasting sessions were randomly assigned, and were conducted on two different days within 5 weeks. Gas exchange was determined by indirect calorimetry. Baseline respiratory quotient (baseline RQ) was determined in overnight fasted individuals before the beginning of each session. Then, RQ was measured at the end of the clamp (last 20 min), and at the end of prolonged fasting (last 20 min), and the change in RQ (end – baseline) was calculated. We assessed correlations by Pearson test, and mean differences by t test.

Results

Baseline RQ was similar between clamp and prolonged fasting sessions (0.83 ± 0.08 and 0.80 ± 0.07, respectively; p = 0.23). RQ increased at the end of glucose clamp to 0.95 ± 0.05 (range: 0.84–1.04; p < 0.0001). In turn, RQ at the end of prolonged fasting was 0.77 ± 0.05 (range: 0.69–0.83), which was not different from baseline RQ (p = 0.13). The changes in RQ during glucose clamp (0.13 ± 0.07) and during prolonged fasting (−0.03 ± 0.06) were unrelated (r = 0.42; p = 0.16). However, the RQ achieved at the end of glucose clamp and at the end of prolonged fasting were strongly associated (r = 0.80; p < 0.001). In turn, insulin sensitivity (M-value of 9.0 ± 2.2 [4.8–12.9] mg glucose/kg/min) correlated with the RQ at the end of prolonged fasting (r = 0.60; p = 0.02), and trended to correlate with the RQ at the end of glucose clamp (r = 0.48; p = 0.08). The association between RQs achieved at the end of prolonged fasting and at the end of glucose clamp remained significant after controlling for the M-value (r = 0.74; p = 0.004).

Conclusion

We showed that enhanced MetFlex to glucose excess (i.e. glucose clamp) was accompanied by impaired MetFlex to glucose deprivation (i.e. prolonged fasting). Thus, independent mechanisms would determine the capacity to adapt glucose-to-lipid oxidation ratio under conditions of high vs. low glucose availability. The association between insulin sensitivity and RQ at the end of prolonged fasting suggests that individuals with high insulin sensitivity display an impaired capacity to switch to lipid oxidation when glucose availability decreases.

Obes Facts. 2018 May 26;11(Suppl 1):65.

O14.3 The effect of long term Arabinoxylan-oligosaccharide supplementation on gastrointestinal functioning and metabolic parameters: A randomized controlled trial

M Müller 1, G Hermes 2, EE Canfora 1, JJ Holst 3, EG Zoetendal 2, H Smidt 2, F Troost 4, K Lenaerts 5, AAM Masclee 4, EE Blaak 1

Introduction

Prebiotic fibers may induce shifts in gastro-intestinal transit time, microbiota composition and short chain fatty acids (SCFA) production which may contribute to improved gut functionality and metabolic health. Here, we investigate long term effects of Arabinoxylan-Oligosaccharide (AXOS), a dietary fiber with strong prebiotic potential, on gastro-intestinal transit time, gut microbiota composition, and metabolic profile in healthy participants with delayed gastrointestinal transit.

Methods

Forty-eight healthy men and women (BMI 20–30 kg/m2) with a slow whole-gut transit time (>35h) were included in this double-blind, placebo-controlled, parallel intervention study. The participants were randomly allocated to a daily intake of 15g AXOS or isocaloric placebo (maltodextrin) for 12 weeks. Before and after treatment, whole gastro-intestinal (radio-opaque marker method) and small intestinal transit time (hydrogen breath test), gastric emptying rate (13C-octanoic acid breath test), gut permeability (multi-sugar assay) and stool consistency via Bristol stool chart (BSC) scale were assessed. Fecal microbiota composition and short chain fatty acids (SCFA) concentrations were investigated. Energy expenditure and substrate oxidation, plasma glucose, insulin and Glucagon-like peptide 1 (GLP-1) were measured after a standardized breakfast meal.

Results

After 12 weeks, the abundance of fecal Bifidobacterium spp. increased in both groups, with a tendency towards a more pronounced increase with AXOS compared to placebo (2.5-fold change and 1.1-fold change respectively, NS). This was accompanied by a significantly reduced microbial richness compared to placebo (inverse Simpson index, P < 0.001). Whole and small intestinal transit and gastric emptying were not affected but BSC scores significantly changed towards softer stool consistency after AXOS intake (BSC score 2.7 ± 0.19 to 3.3 ± 0.19, P < 0.01). After AXOS intake, we observed a trend towards increased postprandial fat oxidation (iAUC, P = 0.073) and a decreased early GLP-1 response (AUC0–60min, P = 0.005) after a standardized breakfast. Fasting and postprandial energy expenditure, glycemic and insulinemic responses, fecal SCFA and gut permeability were not affected.

Conclusion

Our data indicate that long term AXOS supplementation tended to increase fecal Bifidobacterium spp. abundance, did not affect gastro-intestinal transit time but improved stool consistency. Postprandial fat oxidation tended to increase after AXOS, whilst early postprandial GLP-1 was decreased. The mechanisms by which AXOS induces these effects on gastro-intestinal and metabolic health require further study.

Obes Facts. 2018 May 26;11(Suppl 1):65.

O14.4 Effects of Different Metabolic States and Surgical Models on Glucose Metabolism and Secretion of Ileal L-Cell Peptides: Results from the HIPER-1 Study

E Cagiltay 1, A Celik 2, J Dixon 3, S Pouwels 4, S Santoro 5, A Gupta 6, BO Celik 2, S Ugale 7, M Abdul-Ghani 8

Introduction

To compare the impact of 4 surgical procedures (mini gastric bypass [MGB], sleeve gastrectomy [SG], ileal transposition [IT], and transit bipartition [TB]) versus medical management on gut peptide secretion, beta cell function, and resolution of hyperglycemia in patients with type 2 diabetes.

Methods

A mixed-meal tolerance test (MMTT) was administered 6–24 months after each surgical procedure (mini gastric bypass [MGB], sleeve gastrectomy [SG], ileal transposition [IT], and transit bipartition [TB], n = 30 in each group) and the result was compared to matched lean (n = 30) and obese (n = 30) type 2 diabetes patients undergoing medical management

Results

MGB and IT patients had a greater increase in plasma glucose concentration following MMTT than SG and TB patients. MGB patients exhibited the greatest increase in the incremental area under the curve of plasma glucose concentration above baseline (ΔG0–120) (p < 0.0001). Insulin sensitivity was comparable across surgical groups, and statistically greater in surgical patients than in obese nonsurgical patients (p < 0.0001). Beta cell responsiveness to glucose was greater in SG and TB than in MGB and IT patients (p < 0.001) despite a smaller increase in ΔGLP-10–120 relative to IT. Postoperative beta cell function was the strongest predictor of hyperglycemia resolution.

Conclusion

The present study demonstrated that the level of beta cell function after bariatric surgery is the strongest predictor of hyperglycemia resolution. The study also demonstrates a disconnection between postprandial GLP-1 levels and beta cell function among the studied surgical procedures.

Obes Facts. 2018 May 26;11(Suppl 1):65–66.

O14.5 Hepatic CB1 Receptor Regulates Soluble Leptin Receptor Levels and Promotes Obesity-induced Leptin Resistance

A Drori 1, A Gammal 1, R Hadar 1, D Wesley 2, J Tam 1

Introduction

Leptin plays a major role in regulating body weight via activating hypothalamic leptin receptor. The soluble form of leptin receptor (SLR), secreted by the liver, regulates leptin’s bioavailability and bioactivity. Diet-induced obesity (DIO) is associated with reduced SLR levels, hyperleptinemia, and increased activity of the endocannabinoid (eCB) system via the stimulation of the cannabinoid-1 receptor (CB1R). Recently, we demonstrated that peripheral blockade of CB1R attenuates the obesity-associated leptin resistance via reducing leptin secretion and increasing its renal clearance, as well as by restoring hypothalamic leptin signaling. Yet, the role of SLR in this phenomenon has not been reported.

Methods

By using both pharmacological and genetic approaches that target the hepatic CB1R, we determined its contribution to the expression and/or subsequent release of SLR in vivo and in vitro.

Results

Compared to lean mice, DIO wild type mice were characterized by increased plasma leptin levels, reduced hepatic expression of leptin receptor isoforms and circulating levels of SLR. These changes were reversed by a 7-day treatment with the peripherally restricted CB1R antagonist, JD5037. Mice with a specific hepatic ablation of CB1R had comparable hepatic expression and plasma levels of SLR when fed either a standard or a high-fat diet, while mice overexpressing CB1R only in hepatocytes recapitulated the obese wild type phenotype. Further evidence for a direct regulation of SLR expression by CB1R was obtained in immortalized mouse hepatocytes in which synthetic stimulation of CB1R reduced the secreted levels of SLR into the media, an effect that was completely reversed by JD5037. Moreover, the regulation of SLR by CB1R involved the CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP), since stimulating CB1R in CHOP-/- hepatocytes did not affect SLR expression levels in comparison to normal hepatocytes.

Conclusion

These findings highlight a novel role of the hepatic CB1R in regulating SLR levels. Increased activity of the eCB system in obesity may target hepatic CB1R to decrease the expression and/or subsequent release of SLR into the circulation, and thus may promote hyperleptinemia and leptin resistance.

Obes Facts. 2018 May 26;11(Suppl 1):66.

O14.6 Epigenetic regulation of skeletal muscle metabolism after bariatric surgery in humans

S Gancheva 1, M Ouni 2, C Koliaki 3, J Szendroedi 1, T Jelenik 1, D Markgraf 1, M Schlensak 4, A Schürmann 2, M Roden 1

Introduction

Bariatric surgery improves insulin sensitivity (IS) due to metabolic changes which have been related to weight-loss. Of note, environmental factors have been shown to modulate IS by DNA methylation. This study tested the hypothesis that weight loss due to bariatric surgery causes epigenomic changes, which in turn modify muscle metabolism. We previously reported that IS fails to improve at 2 weeks (2 w), but increases during the following 52 weeks (52 w).

Methods

Muscle mitochondrial function was measured in 49 obese humans (OBE; 40 ± 10 yrs, BMI 51 ± 7 kg/m2) before and during 52 w after bariatric surgery. Muscle lipid intermediates, genome-wide gene expression and DNA methylation were analyzed in a subgroup of 16 OBE.

Results

At 2 w, augmented adipose tissue lipolysis transiently increased specific muscle diacylglycerols, which prevented from rapid improvement IS despite slightly increased muscle oxidative capacity. At 52 w, muscle mitochondrial function and intracellular lipids were similar in OBE and lean humans. Acute alterations in expression of 1287 genes involved primarily in mitochondrial function, transcriptional regulation, protein transport, fatty acid metabolism and inflammatory processes, but not changes in DNA methylation, contribute to transient upregulation of mitochondrial function and lipolysis. At 52 w, 109105 CpGs were differentially methylated, which related to improved IS. Interestingly, epigenetic alterations in the TOMM7 gene, encoding a translocase of the outer mitochondrial membrane involved in transport of pre-proteins into mitochondria, related to reprogramming transient changes in mRNA expression at 2 w.

Conclusion

Metabolic alterations after bariatric surgery leads to differential DNA methylation of genes involved in muscle energy metabolism, which contributes to beneficial changes in gene expression.

Obes Facts. 2018 May 26;11(Suppl 1):66–67.

T1P2 Prevention of osteopontin cleavage by thrombin reduces obesity mediated adipose tissue inflammation but does not improve insulin sensitivity

B Wanko 1, S Peraramelli 2, Q Zhou 2, W Shen 3, J Morser 2, LL Leung 2, TM Stulnig 1

Introduction

It is well established that obesity goes in line with a chronic low-grade inflammation, triggering the onset of metabolic diseases such as type 2 diabetes. Obesity mediates a strong upregulation of – mainly macrophage derived – osteopontin (OPN) in the adipose tissue. Cleavage of OPN by thrombin exposes additional integrin binding sites and renders OPN more active. In this study, the in vivo effect of OPN cleavage by thrombin on adipose tissue inflammation and insulin resistance was investigated.

Methods

An OPN knock-in (OPN KI) mouse, carrying a mutation at the thrombin cleavage site of OPN (R153) which blocks cleavage of OPN by thrombin, was analyzed. Wildtype (wt), OPN knock out (OPN KO) and OPN KI mice were put on low fat (LFD) or high fat diet (HFD). After 14 weeks, an insulin tolerance test was performed using 2 U/kg insulin. To assess the body composition, Dual-energy X-ray absorptiometry (DXA) was performed. After 16 weeks, mice were sacrificed and gene expression in the adipose tissue was analyzed by RT-PCR.

Results

Insulin resistance on HFD was similar in OPN KI compared to wt mice whereas it was significantly reduced in OPN KO mice. DXA scans revealed that wt, OPN KO and OPN KI mice on HFD exhibited the same percentage of fat. However, CCL2, emr1, TNF-α, INF-γ, IL-12p40 were significantly downregulated in OPN KO and similarly in OPN KI compared to wt mice on HFD.

Conclusion

The OPN KI mouse model represents a unique tool to investigate the in vivo effect of OPN cleavage by thrombin. The adipose tissue inflammation was markedly reduced in OPN KI mice similar to OPN KO mice, indicating that thrombin cleaved OPN is a main driver of adipose tissue inflammation. In contrast, blockade of OPN cleavage did not increase the insulin sensitivity indicating that OPN and its cleavage affect adipose tissue inflammation and insulin resistance by different mechanisms. The work is funded by a grant (I01BX001959) from the Department of Veterans Affairs, USA (to L.L.L.) and by the CCHD doctoral program of the FWF (W1205-B09), and the Federal Ministry of Economy, Family and Youth and the National Foundation for Research, Technology and Development, Austria (to T.M.S.)

Obes Facts. 2018 May 26;11(Suppl 1):67.

T1P3 Modulation of VEGFB signaling by DDE exposure in obesity

AC Guerra 1, R Costa 1, I Rodrigues 1, C Neves 1, H Veiga 1, S Ferreira 1, Si Sousa 2, VF Domingues 2, C Calhau 3, D Pestana 3, R Negrão 1

Introduction

Obesity is a multifactorial disease characterized by an increase in adipose tissue (AT) mass, which should be accompanied by an increase in angiogenesis, modulated by vascular endothelial growth factor (VEGF)-A. Fatty acid uptake into AT, liver and heart was shown to be modulated by VEGF-B signaling, through an increase in fatty acid transport protein (FATP)3 and FATP4 expression. Persistent organic pollutants, as p,p’-dichlorodiphenyldichloroethylene (p,p’-DDE), can accumulate in AT, leading to dysregulation of this tissue or, if released into blood circulation, can act as endocrine disruptors. The aim of this study was to verify if p,p’-DDE exposure, in different diet contexts, can change VEGF-B signalling and thus modulate the uptake of fatty acids across the endothelium into different tissues. It was also aimed to verify the effect of p,p’-DDE in the angiogenic process.

Methods

Wistar rats were divided into four treatment groups during 12 weeks: Standard diet (St), St with DDE (St+DDE, 100 μg/kg/day), High-fat diet (HFD) and HFD with DDE (HFD+DDE, 100 μg/kg/day). At the end of the treatment, plasma biochemical analysis was performed and the effect in the uptake of fatty acids was analysed in mesenteric adipose tissue (mAT), liver and heart by analysing Vegfb, Vegfr1, Fatp3 and Fatp4 genes expression by qRT-PCR as well as by quantification of tissue lipid content. The angiogenic effect in mAT was evaluated by analysis of Vegfa and Vegfr2 gene expression by qRT-PCR and through the quantification of blood vessels present in tissue (immunohistochemistry to CD31). Statistical analysis included two-way ANOVA followed by Turkey’s multiple comparison test.

Results

Although HFD alone increased rats’ body weight, mAT mass, adipocytes area and heart weight, rats concomitantly fed with HFD and exposed to DDE manifested a more pronounced dyslipidemia and an increase of plasma markers of tissue dysfunction. In mAT, HFD and DDE exposure promoted angiogenesis by increasing the expression of Vegfa and Vegfr2 genes, with DDE also increasing the release of VEGF-A. Moreover, DDE exposure and HFD increased the expression of Vegfb, Vegfr1 and Fatp3 genes, in mAT. In liver and heart, DDE exposure increased the expression of Vegfb, Vegfr1, Fatp3 and Fatp4 genes. In liver, HFD but also DDE showed to promote tissue lipid accumulation. In the heart, only rats fed with HFD increased heart triglyceride concentration.

Conclusion

The results allowed to conclude that in animals fed a HFD, the exposure to DDE, promoted tissue dysfunction, dyslipidemia and angiogenesis. DDE exposure modulated Vegfb/Vegfr1 signaling and thus the Fatp3 and Fatp4 genes in several tissues, increasing lipid accumulation in the liver. Therefore, DDE exposure seems to contribute to metabolic disorders and obesity.

Obes Facts. 2018 May 26;11(Suppl 1):67.

T1P4 Effect of maternal and offspring diet on adipose tissue morphology and number of CD68 positive cells in male rat offspring

D Šnajder 1, R Mujkić 2, Ž Perić Kačarević 2, A Grgić 2, V Blažičević 3, R Radić 2

Introduction

Adipose tissue can be divided into two main types, white and brown. White adipose tissue is predominant in the body of mammals and specialized to store energy. To be able to adapt to excessive supply of energy, adipose tissue expansion can occur through several ways: 1. hypertrophy and/or hyperplasia of adipocytes, 2. infiltration of inflammatory cells and 3. remodeling of vasculature and extracellular matrix. Adipose tissue expansion, under certain conditions, can be connected with chronic inflammation. Prolonged inflammation in obesity can lead to obesity-related insulin resistance and tissue dysfunction.

Methods

Ten female Sprague Dawley rats were at 9 weeks of age randomly divided into two groups and fed either standard laboratory chow or food rich in saturated fatty acids during 6 weeks and then mated with genetically similar male rats. After birth and lactation male rat offspring from both groups were divided into four subgroups depending on the diet they were fed until 22 weeks of age. After sacrifice, samples of white adipose tissue were taken from the subcutaneous compartment and from two compartments of visceral white fat (epididymal and perirenal). Histomorphometric analysis of digital images of histological tissue sections was conducted using the CellProfiler program v. 2.1.1., and immunohistochemical staining for CD68 was performed.

Results

Greater mean surface area of subcutaneous and epididymal adipocytes was found in groups of male rat offspring with altered diet. In perirenal adipose tissue the highest number of adipocytes and the smallest surface adipocyte area was measured in the group where both mother and offspring were fed high-fat diet. The number of CD68 positive cells per mm2 of adipose tissue was the highest in groups where both mother and offspring were fed a diet rich in saturated fatty acids and it was especially high in subcutaneous white adipose tissue, although there was no statistical significance among groups.

Conclusion

Mother’s diet and changes in postnatal diet can lead to alterations of adipose tissue morphology and infiltration of inflammatory cells.

Obes Facts. 2018 May 26;11(Suppl 1):67–68.

T1P5 IRX5 regulates adipocyte amyloid precursor protein and mitochondrial respiration in obesity

J Bjune 1, C Haugen 2, O Gudbrandsen 3, OP Nordbø 3, P Njølstad 1, JV Sagen 2, S Dankel 2, G Mellgren 2

Introduction

A causal obesity risk variant in the FTO locus was shown to act via increased adipose expression of the iroquois homeobox gene family members IRX3 and IRX5. These transcription factors were found to inhibit adipocyte thermogenesis, but a role for Irx5 in regulation of energy metabolism and fat mass has not been demonstrated in vivo.

Methods

We here examined diet-dependent fat mass development in Irx5 knock-out mice compared to wild-type mice. Further, we analyzed global gene expression in the mouse adipose tissue and in isolated human adipocytes in search of novel mechanisms by which Irx5 regulates adipose metabolism.

Results

Irx5 knock-out mice weighed less, had diminished fat mass and were protected from diet-induced fat accumulation compared to wildtype mice. Key adipose mitochondrial function genes Pgc-1α and Ucp1 were upregulated, and a gene network centered on App was downregulated in the knock-out mice and in primary mouse adipocytes with stable Irx5 knock-down. IRX5 overexpression increased APP promoter activity in luciferase assays and inhibited transactivation of PGC-1α and UCP1. Knock-down of Irx5 and/or App significantly increased mitochondrial respiration in adipocytes and this effect could partially be rescued by overexpression of APP. An APP-centered network was also enriched in isolated adipocytes from obese compared to lean people.

Conclusion

Loss of Irx5 in mice increased adipose mitochondrial respiration and protected against diet-induced obesity, likely involving a novel Irx5-dependent regulation of App.

Obes Facts. 2018 May 26;11(Suppl 1):68.

T1P6 Polarization of human adipose tissue macrophages in obesity-induced inflammation

K Strand 1, N Stiglund 2, ME Haugstøyl 3, G Mellgren 3, N Björkström 2, J Fernø 3

Introduction

Obesity is associated with a chronic, low-grade inflammation in the adipose tissue (AT). During development of obesity, macrophages (Mϕs) infiltrate the adipose tissue where they undergo polarization from an anti-inflammatory M2 into a pro-inflammatory M1 state. Cytokines produced by M1 Mϕs is believed to contribute to the development of insulin resistance. Inflammation and Mϕ infiltration appear to be more distinct in the visceral adipose tissue (VAT) than in the subcutaneous adipose tissue (SAT). However, most of our knowledge on ATMϕs comes from studies with animal models, and confirmatory studies, including Mϕ deep phenotyping, from human samples is warranted.

Methods

In this study, we aimed to characterize macrophage subsets in human blood, SAT and VAT in relation to obesity-induced insulin resistance. Matched (from the same patient) blood, SAT and VAT biopsies were obtained from morbidly obese subjects undergoing bariatric surgery. Patients were classified as either insulin resistant or insulin sensitive based on their HOMA-IR values. Macrophage subsets in the blood and adipose tissue were analyzed with 12-color flow cytometry using a BD LSR Fortessa.

Results

M1 macrophages (defined as CD11c+CD206+ cells) were more frequent in VAT compared to SAT. These M1 macrophages also expressed the pro-inflammatory marker C-C chemokine receptor 2 (CCR2) at higher levels than M2 macrophages and monocytes, in both VAT and SAT. Patients in the high HOMA-IR group had a higher percentage of M1 macrophages and a lower percentage of M2 macrophages in their adipose tissue compared to patients in the low HOMA-IR group.

Conclusion

Our findings demonstrate that VAT harbours more pro-inflammatory macrophages than SAT and that inflammation in VAT is associated with insulin resistance defined by HOMA-IR. These observations are in line with the understanding that VAT is the most important adipose depot for obesity-induced insulin resistance in humans.

Obes Facts. 2018 May 26;11(Suppl 1):68.

T1P7 Impaired ASC-1 function reduces adipocyte serine uptake and promotes visceral adiposity

R Å Jersin 1, AG Madsen 1, A Willems 1, E Fjære 2, J Bjune 3, S Ellingsen 4, L Madsen 2, JV Sagen 1, G Mellgren 5, SN Dankel 6

Introduction

Visceral adiposity associates with increased risk of developing metabolic diseases such as type 2 diabetes, cardiovascular disease and several forms of cancer. Identifying novel molecular mechanisms responsible for regional fat storage may allow development of new therapeutic strategies.

Methods

We performed a systematic genome-wide screen of altered gene expression linked to visceral adiposity, followed by relevant functional assays in both mouse and primary human adipocyte cultures, including transcriptomics, Seahorse mito stress test, metabolomics, radiometric amino acid uptake assay, Oil-Red-O lipid staining and reactive oxygen species (ROS) assay. In addition, an overfeeding experiment was conducted in 8-week-old knockout zebrafish, with analysis of weight gain, adipocyte morphology, and adipose transcriptomics by RNA sequencing.

Results

We identified 65 genes showing both adipose depot-dependent and fat loss-dependent expression in severely obese patients undergoing bariatric surgery. The gene, encoding the neutral amino acid transporter alanine-serine-cysteine transporter 1 (ASC-1), was expressed at the highest level in isolated visceral adipocytes, indicating a potential novel role for this amino acid transporter in the regulation of visceral adiposity. By profiling amino acid fluxes during adipocyte differentiation in vitro, we found that ASC-1 inhibition by a selective inhibitor decreased adipocyte uptake particularly of serine in mature adipocytes. Additionally, inhibiting ASC-1 in both primary human and murine adipocytes decreased mitochondrial respiratory capacity and increased lipid accumulation, in association with increased reactive oxygen species (ROS) generation. ASC-1 knockout zebrafish showed increased body weight and adipocyte enlargement after eight-weeks of overfeeding compared to their wild-type counterparts. RNA sequencing data for zebrafish adipose tissue showed up-regulation of genes involved in fatty acid and lipid metabolic processes in the ASC-1 knockout fish, consistent with the increased lipid accumulation in the inhibitor-treated cell models. Additionally, genes involved in ROS generation, leukocyte migration and inflammatory response were highly expressed in the knockout zebrafish compared to the wildtype fish.

Conclusion

Our translational study reveals an important role for ASC-1-mediated serine uptake in adipocytes in protecting against excessive lipid accumulation, and points to increased ROS generation and reduced mitochondrial respiratory capacity as a central early mechanism in the development if visceral adiposity.

Obes Facts. 2018 May 26;11(Suppl 1):69.

T1P8 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):69.

T1P9 Nrf2-mediated Antioxidant Defense and Peroxiredoxin 6 are Linked to FAHFA biosynthetic pathway

M Pravenec 1, O Kuda 1, M Brezinova 1, J Silhavy 1, V Landa 1, C Dodia 2, F Kreuchwig 3, L Balas 4, T Durand 4, N Hubner 3, AB Fisher 2, J Kopecky 1

Introduction

Fatty acid esters of hydroxy fatty acids (FAHFAs) are lipid mediators with anti-diabetic and anti-inflammatory properties that are produced in white adipose tissue (WAT) via de novo lipogenesis, but their biosynthetic enzymes are unknown.

Methods

Using a combination of lipidomics in WAT, QTL mapping and correlation analyses in rat BXH/HXB recombinant inbred strains, and response to oxidative stress in murine models, we elucidated the potential pathway of biosynthesis of several FAHFAs.

Results

Analysis of WAT samples identified ~160 regioisomers documenting the complexity of this lipid class. The linkage analysis highlighted several members of Nuclear factor, erythroid 2-like 2 (Nrf2)-mediated antioxidant defense system (Prdx6, Mgst1, Mgst3, Gpx7), lipid-handling proteins (Cd36, Scd6, Acnat1, Acnat2, Baat) and family of flavin containing monooxygenase (Fmo) as the positional candidate genes. Transgenic expression of Nrf2 and deletion of Prdx6 genes resulted in reduction of palmitic acid ester of 9-hydroxystearic acid (9-PAHSA) and 11-PAHSA levels, while oxidative stress induced by an inhibitor of glutathione synthesis increased PAHSA levels nonspecifically.

Conclusion

Our results indicate that the synthesis of FAHFAs via carbohydrate-responsive element-binding protein (ChREBP)-driven de novo lipogenesis depends on the adaptive antioxidant system and suggest that FAHFAs may link activity of this system with insulin sensitivity in peripheral tissues.

Obes Facts. 2018 May 26;11(Suppl 1):69.

T1P10 GLP-1 receptor agonists induce the browning of white adipocytes

M Rossato 1, M Granzotto 1, L Molinari 1, V Silvestrin 1, S Leandri 1, R Vettor 1

Introduction

Obesity is a multifactorial disease rapidly increasing with a global estimated prevalence of about 20% in 2030. The first line of treatement consists in a personalized hypocaloric diet together with proper physical activity. Pharmacotherapy is indicated for patients with BMI>30 kg/m2 or BMI>27 kg/m2 with at least one complication; neverthless current drugs are not effective in the long-term and are associated with many different side effects because their lack of specificity. A novel potential therapeutic target is represented by the recruitment of brown adipose tissue (BAT) for its thermogenic properties but its amount is minimal in the adult and then with probably reduced, albeit significant, effects on weight reduction. For this reason the induction of the browning of white adipose tissue seems to represent a challenge to induce a higher increase of energy consumption given the huge amount of white adipose tissue in obese subjects. In this study we evaluated the expression of the GLP-1 receptor and the in vitro effects of its activation on the thermogenic program in 3T3-L1 cells.

Methods

3T3-L1 cells were cultured in adipogenic medium and seeded in culture plates to complete differentiation to mature adipocyte. We investigated the mRNA expression of GLP-1 receptor by PCR using specific primers. Then the cells were treated for 24 hours with control medium, exendin-4 and liraglutide at increasing concentrations (1, 10, 100 nM). Furthermore in separate experiments cells were treated with a fixed dose (100 nM) of exendin-4 and liraglutide for 48 and 72 hours. By RT-PCR we evaluated the expression of specific genes markers of adipogenesis, lipid metabolism, mitochondriogenesis and of browning differentiation. Finally we evaluated the effects of exenatide and liraglutide on oxygen consumption using the Seahorse bioenergetics analyzer.

Results

Our results confirm the expression of GLP-1 receptor in 3T3-L1 cells, a well known model of white adipocytes. The stimulation with exendin-4 and liraglutide increased the expression of thermogenic genes involved in energetic substrate consumption and heat production. The analysis of oxygen consumption rate showed that both exenatide and liraglutide increased oxygen consumption in 3T3-L1 cells in a dose and time-dependent manner.

Conclusion

The results of this study seem to confirm the hypothesis that white adipocytes may undergo a transdifferentiation browning process to beige adipocytes after stimulation with GLP-1 receptor agonist. Exendin and liraglutide, two well known GLP-1 receptor agonists, are widely used in the treatment of type 2 diabetes, although it has been shown that they can lead to weight reduction. To this respect liraglutide has been authorized for the treatment of obesity in human. The mechanisms of action of liraglutide have not been fully elucidated, although it is thought that it exert a central effect modulating the mechanisms regulating food intake. Our results extend those observations suggesting that GLP-1 receptor agonists might stimulate also the peripheral energy consumption inducing the browning of white adipose tissue thus possibly contributing to calorie burning and weight reduction.

Obes Facts. 2018 May 26;11(Suppl 1):69–70.

T1P11 Unraveling the missing heritability of obesity by screening for structural variation in olfactory receptor genes

S Diels 1, E Geets 1, K Van Hoorenbeeck 2, G Massa 3, A Verrijken 4, S Verhulst 2, L Van Gaal 4, W Van Hul 1

Introduction

Obesity is a highly heritable complex disorder characterized by an excessive accumulation of adipose tissue that results from the persistent imbalance between energy intake and expenditure. Its increasing prevalence and associated morbidity imposes an enormous burden on human health. Although the environment and a passive lifestyle are major contributors to the etiology of obesity, studies have shown that 40–70% of the interindividual variability in BMI is attributed to genetic factors. A total of 97 BMI-associated loci were identified that account for approximately 2.7% of the estimated heritability. This leaves a substantial component still missing for which other forms of variation need to be considered. Copy number variants account for a major proportion of human genetic variation and have been predicted to have an important role in the genetic susceptibility to common disease. Genome-wide copy number analysis associated chromosome 11q11 with obesity. As this region is rich in olfactory receptor genes, we hypothesize that variation in olfactory receptor genes might be implicated in the pathogenesis of obesity.

Methods

Multiplex Amplicon Quantification analysis was applied to screen for copy number variants at chr.11q11 in 344 obese children and adolescents.

Results

In 26% of this study population we identified a 67 kb deletion exclusively covering the four olfactory receptor genes OR4C11, OR4P4, OR4S2 and OR4C6. By performing in silico analysis, we estimated the natural variation of this copy number variant region between 5–55%.

Conclusion

Additional screening of a control population will be necessary to demonstrate a clear difference in frequency of copy number variation at the 11q11 region between the obese cohort and the control population. This will enable us to depict the involvement of structural variations in olfactory receptor genes to the obese phenotype.

Obes Facts. 2018 May 26;11(Suppl 1):70.

T1P12 Roux-en-Y Gastric Bypass Surgery Normalizes Dopamine D1, D2 Receptor and DAT Levels in the Striatum and Improves Dopamine Modulation of Sucrose Reward

A Hajnal 1, E Orellana 1, J Hamilton 2, S Swenson 2, PK Thanos 2

Introduction

Roux-en-Y gastric bypass surgery (RYGB) is one of the most effective treatments for morbid obesity. One of the potential underlying mechanisms of long-term maintenance of weight loss achieved by the surgery is an alleviated reward deficiency caused by obesity. As opposed to improved eating behaviors (e.g. reduced preference for highly palatable foods, reduced food cravings and food addiction), however, RYGB may also increase susceptibility to alternative (i.e., non-food) rewards such as alcohol and substance use. This study examined the effects of RYGB on the dopamine system in a dietary obese rat model to elucidate these observed changes in reward-related behaviors.

Methods

Sprague Dawley male rats were assigned to 4 groups: Normal diet with sham surgery, high fat diet (HFD) with sham surgery, HF restricted diet with sham surgery, and HFD with RYGB. Following the surgeries, rats were kept on their respective diets for 9 weeks before they were trained on a progressive ratio schedule of reinforcement (PR) sucrose self-administration and tested for the effect of D1 or D2 receptor antagonists (SCH23390, raclopride) (Experiment 1) or were sacrificed for histological assessment (Experiment 2) using autoradiography with [3H] SCH23390, [3H]spiperone, and [3H]WIN35,428 ligands to examine dietary and RYGB effects on D1, D2 receptor and DAT levels.

Results

In Experiment 1, compared to sham surgery, RYGB increased sucrose seeking for lower (< 0.3M) and reduced performance for higher concentrations (>0.3M). Furthermore, RYGB reduced sensitivity for D1 or D2 antagonist in reducing sucrose reward (PR-break-point). In Experiment 2, HFD rats (ad-libitum or restricted-fed) had decreased D1 receptor levels in the ventrolateral striatum and the nucleus accumbens core. In addition, HFD was associated with decreased D2 levels in the dorsomedial, dorsolateral, ventrolateral, and ventromedial regions of striatum as well as the nucleus accumbens core and shell. In contrast to D1 and D2 levels, DAT levels were most affected by a restricted HFD.

Conclusion

The changes in dopamine receptor levels observed between obese rats and RYGB rats demonstrate that effects of HFD on the dopamine system were reversed by RYGB. The behavioral studies provided further evidence for improved dopamine signaling in controlling sucrose reward. These findings provide mechanistic insights into the effects of RYGB on the dopamine system and suggest that improved dopamine signaling in the striatum may explain both the beneficial (improved food reward) and the potential adverse effects on reward behaviors such as an increased alcohol and substance use.

This research is supported by a National Institutes of Health Grant AA024490.

Obes Facts. 2018 May 26;11(Suppl 1):70.

T1P13 Acylated ghrelin response to a standardised meal is associated with the glucose response, but not with visceral adipose tissue or liver fat levels in healthy men and women

F Reistenbach Goltz 1, AE Thackray 1, V Varela Mato 1, JA King 1, DJ Stensel 1

Introduction

The homeostatic control of appetite and energy intake involves a variety of gastrointestinal peptides, of which the orexigenic hormone acylated ghrelin and the anorexigenic hormone peptide YY (PYY) have received widespread attention. Limited evidence suggests an inverse association between visceral adipose tissue and fasting ghrelin concentrations may exist. However, this finding is not universal and less is known regarding the influence of body fat distribution on the postprandial ghrelin and PYY responses. This study investigated the association between abdominal adiposity and concentrations of glucose and appetite-regulatory hormones in the fasted and postprandial state.

Methods

A total of 112 healthy participants (Table 1) completed three visits in a cross-sectional design. Table 1. Participant characteristics (n = 112, 56 males).

During visit 1, anthropometric data (stature, body mass and skinfold thickness) were collected and peak $$O2 was measured using an uphill incremental treadmill test to volitional exhaustion. During visit 2, venous blood samples were taken in the fasted state and at 0.5, 1 and 2 h post-prandially for the measurement of acylated ghrelin, total PYY, glucose and insulin concentrations. Leptin concentration was measured in the fasted state. A standardised meal (4430 kJ, 40% carbohydrate, 18% protein, 42% fat) was consumed immediately after the fasting sample. During visit 3, visceral adipose tissue and liver fat percentage were quantified using 3-T magnetic resonance imaging. Pearson’s correlation coefficients were used to examine relationships between adiposity outcomes and circulating concentrations of glucose and appetite-regulatory hormones in the fasted and postprandial states.

Results

Fasting concentrations and delta total area under the curve (AUC) for acylated ghrelin and total PYY were not associated with age, BMI or body fat percentage (r ≤ 0.183, P ≥ 0.054). Visceral adipose tissue and liver fat percentage were positively associated with fasting glucose and insulin concentrations (r ≥ 0.284, P ≤ 0.005) and insulin delta AUC (r ≥ 0.277, P ≤ 0.005). No associations were observed between abdominal adiposity parameters and fasting acylated ghrelin, total PYY and leptin concentrations (r ≤ 0.071, P ≥ 0.483) or delta AUC for acylated ghrelin, total PYY and glucose (r ≤ 0.091, P ≥ 0.368). Fasting acylated ghrelin and total PYY were not associated with fasting leptin, glucose or insulin concentrations (r ≤ 0.139, P ≥ 0.145). Acylated ghrelin delta AUC was negatively associated with glucose delta AUC (r = −0.276, P = 0.003), but not with insulin delta AUC (r = 0.055, P = 0.565). Total PYY delta AUC was not associated with insulin or glucose delta AUC (r ≤ −0.140, P ≥ 0.140).

Conclusion

Our results suggest that general and abdominal adiposity are not associated with fasting or postprandial acylated ghrelin and total PYY in healthy individuals. However, postprandial changes in acylated ghrelin were associated with changes in glucose after the consumption of a standardised meal.

Tab. 1.

 Mean (SD)
 Range
Age (years) 34 (9) 18 to 50
BMI (kg/m2) 25.2 (3.9) 18.4 to 40.3
Body fat (%) 22.3 (8.7) 5.2 to 45.2
Visceral adipose tissue (L) 1.7 (1.3) 0.1 to 6.2
Liver fat (%) 2.1 (1.8) 0.5 to 10.4
Peak oxygen uptake ($$O2) (mL/kg/min) 44 (9) 21 to 81
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Obes Facts. 2018 May 26;11(Suppl 1):70–71.

T1P14 Impact of energy flux on sleeping energy expenditure and fat oxidation during energy balance, caloric restriction and overfeeding

A Nas 1, FA Hägele 2, F Büsing 2, A Bosy-Westphal 2

Introduction

There is evidence that body weight regulation is improved when physical activity and energy intake are both high (high energy flux, EF). Thus, a high EF may prevent a decrease in energy expenditure due to caloric restriction or favor a potential increase of energy expenditure due to overfeeding.

Methods

In an ongoing randomized controlled crossover trial, 8 participants (BMI 23.1 ± 2.5 kg/m2) underwent three 24h-interventions with different levels of energy flux: (i) low, PAL = 1.3 (ii)°medium, PAL = 1.5 and (iii) high energy flux, PAL = 1.6 each at energy balance (EB), caloric restriction (CR) and overfeeding (OF) (100%, 75% or 125% of individual energy requirement with 50% CHO, 35% fat, 15% protein) in a caloric chamber. Daily energy requirement for each energy flux was measured before intervention. Different levels of energy flux were accomplished by walking (4 km/h) on a treadmill (0, 165 and 330 min). Total energy expenditure (TEE), sleeping energy expenditure (SEE) as well as 24h-macronutrient oxidation (n = 5) were determined. Nitrogen excretion was used to correct for protein oxidation.

Results

During EB, CR and OF SEE was higher with high compared to low energy flux (+12 kcal/3h; +15 kcal/3h and +22 kcal/3h, all p < 0.05) and during EB and OF SEE was higher with medium compared to low energy flux (+11 kcal/3h and + 13 kcal/3h, both p < 0.05). TEE during CR was lower with low and medium energy flux, but not with high EF when compared with EB (−104 kcal/d and −134 kcal/d; both p < 0.05). During EB, fat oxidation as a percentage of TEE and the relationship between fat oxidation and intake (oxidation/intake) were higher with medium EF compared to low EF (both p < 0.05), but not with high energy flux.

Conclusion

A high energy flux increased sleeping energy expenditure and prevented the drop in total energy expenditure with caloric restriction. Therefore a high energy flux may have a beneficial effect on body weight regulation. Moreover there was a tendency for a positive impact of energy flux on fat balance.

Obes Facts. 2018 May 26;11(Suppl 1):71.

T1P15 The effects of beetroot juice on lipid metabolism, inflammation and oxidative stress in spontaneously hypertensive rats expressing human C-reactive protein

J Silhavy 1, M Pravenec 1, V Zidek 1, V Landa 1, M Simakova 1, P Mlejnek 1, H Malinska 2, M Huttl 2, O Oliyarnyk 2, I Markova 2, L Kazdova 2

Introduction

In recent years, red beetroot (Beta vulgaris var. rubra L.) has attracted attention as a health promoting functional food. Preliminary studies showed that beetroot juice can reduce blood pressure. Beetroot’s effect on the vasculature is largely attributed to its high inorganic nitrate content which is reduced to nitric oxide (NO). On the other hand, effects of beetroot on glucose and lipid metabolism remain controversial.

Methods

We measured parameters of glucose and lipid metabolism, oxidative stress and inflammation in spontaneously hypertensive rat expressing human C-reactive protein (SHR-CRP rats), an animal model of inflammation and metabolic syndrome, after administration of beetroot juice (James White, Ipswich, UK) in drinking water for 4 weeks.

Results

Treatment of three-month-old SHR-CRP male rats with beetroot juice versus untreated controls was associated with significantly reduced oxidative stress as estimated by reduced hepatic levels of lipoperoxidation products, conjugated dienes and TBARS, with decreased inflammation and with lower weight of epididymal fat, lower plasma triglycerides and hepatic cholesterol. In addition, SHR-CRP rats treated with beetroot juice exhibited increased sensitivity of white adipose tissue (WAT) to insulin action and activation of brown adipose tissue (BAT) when glucose oxidation was significantly increased. On the other hand, parameters of glucose metabolism, including plasma glucose, insulin and insulin stimulated glycogenesis in skeletal muscle were not affected by beetroot juice treatment.

Conclusion

These results suggest that beetroot juice affects parameters of lipid metabolism, inflammation and oxidative stress and could potentially ameliorate dyslipidemia in a rodent model of inflammation and metabolic syndrome.

Obes Facts. 2018 May 26;11(Suppl 1):71.

T1P16 Pubertal protein malnutrition blunts fat accumulation and does not aggravate the deleterious effects of high-fat diet on glucose homeostasis and skeletal muscle insulin resistance in young adult mice

R CS Branco 1, RL Camargo 2, TM Batista 3, JF Vettorazzi 1, C Lubaczeuski 4, LHM Bomfim 4, LR Silveira 4, AC Boschero 4, CC Zoppi 4, EM Carneiro 4

Introduction

The thrifty phenotype hypothesis states that nutritional restriction in early stages of development is associated with whole-body metabolic programing that may facilitate the onset of obesity, peripheral insulin resistance and type 2 diabetes mellitus later in life after increased caloric intake. In animal models it has been shown that protein malnutrition during gestation and/or lactation and puberty is associated with increased skeletal muscle insulin sensitivity and glucose tolerance in early adulthood. However, the consequences of nutritional insults, such as high-fat diet after protein restriction is still controversial. An interesting study has showed that protein restriction during gestation and lactation exacerbated insulin resistance induced by high-fat diet (HFD) in young adult mice. Another work has shown that protein restriction during gestation increased skeletal muscle mitochondrial function, increased energy expenditure (EE) and prevented weight gain in mice when fed a HFD in old mice. We have shown that pubertal protein restriction does not potentiate high-fat diet-induced glucose intolerance and insulin resistance in mice. However, the metabolic alterations underlying the phenotype of protein restrict rodents fed a HFD has not been fully elucidated. Since skeletal muscle accounts for the majority of whole-body metabolic rate, we hypothesize that this tissue may have an important role on the phenotype found on young adult protein restricted mice fed a HFD.

Methods

30-days old male C57BL/6 mice were fed a control (14% protein-CD) or a protein-restricted (6% protein-RD) diet for 6 weeks. Afterwards, mice received an HFD for 8 weeks (CH and RH).

Results

CH mice displayed increased fat accumulation and fasting plasma glucose and insulin levels, glucose intolerance and insulin resistance when compared to CD mice. RH mice displayed reduced weight gain, fat accumulation and showed no differences on fasting plasma glucose and insulin levels when compared to CH. RH displayed glucose intolerance at the same magnitude as CH, however were more insulin sensitive. HFD reduced EE in CH mice. Both RD and RH mice displayed increased EE when compared to CH mice. CH mice displayed reduced gastrocnemius citrate synthase (CS), PGC1alpha protein content and reduced levels of malate and oxaloacetate when compared to CD. RH displayed increased protein content of CS and PGC1alpha, malate and alpha-ketoglutarate levels when compared to CH. HFD reduced AMPK and ACC phosphorylation ratio in CH when compared to CD. RH mice showed increased AMPK and ACC phosphorylation ratio when compared to CH. RD and CH displayed higher levels of gastrocnemius malonyl-CoA when compared to CD. RH showed lower levels of malonyl-CoA than RD. Finally, CH showed increased levels of intramuscular triacylglycerol (TAG) when compared to CD. RH mice displayed reduced levels of TAG when compared to CH and did not differ from CD.

Conclusion

In conclusion, our data show that protein undernourishment after weaning does not potentiate fat accumulation and insulin resistance in adult young mice fed a HFD. This outcome is associated with increased skeletal muscle mitochondrial oxidative capacity and reduced lipids accumulation.

Obes Facts. 2018 May 26;11(Suppl 1):72.

T1P17 Fat mass exerts an inhibitory effect on food intake in lean individuals varying in physical activity levels

K Beaulieu 1, M Hopkins 2, J Blundell 3, G Finlayson 1

Introduction

Evidence indicates that fat-free mass is a strong driver of energy intake (EI) under conditions of approximate energy balance, but reported associations between fat mass and EI have been weaker and less consistent. However, these findings have been observed primarily in individuals with overweight and obesity. Since it has been proposed that the inhibitory effect of fat mass on appetite becomes weaker at higher levels of body fat, this study examined the associations between body composition and EI in lean individuals, and whether PA moderates this relationship.

Methods

Data from two studies employing common methodological procedures were pooled in the present analysis (n = 70). Participants (61% female, age: 29.5 ± 9.1 yr, body mass index: 22.7 ± 2.3 kg/m2, total moderate-to-vigorous PA (MVPA): 136.2 ± 58.4 min/day; mean ± SD) completed a preliminary assessment where body composition (air displacement plethysmography) was measured and wore a multi-sensor device (SenseWear Armband) over 5–7 days to estimate free-living PA. This was followed by a probe day where ad libitum EI was measured at test meals. Pearson’s correlations controlling for study were conducted to assess relationships among variables. To examine the effects of PA level on the relationship between fat mass and meal size, participants were grouped by sex-specific tertiles of measured daily MVPA: low (LoMVPA; 14 females/9 males), moderate (ModMVPA; 15 females/9 males) and high (HiMVPA; 14 females/9 males).

Results

Meal size (951 ± 279 kcal) was inversely associated with fat mass (r = -.26, p = .03) and positively associated with fat-free mass (r = .44, p < .001). Fat mass (r = -.50, p = .002) and fat-free mass (r = .51, p = .002) were also associated with daily EI (2599.7 ± 620.6 kcal) in a subsample of 34 participants. The inverse association between fat mass and meal size was strongest in HiMVPA (r = -.43, p = .05), compared with LoMVPA (r = -.17; p = .46) and ModMVPA (r = -.06, p = .78).

Conclusion

These data demonstrated that fat mass was inversely associated with meal size and daily EI in lean and relatively active individuals. We interpret this as an inhibitory effect of body fat on EI in lean individuals. The study confirmed that fat-free mass was positively associated with EI. The strength of the association between fat mass and meal size may be moderated by PA level (or factors related to high PA). This supports a role for fat mass in inhibiting food intake in lean individuals, and for PA in enhancing the sensitivity of appetite control.

Obes Facts. 2018 May 26;11(Suppl 1):72.

T1P18 The rate of weight-loss does not affect appetite sensations differently in women living with obesity

L J Hintze 1, GS Goldfield 2, E Doucet 1

Introduction

Increases in appetite driving energy intake (EI) upward have been frequently reported as consequence of weight-loss. However, it remains unknown whether the degree of energy restriction, i.e. the rate of weight loss, impacts the magnitude of increase in appetite and energy intake. Accordingly, the objective of this study was to investigate how the rate of weight loss impacts the changes in appetite sensations and EI in women living with obesity.

Methods

Twenty-six women (32.5 ± 9.57 years) were assigned to either fast (n = 13) (−1000kcal/day; 10-week) or slow (n = 13) (−500kcal/day; 20-week) weight loss. Appetite ratings (Desire to eat, hunger, fullness and prospective food consumption = PFC) were measured using Visual Analogue Scale. Measures of appetite were taken fasting, at time 0, 30, 60, 90, 120, 150 and 180 min after a standard breakfast. AUC was calculated using the trapezoid method. EI was measured with a validated food menu after approximately 210 min after breakfast. Body composition was assessed by DXA.

Results

Changes in body weight (−5.26 ± 3.68%, P < 0.001, η2 = 0.707), FM (−4.74 ± 6.61%, P = 0.01, η2 = 0.380) and FFM (−5.28 ± 4.9%, P < 0.001, η2 = 0.546) were not significantly different between groups after the intervention. Fasting desire to eat (p = 0.007, η2 = 0.268), hunger (p = 0.001, η2 = 0.377) and PFC (p < 0.001, η2 = 0.408) increased comparably between both groups after weight loss. On the other hand, post prandial AUC for desire to eat, hunger, PFC and fullness did not change. EI decreased by the end of the trial (p = 0.025, η2 = 0.191). No time x group interactions were noted for any of those variables, indicating changes between groups were not significant.

Conclusion

The results suggest that different rates of weight loss impact on fasting and postprandial appetite in women in a similar way, even when final weight losses are comparable between groups.

Tab. 1.

Body composition, appetite and energy intake changes before and after weight loss

Slow (n = 13) Fast (n = 13)
Baseline Post Intervention Baseline Post Intervention P time* group
Body weight (Kg) 87.06(12.09) 83.15 (11.59) 95.02(15.77) 89.44(16.44) <0.001 0.193
Body Fat (Kg) 41.11 (5.16) 38.98(5.44) 45.45(8.10) 43.11(8.40) 0.01 0.462
Fat Free Mass (Kg) 42.51(8.07) 44.73(6.86) 42.27(7.63) <0.001 0.799
Fasting Desire to eat (mm) 63.69(12.76) 82.23(14.74) 69.11(20.47) 83.83(24.51) 0.007 0.736
Fasting Hunger (mm) 57.71(18.84) 74.60(17.82) 62.25(18.40) 81.02(19.09) 0.001 0.842
Fasting PFC (mm) 54.98(21.74) 70.7(24.83) 60.29(16.98) 80.10(11.35) <0.001 0.651
Fasting Fullness (mm) 17.5 (22.26) 14.46(19.12) 15.37(17.99) 8.56(12.94) 0.328 0.706
AUC Desire to Eat (mm.min) 10691.54 (5434.30) 6984.23 (5712.12) 9040.96 (5277.37) 9631.11 (7532.79) 0.321 0.175
AUC Hunger (mm.min) 9284.42 (5286.46) 7283.65 (6105.62) 8822.31 (4535.31) 9198.46 (6868.86) 0.548 0.381
AUC PFC (mm.min) 11749.61 (4546.78) 9470.31 (6635.62) 10403.08 (5223.02) 11181.34 (7478.93) 0.628 0.327
AUC Fullness (mm. min) 24444.23 (5584.35) 26167.50 (5825.78) 23751.92 (5552.87) 23986.73 (7463.29) 0.447 0.810
Total EI Lunch (Kcal) 602.53 (181.99) 574.77 (242.99) 740.04 (266.67) 527.21 (232.60) 0.025 0.079
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AUC: Area Under the Curve; PFC: Prospective Food Consumption; EI: Energy Intake

Obes Facts. 2018 May 26;11(Suppl 1):72–73.

T1P19 A single day of overfeeding does not elicit compensatory appetite or energy intake responses during the next day

K Deighton 1, AJ King 1, J Matu 1, OM Shannon 1, O Whiteman 1, A Long 1, A Holliday 1

Introduction

Excessive energy consumption in relation to energy expenditure has resulted in 62% of adults in England being classified as either overweight or obese in 2014. Understanding the energy balance responses to acute episodes of excess food consumption is important to appreciate the potential implications of contemporary eating patterns such as “cheat meals” or “cheat days” for weight gain.

Methods

Eight healthy male participants (mean (SD); age: 22 (2) years, body mass index 26.2 (4.5) kg.m−1) completed two 28-hour experimental trials in a single-blind randomised crossover design interspersed with a minimum washout period of one-week. All participants were weight stable and standardised their habitual diet for three days prior to each trial. On the first day of each trial, participants consumed breakfast, lunch and an evening meal under laboratory supervision. The energy content of all meals comprised 50% carbohydrate, 15% protein and 35% fat. On one trial, these meals provided the calculated energy requirements for each individual (Energy Balance trial, EB). On the other trial, the content of the meals was covertly manipulated to increase the energy content by 50% (Overfeeding trial, OF). On the second day of each trial, participants arrived to the laboratory having fasted overnight, and completed a mixed meal tolerance test. Composite appetite scores (CAS) were obtained for 180min postprandially, prior to the assessment of ad libitum energy intake using a homogenous pasta meal. Data were analysed using Cohen’s d effect sizes and paired t-tests.

Results

Participants ingested 2600 (165) kcal on the first day of EB and 3900 (248) kcal on the first day of OF, respectively. On the second day of the trials, fasted CAS was moderately higher in EB (80 (16) mm) than OF (72 (17) mm) (d = 0.50; p = 0.247). However, area under the curve for CAS was not different between trials in response to the meal tolerance test (EB 58 (14) mm; OF 57 (12) mm; d = 0.02; p = 0.885). Energy intake at the ad libitum meal was not different between trials (EB 1396 (319) kcal; OF 1437 (235) kcal; d = 0.13; p = 0.743).

Conclusion

A single day of overfeeding may reduce fasting appetite perceptions on the next morning but these effects did not persist after the consumption of a standardised breakfast meal. This resulted in similar ad libitum energy intakes between trials. The absence of compensatory changes in postprandial appetite and energy intake during the day after a 50% energy surplus raises concerns regarding the dietary practices of “cheat meals” and “cheat days”. Populations advocating this dietary pattern should be aware of the need to consciously monitor food intake across other days of the week to prevent the gradual accumulation of a positive energy balance.

Obes Facts. 2018 May 26;11(Suppl 1):73.

T1P20 Fibrinogen like protein-1 plays as a link between obesity and bladder cancer

C Hu 1, H Wu 2, J Wu 2, Y Yang 2, F Lu 2, C Chang 2

Introduction

Obesity is a growing epidemic worldwide. Many urologic cancers are ranked among the current leading causes of cancer, depending on many interrelated factors, such as obesity, and dietary intake. Several studies supports a positive association between obesity and bladder cancer risk. However, factors that mediate between these two diseases are still obscure. Fibrinogen like protein-1 (FGL1) is a novel adipokine that exerts effects on adipogenesis, and the development of type 2 diabetes. In addition, FGL1 plays as a mitogen that regulates cell proliferation; however, the effects of FGL1 on bladder cancer is still unknown. Thus, the aim of this study was to evaluate the role of FGL1 in obesity and bladder cancer.

Methods

Obesity in mice was induced using a high fat diet containing 35% fat. Serum FGL1 concentrations were determined by ELISA kits. Lenti-viral vectors containing FGL1 gene, short hairpin RNA targeted to FGL1 (shFGL1) or green fluorescent protein (GFP, as control) were used to overexpress or knockdown FGL1 expression in murine bladder tumor-2 cells (MTB-2). Cell proliferation rate was determined by MTT assay. FGL1 gene manipulated MTB-2 cells were injected subcutaneously into the right flanks of each C57BL/6 mouse, and the tumor volume and lifespan were recorded.

Results

Overexpression of FGL1 increased the proliferation rate of MTB-2 cells, whereas knockdown of FGL1 decreased the proliferation rate of the cells. Treatment of ERK1/ inhibitor blocked the effect of FGL1 on cell proliferation, indicating that FGL1 regulated cell proliferation through an ERK1/2-dependent pathway. In addition, plasma glucose and insulin levels were significantly increased in mice fed with a high fat diet, implying the development of insulin resistance. Furthermore, the plasma FGL1 concentrations were also significantly increased in mice fed with a high fat diet, and the MTB-2 bladder tumor size was significantly larger in obese mice as compared with chow group. On the other hand, deletion of FGL1 significantly decreased the tumor size.

Conclusion

Our results indicated that obesity might increase the serum FGL1 levels and further exacerbate the bladder tumor progression.

Obes Facts. 2018 May 26;11(Suppl 1):73.

T1P21 MiR-15b as a novel adipogenic enhancer promotes adipogenesis in pediatric obesity

F Ma 1, S Ouyang 1, Z Liu 1, Y Li 1

Introduction

The metabolic disorder caused by obesity is an important risk factor for metabolic diseases such as coronary heart disease and hypertension. Studies have shown that miRNA affects fat development in adipose tissue, but the specific mechanism is not clear. Our previous study found that the expression of plasm miR-15b in obese children was significantly higher than the control group; the concentration of miR-15b adjusted by the expression of adipose transcription factor and cyclin CCND1. Then, we hypothesized that miR-15b targeted CCND1 in ADSCs adipogenic differentiation during obesity.

Methods

Plasma miRNA chip of clinical obesity and lean children and obese mice induced by high fat diet were used to construct an obesity model. Then miR-15b knockout mice was used to explore the relationship between miR-15b and obesity. Cell differentiation in different periods were analyzed based on adipogenic differentiation of ADSCs.

Results

The miR223, miR15b and miR199a were highly expressed in clinical obesity than lean children groups and the expression of miR-15b in adipose tissue increased significantly in the obese mice. Dual luciferase reporter assay validated that CCND1 is the target gene of miR-15, which can effectively inhibited the expression of CCND1. The visceral adipose tissue of high fat feeding miR-15b knockout mice is less than that of normal feeding mice.

Conclusion

results suggested that, miR-15b targeted CCND1 on effect of ADSC to differentiate into adipose cells. MiR-15b may be a new circulator marker during obesity and provide a theoretical basis and new therapeutic targets for the early intervention of obesity.

Obes Facts. 2018 May 26;11(Suppl 1):73.

T1P22 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):73–74.

T1P23 Jussara pulp (Euterpe edulis Mart.) supplementation associated to short-term high fat diet effects on improves adipose tissue inflammation: A dose response test

L P Pisani 1, AB Santamarina 1, G Jamar 1, LV Mennitti 1, HDC Cesar 1, VV Rosso 1, LM Oyama 2

Introduction

Obesity is associated with high-fat diet intake, which are rich in saturated fatty acids and poor in dietary fibers. These dietary patterns are related to low-grade proinflammatory mechanisms, such as the Toll-like receptor 4 (TLR4) pathways, which are rapidly activated during the intake of high-fat diets. Interest in nutraceutical foods with potential health benefits has been increasing. Juçara, a berry from Euterpe edulis Mart. palm tree, is rich in anthocyanins and ω−3 and ω−9 fatty acids, and it can be used to prevent the development of comorbidities associated with obesity, such as systemic low-grade inflammation.

Methods

We evaluated the effect of short-term high-fat diet intake associated with two different doses of freeze-dried juçara pulp on the inflammatory pathway. Male Wistar rats with ad libitum access to food and water were divided into four groups: control diet (C), high-fat diet (HFC), high-fat diet juçara 0.25% (HFJ0.25%), and high-fat diet juçara 0.5% (HFJ0.5%). After overnight fasting, animals were euthanized, and serum was collected for adiponectin analyzes. Retroperitoneal white adipose tissue (RET) was collected for elisa assay of Interleukin 10 (IL-10), Tumor necrosis factor-α (TNF- α), and western blotting protein analyzes of Toll-like 4 (TLR4) pathway.

Results

The HFJ0.25% exerted a protective role against high-fat diet deleterious effects in RET reducing TRAF6 (p = 0.048) in related to HFC group and modulating the cytokines analysed. There were no differences in the TLR4, MYD88 and phosphorylated NFκBp50 protein expressions in RET. TNF-α concentrations in RET were higher in HFC (p = 0.033) and HFJ0.5% (p = 0.003) than in C group, but there was no difference in HFJ0.25% group. In turn, interleukin-10 was increased in HFC (p = 0.032) and HFJ0.5% (p = 0.009) compared with C group in RET. Our results also showed that HFJ0.25% also had higher serum adiponectin levels than C group.

Conclusion

We observed that the HFJ0.25% group showed better protective effects than the HFJ0.5% group. Therefore, 0.25% of juçara can be used for treating and preventing obesity related inflammation through the TLR4 pathway, which was activated by high-fat diet intake.

Conflicts of Interest

Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2016/14133-0).

Obes Facts. 2018 May 26;11(Suppl 1):74.

T1P24 Glucagon-like peptide 2 (GLP-2): an underestimated signal in metabolic control

M Ejarque 1, D Beiroa 2, E Calvo 3, N Keiran 3, R Nogueiras 2, J Vendrell 1, S Fernandez-Veledo 1

Introduction

Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone released in response to dietary nutrients as GLP-1, which acts through a specific receptor, the GLP-2 receptor (GLP-2R). To date, GLP-2R expression has been mainly located in gut, where it exerts potent trophic effects, and in brain, where it acts as an anorexigenic hormone. Nonetheless, some in vivo observations suggest a wider expression profile than expected. This work aims to gain insight into the molecular function of GLP-2/GLP-2R axis on energetic metabolism, focusing on its potential modulatory function on adipose tissue (AT).

Methods

SGBS cell line was used as an in vitro model of human subcutaneous pre-adipocytes. Gene and protein expression studies were performed. Animal studies. Chow and high-fat diet (HFD) mice were treated once a day with GLP-2 analogue (Teduglutide) for 4 weeks, and different metabolic studies were performed.

Results

In agreement with previous data, short-term GLP-2 agonist centrally-treated mice showed a decreased food intake and weight gain. Surprisingly, these effects were not maintained in a chronic treatment of 14 days. Chronic modulation of central GLP-2R of diet-induced obesity (DIO) mice did not affect metabolism either. Conversely, chronic activation of peripheral GLP-2R provided body weight-independent glucose tolerance. Interestingly, Teduglutide shown an anti-inflammatory effect on visceral AT meanwhile it had lipogenic effects on subcutaneous AT, suggesting that GLP-2 agonism may have a direct effect on AT. Remarkably, our results demonstrate that GLP-2R is also expressed in AT, mainly in adipocyte fraction. Different from what is seen in intestine, in vitro studies revealed no effects of GLP2 on adipocytes proliferation. However, and consistent with in vivo data, GLP-2 treatment produced an increase on lipids accumulation with an up-regulation of lipogenic genes in subcutaneous adipocytes.

Conclusion

Overall, our data identify AT as a new target for GLP-2 activity. Understanding the role of GLP-2 in the metabolic events that take place in AT may help to define new Teduglutide potential indications of clinical usefulness in obesity.

Acknowledgement

Ministry of Spain − FIS (PI14/00228); Ciberdem (Cb07/08/0012); EFSD.

Obes Facts. 2018 May 26;11(Suppl 1):74.

T1P25 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):74.

T1P26 A distinct molecular signature of adipose tissue in constitutional thinness

N Gheldof 1, Y Ling 2, C Canto 3, B Galusca 2, N Germain 2, B Estour 2, J Hager 1

Introduction

Most studies in the obesity field have focused on metabolic changes occurring in obese populations, but less is known about people on the other side of the weight spectrum. Constitutional Thinness (CT) is a state of extremely low but stable body mass index (BMI, generally lower than 18 kg/m2) despite normal feeding, exercise and psychological profile. The goal of the present study is to gain understanding in the mechanism of this strong resistance to weight gain in CT. In particular, given the importance of adipose tissue in the obesity etiology, we present here our integrative analyses on the molecular characterization of adipose tissue in those people.

Methods

We conducted a clinical study on 30 CT and 30 normal weight individuals matched for gender and age (including 15 women and 15 men per group). Standard clinical variables were measured, and subcutaneous adipose tissue biopsies were taken. Adipocyte size was evaluated by histology, and transcriptomic profiling was performed by RNAseq and validated by Nanostring technology. In addition, mitochondrial function was analyzed by Oroboros high-resolution respirometry, and mitochondrial DNA content evaluated by Taqman qPCR.

Results

Adipocytes were markedly smaller in CT compared to the controls, and females had even smaller adipocytes than their male counterparts. Respiration assays did not show any difference in uncoupling, suggesting that there is not more brown/beige-like activity of the subcutaneous adipose tissue in CT. However, we observed a significant higher mitochondrial complex II activity in both male and female CT, resulting in higher electron transport chain activity. This higher activity was in line with the mitochondrial DNA content, which appeared to be higher in CT. Gene expression profiling demonstrated a distinct transcriptomic signature in CT adipose tissue samples. Pathway analyses revealed an increase in fatty acid oxidation pathways, but also triglyceride biosynthesis. This suggests the presence of a different futile fuel cycling, potentially associated with the observed increased mitochondrial activity.

Conclusion

In summary, despite the fact that CT individuals had smaller adipocytes, the mitochondrial content of adipose tissue from these people was higher, resulting in higher mitochondrial activity. We propose that this increased mitochondrial function could be a mechanism by which CT people maintain their lower weight.

Obes Facts. 2018 May 26;11(Suppl 1):74.

T1P27 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):74.

T1P28 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):75.

T1P29 PD-1+ conventional CD4 T cells show resting tissue-resident memory features and are impaired in local obesity-driven inflammation

A Petrelli 1, S Cardellini 1, PG Gazzetta 2, M Bissolati 2, A Saibene 3, C Socci 2, M Battaglia 1

Introduction

Obesity is associated with significant changes in T cell populations localized in the visceral adipose tissue (VAT), which have been described to have a critical role in the induction of local inflammation. A subset of CD4 T cells expressing PD-1 has been described to recapitulate obesity-driven inflammation in the VAT of lean mice. In humans, PD-1+ CD4 T cell function is still controversial, as they have been described as recently activated cells, endowed with regulatory properties and also exhausted in chronic environments. Since PD-1+ CD4 T cell role in obesity-mediated local inflammation is yet to be investigated, herein we aimed to determine the profile of this cell subset in the VAT of obese patients (OB) and lean controls (LC).

Methods

Whole blood and stromal vascular fraction (SVF) obtained from the VAT of obese patients (OB) undergoing bariatric surgery and lean controls (LC) undergoing kidney living donation were compared to assess the phenotype of PD-1-expressing cells, focusing on the conventional CD4 T cell subset (Tconv) – obtained by excluding regulatory T cells from the analysis -.

Results

To determine the features of VAT-derived PD-1+ Tconv in physiological condition, they were compared with PD-1+ Tconv coming from the peripheral blood (PB) of the same LC subjects. PD-1+ Tconv were found elevated in the VAT of LC, characterized by a memory (CD45RA-) phenotype, and with a reduced proliferative as well as cytotoxic capacity. These characteristics were not driven by their memory profile, thus indicating a tissue-specific skewing of PD-1+ Tconv, endowed with a resting profile in physiological conditions. To assess local features of PD1+ Tconv cells, they were compared with the PD-1- subset from the VAT of LC. This comparison showed enrichment of tissue-resident memory cell (TRM) markers (i.e. CD69+, CD45RA- and CCR7-) and shewing towards the Th1 phenotype in the PD-1+ subset, indicating that PD-1+ Tconv localized in the VAT, in physiological conditions, are endowed with a resting profile and are enriched with TRM cell markers. When a comparison with the VAT of OB patients was performed, we found that the frequency of PD-1+ Tconv was reduced in obesity, indicating that shortage of PD-1 Tconv is an obesity-specific characteristic of the VAT.

Conclusion

To conclude, these data show that at the site where inflammation is ongoing in obesity, the PD-1+ Tconv cell subset, previously described as driver of local inflammation in a mice model, is instead endowed with a resting phenotype, and is reduced in frequency compared to physiological conditions. These findings pave the way for further investigation of the potentially protective role of PD-1+ Tconv cells in obesity-driven local inflammation of the VAT.

Obes Facts. 2018 May 26;11(Suppl 1):75.

T1P30 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):75.

T1P31 Expression of LR11/SorLA, a thermogenesis suppressor, is regulated in adipogenesis of cultured adipocytes

M Jiang 1, H Ebinuma 2, T Murano 3, H Bujo 1

Introduction

Thermogenesis in brown (or beige) adipose tissue (BAT) is a significant component of energy expenditure. The decreased thermogenic activity in BAT is associated with the decreased energy expenditure in obese patients with type 2 diabetes. We have recently shown that the soluble form of the low-density lipoprotein receptor relative, LR11/SorLA (sLR11), suppresses thermogenesis in adipose tissue in a cell-autonomous manner in mice, and proposed that sLR11 may be applied for the detection and treatment of disturbed metabolic conditions as a novel fine-tuning negative regulator. Here, we analyzed the sLR11 mRNA expression levels in the process of adipogenesis using cultured cells.

Methods

3T3-L1 preadipocytes were proliferated and differentiated into mature adipocytes using standard procedures. mRNA expression levels were determined using real-time RT-PCR.

Results

sLR11 mRNA levels were drastically increased in the period of exponentially proliferating cells conditions after serum addition, and the enhanced expressions were gradually decreased at the subsequent period toward cell confluency. The expression levels of sLR11 after stimulation for maturation were drastically decreased, and the nearly undetectable levels were sustained for further incubation period. The sLR11 expression patterns were in contrast to the increases in those of PPARγ and LPL in the course of maturation.

Conclusion

sLR11 gene expressions were regulated during the proliferation and maturation of cultured adipocytes. sLR11 may play a role in the regulation of thermogenic activity as a physiological suppressor in adipogenesis.

Obes Facts. 2018 May 26;11(Suppl 1):75–76.

T1P32 IL-32a constitutes a link between obesity and colon cancer by promoting adipose tissue inflammation and extracellular matrix remodelling

V Catalan 1, J Gomez-Ambrosi 1, A Rodriguez 1, B Ramirez 1, VA Ortega 1, JL Hernandez-Lizoain 2, J Baixauli 2, S Becerril 1, F Rotellar 2, V Valenti 2, R Moncada 3, C Silva 4, J Salvador 4, G Frühbeck 4

Introduction

Adipose tissue inflammation is an important mechanism whereby obesity promotes colon cancer (CC) risk and progression. Since interleukin (IL)-32 is an important inflammatory and remodelling factor in obesity and is also related to CC development, our aim was to explore whether obesity can influence the circulating and expression levels of IL-32α in patients with CC, thereby promoting a microenvironment favourable for tumor growth. Furthermore, we investigated the potential regulatory role of IL-32 in inflammation and extracellular matrix (ECM) remodelling in human CC cells.

Methods

Visceral adipose tissue (VAT) gene and protein expression levels as well as circulating concentrations of IL-32α were analysed in 84 subjects (27 lean and 57 obese) further subclassified in 49 without CC and 35 with CC. The effect of IL-32a on the expression levels of inflammation and ECM remodelling related-genes in cultures of human CC cells was also explored.

Results

Significant differences in circulating IL-32α concentrations were observed, being significantly increased due to obesity (P = 0.009) and CC (P = 0.026). Obese patients with CC showed increased gene (P < 0.05) and protein (P < 0.01) expression levels of IL-32α compared with obese patients without CC. Inflammatory-related factors and hypoxia significantly enhanced (P < 0.01) the expression of IL32A expression in human CC cells. IL-32α treatment significantly enhanced the mRNA levels of the inflammatory factors TNF (P < 0.01), CCL2 (P < 0.05) and IL8 (P < 0.05) in CC cells. We also detected a strong upregulation (P < 0.001) of the ECM remodelling genes SPP1 and MMP9 after IL-32a treatment in CC cells. Interestingly, a significant increase (P < 0.05) in CC cells preincubated with the adipocyte-conditioned medium obtained from obese volunteers was observed.

Conclusion

The upregulated levels of IL-32 in patients with obesity and CC as well as its capacity to induce pro-inflammatory and ECM remodelling genes suggest the involvement of IL-32 in the development of obesity-associated CC.

Obes Facts. 2018 May 26;11(Suppl 1):76.

T1P33 β-adrenergic regulation of uncoupling protein 1 in human brown adipocytes

M J Riis-Vestergaard 1, SB Pedersen 1, JM Bruun 2, JB Hansen 3, B Richelsen 1

Introduction

Activation of brown adipose tissue (BAT) in adult humans is of great interest as potential pharmacological target for treatment of obesity and metabolic syndrome since BAT is able to increase energy expenditure by non-shivering thermogenesis through activation of uncoupling protein 1 (UCP1) resulting in heat generation. In rodent BAT this process is prominently induced through β3-adrenergic receptor (β3-AR) stimulation, whereas the primary AR involved in human BAT activation is still unclarified. Therefore, we aimed to evaluate the importance of the three different β-adrenergic subtypes for UCP1 activation in human BAT.

Methods

From human deep neck fat biopsies we have recently developed an immortalized human BAT cell model (TERThBA)1. TERThBA cells were cultured for 10 days to obtain maturity and the biological effects of sub-type specific AR-agonists on UCP1 expression were evaluated. In addition, both whole BAT biopsies and TERThBA were evaluated for expression of the β1-, β2-, and β3-ARs using qPCR.

Results

TERThBA displayed responsiveness to the β-AR agonist isoproterenol (1mM) with a 7.6-fold increase in UCP1 expression (p = 0.001) relative to baseline, whereas β2- and β3 selective agonists did not induce UCP1 expression. In addition, the predominant AR found in whole human BAT biopsies was the β1-AR, whereas β3-AR was undetectable. This finding was confirmed in the TERThBA cell model by a 129-fold higher expression of the β1-AR (p = 0.001) relative to the β3-AR.

Conclusion

The new TERThBA cell model displays responsiveness to β-AR agonists and expresses, unlike rodents, β1-AR rather than β3-AR. Human BAT activity may primarily be induced by β1-AR. Our findings add novel information of potential interest in the development of specific compounds targeting AR in human brown adipocytes.

Funding

Research related to this abstract was funded by Aarhus University, by the Innovation Fund Denmark, the Novo Nordisk Foundation, AP Møller Foundation, and Central Denmark Region.

Conflict of Interest

The authors have none disclosed.

Reference

  • 1.Markussen LK, Isidor MS, Breining P, et al. Characterization of immortalized human brown and white pre-adipocyte cell models from a single donor. PLoS One. 2017;12((9)):e0185624. doi: 10.1371/journal.pone.0185624. [DOI] [PMC free article] [PubMed] [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):76.

T1P34 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):76.

T1P35 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):76.

T1P36 Leptin participates in inflammation and extracellular remodelling of adipose tissue via nitric-oxide dependent mechanisms

S Becerril 1, A Rodriguez 1, V Catalan 1, L Méndez-Giménez 1, B Ramirez 2, N Sainz 1, M Llorente 3, X Unamuno 1, J Gómez-Ambrosi 1, G Frühbeck 1

Introduction

The extracellular matrix (ECM) of adipose tissue (AT) undergoes constant remodelling in obesity involving the combination of matrix synthesis and degradation, where different proteins, including tenascin (TNC), are deposited. The aim of the present study was to analyze the impact of the absence of the iNOS gene in inflammation and ECM remodelling of AT in ob/ob mice since a functional relationship between leptin and iNOS has been described.

Methods

Double knockout (DBKO) mice simultaneously lacking the ob and iNOS genes were generated and the expression of genes involved in inflammation and ECM remodelling were analyzed in AT. Moreover, leptin-deficient mice were classified in three groups: control, leptin-treated (1 mg kg–1 day–1) and pair-fed.

Results

The absence of leptin increased inflammation and fibrosis in AT. As expected, leptin administration improved the phenotype of obesity. iNOS deletion in ob/ob mice improved insulin sensitivity, AT inflammation and ECM remodelling, as evidenced by lower AT macrophage infiltration (P < 0.01) and collagen deposition (P < 0.01), a downregulation of the proinflammatory and profibrogenic genes Tnf (P < 0.01), Emr1 (P < 0.01), Hif1a (P < 0.01), Col6a1 (P < 0.01), Col6a3 (P < 0.01) and Tnc (P < 0.05), as well as lower (P < 0.05) circulating TNC levels. Interestingly, leptin upregulated TNC expression and release through NO-dependent mechanisms in 3T3-L1 adipocytes.

Conclusion

iNOS deficiency in ob/ob mice improved AT inflammation and ECM remodelling-related genes by diminishing fibrosis and metabolic dysfunction. iNOS activation by leptin is necessary for the synthesis and release of TNC, suggesting an important role of this alarmin in the development of AT inflammation and fibrosis.

Obes Facts. 2018 May 26;11(Suppl 1):76–77.

T1P37 High-fat diet and dietary supplements, betaine and polydextrose, induce changes in adipose tissue inflammation and metabolism in C57BL/6J mice

K Airaksinen 1, J Jokkala 2, I Ahonen 3, M Kolehmainen 2, K Tiihonen 1, K Hanhineva 2

Introduction

High-fat feeding is a likely cause of low-grade inflammation and obesity-related disturbances. Metabolic syndrome is a consequence of imbalanced adipocyte physiology and metabolism usually due to obesity caused excess adiposity [1]. This study focused on the effects of high-fat diet together with two dietary supplements, betaine and polydextrose, on metabolic changes in adipose tissue of diet-induced obese mice. Previously, dietary betaine (N,N,N-trimethylglycine) has improved adipose tissue function in vivo [2]. In vitro, betaine has reduced inflammation [3]. Polydextrose, a non-viscous soluble fiber, is known for its capacity to influence lipid metabolism and to regulate energy and glucose metabolism [4].

Methods

Forty C57BL/6J male mice were fed a high-fat (HF) diet for 8 weeks and compared against a low-fat (LF) diet control group (n = 10). For the last 4 weeks, HF-fed animals were randomized to receive one of the following supplementations alongside with the HF diet: 1% of betaine (Betafin® BP20, Danisco), 3.33% of polydextrose (Litesse® Ultra, Danisco), or their combination. One HF group remained without any supplementation. Weight gain and cumulative energy intakes were measured. Blood samples were analyzed for glucose, insulin, betaine, and satiety and inflammatory markers. Fat depots from subcutaneous and visceral adipose tissue were analyzed for inflammatory status and metabolic profiles with qPCR and LC-QTOF-MS.

Results

HF feeding increased the body weight gain and energy intakes, when compared to the LF diet. HF diet induced a statistically significant increase in inflammatory marker gene expression levels in both fat depots. Non-targeted metabolomics revealed clear differences between the LF and HF groups in the levels of several identified metabolite species, mainly carnitines, lipids and amino acids. Betaine supplementation alleviated the HF feeding-induced pro-inflammatory adipokine expression, namely the IL-6. Dietary betaine increased plasma betaine level as well as betaine and butyrobetaine levels in adipose tissue.

Conclusion

High-fat diet induced changes in carnitine and lipid metabolism in adipose tissue. Betaine supplementation increased the levels of betaine and its derivatives and some carnitine species, as reported previously also in muscle and liver [5]. Betaine reduced adipose tissue inflammation to some extent.

Conflicts of Interest

This study was done in collaboration between University of Eastern Finland (Kuopio, Finland) and DuPont Nutrition and Health (Kantvik, Finland). Betaine (Betafin®BP20) and polydextrose (Litesse® Ultra) were supplied by DuPont Nutrition and Health.

References

Obes Facts. 2018 May 26;11(Suppl 1):77.

T1P38 MicroRNAs expression profile of subcutaneous adipose tissue from obese patients associated with calorie restriction

E Montastier 1, J Bolton 1, A Valsesia 2, S Bonnel 1, J Hager 2, W Saris 3, A Astrup 4, D Langin 1, N Viguerie 1

Introduction

MicroRNAs (miRs) are endogenous small RNAs that post-transcriptionally regulate gene expression. They have been shown to control various pathways in adipose tissue (AT). miRs can be secreted and are particularly stable in biological fluids (such as urine and blood plasma), underscoring their potential role as biomarkers. The aim of this work was to analyze the change in AT miRNome during 8-week calorie restriction program, by comparing baseline to the end of diet in obese/overweight individuals.

Methods

The multi-center dietary intervention (DioGenes project) involved 548 subjects. All were well characterized: physical activity and eating behaviour questionnaires, food diaries, anthropometric parameters, blood and urinary metabolic parameters. The subjects were asked to complete a 3-day weighed food record, including 2-week days and 1 weekend day and validated by a nutritionist. Needle subcutaneous AT biopsies were performed at baseline and after 8 weeks. MiRs expression profiling was determined by microRNA microarrays probing 2578 miRs and validated using RTqPCR. Mixed effects models using Δ miR expression as dependent variable, were adjusted for age, sex, % weight change, and Δ energy intake, with centre included as a random effect. Bootstrapping (R = 5000) was applied to identify miR that remained significant. Analyses used R (version 3.2.2), packages lme4 (version 1.1–11) and boot (version 1.3–17).

Results

One hundred fifty eight subjects (discovery group) with both food diaries and AT miRs expression data available were studied. Ten miRs were differentially regulated with p < 0.05, of which 9 remained significant after internal validation using bootstrap analysis. All but 1 had negative b, indicating that with increased caloric restriction, miR expression decreased. Top miRs were validated using RT-qPCR on 142 subjects (validation group) using the same Methods. Mir-26b-5p was selected as the most stable for use as reference miR. One miR, miR-22–3p, was validated with 23.1% down regulation with 10000 kJ (2400 kcal) calorie restriction.

Conclusion

Future studies will determine whether identified AT miRs are also detectable in plasma, assuming that plasma miRs are potentially produced by AT and can be used as easy accessible biomarkers.

Obes Facts. 2018 May 26;11(Suppl 1):77.

T1P39 Role of CD146 (MCAM) in subcutaneous white adipose progenitor cells

S Hörl 1, A Ejaz 1, F Hatzmann 1, H Viertler 1, M Mattesich 2, ME Zwierzina 2, S Hammerle 1, P Waldegger 1, G Pierer 2, W Zwerschke 1

Introduction

Adipose tissue is the major triglyceride/energy storage of the body and an essential regulator of metabolic homeostasis. The increase of white adipose tissue mass due to excessive food intake is a result of an increase in adipocyte size and number. An increased adipogenic differentiation of adipose-derived stromal/progenitor cells (ASC) contributes most likely to the adipose tissue growth that is characteristic for obesity. Adipogenesis is regulated by a large number of signals and not completely understood. A frequently used ASC marker protein is CD146, also referred to as melanoma cell adhesion molecule (MCAM), which belongs to the immunoglobulin superfamily and plays a role in cell adhesion. The aim of the present study was to better understand the role of CD146 in ASCs.

Methods

Human ASCs were isolated from the stromal vascular faction (SVF) of human abdominal subcutaneous white adipose tissue, characterized by FACS as cell surface (cs)-DLK1-/cs-CD34+/cs-CD1467CD45-/CD31-, and studied in cell culture.

Results

The CD146 protein was characterized in the human ASCs. The impact of CD146 on adipocyte differentiation was analysed in CD146 gene-silencing experiments using small-hairpin RNAs. We found effects of CD146 on adipogenesis. The detailed results will be presented at the poster.

Conclusion

CD146 is influencing adipogenesis.

Obes Facts. 2018 May 26;11(Suppl 1):78.

T1P40 Physiological Regulation of Brown Adipose Tissue with Obesity by Mild-Cold Exposure, a B3-Agonist and Exercise Training at Thermoneutrality

P Aldiss 1, J Lewis 2, F Ebling 2, H Budge 1, M Symonds

Introduction

Therapeutic activation of thermogenic brown adipose tissue (BAT) is a potential strategy to prevent obesity and metabolic disease in humans. However, it is now recognised that rodent studies examining BAT physiology are carried out at sub-thermoneutral temperatures (e.g. ~20°C), and are not translationally relevant to humans as BAT is ‘hyperactive’. Therefore, the aim of this study was to determine the effect of common regulators of BAT metabolism when animals were raised at thermoneutrality (28°C).

Methods

Thirty weanling Sprague-Dawley rats were housed at thermoneutrality (28°C) and randomised to either chow (C, n = 6) or a high-fat diet (HFD, n = 24) from 3-weeks of age. At 12 weeks, subgroups (n = 6) of HFD were randomised to either mild-cold exposure (20°C), Mirabegron, a selective β3-agonist (0.75mk/kg/d) or exercise training (1h/d, 5 d/week). Metabolic assessment was undertaken in CLAMS during the last 48h to assess energy intake (EI), expenditure (EE) and physical activity (PA) in addition to the acute response to administration of Mirabegron. Key thermogenic and metabolic genes were analysed in interscapular BAT by qPCR in addition to targeted insulin resistance PCR Arrays (86 key genes, n = 3).

Results

No interventions reduced body weight or fat mass. Intriguingly however, mild-cold exposure significantly increased weight-gain during the 4-week period (78.6 vs. 119.8g). This was accompanied by a significant increase in inguinal AT (7.14 vs 16.14g) in cold-exposed animals whilst BAT mass was significantly increased with exercise-training (0.74 vs. 1.2g). There was no difference in 24h EE, EI or PA between groups. Key thermogenic genes in BAT were unchanged by the interventions. CITED1 expression was upregulated by HFD and reduced by all interventions whilst PRDM16 expression was reduced by HFD and increased by exercise. Similarly, expression of PPARA, mTOR and the ‘beige’ marker TBX1 were upregulated by exercise only. Targeted PCR arrays demonstrated an upregulation of inflammatory markers e.g. TLR4, EMR1, CASP1 and IL18R1 and a downregulation of metabolic genes e.g. SCD1, FASN, ACACB, HK2 with HFD. β3 increased FASN, whilst IL18R1, IL6 and STAT3 were downregulated along with IRS2, LEP, ADIPOR1, INSR and PIK3R1. Exercise upregulated FASN, SCD1, HK, ACACA, ACACB and PDK2 but NLRP3, IL1β, PYCARD, LPL, IRS2, INSR, FABP4 and CD36 were all downregulated.

Conclusion

We show there is no consistent upregulation of BAT as determined by key thermogenic genes in response to common stimuli when examined at thermoneutrality. Effects of interventions on BAT carried out at sub-thermoneutrality are most likely to be a consequence of chronic mild-cold stress and are unlikely to be translated to humans.

Obes Facts. 2018 May 26;11(Suppl 1):78.

T1P41 Parathyroid hormone induces browning of human adipocytes

O C Hedesan 1, A Fenzl 1, A Digruber 1, S Baumgartner-Parzer 1, M Bilban 2, L Kenner 3, M Vierhapper 4, A Elbe-Bürger 5, FW Kiefer 1

Introduction

Due to the ability to dissipate chemical energy in form of heat, brown adipose tissue (BAT) and browning of white adipose tissue (WAT) have gained significant interest as potential therapeutic targets against obesity and related complications. Numerous genetic factors and some hormones have been identified as potent regulators of a thermogenic program in adipocytes. Recent preclinical studies suggest that parathyroid hormone (PTH) and PTH related peptide promote adipose tissue browning and thereby cause energy wasting and cachexia in mouse models of cancer and kidney failure. However the role of PTH in human adipose thermogenesis and energy consumption has not been investigated yet.

Methods

Human adipose precursor cells (hAPCs) were isolated from different donors undergoing abdominoplastic surgeries and were stimulated with various PTH concentrations (10nM and 100nM) or isoproterenol (10μM) at different stages of differentiation.

Results

Acute PTH treatment (6h) induced a robust transcriptional thermogenic program in fully differentiated human subcutaneous adipocytes. The PTH effects were even more pronounced as those of the established β-agonist isoproterenol. PTH administration during adipogenic differentiation committed human APCs towards a beige or BAT-like phenotype. These PTH-mediated molecular changes were accompanied by a strong increase in the oxidative respiratory capacity, reflecting enhanced cellular metabolic activity.

Conclusion

Our data not only suggest a hitherto unknown endocrine parathyroid-adipose tissue axis in humans but significantly extend the limited knowledge of PTH action in human adipocytes and may therefore have important clinical implications for conditions associated with altered PTH secretion.

Obes Facts. 2018 May 26;11(Suppl 1):78–79.

T1P42 Cholecystokinin up-regulates adiponectin gene expression in white adipocytes and enhances adiponectin plasma levels in rats

A Plaza 1, B Merino 2, N Del Olmo 2, M Ruiz-Gayo 2

Introduction

Cholecystokinin (CCK) has been shown to regulate postprandial triglyceride (TG) uptake by white adipose tissue (WAT) by a mechanism involving the activation of the angiopoietin-like protein 4/lipoprotein lipase (LPL) axis. This newly characterized endocrine action suggests that CCK pathways are integral to mechanisms aimed at maintaining WAT homeostasis. Our goal was to investigate the role of CCK in regulating the expression of adiponectin, an adipokine endowed with auto/paracrine and endocrine functions, pivotal for maintaining insulin responsiveness.

Methods

The effect of acute and chronic CCK-8 (a bioactive fragment of CCK) on both adiponectin plasma levels and WAT gene expression was investigated in rats. The specificity of CCK-8 actions was characterized by using selective CCK-1 (CCK-1R) and CCK-2 receptor (CCK-2R) antagonists. In vitro experiments were carried out in engineered pre-adipocytes lacking either CCK-1R or CCK-2R.

Results

Acute treatment with CCK-8 (10 mg/kg) enhanced adiponectin gene expression (Adipoq) in subcutaneous WAT (Sc-WAT; p < 0.01), while chronic CCK-8 (10 mg/kg, twice a day, 12 days) increased Adipoq expression both in Sc-WAT (p < 0.01) and visceral WAT (Vis-WAT; p < 0.05). The increment of Adipoq expression was accompanied by a raise of plasma adiponectin concentration (p < 0.05 and p < 0.05 after acute and chronic treatment, respectively). CCK-8 effects were specifically abolished by L-365,260, a selective CCK-2R antagonist. In vitro studies, revealed that CCK-8 (10mM), induced Adipoq expression (p < 0.01). This effect was also specifically blocked when CCK-2R expression was silenced.

Conclusion

Our study demonstrates that CCK-2R activation promotes adiponectin synthesis in WAT and supports the concept that CCK-8 contributes to preserve WAT homeostasis. Otherwise, our data lead to hypothesize that CCK systems might be integral to mechanisms aimed at preserving insulin responsiveness.

Funding

Ministerio de Economía y Competitividad (BFU2012–35353; BFU2016–78556R), European Regional Development Fund, and Fundación Universitaria San Pablo-CEU. AP is supported by the postgraduate fellowship program of MINECO (BES-2012–063773).

Obes Facts. 2018 May 26;11(Suppl 1):79.

T1P44 Effects of resveratrol administration and energy restriction in brown adipose tissue from rats fed an obesogenic diet

I Milton 1, L Aguirre 2, U Etxeberria 3, FI Milagro 4, JA Martínez 3, MP Portillo 1

Introduction

Energy restriction, an intervention commonly used for obesity treatment, has been described as an inducer of mitochondrial biogenesis and thermogenesis in brown adipose tissue (BAT). The activation of these processes on this tissue are involved in the body-weight lowering effect induced by this treatment. Nevertheless, compliance with this treatment is sometimes poor. Resveratrol, a natural phenolic compound that belongs to the stilbene group, has been widely reported to exert effects similar to those produced by energy restriction. The aim of this study was to analyze and to compare the effects of resveratrol and a mild energy restriction on markers of mitochondrial activity and thermogenesis in brown adipose tissue from rats fed an obesogenic diet.

Methods

36 male six-week-old rats were fed a high-fat high-sucrose diet for 6 weeks and then divided into four groups and fed a standard diet for 6 additional weeks: control group (C), resveratrol group (RSV, resveratrol 30 mg/kg/d), restricted group (R, 15% energy restriction) and combined group (RR, 15% energy restriction and resveratrol 30 mg/kg/d). Citrate synthase (CS) activity was measured spectrophotometrically in BAT. Uncoupling protein 1 (UCP1), mitochondrial transcription factor A (TFAM) and sirtuin 3 (SIRT3) protein contents, as well as the ratio acetylated peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α)/Total PGC1α were analyzed by Western blot. Statistical analysis was performed by using one way ANOVA and Newman-Keuls as post-hoc test.

Results

An increase on CS activitty was observed in the RR group when compared with the C group (a trend in the RSV and R groups). Higher UCP1 protein levels were observed in the RSV group when compared with the C group, while in the case of TFAM, the three treated groups showed increased levels when compared with the C group (with no differences among them). Regarding SIRT3, greater protein content was observed in both restricted groups than in the C group (with no differences between them), while in the case of RSV, a trend toward higher protein content was also observed. Finally, decreased PGC1α acetylation status was appreciated in RSV and RR groups, and a trend in the case of R group.

Conclusion

Resveratrol administration and energy restriction increased the expression and activity of proteins related to mitochondrial density/activity. Although both interventions seem to act similarly, under our experimental conditions, resveratrol induced thermogenesis more efficiently than energy restriction. The mechanisms of action of these two strategies are different. When resveratrol administration and energy restriction were combined, no synergic or additive effects were appreciated.

Obes Facts. 2018 May 26;11(Suppl 1):79.

T1P45 Anti-Obesity and Anti-Diabetic Effects of Palmitoleic Acid in Adipose Tissue

F Kucuk Baloglu 1, F Severcan 2

Introduction

Fundamental investigations on obesity and obesity related type 2 diabetes (T2D) are very important for future therapeutic studies. The increase in the expansion of visceral (VAT) and subcutaneous adipose tissue (SCAT) mass is the main reason of obesity and mostly this process results in disturbed glucose and lipid metabolism. Since VAT and SCAT have a critical role in obesity related T2D, these two types adipose tissues were used in the present work. In the light of this information, it was aimed to investigate the therapeutic effect of palmitoleic acid (PA) on the obesity related T2D-induced changes of the biomolecular profile in adipose tissue.

Methods

In current study, 10 week old C57BL/6 male mice were used and experiments were performed on their VAT and SCAT samples. There were 3 different groups namely SD, HD, PHD having 10 mice in each group. The oral glucose tolerance test (OGTT) was performed for serum samples of mice and then insulin and glucose levels were obtained at particular time intervals. The molecular alterations in the concentration and composition of adipose tissue were investigated by Fourier transform infrared (FTIR) microspectroscopy and chemometrics. The spectral area ratios of several functional groups of lipids and proteins were calculated in order to find out compositional and concentrational changes of the biomolecules.

Results

The results of the current study revealed that the PA shows a therapeutic effect on body weight, glucose and insulin levels in obese and diabetic mice. Obesity and T2D caused some alterations in molecular composition in adipose tissue as an increased lipid/protein ratio, an increased carbonyl/lipid ratio and a decreased unsaturated/saturated lipid ratio. Our FTIR microspectroscopy and multivariate analysis results indicated that the PA has a recovery effect on these destructive alterations of obesity and T2D in adipose tissue (Figure 1).

Conclusion

The current study indicated that the PA have a therapeutic effect on the structural and compositional alterations in adipose tissue caused by obesity related T2D. This recovery effect of PA on these destructive alterations of obesity and T2D were significant for both SCAT and VAT. The detection of the therapeutic effect of PA can be accepted as a preliminary study for clinical phase I studies in the scientific sense, which may also indicate its importance as an active agent in pharmaceutical industry.

Obes Facts. 2018 May 26;11(Suppl 1):79–80.

T1P46 Prevalence of NAFLD in 3351 obese patients, stratified by degree of obesity

F Coccia 1, D Capoccia 1, G Guarisco 1, M Testa 1, R Rendina 1, F Leonetti 1

Introduction

The increased prevalence of obesity is associated with the increase of other pathological conditions, such as NAFLD (Non-Alcoholic Fatty Liver Disease) which represents the most frequent liver disease in Western countries. The gold standard for diagnosis of NAFLD is the liver biopsy which is only justified in sever liver disease. The NAFLD liver fat score (NAFLD-LFS) is an index based on clinical and laboratory data that detects the presence of steatosis with rapid and non-invasive Methods. The purpose of this study was to detect the presence of NAFLD in a cohort of 3351 morbid obese patients (pt), stratified by degree of obesity, using the NAFLD-LFS index.

Methods

3351 pt (2340 females), age 44 ± 14 years, of which 905 with type 2 diabetes (DM), have been clinically evaluated with anthropometric parameters and laboratory exams and then divided in 5 classes by degree of obesity and BMI: I (BMI 30–35 Kg/m2): 654 pt, II (BMI 35–40 Kg/m2) 910 pt, III (BMI 40–50 Kg/m2) 1309 pt, IV (BMI 50–60 Kg/m2) 393 pt, V (BMI > 60 Kg/m2) 89 pt. For the entire cohort and each class, prevalence of metabolic syndrome (MS) has been calculated according to the criteria of the International Diabetes Federation. NAFLD-LFS is defined as follow: [(−2.89+1.18*MS (yes 1, no 0) +0.45*DM (yes2, no 0)+0.15*fasting insulin+0.04*AST−0.94*AST/ALT)]. For all the cohort and each class NAFLD-LFS index was calculated. Values ≤ −0.640 rule out, while values > −0.640 rule in NAFLD.

Results

the prevalence of MS in the entire cohort is 21%, remaining stable from the I to the IV class (21.3%, 19.1%, 21.8%, 19.8%) and significantly increasing in V to 31.5% (p < 0.05). The prevalence of NAFLD is 54.2% in the entire cohort and increases significantly (p < 0.05) from I to V class (39.9%, 48.7%, 60.6%, 65.4% and 67.4%, respectively). Triglycerides and transaminases do not show significant differences in the five classes.

Conclusion

The prevalence of NAFLD in the obese population, detected with the NAFLD-LFS score, is about 50% and increases with the increase of BMI. The prevalence of MS increases significantly only in more severe obesity. The use of the NAFLD-LFS index, although not yet validated, appears to be a useful instrument to detect the presence of NAFLD in a large population of obese patients in a rapid and non invasive way.

Obes Facts. 2018 May 26;11(Suppl 1):79–80.

T1P50 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):80.

T1P51 Gene marker panel for omental and subcutaneous adipocytes in humans

DSP Tallapragada 1, G Mellgren 1, S N Dankel 1

Introduction

Major adipose depots include subcutaneous (SC) and intra-abdominal (visceral) fat, the latter comprising the omental (OM) and mesenteric depots. Visceral fat accumulation increases the risk of diseases such as type 2 diabetes mellitus, heart disease and cancer. Primary cell cultures can be useful for studying metabolic differences between different adipose tissue depots. However, due to adipocyte heterogeneity and possible culturing artefacts, it is important to ensure that in vitro differentiated primary visceral and subcutaneous adipocytes possess differences that are relevant in vivo. We here sought to identify a gene marker panel for visceral and subcutaneous adipocytes based on freshly isolated adipocytes and SVF.

Methods

Adipocytes and stromal vascular fraction (SVF) were isolated from paired OM and SC adipose tissue biopsies collected from 12 severely obese patients. The isolation procedure was completed within 55 ± 5 minutes, before freezing the mature adipocytes and paired SVFs. Total RNA was extracted using the RNeasy Lipid Tissue Midi Kit (Qiagen) and global gene expression was measured by the Illumina HumanHT-12 v.3 Bead-Chip. Signal intensity values were quantile normalized and differential expression analysis was performed using the limma package in R.

Results

With a fold change ≥3 and q-value < 0.05 cut-off, we identified 59 and 142 differentially expressed transcripts between SC and OM depots in adipocytes and SVF, respectively. To identify genes specific to adipocytes or SVF, we further used a filter on expression level (signal intensity > 1000) and 3-fold difference in mean expression level between adipocytes and SVF. Transcripts for CCDC3, SLC7A10 and ULK4P1 were enriched in OM adipocytes and for EGFL6, ALDOC and CCND1 in SC adipocytes. Transcripts for MSLN, ANXA8, KLK11, RARRES1 and GREM1 were enriched in OM SVF and CFH, PLA2G2A, FCGBP and VCAN in SC SVF. We also identified transcripts that were differentially expressed (fold change ≥3 and q-value < 0.05 cut-off) between OM and SC depots in both adipocytes and SVF, presumably with stable expression throughout adipocyte differentiation: ITLN1, RSPO3 and RN7SK were highly expressed in the OM fractions, whereas WISP2, HOXC8, IRX3 and TWIST1 were highly expressed in the SC fractions.

Conclusion

Through a genome-wide expression screen in adipocytes harvested directly from human adipose tissue in vivo, we identified several transcripts with clearly differentially expression between OM and SC adipocytes and SVF. The identified gene panel may be useful for ensuring the in vivo relevance of functional comparisons of cultured primary OM and SC adipocytes, and may also on their own play important metabolic roles that give rise to functional differences between OM and SC adipocytes.

Obes Facts. 2018 May 26;11(Suppl 1):80–81.

T1P52 Acute and chronic intake of palmitic and oleic acid-enriched diets differently affect the expression of adipocyte-specific genes in adolescent and adult mice

A Plaza 1, B Merino 1, A Contreras 1, V Naranjo 1, N Del Olmo 1, M Ruiz-Gayo 1

Introduction

Dysfunctional adipose tissue, characterized by a deregulation of its lipogenic and lipolytic activities together with an altered pattern of adipokine production, is associated to the intake of highly saturated fat diets. In this study we aim at comparing the influence of two diets, containing either high or low saturated fat/unsaturated fat ratios, on the expression of adipocyte-specific genes. Otherwise the age-dependent impact of these diets was also investigated.

Methods

The study was carried out in adolescent (4-week old) and adult (8-weeek old) C57BL/6J male mice, that received either a standard rodent chow (SD), a palmitic acid-enriched diet (PHFD; 60% SD + 40% palm oil containing 48% palmitic acid and 35% oleic acid), or an oleic acid-enriched diet (OHFD; 60% SD + 40% high-oleic sunflower oil containing 80% oleic acid and 4% palmitic acid) during either 48 h or 8 weeks. The expression of adipocyte-specifc genes (adiponectin, leptin, aquaporin 7, hormone sensitive lipase, lipoprotein lipase, and PPARγ) was analysed in both subcutaneous and visceral WAT by means of RT-PCR.

Results

1) In adolescent mice, 48 h PHFD repressed the expression of adiponectin, aquaporin 7, hormone sensitive lipase, lipoprotein lipase, and PPARγ genes in both subcutaneous and visceral WAT, while 48 h OHFD only down-regulated PPARγ and LPL gene expression in these tissues. Eight-week dietary treatment (both PHFD and OHFD) reduced adiponectin, hormone sensitive lipase, and PPARγ gene expression. Leptin gene expression was differently affected by these diets as it was up-regulated by OHFD and repressed by PHFD. 2) In adult mice, 48 h PHFD only repressed adiponectin and PPARγ expression in visceral WAT, while OHFD was without effect regardless the WAT deposit analysed. After 8-week treatment, both PHFD and OHFD triggered similar effects. Thus adiponectin gene expression was down-regulated in both subcutaneous and visceral WAT, while PPARγ was only down-regulated in visceral WAT. Leptin expression was up-regulated in both tissues.

Conclusion

Our data show that gene expression is more sensitive to short-term dietary treatments in adolescent than in adult animals. In contrast, an 8-week treatment seems to modulate gene expression in both adolescent and adult mice. In regard to diet composition, PHFD appears to be more aggressive than OHFD after short-term treatment. Nevertheless, 8-week PHFD and OHFD triggered similar effects. Our findings support the concept that the vulnerability of WAT to HFD is more prominent in adolescent than in adult individuals. Moreover, PHFD seems to be more effective than OHFD during short-term treatment, although both diets have similar effects after long-term treatments.

Funding

Ministerio de Economía y Competitividad (BFU2016–78556R), European Regional Development Fund, and Fundación Universitaria San Pablo-CEU. AC and AP are supported by the postgraduate fellowship programs of Universidad San Pablo-CEU and MINECO (BES-2012–063773), respectively.

Obes Facts. 2018 May 26;11(Suppl 1):81.

T1P53 Bilateral carotid sinus nerve resection decreases weight gain, body fat mass and obesity associated co-morbidities in rodents

BF Melo* 1, CS Prego* 1, JF Sacramento 1, S V Conde 1

Introduction

Obesity is reaching epidemic proportions and it is clear that the existing therapies are scarce to address this problem(1). Recently, the carotid bodies (CBs), classically described as an O2 sensor has been shown to be involved in glucose homeostasis. It was described in animal models of metabolic syndrome that CB activity is increased and that the abolishment of its activity, via bilateral carotid sinus nerve (CSN) resection, prevents and reverses insulin resistance and glucose intolerance (2,3) an effect that was mainly due to the restore of glucose uptake by the adipose tissue (3). The main aim of this work was to evaluate the role of CB in the development of obesity and the impact of CSN denervation in weight gain and fat mass deposition and obesity associated co-morbidities.

Methods

Male Wistar rats were randomly divided into 2 groups and submitted to 10 weeks of hypercaloric (HF, 5.1Kcal/g) or control (2.56Kcal/g) diets. After 10 weeks of diet, animals were submitted to either bilateral CSN ablation or sham surgery. CSN resection was confirmed by the absence of ventilatory responses to hypoxia by pletismography. After CSN surgery, the animals were kept on their respective diets for 9 weeks at the end they were anesthetized with pentobarbital (60 mg/kg i.p.) and tissues were collected, weighed and kept for further studies, as western blot analysis of the expression of proteins involved in insulin signalling and glucose uptake. Caloric intake, body weight, insulin sensitivity and glucose tolerance were monitored throughout the experiments. Deposition of lipids in the liver and lipid profile were evaluated. Insulin and c-peptide levels were measured. Mitochondrial density and activity were investigated in brown (BAT) and white adipose tissues.

Results

Bilateral CSN resection in HF animals decreased 61% weight gain and 24% the total body fat mass, with the amount of BAT increasing by 46%. Additionally, CSN resection in HF rats decreased significantly 34% lipid deposition in the liver and improved lipid profile since total cholesterol decreased ≈ 10%, nonesterified fatty acids ≈ 21% and triglycerides showing a trend to decrease (p value = 0.08). As expected, HF diet induced whole-body insulin resistance (KITT HF before surgery = 4.4 ± 0.9%glucose/min; KITT HF after 10 weeks of diet = 1.8 ± 1.0%glucose/min) and glucose intolerance (AUC glucose excursion of controls = 20016.8 ± 450.4 mg/dlxmin; AUC glucose excursion curve HF after 10 weeks of diet = 25415.3 ± 689.3mg/dlxmin). CSN resection restored insulin sensitivity and glucose tolerance 1 week after surgery, an effect that was maintained until the last week of evaluation (KITT 9 weeks after surgery = 4.5 ± 0.3%glucose/min; AUC HF 9 weeks after surgery = 23264.3 ± 433.7mg/dlxmin). Additionally, CSN resection in HF animals improved in insulin secretion, as they showed decreased hyperinsulinemia and c-peptide levels.

Conclusion

Taking into account our Results, we can suggest that suppression of CB activity could be a valuable tool in future therapeutic interventions for obesity and associated comorbidities.

*Both authors contributed equally to this work.

References

Obes Facts. 2018 May 26;11(Suppl 1):81.

T1P54 In vitro and in vivo anti-obesity effects of carob and wakame combination

L Aguirre 1, AB Martin-Diana 2, C Martínez-Villaluenga 3, I Milton 4, D De Luis 5, A Lasa 1, MP Portillo 1, D Rico 2

Introduction

Metabolic Syndrome (MetS) encompasses a constellation of several risk factors including hyperglycemia, raised blood pressure, dyslipidemia and visceral obesity that predispose to the development of cardiovascular disease and type 2 diabetes mellitus. In the last years, this syndrome is becoming one of the most important health concerns due to its rising prevalence. The purpose of this study was to analyse the triglyceride-lowering effect of extracts from Ceratonia siliqua L. (carob fruit) and Undaria pinnatifida (wakame seaweed) in 3T3-L1 mature adipocytes and the anti-obesity potential of effective combinations in dietetic obese Wistar rats in order to ameliorate the MetS.

Methods

3T3-L1 mature adipocytes were treated during 24 h with carob’s pod (10, 50 and 100 mg/mL) and wakame (1 and 10 mg/mL) methanolic extracts and their combination. Triglyceride (Tg) content was quantified by using commercial kits. Forty adult male Wistar rats were fed with a commercial high-fat high-fructose diet for 8 weeks in order to generate the MetS. After this period, ten animals were sacrificed (MetS group) and the rest were divided into 3 groups. All groups were fed with a semi-purified adequate-calorie diet for 4 additional weeks. The groups were the control group (C) and two snack groups where all the complex carbohydrates of the diet were replaced by a snack formulation with combinations of 1/50 (1/50 group) or 1/5 of wakame/carob’s pod (1/5 group). At the end of experimental period, animals were sacrificed and liver and white adipose depots were dissected and weighed. Total Tg content was measured by using commercial kits.

Results

The reduction of the Tg content in cell culture was effective at the dose of 100 mg/mL of carob (28% of reduction) as well as 1 and 10 mg/mL of wakame (21% and 25% of reduction respectively). Similarly, combinations of 1/5 and 1/50 of wakame/carob decreased Tg content by in 27% and 36% respectively. In view of these Results, an in vivo experiment was carried out with the two combinations. None of them was effective in reducing the white adipose tissue weight. However, snack inclusion in the adequate-calorie diet (1/5 and 1/50 groups) diminished liver weight when compared with MetS group. This effect was due to a decrease in Tg content (53 ± 5, 34 ± 3 and 32 ± 3 mg/g of tissue for MetS, 1/50 and 1/5 groups respectively).

Conclusion

The 1/5 and 1/50 combinations of wakame and carob’s pod in snack formulation showed in vitro and in vivo fat-lowering properties. Consequently, they can be proposed as useful functional ingredient formulation to ameliorate the Metabolic Syndrome.

Obes Facts. 2018 May 26;11(Suppl 1):81–82.

T1P55 Hypothyroidism leads to leptin alterations in male Wistar rats Hypothyroidism leads to leptin alterations in male Wistar rats

DS Mironova 1, T Hanjieva-Darlenska 1

Introduction

Obesity is associated with several metabolic and endocrine disorders. Changes in plasma concentrations, secretion patterns, and clearance of various hormones are observed in obese patients. Thyroid disorders play a vital role in regulation of metabolism. The experimentally induced hypothyroidism in creates various metabolic disorders in animals. This phenomenon could potentially be used tothis understand the important interplay between the thyroid function and the adipose tissue. Leptin is one of the major hormones produced by adipocytes. Our results found increased serum leptin levels in male Wistar rats. These data could explain the link between thyroid disorder, leptin levels and body weight control.

Methods

The study was performed with 18 Wistar male rats with initial body weight of 250 g, on an average. Then rats were divided into three groups: group 1 with experimentally induced hyperthyroidism; group 2 with experimentally induces hypothyroidism, and group 3a control. In group 1 was induced hyperthyroidism, group 2- hypothyroidism and group 3- control. The animals of the hypothyroid group received propylthiouracil (PTU) at a dose of 1mg/ml, diluted in drinking water. The hyperthyroid group received L-tyroxin at dose 2μg/ml, diluted in drinking water. The control group received drinking water. At the end of that period, blood samples were collected from rat tails to investigate the levels of thyroid hormones and leptin.

Results

A model of experimentally induced hypothyroidism was induced in male Wistar rats based on. significantly increase of TSH levels and reduction of T3 and T4 hormone levels. The group was compared to one with induced hyperthyroidism and control group. The results showed changes in serum leptin levels between the experimental groups compared to the control group. The hypothyroideal group demonstrated a remark effect on leptin levels (Figure 4). An effect on body weight after the 4-week period was also observedThere were no significant difference i between the three groups.

Conclusion

The study was initiated with the objective of developing a model of experimental induced hypothyroidism and to observe the effect on adipose tissue hormone leptin and it secretion. The experimentally induced hypothyroid in Wistar rats allows to easily study the metabolic disruptences Our data suggest that there is a possible relationship between leptin and the thyroid gland via an influence of leptin on the negative feedback regulation of thyroid hormones. The low level of T3 in hypothyroid rats may lead to decreased leptin expression and decreased conversion of T4 to T3. Body weight A limitation of our study was the short period of the experiment. This could explain the lack of on the body weight in the three groups for a 4-week period Some studies suggest aleptin resistance, due to a disorder in leptin receptor signaling (Ref). This could be used for further analysis of adipose tissue endocrine function and leptin resistance as a reason for metabolic disorders. In conclusion, our study demonstrated a development of experimental model of hypothyroidism in male Wistar rats. This model could be easily used for investigation of the role of thyroidal hormones on leptin secretion, and adipose tissue.

Obes Facts. 2018 May 26;11(Suppl 1):82.

T1P56 RAP1 expression and its transcriptional regulation by CEBP-beta in visceral adipose tissue

C Formichi 1, S Cantara 2, G Sebastiani 2, N Brusco 1, GE Grieco 2, C Maccora 3, A Tirone 4, G Vuolo 4, F Pacini 3, C Ciuoli 3, F Dotta 2

Introduction

Obesity is a complex disease, associated with high mortality and morbidity, and its prevalence has dramatically increased in the last decades. However, factors involved in the development of metabolic complications of obesity are still to be fully elucidated. Previous studies demonstrated that the deletion of telomeric protein RAP1 – a component of shelterin complex – in mouse is associated with the development of adult-onset obesity and metabolic impairment. Our aim was to evaluate RAP1 expression in human tissues

Methods

We evaluated RAP1 expression with real time PCR in visceral (VAT) and subcutaneous (ScAT) adipose tissue of 49 obese patients and 14 metabolically healthy normal-weight subjects. To explore the cause of a reduced RAP1 expression in VAT of obese patients, we investigated predicted transcription factors, using predictive algorithms, and selected the adipogenic transcription factor CEBPβ and evaluated its expression in VAT of 10 obese patients and 4 controls with Western Blot analysis. In addition, we performed ChIP analysis on chromatin samples from cultured visceral preadipocytes.

Results

RAP1 mRNA expression was significantly reduced in VAT of obese patients with metabolic syndrome (n = 37) compared to metabolically healthy obese (n = 12) and controls (respectively, p = 0,042 and p < 0,0001); no difference was found in RAP1 expression in ScAT between obese and controls (p = 0,246). Next, we analyzed CEBPβ expression; of note, previous studies demonstrated that an increased ratio between the inhibiting isoform (LIP, liver-enriched transcriptional inhibitory protein) and the activating isoform (LAP, liver-enriched transcriptional activating protein) of CEBPβ can inhibit the transcription of target genes. Obese patients show a higher LIP/LAP ratio compared to controls (p = 0,024); moreover, obese patients with higher LIP/LAP ratio have an unfavorable metabolic profile compared to obese patients with lower LIP/LAP ratio. ChIP analysis confirmed that CEBPβ can bind RAP1 promoter.

Conclusion

In conclusion, our data highlight the role of an altered expression pattern of transcription factor CEBPβ in RAP1 reduced expression in VAT; this mechanism could be involved in the development of obesity-related metabolic complications.

Obes Facts. 2018 May 26;11(Suppl 1):82.

T1P57 Effects of Ginkgo biloba extract (GbE) on FAS and perilipin gene and protein expression

BKS Hirata 1, MM Cruz 2, RDCC Sá 2, TSM Farias 2, MMF Machado 2, AA Bueno 1, MIC Alonso-Vale 2, MM Telles 2

Introduction

Taking into consideration the severity and risks associated with obesity, alternatives treatment strategies are highly necessary and Ginkgo biloba extract (GbE) has been investigated as a non-conventional therapy. Our laboratory has previously demonstrated that GbE treatment reduced body adiposity and fatty depot mass on diet-induced obese rats. However, it is unknown the mechanism of action involved with positive effects of GbE. In view of the above considerations, the aim of this study was to evaluate the effect of GbE on gene and protein expression of proteins involved in lipolysis and de novo synthesis of fatty acids on epididymal adipose fat pad in obese rats.

Methods

Male rats were fed from 2 to 4-mo-old with high fat diet and thereafter treated for 14 days with 500mg/kg of GbE (HFD+GbE) or saline (HFD). NFD group was control group and received normal fat-diet during all the period and saline during treatment. Rats were euthanized and epididymal fat depot was removed. Gene expression of ATGL, HSL, Perilipin, FAS, ap2, SSEBP and PPARγ were evaluated by RT-PCR and Western blotting was used to FAS protein expression levels.

Results

Both HFD and HFD+GbE groups reduced food/energy intake in comparison to NFD group (45.1% and 50.0%, respectively, p = 0.001). HFD+GbE also fairly decreased food/energy intake comparing to HFD (8.8%, p = 0.01). Perilipin gene expression was increased by 335%(p = 0.03) in HFD in comparison to NFD, while HFD+GbE was reduced by 95.2% in comparison to HFD (p = 0.01). Gene expression of FAS also decreased 70.7% in HFD+GbE in comparison to NFD (p = 0.02). Besides decreasing gene expression, the protein expression of FAS was reduced by 38% in HFD+GbE group in comparison to NFD group (p = 0.03).

Conclusion

GbE decreased gene and protein expression of important proteins involved in two metabolic process: lipolysis and de novo synthesis of fatty acids. This allows us to suggest GbE might be investigated as an antiobesogenic therapy, since positive results have been observed. It is important to note that the GbE effects were observed in rats kept feeding with high fat diet. The data suggest that GbE might have potential as a therapy to treat obesity and its comorbidities, especially for obese subjects resistant to adhere to a nutritional education program.

Obes Facts. 2018 May 26;11(Suppl 1):83.

T1P58 Influence of the Nutritional State and Fatigue on the Scapular Neuromuscular Control

G Mendez-Rebolledo 1, FJ Berral De La Rosa 2

Introduction

It has been observed that the measurement of skinfolds has a strong relationship with total subcutaneous adipose tissue and intramuscular fat. This accumulation of adipose tissue affects the metabolic capacity and accelerates the appearance of muscle fatigue during functional activities. However, there are few reports investigating the effect of these factors on neuromuscular control and electromyographic recording. The objective of this research was to determine the influence of nutritional status and fatigue on the onset latency of the scapular muscles.

Methods

Twenty-four participants were randomly assigned to one of the following groups: non-fatigue and fatigue. Measurements of weight, height, and skinfolds [axillary (AXS), pectoral (PES), triceps (TRS), subscapular (SBS), ileocrestal (ICS), abdominal (ABS), and anterior thigh (ATS)] were made, and the percentage of body fat was calculated by the Siri equation, where the body density considered was that proposed by Jackson & Pollock. The onset latency of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) muscles was measured with electromyography during an arm raise test. The influence of the nutritional status on the onset latency of each muscle was analyzed through a multiple linear regression model adjusted for the variables: skinfolds (AXS, PES, SBS), body fat percentage, and fatigue. An alpha level < 0.05 was considered in all tests.

Results

There were not significant differences in BMI between groups (p > 0.05). The multiple linear regression model showed that UT onset latency was not influenced by skinfolds, percentage of body fat, and fatigue (P > 0.05). In the MT, LT and SA muscles, the presence of fatigue factor was associated with a greater muscle onset latency (Table 1), and the model was not influenced by skinfold (PAX, PPE, and PSB), except for SA which was influenced by the simultaneous presence of PSB and muscle fatigue.

Conclusion

Muscle fatigue influences the onset latency of the MT, LT and SA muscles. In SA, the presence of subcutaneous adipose tissue in the subscapular region and the performance of fatiguing tasks influence the onset latency. It is suggested to consider these results for the electromyographic record of the SA muscle.

Tab. 1.

Multiple linear regression model of the onset latency of each scapular muscle, adjusted to the variables: skinfolds, percentage of body fat (%BF), and fatigue. * significant difference (P < 0.05). MT, middle trapezius, LT, lower trapezius; SA, serratus anterior; AXS, axillar skinfold; PES, pectoral skinfold; SBS, subscapular skinfold.

Dependent Variable
R2
 β
 P
AXS 0.008 −1.2 0.683
%BF 0.031 2.6 0.717
Fatigue 0.561 120.2 0.001*
PES 0.033 9.5 0.398
MT onset latency (ms) %BF 0.033 −8.4 0.703
Fatigue 0.605 127.0 0.001*
SBS 0.115 2.9 0.105
%BF 0.122 −1.2 0.255
Fatigue 0.571 115.1 0.001*
AXS 0.025 1.4 0.460
%BF 0.031 0.0 0.720
Fatigue 0.442 103.5 0.008*
PES 0.036 8.9 0.378
LT onset latency (ms) %BF 0.036 −7.3 0.683
Fatigue 0.480 109.6 0.004*
SBS 0.013 −4.7 0.601
%BF 0.029 5.6 0.735
Fatigue 0.473 111.9 0.004*
AXS 0.033 1.9 0.398
%BF 0.033 −1.2 0.704
Fatigue 0.307 55.1 0.025*
PES 0.005 −0.3 0.732
SA onset latency (ms) %BF 0.034 1.3 0.697
Fatigue 0.293 54.5 0.034*
SBS 0.137 3.8 0.045*
%BF 0.156 −2.2 0.169
Fatigue 0.347 47.8 0.033*
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Obes Facts. 2018 May 26;11(Suppl 1):83–84.

T1P59 The role of ghrelin on adipocyte differentiation in morbidly obese patients

V Mocanu 1, I Hristov 1, I Silivestru-Cretu 1, I Armasu 1, F Zugun-Eloae 1, L Labusca 1, DV Timofte 1

Introduction

In obese patients, the subcutaneous adipose derived stem cells (ASCs) is chracterized by loss of stemcellness being already committed to adipocyte differentiation and showing an upregulated inflammatory gene expression. The role of ghrelin on proliferation and differentiation of subcutaneous ASCs is controversial. We aimed to assess the role of agonist ghrelin receptor, hexareline, on adipogenesis in normal weight and morbid obese patients.

Methods

The adipose tissue was obtained from normal weight subjects undergoing unrelated surgical procedures (N = 4) and from morbidly obese patients (N = 6) who underwent laparoscopic sleeve gastrectomy (LSG). The subcutaneous preadipocyte were isolated and cultured with a adipogenic differentiation cocktail and ghrelin at the final concentrations of 0.1 or 1 nmol/L. Qualitative and quantitative evaluation of differentiation were performed using Oil-Red O staining and RT-PCR mesurement of peroxisome proliferator-activated receptor gamma (PPARγ) expression.

Results

PPARγ mRNA levels were significantly lower in the ASCs derived from the post-LSG group than in the nonobese control subjects. Hexarelin treatment stimulated adipogenesis of ASCs in a dose-dependent manner.

Conclusion

This study suggests the ghrelin involvement in human preadipocytes capacity to differentiate into mature adipocyte.

Conflicts of Interest

This research received financial support from “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania, through the grant Ideas-Teams contract number 29032/28.12.2016.

Obes Facts. 2018 May 26;11(Suppl 1):84.

T1P60 The effects of water temperature on gastric antral cross-sectional area and energy intake in healthy young men

K Kashiwabara 1, Y Hamada 2, T Yanaoka 1, K Kurata 3, R Yamamoto 1, K Suzuki 4, M Miyashita 4

Introduction

Immediate pre-meal water ingestion has been shown to reduce energy intake in healthy young men (Eur J Nutr. 2016;55:815–819), whereas gastric antral area and distension are related to the induction of appetite-related sensation, leading to subsequent energy intake in healthy young and older adults (Am J Clin Nutr. 2004:80:656–667). However, little is known regarding the effect of antral area on energy intake in response to pre-meal water ingestion at different temperatures in humans. Therefore, the present study examined the effects of different water temperatures ingesting immediately before a meal on gastric antral cross-sectional area and energy intake in healthy young men.

Methods

Eleven young men completed three trials in a random order. Subjects visited the laboratory at 8:45 after a 10-h overnight fast and consumed water of 500 mL at 2°C, 37°C and 60°C at 9:00. The antral cross-sectional area was measured every 10 min using the ultrasound imaging systems over 1 h until 10:00. Subjective appetite was examined periodically using the visual analogue scale throughout the study. Each subject consumed the test meal at 10:00 until they felt completely full, and energy intake was calculated.

Results

Energy intake differed among trials (6.7 ± 1.8 vs 7.9 ± 2.3 vs 8.5 ± 3.2 MJ for the 2°C, 37°C and 60°C trials, respectively; P = 0.009) (Figure). Post hoc tests revealed that energy intake in the 2°C trial was 19% and 26% lower than the 37°C (P = 0.039) and 60°C (P = 0.025) trials, respectively. The time taken to feel completely full was 5.9 min shorter in the 2°C trial than the 60°C trial (P = 0.046). The rate of increase in antral cross-sectional area differed among trials (10.0 ± 5.0 vs 9.3 ± 1.2 vs 6.8 ± 2.1 cm2 for the 2°C, 37°C and 60°C trials, respectively; trial×time interaction: P < 0.001). The antral cross-sectional area immediately after water ingestion was greater in the 2°C (P = 0.030) and 37°C (P = 0.019) trials than the 60°C trial. Subjective feeling of hunger differed among trials (trial×time interaction: P = 0.027). The subjective feeling of hunger tended to be lower in the 2°C trial than the 60°C trial at 30 min (44 ± 29 vs 63 ± 21 mm for the 2°C and 60°C trials, respectively; P = 0.074) and at 60 min (57 ± 26 vs 76 ± 18 mm for the 2°C and 60°C trials, respectively; P = 0.086) after drinking.

Conclusion

This study demonstrated that ingesting cold water, compared with warm water, before a meal increases antral cross-sectional area and reduces subsequent energy intake in healthy young men. The potential mechanisms of reduced energy intake after ingesting cold water may be related to delayed gastric emptying, leading to greater gastric distension (Gut. 1988;29:302–305) and fullness, and a consequent reduction in subsequent energy intake.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):84.

T1P62 Impact of energy flux on subjective appetite sensations and ad libitum energy intake in healthy subjects

F A Hägele 1, F Büsing 1, A Nas 2, A Bosy-Westphal 1

Introduction

Appetite is proposed to easier match energy requirement at a high level of physical activity (high energy flux, EF) but not with sedentary behavior (low EF). We therefore hypothesize that ad libitum energy intake and appetite sensations are higher with low EF.

Methods

Fourteen healthy adults (11 men, 3 women; 25.2 ± 4.0 y; BMI 23.8 ± 3.3 kg/m2) participated in an ongoing randomized cross-over intervention in a metabolic chamber. Three levels of daylong EF (PAL: 1.3 low, 1.5 medium or 1.7 high) were compared under isocaloric condition, caloric restriction and overfeeding (100%, 75% or 125% of individual energy requirement), as well as with ad libitum energy intake (50% CHO, 35% fat, 15% protein). Ad libitum energy intake and energy expenditure were measured over 24h in a metabolic chamber. Daylong subjective appetite ratings (tAUC) were assessed using visual analogue scales for hunger, fullness and desire to eat before and after each meal and every 2h during the day.

Results

Daylong hunger and desire to eat were higher with low compared to medium and high EF during isocaloric condition (all p < 0.01) and were also higher with low compared to high EF during overfeeding (all p < 0.05). Furthermore daylong hunger was higher with low compared to medium EF during overfeeding (p < 0.05). By contrast, daylong fullness was higher with high and medium compared to low EF during all energy balance conditions (all p < 0.05), except for medium vs. low EF during caloric restriction. Ad libitum energy intake was higher with low compared to medium and high EF (both p < 0.01) and tended to be higher with mediumcompared to high EF (p = 0.054), leading to a positive energy balance (low EF: +16.9 ± 10.9% and medium EF: +6.5 ± 10.6%, p < 0.05).

Conclusion

A low level of physical activity led to increased appetite sensations and spontaneous overfeeding during ad libitum energy intake. Hence, we may deduce that appetite is regulated asymmetrically, being more effectively controlled at higher physical activity.

Obes Facts. 2018 May 26;11(Suppl 1):85.

T1P158 Potato fibers have positive effects on subjective appetite sensations in healthy men but not on fecal fat excretion: A randomized controlled single-blind crossover trial

TK Thorning 1, CJ Bertolt 1, C Ritz 1, A Astrup 1, A Raben 1

Introduction

Dietary fiber can affect appetite and gut metabolism, but no studies have investigated the effect of the potato fibers FiberBind or rhamnogalacturonan I (RG-I) in this regard. The aim of the present study was to explore the effect of daily intake of FiberBind, RG-I or control on appetite sensations and fecal fat excretion.

Methods

The study was a single-blinded, randomized, three-way crossover trial in 18 healthy young men. In 21-d periods, wheat buns with FiberBind, RG-I, or a control were consumed. Measurements were fecal fat excretion, blood samples (fasting and postprandial), body weight, blood pressure, exhalation of hydrogen and appetite registrations during a 3-h meal test (with simultaneous blood sampling in a subgroup, n = 9).

Results

Compared to RG-I and control, FiberBind caused a higher composite satiety score (6 ± 2% and 5 ± 2%), a lower prospective food consumption (5 ± 2% and 6 ± 2%) and a lower desire to eat (7 ± 3% and 6 ± 3%), P < 0.05. FiberBind also caused higher satiety (6 ± 2%) and fullness (9 ± 3%) compared to RG-I, P < 0.05. The RG-I fiber caused higher postprandial glucose concentration compared to FiberBind (0.33 ± 0.12 mmol/L and 55 ± 17%) and higher insulin concentration at 180 min. compared to control, P < 0.01. Compared to the control, RG-I and FiberBind lowered peak-insulin-concentration (103 ± 37 pmol/L and 82 ± 37 pmol/L P = 0.006, P = 0.03), delayed time-to-peak glucose (16 ± 4 min and 10 ± 4 min, P < 0.0001, P = 0.02) and increased exhaled hydrogen (0.39 ± 0.10 ppm and 0.15 ± 0.1 ppm). No significant effects of the fibers on fecal fat and energy excretion or energy intake were found, but RG-I increased fecal abundance of Bifidobacterium (3 ± 1%, P < 0.05) compared to the control and FiberBind.

Conclusion

Intake of FiberBind caused a decrease in the subjective appetite sensations, but neither FiberBind nor RG-I had an effect on ad libitum energy intake or fecal fat excretion.

Tab. 1.

Carbohydrate Protein Fat Fiber Energy
(E%) (g) (E%) (g) (E%) (g) (g) (kJ)
RG-I meal 80.5 88.0 9.4 11.0 10.1 5.5 14.4 2000
FiberBind meal 80.0 87.4 10.0 11.7 10.1 5.4 14.3 2000
Control meal 80.5 92.7 9.4 11.0 10.1 5.5 4.3 2000
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RG-I meal: meal with 2 test buns containing RG-I potato fibers. FiberBind meal: meal with 2 test buns containing potato pulp fibers. Control meal: meal with 2 control test buns without potato fiber. All meals were served with 4.4 g butter, 20 g jam sweetened with stevia, and 250 g water. Abbreviations: E%, energy percentage; g, grams; kJ, kilojoule; RG-I, Rhamnogalactoronan I.

Obes Facts. 2018 May 26;11(Suppl 1):85.

T1P64 Effect of food acceptability on postprandial appetite hormones of obese male subjects

N El Helou 1, O Obeid 1, A Olabi 1

Introduction

Food intake and appetite are controlled by several factors including: sensory, cognitive, hormonal and metabolic signals (1). Sensory properties of a food item, and more specifically palatability influence our choices, preferences and portions (2). Accordingly, understanding the effect of food hedonic properties on postprandial appetite-related hormonal response, offers a possibility of a long-term weight management solution. Thus, a study was conducted to determine the effect of hedonic manipulation, (high-acceptability (HA) vs. modified low-acceptability (LA)), on postprandial ghrelin and GLP-1.

Methods

A cross over study using fifteen obese male subjects (BMI 30–39.9 kg/m2) was performed. Subjects were randomly assigned to consume, within 10 min, one of two isocaloric meals: HA (vanilla custard) or LA (excessively sweet vanilla custard with added Acesulfame-K). Blood samples were collected at baseline, 15, 30, 60, 120,180 and 240 min after meal. Serum ghrelin and GLP-1 were analyzed.

Results

Serum GLP-1 levels of subjects were minimally affected by meal consumption. Ghrelin levels of the LA meal were not affected during the first two hours, unlike those of the HA meal which dropped significantly (p = 0.005).

Conclusion

The present findings demonstrate that food acceptability/palatability affected the stomach hormone (ghrelin) and failed to affect the intestinally released hormone (GLP-1). Food acceptability seems to selectively affect appetite hormones, which are known to have opposing effects.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):85–86.

T1P65 Palmitoylated prolactin-releasing peptide decreases body weight and improves glucose tolerance in ob/ob mice but not in db/db mice

L Maletinska 1, L Kořínková 1, B Neprašová 1, M Holubova 1, V Pražienková 1, J Kuneš 1

Introduction

Obesity is an escalating epidemic, but an effective non-invasive therapy is still scarce. For obesity treatment, anorexigenic neuropeptides are promising tools, but their delivery from the periphery to the brain is complicated by their peptidic character, bringing about low stability and limited ability to cross the blood-brain barrier. In this study, effect of palmitoylated prolactin-releasing peptide (palm11-PrRP31) was studied in obese db/db mice with non-functional leptin receptor and effect of palm11-PrRP31 alone or in combination with leptin was studied in obese ob/ob mice lacking of endogenous leptin.

Methods

Db/db mice were treated with palm11-PrRP31 subcutaneously twice a day for 14 days. Ob/ob mice were injected with palm11-PrRP31, leptin, or their combination subcutaneously twice a day also for 14 days. Food intake and body weight was monitored during the treatment. At the end of experiment an oral glucose tolerance test was performed and metabolic parameters in blood samples were measured.

Results

The treatment with palm11-PrRP31 decreased significantly body weight (BW) but did not improve tolerance to glucose in db/db mice compared to saline treated db/db controls. The treatment of ob/ob mice with palm11-PrRP31 alone slightly decreased BW. On the contrary, leptin alone did not change BW compared to saline treated ob/ob controls. On the other hand there was a very significant decrease in BW in ob/ob mice treated with leptin plus palm11-PrRP31. This combination also lowered fasting blood glucose more significantly than single leptin or palm11-PrRP31.

Conclusion

In conclusion, our results clearly demonstrated synergism of prolactin-releasing peptide and leptin in ob/ob mice, namely attenuating effect on BW and fasting glucose. On the other hand, palm11-PrRP31 did not affect BW and intolerance to glucose in db/db mice, probably because of the impaired leptin receptor signalling in this model.

Disclosure

This study was supported by GACR 15–08679S, TACR TE01020028, RVO:61388963 and RVO:67985823.

Obes Facts. 2018 May 26;11(Suppl 1):86.

T1P66 Anti-obesity and anti-diabetic effect of palmitoylated PrRP analog in several rat models

B Neprašová 1, L Kořínková 1, M Holubová 1, V Panajotová 2, J Stohr 2, J Kuneš 3, L Maletinska 1

Introduction

Anorexigenic neuropeptides have the potential to decrease food intake and ameliorate obesity but are ineffective after peripheral application, because of their limited ability to cross the blood-brain barrier. We have designed lipidized analogs of neuropeptide prolactin-releasing peptide (PrRP), which overcome this problem. The aim of this study was to characterize the effect of a palmitoylated PrRP analogs in several rat models of obesity and diabetes: diet-induced obese (DIO) Sprague-Dawley rats, leptin receptor-deficient Zucker diabetic (ZDF) rats and spontaneously hypertensive obese rats (SHROB) with impaired leptin receptor signaling.

Methods

The rats were treated intraperitoneally for two or three weeks with palmitoylated analogs of PrRP. Body weight (BW) and food intake were monitored during the treatment and oral glucose tolerance test was performed at the end of experiment. Blood samples were collected for determination of metabolic parameters.

Results

In the DIO Sprague-Dawley rats, a two-week treatment lowered significantly food intake and BW. This treatment also improved tolerance to glucose and tended to decrease leptin levels and adipose tissue masses in a dose-dependent manner. In contrast, in ZDF rats, the same treatment lowered food intake but did not significantly affect BW or tolerance to glucose, probably in consequence of severe leptin resistance due to a non-functional leptin receptor. Finally, the three-week treatment lowered food intake and BW in both SHROB and their controls spontaneously hypertensive rats (SHR). However, the decrease was more pronounced in SHR than in SHROB probably because of the impairment of leptin receptor signaling. Surprisingly, the treatment improved tolerance to glucose and tended to decrease leptin levels in both SHR and SHROB.

Conclusion

Our data suggest a good efficacy of lipidized PrRP in rat models of obesity and diabetes. Thus, the strong anorexigenic, body weight-reducing and blood glucose-improving effects make palmitoylated PrRP an attractive candidate for anti-obesity and glucose-lowering treatments.

Obes Facts. 2018 May 26;11(Suppl 1):86.

T1P67 Activity Energy Expenditure is an Independent Predictor of Food Intake in Humans

M Hopkins 1, G Finlayson 2, K Beaulieu 3, C Duarte 3, C Gibbons 4, A Johnstone 5, S Whybrow 5, G Horgan 5, J Blundell 4, RJ Stubbs 3

Introduction

There is now strong evidence that the biological energy demands of metabolically active tissue create a functional drive to eat and that resting metabolic rate (RMR) is a major determinant of energy intake (EI). However, the extent to which behavioural components of total daily energy expenditure (TDEE) such as activity energy expenditure (AEE) exert independent effects on EI is not known. Therefore, the present cross-sectional study examined the associations between body composition, RMR, AEE and EI under free-living conditions.

Methods

Data for 188 individuals (85 males; 103 females; mean BMI = 25.4 ± 4.0kg/m2) were collated from the control conditions of four studies employing common measures of body composition (air displacement plethysmography) and RMR (indirect calorimetry). Daily EI and TDEE were measured over seven consecutive days using weighed-dietary records and the flex heartrate method, respectively. AEE was calculated as TDEE − RMR.

Results

Large intra-individual variability in daily EI and TDEE was seen (mean CVs for daily EI & TDEE; ± 24.2% and ± 20.0%, respectively). Daily values of EI and TDEE were associated (range in r = 0.24 to 0.43; P = 0.001), but adjusting for age, sex and body mass reduced these associations (range in r = 0.01 to 0.24; P = 0.001 to P = 0.898). However, when the daily EI and TDEE values were averaged across the seven day period, a stronger association between EI and EE was seen (r = 0.53; P < 0.001) and this remained significant after adjusting for age, sex and body mass (r = 0.28; P < 0.001). Furthermore, linear regression indicated that fat mass (ß = −0.28; P = 0.001), RMR (ß = 0.39; P = 0.002) and AEE (ß = 0.22; P = 0.001) were all independent predictors of mean daily EI, with AEE adding ≈3% of unique variance to the model after controlling for age, sex and study (F(9,178) = 16.971, P < 0.001; R2 = 0.462).

Conclusion

When physical activity was allowed to vary under free-living conditions, AEE independently predicted EI alongside other biological determinants arising from body composition and metabolism, albeit, more weakly. It is theoretically important that total daily EE and its metabolic (i.e. RMR) and behavioral (i.e. AEE) sub-components can all be considered determinants of EI, and indicate that appetite control is an emergent function of the relationship between EE and EI. Therefore, biological and behavioural components of TDEE should be measured in energy balance studies to better understand potential determinants of EI.

Obes Facts. 2018 May 26;11(Suppl 1):86–87.

T1P68 Specific features of the hypothalamic leptin signalling response to cold exposure are reflected in peripheral blood mononuclear cells

B Reynés 1, M Klein Hazebroek 2, E García-Ruiz 3, J Keijer 4, P Oliver 1, A Palou 1

Introduction

Cold exposure elicits several physiological effects in order to maintain body temperature, which results in a fat loss related to lipid mobilization and thermogenic activation. Accordingly, cold exposure produces severe hypoleptinemia, which is linked to compensatory hyperphagia to counteract fat loss. In this study we aimed to investigate the hypothalamic molecular mechanisms involved in cold-induced hyperphagia, and the potential of peripheral blood mononuclear cells (PBMC) to reflect this food intake regulation.

Methods

We analysed the effect of cold exposure on gene expression of orexigenic and anorexigenic peptides, and of leptin signalling-related genes in the hypothalamus and PBMC of rats at different ages (1, 2, 4, and 6 months), as well as in ferrets.

Results

show that hypoleptinemia related to cold exposure could be responsible for the increased orexigenic/anorexigenic peptide gene expression ratio in the hypothalamus especially in young rats, which is mainly due to decreased anorexigenic gene expression. However, cold exposure in ferrets, an animal model closer to humans, resulted in a increased mRNA levels of orexigenic genes. The most outstanding result of our study is that PBMC reflected the specific modulation of leptin signalling in the hypothalamus, which was affected differentially in rats and ferrets.

Conclusion

Our results point towards PBMC as easily obtainable biological material to be considered as a potential surrogate tissue to perform further studies on the regulation of hypothalamic leptin signalling in response to cold exposure.

Obes Facts. 2018 May 26;11(Suppl 1):87.

T1P69 Effects of Chronic NAD Supplementation on Energy Metabolism and Circadian Rhythm in Obese Mice

M Kim 1, E Roh 2

Introduction

Adequate nicotinamide adenine dinucleotide (NAD) content in hypothalamic neurons is known to be critical for the maintenance of normal energy balance and circadian rhythm. In this study, we studied beneficial metabolic effects of chronic NAD supplementation on diet-induced obesity (DIO) and obesity-related disruption in circadian rhythms.

Methods

C57BL6 ice were fed a high fat diet (HFD) for 12 weeks and received intraperitoneal injection of either saline or NAD (1 mg/kg/day) for the last 4 week-period. Control mice were fed a chow diet and injected with saline for the same period. Body weights were daily monitored. Circadian rhythms in food intake, energy expenditure, and locomotor activity were determined at the end of NAD treatment. The effect of NAD treatment on the transcriptional activity of clock gene period 1 (PER1) was studied in hypothalamic neuronal cells.

Results

Chronic NAD supplement significantly attenuated weight gain in HFD-fed DIO mice. Furthermore, NAD treatment partially recovered blunted rhythms in diurnal patterns of feeding and locomotor activity in DIO mice. Exogenous NAD supply rescued from cellular NAD depletion-induced suppression in the PER1 transcriptional activity in hypothalamic neurons.

Conclusion

Our findings indicate a therapeutic potential of NAD supplementation in obese subjects with altered circadian behaviors.

Obes Facts. 2018 May 26;11(Suppl 1):87.

T1P70 An oxide transport chain essential for canonical leptin signaling in hypothalamic neurons

S Fruhwürth 1, X Wu 2, KJ Williams 2

Introduction

Obesity is a worldwide health problem that is caused by excessive food intake and a sedentary lifestyle resulting in a chronic positive energy imbalance. The maintenance of a healthy energy balance is essential for the prevention of obesity. But, we still do not understand the molecular mechanisms responsible for overeating. Leptin is made by adipose tissue and then acts in the hypothalamus to inhibit caloric intake and increase energy expenditure (Figure 1). Importantly, obese people exhibit high circulating levels of leptin, yet the hypothalamus no longer responds to this hormone to suppress appetite. We previously reported a novel signaling pathway for insulin in liver and endothelium. This pathway, abbreviated “NSAPP” after its 5 major proteins, begins when insulin stimulates the NADPH oxidase-4 (NOX4) to generate O2•-. After conversion of O2•- into H2O2 by superoxide dismutase-3 (SOD3), the pathway ends when aquaporins (AQPs) channel H2O2 to inactivate protein tyrosine phosphatases (PTPases) which otherwise block leptin signaling (Figure 1). For the current study, we hypothesized that the NSAPP pathway is also required for leptin action in hypothalamic neurons.

Methods

Leptin-stimulated production of intracellular H2O2 in mouse hypothalamic cell lines GT1–7 and HypoA-POMC/GFP was monitored with a fluorogenic probe (CellROX). Knockdown was performed using CRISPR lentiviruses. Leptin-stimulated phosphorylations of key tyrosyl residues were assessed by immunoblotting.

Results

We found that all proteins of the NSAPP pathway are present in rat hypothalamus. In murine hypothalamic cell lines, leptin induced a burst in intracellular CellROX staining that we definitively identified as H2O2 by its quenching by catalase. Inhibition of NOX4 with diphenyliodonium abolished the leptin-induced H2O2 burst and blocked leptin signaling to key tyrosine phosphorylation sites on JAK2 and STAT3. Strikingly, knockdown of SOD3 also blocked leptin signaling to JAK2 and STAT3.

Conclusion

Our results indicate that leptin activates the NSAPP pathway in hypothalamic neurons. Moreover, this novel pathway is essential for canonical leptin signaling to JAK2/STAT3, which regulate key neuropeptides that control appetite. Remarkably, insulin and leptin both require the NSAPP pathway, suggesting that a defect in this pathway could explain simultaneous resistance to the appetite-suppressing effects of both hormones.

Fig. 1.

Fig. 1

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Leptin requires the novel NSAPP oxide transport chain (red) for canonical signaling through JAK2 and STAT3 (blue).

Obes Facts. 2018 May 26;11(Suppl 1):87–88.

T1P71 Central role of diet consistency compared to diet composition in overconsumption of lean and DIO mice

B Klausz 1, Z Kovács 1, B Varga 1, C Csekő 1

Introduction

Diet induced obesity (DIO) test is one of the best known and most human relevant animal model of obesity, however, application of healthier nutrition regime during drug treatment phase is rarely applied in mice – while it is usually recommended in human cases. When we tried to switch the obese mice to a healthy control diet, their food intake became abnormally low hamstring concomitant drug testing. As various potential reasons could have been raised − ranging from masticatory muscle hypofunction to food addiction induced reward devaluation – we performed nutritional study series to investigate the diet choice characteristics of obese and lean mice.

Methods

Male C57BL6OlaHsd mice fatted with Research Diet D12492 high fat diet for at least 12 weeks were used as obese subjects. Lab chow fed mice were the lean participants. After habituation to the experimental conditions, diet choice and diet change tests were conducted with pelleted and grounded diets along with daily food intake and body weight measurements.

Results

Offering pelleted lab chow or healthy control diet to high fat diet fed obese mice did not influence intake pattern or body weight, but removal of the high fat diet resulted in dramatic consumption decrease and weight loss. In the subsequent experiment, lean mice preferred pelleted high fat diet over lab chow, but when their former chow were reintroduce after only six days, their caloric intake and body weight fell significantly. Offering of pelleted healthy control diet was without any effect in lean lab chow fed mice. However, allowance to grounded healthy control diet or grounded lab chow induced food intake pattern changes similar to high fat diet.

Conclusion

Regarding overconsumption, consistency of a diet seems to be more important than its composition, furthermore, even a few day availability of a palatable diet seems to decrease the subjective value of the less preferred diets – even causing starvation and weight loss. Applications of these concepts in DIO test protocols have already been started.

Obes Facts. 2018 May 26;11(Suppl 1):88.

T1P72 The effects of relaxin-3 knock-down neurons on body weight and food intake in female rats

C De Avila 1, S Ma 2, A Gundlach 2, E Timofeeva 3, C Cifani 1

Introduction

The relaxin-3 neuropeptide (RLN3) is part of the relaxin family, insulin superfamily and is primarily expressed in the brain at the nucleus incertus (NI) of the brainstem. Previously we demonstrated that the intracerebroventricular injection of RLN3 increased chow intake in satiated rats and this effect was significantly higher in female compared to male (Table 1). We also showed that RLN3 affects the expression of gonadotropin releasing hormone (GnRH) and gonadotropic axis activity in female rats. The present study was designed to investigate the knock-down effects of RLN3-positive neurons in NI on body weight, food intake correlated with estrous cycle stage, and behavioral tests in female rats. Table 1. Effects of intracerebroventricular (icv) injections of 800 pmol of RLN3 or Vehicle (CSF) on Cumulative Food Intake Relative to BW (mg/g BW) after 60min in Male and Female Rats. (adapted from Lenglos et al. 2015).

Methods

Female rats were divided into 2 groups: control and knockdown (n = 9–10 / group). The control group received a bilateral infusion of pAM DCA miRC and the knock-down group received miR499 via the viral vector 1 / 2AAV. Three weeks after injection, food intake and body weight were measured every 24 hours. The phases of the estrous cycle have also been characterized. At week seven, the rats were subjected to the behavioral tests Light Dark box and Large Open Field. In the eighth week of infection, the brains were removed, as well as blood by intracardiac sampling.

Results

The knock-down rats have a significantly decreased body weight compared to the control group (Figure 1). Decreased food intake during the estrus phase of estrous cycle was suppressed in knock-down rats. In addition, knock-down animals showed significantly higher anxiety behavior in the Large Open Field, compared with control rats. Figure 1. Body weight (g) after virus injection. Week 1–3: infection. Multiple t-test.

Conclusion

Blocking the expression of RLN3 in NI induces a disruption in food intake behavior associated with weight loss and higher anxiety. Furthermore, these results suggest RLN3 may mediate the effects of estradiol on food intake in female rats.

Fig. 1.

Fig. 1

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Tab. 1.

Male – CSF 4.03 ± 0.67
Male – 800 pmol 8.41 ± 1.86a
Female – CSF 4.04 ± 0.73
Female – 800 pmol 11.93 ± 1.45ab
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a

Significantly (repeated-measures ANOVA followed by Fisher’s protected least significant difference) different compared with CSF group within the same gender.

b

Significantly different compared with male rats within the same treatment.

Obes Facts. 2018 May 26;11(Suppl 1):88–89.

T1P74 The impact of metabolic state on neurocognitive responses to visual food cues

N Stamataki 1, S McKie 2, R Elliott 2, J McLaughlin 1

Introduction

In healthy individuals the exposure to food cues initiates complex brain processes, including integrating the salience of external food stimuli with internal metabolic state. Eating behaviour requires that changes in metabolic status are recognized by the central nervous system which regulates brain responses to sensory information. Inputs from attentional control, decision-making, reward-processing and homeostatic brain areas are required to counterbalance the salient information from palatable food cues and prevent eating beyond energy needs. Previous fMRI research has shown that a satiated state is associated with diminished brain responses to food cues in regions implicated in processing sensory stimuli. The aim of this study is to examine the efficacy of two computer-based behavioural tasks to detect a difference in neurocognitive responses to visual food cues in response to changes in metabolic status in normal-weight controls.

Methods

Twenty healthy participants (7 males) with a normal body mass index (BMI) (mean age: 24.3 years, mean BMI: 21.3 kg/m2) were recruited and completed two separate visits after an overnight fast, corresponding to one fasted and one fed session (randomised order), in which participants were served a standardized carbohydrate-rich breakfast. Blood glucose levels and subjective appetite were measured in the fasted state and 30 min after the consumption of the meal. A visual dot-probe task (DPT) (picture version), which assesses attention allocation to food-related cues, and an implicit association task (IAT) (word version) designed to tap associations between concepts (i.e. pleasant and food) were administered. In both tasks participants were asked to respond as quickly and accurately as possible and their reaction time was recorded.

Results

The consumption of the standardized breakfast significantly increased blood glucose levels and suppressed appetite. results of the dot probe task showed that in the fasted state participants exerted a higher attentional bias score (mean reaction time to respond when the dot replaces a neutral picture minus the mean reaction time to respond when the dot replaces a food picture) towards food-related images compared to response in the fed state (p < 0.05). Analysis of IAT revealed that participants were slower when food+unpleasant shared the same response key compared to when food+pleasant words were put on the same side. This was evident both for the fasted (p < 0.0001) and fed state (p < 0.0001), however no difference was found between them.

Conclusion

Our preliminary results suggest that the metabolic state seems to affect attention to palatable food cues, with a fasted state to be associated with a higher attentional bias in healthy and normal weight participants. Implicit attitudes to food words were not found to rely on the physiological state in this study. The DPT was found to be an effective tool in assessing attention allocation after exposure to food stimuli between fasted and fed states. Identifying how the needs of the body affect the way the brain processes food cues is critical in our efforts to understand neurobehavioural regulation of food intake and obesity risk.

Obes Facts. 2018 May 26;11(Suppl 1):89.

T1P75 Spatial memory impairment induced by palmitic acid enriched-diet in adolescent mice

A Contreras 1, V Naranjo 1, A Plaza 1, B Merino 1, L Morales 1, V Cano 1, M Ruiz-Gayo 1, N Del Olmo 1

Introduction

The consumption of high-fat diets (HFD) is associated with hippocampus-dependent cognitive deficits, mainly in adolescent individuals. HFD used in most studies contain elevated amounts of both palmitic and oleic acids, together with large amounts of sucrose, making very difficult to properly identify the relative influence of each fatty acid within the hippocampus. Our study aimed to investigate the lasting effects of diets enriched with either oleic (OHFD) or palmitic acids (PHFD) on hippocampal-dependent spatial memory in adolescent and adult mice.

Methods

Adolescent (4-week old) and adult (8-week old) male C57BL/6 mice fed either standard rodent diet (SD), OHFD (60% SD + 40% high-oleic sunflower oil, containing 80% oleic acid and 4% palmitic acid), or PHFD (60% SD + 40% palm oil, containing 48% palmitic acid and 35% oleic acid) during 8 weeks. Spatial memory was evaluated by analyzing the spontaneous alternation in the Y-maze. The effect of these diets on glutamatergic transmission-related genes such as glt1, gluA 1–2 and grin2 A-D was evaluated by RT-qPCR.

Results

Our results show that both OHFD and PHFD induced a greater increase of body weight than SD in adolescent as well as in adult mice. Nevertheless, adolescent mice, but not adult mice, that consumed PHFD displayed impaired spatial memory in the Y-maze test compared to the other two groups. Moreover, modifications in hippocampus gene expression in this cohort were compatible with the above mentioned behavioral impairment.

Conclusion

Our study shows that the exposure to PHFD, but not to OHFD, during the adolescence impairs hippocampus-dependent memory processes. Furthermore, our findings support the concept that the neurobehavioral vulnerability to this kind of diets is more prominent during the adolescent that during the adult period.

Funding

Ministerio de Economía y Competitividad (BFU2016–78556R), European Regional Development Fund, and Fundación Universitaria CEU-San Pablo. The presenter is supported by the post-graduate fellowship programs of Universidad CEU-San Pablo.

Obes Facts. 2018 May 26;11(Suppl 1):89–90.

T1P76 The hunger games; taste, GLP-1 and female gender involved

M Baretić 1, V Kušec 2, V Uroić 3, I Pavlić-Renar 4, V Altabas 5

Introduction

The crucial role of the gustatory system during evolution was to detect potentially toxic nutrients or to detect indicators of spoilage. As the human brain evolved and body volume increased, tooth and gut size decreased. Nutritional characteristics also evolved in conjunction with the high metabolic demand of large brains. Incretins are substances secreted in the gut after a meal. The incretin hormone glucagon-like peptide-1 (GLP-1) is released from intestinal enteroendocrine L cells in response to a carbohydrate meal. GLP-1 has many levels of action, but currently it is primarily known for its effect on beta cells. GLP-1 reduces gastric emptying, lowers appetite by promoting satiety via hypothalamic receptors and reduces food intake. Thus, GLP-1 action leads to weight loss. GLP-1 is produced not only in the peripheral nervous system (intestine and pancreas) but also in the central nervous system by neurons located in the nucleus of the solitary tract. Central injections of GLP-1 receptor agonists decrease food intake. There is no specific group of diabetic (or non-diabetic) patients identified as GLP-1 receptor agonist ‘responders” or ‘non-responders” with respect to weight loss. Some patients report a diminished craving for food following GLP-1 therapy and a change in food preference. The gastrointestinal tract is the major connector between food and body weight, it senses basic tastes in a similar manner as the tongue and through similar G-protein-coupled taste receptors. The link between gut hormones and eating behavior is well known, though it has not been thoroughly explored. The aim of this study was to explore how GLP-1 influences taste preference in different genders, insulin sensitivity and body composure.

Methods

Effects of GLP-1 infusion on taste preference were investigated in 14 healthy participants (6 males, 8 females) in a double-blind, placebo-controlled crossover study. Insulin sensitivity was estimated with simultaneously measured fasting plasma glucose and fasting plasma insulin values and body composition was estimated with bioelectrical impedance analysis (total fat mass, mean fat percentage). After an overnight fast and an oral sodium load delivered in the form of soup, volunteers received placebo (500 ml of 0.9% saline) over a 3-hour period. At the end of infusion, participants chose their current food preferences from illustrations of food types representing 5 tastes (sweet, bitter, salty, sour, and umami). After 7 days, the volunteers received an infusion of synthetic GLP-1 (1.5 pmol/kg/min, dissolved in 500 ml of 0.9% saline) and reported their food preferences again.

Results

Change of taste preference after GLP-1 infusion but not after placebo was reported as response, and non-response was reported in the case of taste persistence. A statistically significant difference in response type was found between sexes (χ2 = 4.667, df = 1, p = 0.031), with women being more likely to change their taste preference after GLP-1 infusion than men. There was a positive correlation in responders between the body composition parameter (body fat mass in kg) and basal insulin levels after GLP-1 infusion. We also found a strong positive correlation between insulin resistance and insulin level after GLP-1 infusion in responders (r = 0.89 p < 0.01)

Conclusion

The results of this study indicated that healthy non-obese women were more likely to change their taste preference after GLP-1 infusion than men. Why are women more prone to taste change after GLP-1 infusion than men? Observed change of taste upon GLP-1 infusion in women might be ascribed to estrogen; the weight-lowering effects of estrogens are accomplished by receptor-mediated delivery. The weight-lowering effects of estrogens are associated with decreased food intake and increased energy expenditure in experimental animals, modulating energy expenditure and feeding behavior through leptin-like effects in the hypothalamus. Estrogens act directly on brain serotonin neurons. According to current findings and this study data, recently developed estrogen/GLP-1 medication may be a new strategy for obesity therapy. Also, a current obesity therapy, a GLP-1 receptor agonist, may be more effective (or applied in lower dosages) in females. Gender differences in the physiology of eating and response to GLP-1 stimuli may contribute to better understanding of human obesity and eating disorders. For patients with more visceral fat and higher insulin resistance, a GLP-1 receptor agonist could be more effective (or applied in lower dosages) for the treatment of diabetes.

Obes Facts. 2018 May 26;11(Suppl 1):90.

T1P77 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):90.

T1P78 Maternal diet rich in advanced glycation end products affects early neuromotoric development of the offspring, and associates with higher body weight and lower insulin sensitivity in male progeny

K Sebekova 1, M Csongova 1, R Gurecka 1, I Koborova 1, E Domonkos 1, O Ulicna 2, V Somoza 3, P Celec 1

Introduction

Maternal exposure to a Western type diet during pregnancy might predispose the offspring to manifestation of metabolic and behavioral disturbances in later life. Western type diet contains large amounts of advanced glycation end products, which are thought to be detrimental to cardiovascular health via initiating production of reactive oxygen species, atherogenic, inflammatory, or diabetogenic responses. It remains unclear whether maternal intake of advanced glycation end products rich diet (AGE-RD) might induce alterations in offspring programming.

Methods

Pregnant mice were fed either an AGE-RD (25% bread crusts/75% control chow) or a control diet. Body weight of dams during pregnancy and lactation, as well as that of the offspring till young adulthood was recorded. Moreover, we examined early neuromotoric development of the offspring, and their metabolic status and voluntary behavior in young adulthood.

Results

Consumption of AGE-RD did not induce obesity in pregnant dams. Till weaning, somatic development of the offspring (e.g body weight, incisor eruption, etc.) did not differ between two dietary groups. AGE-RD offspring manifested physiological reflexes (e.g. auditory startle, eye lid, ear twitch and righting reflexes) significantly earlier. As young adults, male offspring of AGE-RD dams were heavier (p = 0.028) and less insulin sensitive (p = 0.025) compared with their control counterparts. AGE-RD offspring showed higher volunteer locomotor activity during the active phase.

Conclusion

Our data indicate that maternal AGE-RD during pregnancy might accelerate maturation of central nervous system of the offspring, and predispose the male progeny to earlier manifestation of obesity and diabetes. These effects were manifested in absence of maternal obesity and gestational diabetes, without a direct consumption of AGE-RD by offspring. Further work is needed to determine the mechanisms by which maternal AGE-RD affects neurobehavioral pathways in offspring, as well as the sex differences in adverse metabolic responses.

Obes Facts. 2018 May 26;11(Suppl 1):90.

T1P79 Chrysin combats obesity in rats by modulating energy intake and expenditure

S A Pai 1, E Martis 2, MS Gursahani 1, SN Mestry 1, RP Munshi 3, AR Juvekar 1

Introduction

An imbalance between energy intake and expenditure accompanied by the hedonic feeding on sweetened beverages are the major factors responsible for the obesity epidemic. Hence the need of the hour is to identify molecules which can simultaneously address multiple causes of obesity. Chrysin is a flavonoid which is found in plants such as Oroxylum indicum, Passiflora incarnata and bee propolis.

Methods

The pancreatic lipase inhibitory (PL) potential of chrysin was studied using in silico and in vitro techniques followed by the determination of the kinetics of inhibition. The effects of chrysin on acute feed intake, sucrose preference test, oral fat tolerance test and locomotor activity were determined in rats. Rats were fed a high fat diet initially for 8 weeks followed by treatment with chrysin (25, 50 and 100 mg/kg orally) for 8 weeks alongwith the high fat diet. The body weight of the rats and the feed and fluid intake were monitored throughout the study. Fecal cholesterol and intraabdominal fat (IAF) weight were also determined.

Results

Chrysin inhibited PL competitively (IC50 = 4.97 ± 0.16μg/ml) and exhibited a docking score of -8.03. It significantly decreased acute feed intake, preference for sucrose and serum triglycerides while it increased locomotor activity in a dose dependent manner. It also protected against body weight gain but it did not affect feed and water intake. Fecal cholesterol increased while IAF decreased significantly in chrysin treated rats.

Conclusion

Chrysin exhibited potential anti-obesity effects by inhibiting PL, reducing sucrose bingeing, increasing the locomotor activity, increasing fecal cholesterol excretion and reducing IAF in rats. It may thus be a potential nutraceutical to combat obesity warranting clinical studies in obese patients.

Obes Facts. 2018 May 26;11(Suppl 1):90–91.

T1P80 A potential role of the high sensitive C-reactive protein (hs-CRP) within the association between insulin sensitivity (IS) and resting metabolic rate (RMR): a mediator analysis

T Drabsch 1, L Stecher 1, J Petzold 1, T Skurk 2, C Holzapfel 1, H Hauner 1

Introduction

Impaired insulin sensitivity (IS) is associated with increased resting metabolic rate (RMR), as well as with low-grade inflammation. Furthermore, positive associations between inflammatory markers such as high sensitive C-reactive protein (hs-CRP) and RMR have been shown in several studies. However, the physiological mechanisms of these associations are still unclear. Aim of the present mediator analysis was to investigate the potential role of the inflammatory state within the IS-RMR association.

Methods

Anthropometric, clinical and lifestyle data was collected according to standard operating procedures in a multicentric study. RMR was measured using indirect calorimetry. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was used as a parameter for IS. Levels of hs-CRP were measured as a marker of the inflammatory state. The regression analysis was performed using SPSS (version 23).

Results

In total, 799 adults (529 women) with a mean age of 32.45 ± 12.25 years and a mean body mass index of 24.56 ± 5.10 kg/m2 were included in the analysis. The regression analysis showed significant evidence for a positive association between HOMA-IR and RMR, and between hs-CRP and HOMA-IR (each p < 0.001). results of the mediator analysis did not show any significant evidence for hs-CRP mediating the association between HOMA-IR and RMR. Furthermore, interaction analysis could not show a BMIxHOMA-IR or BMIxhs-CRP interaction on RMR.

Conclusion

Findings showed a significant evidence for an association between IS and RMR, as well as between IS and hs-CRP in a large German adult cohort. Nevertheless, there is no evidence for a mediator role of hs-CRP levels within the IS-RMR association. Possible explanations might be the investigation of a healthy and young cohort as well as the low specificity of hs-CRP as an inflammatory marker. Furthermore, HOMA-IR is a vague parameter for IS.

Obes Facts. 2018 May 26;11(Suppl 1):91.

T1P81 Effects of serum albumin, calcium levels, cancer stage and performance status on PTHrP-induced weight loss in cancer patients

JH Lee 1, Y Lee 2, H Shin 3, Y Shin 4

Introduction

Recent animal study showed that parathyroid hormone-related peptide (PTHrP) mediates cancer cachexia by adipose tissue browning. Previously, we demonstrated that PTHrP predicts weight loss (WL) in cancer patients. In this study, we investigated whether PTHrP-induced WL is influenced by other factors such as serum albumin, corrected calcium (Ca) levels, cancer stage and performance status of patients.

Methods

From a longitudinal observational cohort, patients referred to medical oncology department of Severance hospital, Yonsei University were enrolled. PTHrP, baseline and follow up body weight and BMI was measured. Patients (n = 219) were divided into 4 groups by PTHrP levels and serum albumin or Ca levels or performance status or cancer stage of individuals, respectively. WL was defined as either %WL < −5% or %WL < −2% plus body mass index < 20kg/m2.

Results

To investigate whether PTHrP-induced WL is influenced by other factors such as serum albumin, Ca levels, performance status of patients and cancer stages, detailed subgroup analysis was further conducted. Cox regression analysis showed that the effect of PTHrP on WL was more prominent in subjects with lower albumin levels, stage 4 cancer, and better performance status (ECOG 1–2). Regardless of calcium levels, effect of PTHrP on WL was maintained, although higher calcium levels and PTHrP showed additive effects on WL.

Conclusion

These results imply that weight reducing effect of PTHrP among cancer patients might be affected by their serum Ca levels and status of nutrition, performance and cancer stages.

Obes Facts. 2018 May 26;11(Suppl 1):91.

T1P82 Resting energy expenditure in overweight adult with Crohn’s disease: a cross-sectional study

I Cioffi 1, N Imperatore 1, O Di Vincenzo 1, R Sammarco 1, M Marra 1, F Contaldo 1, F Castiglione 1, F Pasanisi 1

Introduction

Crohn’s disease (CD) is associated with low body weight and malnutrition; however, recent studies have identified a growing prevalence of obesity in these patients. As a result, the evaluation of resting energy expenditure (REE) in these subjects could be important for an adequate dietary approach. The aim of the study was to compare REE measured (MREE) by indirect calorimetry versus REE predicted (PREE) by the Harris and Benedict (HB) equation, widely used in clinical practice.

Methods

Adult CD patients with BMI > 25 kg/m2, aged between 18–65 years, were considered in this analysis. All participants underwent anthropometric measurement and REE measure by indirect calorimetry with a canopy system. Data were obtained comparing MREE with PREE derived from the HB equation used for the general population. In addition, the average difference between PREE and MREE as well as accuracy at 5% level were evaluated.

Results

Twenty-three overweight CD patients, 12 men (age: 44 ± 11 years; BMI = 28 ± 3 kg/m2) and 11 women (age: 47 ± 15 years; BMI = 27 ± 2 kg/m2) were finally considered for the study. We found a significant difference between MREE and PREE by HB equation in men (MREE = 1880 ± 53 vs. PREE = 1753 ± 161 kcal/d; p = 0.03) but not in women (MREE = 1434 ± 191 vs. PREE = 1372 ± 146 kcal/d; p = 0.13). The average difference between MREE and PREE was − 127 ± 174 kcal/d (7.6%) in men and − 62 ± 127 kcal/d (4.6%) in women. Overall prediction accuracy was low (~ 48%) for HB equation.

Conclusion

These preliminary results showed that REE predicted by HB equation was significantly underestimated compared to MREE in men. Further research is required for a more accurate prediction of resting energy expenditure in overweight/obese CD patients in both sexes.

Obes Facts. 2018 May 26;11(Suppl 1):91.

T1P83 Evaluation of resting energy expenditure and body composition in young males with different underweight conditions

R Sammarco 1, M Marra 1, O Di Vincenzo 1, C De Caprio 1, F Maione 1, E Speranza 1, F Contaldo 1, F Pasanisi 1

Introduction

despite the increased prevalence of anorexia nervosa among males in both community and clinical practice, limited data on nutritional status in underweight males are available in the literature. The aim of this study is to evaluate resting energy expenditure (REE) and body composition in male anorectic patients compared with constitutionally lean and ballet dancers compared with age-matched control subjects

Methods

we studied 17 anorectic (AN) males (age 22.3 ± 5.3years, weight 51.8 ± 4.8 kg, BMI 17.1 ± 1.2 kg/m2), 15 constitutionally lean (CL) (age 23.3 ± 5.2years, weight 56.1 ± 3.3 kg, BMI 17.9 ± 0.6 kg/m2) 12 ballet dancers (DC) (age 19.7 ± 1.6 years, weight 62.3 ± 5.3 kg, BMI 20.0 ± 1.3kg/m2) and 18 control (CTR) subjects (age 22.3 ± 3.7years, weight 70.3 ± 6.5 kg, BMI 22.3 ± 1.7 kg/m2). REE was measured by indirect calorimetry (V max29- Sensormedics) and bioimpedance analysis (BIA) was performed at 50 kHz (DS Medica) early in the morning. Phase angle (a bioimpedance variable related to nutritional status) was used in order to evaluate differences in fat free mass (FFM) characteristics among these three conditions of underweight.

Results

REE both in absolute value and corrected for FFM was significantly higher in CL, and lower in AN, with dancers and controls in between. (REE kcal/die: CL 1726 ± 216, AN 1150 ± 169, CTR 1678 ± 167, DC: 1563 ± 179; p < 0,05) REE/FFM kcal/kg: CL 35.9 ± 6.2, AN 25.2 ± 4.2, CTR 30.0 ± 3.0, DC: 26.6 ± 2.4 p < 0.05). Body composition was similar in AN and CL males (FFM: 46.0 ± 5.2 vs 48.6 ± 4.4 kg ns; FAT %: 10.3 ± 5. vs 13.6 ± 5.7% ns); dancers had the highest FFM (58.9 ± 4.8 kg) and the lowest FAT (5.5 ± 1.8%). Phase angle was similar in CL and CTR (6.9 ± 0.6 vs 6.8 ± 0.4 degree ns) whereas anorectic males had the lowest phase angle (5.8 ± 1.2 degree vs CL and CTR and DC, p < 0.05) and dancers the highest one (7.9 ± 0.7 degree vs CL and CTR and DC, p < 0.05)

Conclusion

This study suggests that resting energy expenditure is higher in constitutionally lean and the REE/FFM ratio allows to differentiate, as far as nutritional status, between CL and AN, despite a similar BMI; phase angle appears to be a marker of qualitative changes in body composition, above all in the field of sport activities, and it seems able to discriminate between intensively trained individuals and other underweight conditions, both pathological or not (AN and CL).

Obes Facts. 2018 May 26;11(Suppl 1):92.

T1P84 Prediction of Resting Energy Expenditure in extreme obese patients improves with BIA parameters

R Sammarco 1, M Marra 1, D Morlino 2, V Amato 3, M Onufrio 3, L Santarpia 4, F Contaldo 2, F Pasanisi 3

Introduction

The relationship between Resting Energy Expenditure (REE) and body composition has not been extensively studied in extreme obese patients. (IMC >50 kg/m2) The aim of this study is to evaluate whether bioimpedance analysis (BIA) can be useful to develop predictive equations for REE in extremely obese adult patients (both males and females)

Methods

Three -hundred and seventy severely obese adult patients (Males 136, Females 234; age range 18–65 y) participated in the study (M:age 33.3 ± 10.8 yrs, weight 165 ± 17 kg, BMI 55.3 ± 4.2 kg/m2;F: age 36.6 ± 11.1 yrs, weight 144 ± 14 kg, BMI 55.7 ± 4.7 kg/m2) REE was measured by indirect calorimetry (V max29- Sensormedics) and bioimpedance analysis were performed at 50 kHz (DS Medica) in all patients. The following variables were considered as possible predictors of REE: 1) general characteristics: age, height, weight, BMI; 2) BIA measures: resistance, reactance, bioimpedance index (heigh2 /resistance = BI index), and phase angle (PA). Statistical analysis was performed using linear correlation and multiple regression analysis (SPSS vers. 18.0).

Results

In males, REE was 3010 ± 241 kcal/die, QR 0.85 ± 0.06, BI 88.0 ± 12.4 and PA 7.36 ± 1.01 degree; for females REE was 2439 ± 300 Kcal/die, QR 0.83 ± 0.07, BI 65.9 ± 9.21 and PA 6.60 ± 0.97 degree. In males, REE was strongly correlated (linear correlation) with body weight (r = 0.454), and BI index (r = 0.471) whereas in females REE was strongly correlated with body weight (r = 0.450) and BI index (r = 0.469) The following predictive equations were obtained by multiple regression analysis in extreme obese according to gender: For individual general characteristics (age, weight, height, BMI): Males: REE (kcal/d) = 6.27 x body weight + 1970; r = 0.454 SEE 215 kcal/d Females: REE (kcal/d) = 9.40 x body weight + 1081; r = 0.450 SEE 267 kcal/d For BIA measures (resistance, reactance, BI index and PA): Males: REE (kcal/d) = 6.21 x BI index + 16.8; r = 0.471 SEE 213 kcal/d Females: REE (kcal/d) = 60.35 x PA+ 15.35 x BI index +1027; r = 0.508 SEE 258 kcal/d For individual general characteristics + BIA measures: Males: REE (kcal/d) = 4.13 x body weight + 6.45 x IB + 1756; r = 0.541 SEE 204 kcal/d Females: REE (kcal/d) = 64.60 x PA +6.27 x body weight + 10.40 x IB + 422; r = 0.570 SEE 246 kcal/d

Conclusion

This study suggests that in extreme obese adult patients, REE can be estimated from body weight but the inclusion of BIA measures such as IB and phase angle into the equations further improves the prediction of resting energy expenditure.

Obes Facts. 2018 May 26;11(Suppl 1):92.

T1P85 Relationship between Sleep Problems and Resting Energy Expenditure in Obese Children and Adolescents

N Acar Tek 1, D Agagunduz 2, R Bozbulut 2, B Deniz Güneş 1

Introduction

The relationship between sleep and obesity is among the popular topics in recent times. Studies have shown that sleep problems are associated with food intake and obesity. However, there is little information about the effects of these sleeping problems on Resting Energy Expenditure (REE).

Methods

Obese children and adolescents (57 males, 46 females) between 7 and 17 years were recruited for the study. Resting Energy Expenditure (REE) measurements of subjects were made with indirect calorimetry (COSMED, FitMatePro, Rome, Italy). It was used the Children’s Sleep Habits Questionnaire (CSHQ) with 33 items to examine sleep habits and possible difficulties with sleep. The validity and the reliability of Turkish Version of Children’s Sleep Habits Questionnaire examined by Fiş, et al. in 2010. The total score of 41 points was accepted as a cut-off point and the values above 41 points were evaluated as “there was a sleeping problem”.

Results

In this study, 77.0% of the participants had sleep problems. When the sleeping problem is evaluated according to the sex, it was found 76.1% of the females and 73.7% of the males had sleep problems. There was no statistically significant difference in terms of sleep problems between the genders (p > 0.05). When REE was evaluated according to gender; the mean REE of the females was 1465.5 ± 305.57 kcal / day and the mean REE of the males was 1547.6 ± 484.00 kcal /day. The mean REE of participants with sleep problems was 1851.0 ± 393.71 kcal /day, while those without sleep problems was 1402.5 ± 353.88 kcal / day (p < 0.05). The mean REEs of the females with and without sleep problems were 1395.6 ± 256.27 kcal / day and 1733.0 ± 294.642 kcal / day, respectively (p < 0.05). The mean REEs of the males with and without sleep problems were 1408.3 ± 421.42 and 1937.5 ± 442.54 kcal / day, respectively (p < 0.05). There was a negative correlation between scores of the children sleeping habit questionnaire and REE values (r: −0.646, p < 0.05), and a negative correlation was found in both genders (in females: r:−0.520, p < 0.05 and in males: r:−0.715, p < 0.05).

Conclusion

The prevalence of sleep problems in obese children&adolescents was high for both genders and it was found that this problem resulted in a decrease in participants’ REEs.

Obes Facts. 2018 May 26;11(Suppl 1):92–93.

T1P86 Relationship Between Chronotype and Resting Energy Expenditure in Obese Children and Adolescents

N Acar Tek 1, D Agagunduz 2, R Bozbulut 2, B Deniz Güneş 1

Introduction

Chronotype is a trait regarding individual circadian preference in behavioral and biological rhythm. In the literature, it is reported that there is aa significant relationship between chronotype and body composition&obesity. However, there is little known about the effects of chronotropy on Resting Energy Expenditure (REE) in this relationship.

Methods

Obese children and adolescents (57 males, 46 females) between 7 and 17 years were recruited for the study. Resting Energy Expenditure (REE)measurements of subjects were made with indirect calorimetry (COSMED, FitMatePro, Rome, Italy). The chronotype was assessed with a 27- item Children’s ChronoType Questionnaire (CCTQ) in which Turkish validity and reliability studies were conducted by Dursun, et al (2015). According to this; morningness / eveningness scale (M / E) score was calculated and classified as ≤23 = morning form, 24–32 = intermediate form and ≥33 = evening form.

Results

When the chronotypes of the participants were evaluated, it was determined that 17.5% of them were morning form, 36.9% were intermediate form and 45.6% were evening form. When evaluating chronotype status according to gender; it was determined that there was no statistically difference between female and male participants in morning form (19.6%, 15.8% respectively), intermediate form (37.0% and 36.8% respectively) and evening form (43.5% and 47.4% respectively) (p > 0.05). The mean REE of the females was 1465.5 ± 305.57 kcal / day and the mean REE of the males was 1547.6 ± 484.00 kcal / day. When REE was assessed acording to all participants’ chronotypes; it was found that the mean REE of the morning form was 1849.8 ± 483.21 kcal / day, 1617.9 ± 331.10 kcal / day for the intermediate form and 1294.6 ± 321.81 kcal / day for the evening form. When the REE of the females acording to their chronotypes was evaluated; it was determined the mean REE of morning form was 1765.1 ± 292.99 kcal / day, 1571.2 ± 220.71 kcal / day for the intermediate form and 1240.8 ± 195.73 kcal / day for the evening form (p < 0.05). When there was evaluated according to the chronotypes of males, the mean REEs of morning, intermediate and evening forms were found to be 1934.4 ± 627.84 kcal/day, 1655.8 ± 400.59 kcal/day and 1344.4 ± 389.05 kcal/day respectively (p < 0.05). It was determined that there was a negative correlation between M / E score and REE in females and males (r: −0.742, p < 0.000, r: −0.493, p < 0.05; respectively).

Conclusion

As a result of the study it was determined that the REEs of the participants were changed according to the chronotypes for both genders. Besides, it was determined that the REEs of the individuals who are in the morning forms are the highest and those who are in the evening forms are the lowest.

Obes Facts. 2018 May 26;11(Suppl 1):93.

T1P87 Changes in Total and Activity Energy Expenditure accompanying continuous versus intermittent energy restriction: The MATADOR study

N Byrne 1, A Hills 1, A Salis 2, N King 3, R Wood 1

Introduction

The MATADOR (Minimising Adaptive Thermogenesis And Deactivating Obesity Rebound) study examined whether intermittent energy restriction (INT) improved weight loss efficiency compared with continuous energy restriction (CON) and, if so, whether INT attenuated compensatory responses associated with energy restriction (ER). We recently reported that INT, delivered as alternating 2-week blocks of ER and energy balance, resulted in greater weight and fat loss without greater loss of fat-free mass (FFM), attenuation of the reduction in resting energy expenditure (REE), and superior weight loss retention after 6 months, compared with an equivalent ‘dose’ of CON[1]. Here we examine the changes in total daily energy expenditure (TEE) and activity energy expenditure (AEE) with INT versus CON, and in a subset, compare differences in TEE at 6-months follow-up[2].

Methods

Men with obesity were randomised to 16 weeks of either: (1) CON, or INT completed as 8 x 2-week blocks of ER alternating with 7 x 2-week blocks of energy balance (30 weeks total). Forty-seven participants completed a 4-week baseline phase and commenced the intervention (CON: N = 23, 39 ± 7 years, 111 ± 9 kg, 34.3 ± 3.0 kg.m–2; INT: N = 24, 40 ± 10 years, 110 ± 14 kg, 34.1 ± 4.0 kg.m–2). During ER, energy intake was equivalent to 67% of weight maintenance requirements in both groups. Body weight, body composition (fat mass (FM) and FFM via air displacement plethysmography) and TEE (via the doubly-labelled water method) was measured at baseline, at Wk16-ER, and at 6-months follow-up.

Results

As previously reported[1], in participants who completed the intervention per protocol, weight loss was significantly greater after 16-weeks ER for INT (N = 17; 14.1 ± 5.6 kg) than CON (N = 19; 9.1 ± 2.9 kg). In both groups, TEE, AEE and REE decreased significantly after 16-weeks of ER. But despite the substantially greater weight loss in INT, the between-group changes in TEE (INT: −457 ± 325, CON: −450 ± 312 kcal), AEE (INT: −337 ± 327, CON: −301 ± 380 kcal) and REE (INT: −120 ± 115, CON: −149 ± 133 kcal) were comparable. In both groups, the change in TEE from baseline to Wk16-ER was predominantly explained by the change in AEE (CON: R = 0.95, INT: R = 0.94, P < 0.001) and not to the change in REE. The change in TEE from baseline to Wk16-ER correlated with the change in body weight only in INT (R = 0.56, P = 0.02). For the subsample where 6-month follow-up TEE data was available, there was a trend (P = 0.08) for larger weight regain in CON (N = 10, 8.4 ± 6.3 kg) compared with INT (N = 14, 4.2 ± 5.9 kg). At follow-up, TEE rebounded from the end of ER in both groups. The between-group difference in TEE change was not statistically significant (INT: 496 ± 620 kcal, CON: 370 ± 295 kcal), and was not correlated with the magnitude of weight change.

Conclusion

Despite INT producing greater weight loss than CON in sedentary obese men, TEE, REE and AEE reduced to a similar degree after 16-weeks of ER in both groups, with the change in TEE predominantly explained by the change in AEE. At the 6-month follow-up, TEE rebounded to baseline levels in both groups despite differential weight regain. [1] Byrne et al. (2017) International Journal of Obesity doi:10.1038/ijo.2017.206 [2] AEE not presented at 6-month follow-up due to large amount of missing REE data

Obes Facts. 2018 May 26;11(Suppl 1):93.

T1P88 Effect of Phosphorus supplementation on Energy Expenditure and Exercise Efficiency

R El-Husseini 1, O Obeid 2, E Fares 2

Introduction

The assessment of human variability in various compartments of daily energy expenditure (EE), under standardized conditions, is essential towards phenotyping for metabolic predisposition to leanness and fatness. Standardized tests are defined at rest and during physical activities in pre- and post-prandial states. ATP and phosphocreatine are both end products of glycogen breakdown. While phosphorus partakes in cellular energy storage, it is also an intrinsic aspect in phosphorylation; the main primer in glycogen metabolism. Phosphorus supplementation, given in a chronic setting, had been associated with a reduction in waist circumference and decreased subjective appetite scores. However, in an acute setting, its effect directly before exercise, is ill-defined. Our aim in this study is to measure the effect of acute phosphorus supplementation on Energy expenditure and exercise efficiency.

Methods

A double blind, crossover trial of 14 water polo players aged between 18 and 22 years old, were supplemented with 400 mg of phosphorus concomitant with a glucose solution, with a phosphorus dose of 1 mg/kcal. We calculated the change in exercise efficiency while controlling for muscle glycogen by asking the participants to fast overnight, and by depleting the remaining reserves through a 25 minutes bike run before meal intake. We then measured the change in work output 3 hours after a 400Kcal glucose solution following a 20 mins bike run at a constant cadence of 85 revolutions per minute and an incremental power output protocol.

Results

There was no significant energy expenditure difference between the phosphorus supplemented group and placebo, however, a significant difference in respiratory quotient was detected at rest (0.81 ± 0.06 vs. 0.87 ± 0.10; p < 0.05). The heartrate difference was significant between phosphorus supplementation and placebo (142 ± 9 vs. 135 ± 9 beats per minute (BPM); p < 0.05), yet phosphorus supplementation left unaffected the exercise efficiency, the respiratory quotient during exercise, and the perception of fatigue.

Conclusion

Phosphorus supplementation has been investigated for its effects on waist circumference and thus energy balance. In our study, it resulted in a significant increase in heart rate with no effect on energy expenditure and exercise efficiency. More studies need to be conducted in order to know whether this increase in heart rate is related to obesity indicators in a chronic setting or not

Obes Facts. 2018 May 26;11(Suppl 1):93–94.

T1P89 Exercising throughout pregnancy: effects of changes in gestational weight gain on mechanical efficiency

KM Denize 1, P Akbari 1, F Haman 1, K B Adamo 1

Introduction

Excessive gestational weight gain (GWG) is associated with considerable risk to mother and baby. For this reason, maternal weight management has become a key to short- and long-term health promotion. Engaging in regular physical activity (PA) is thus encouraged as one such health promotion strategy. However, weight gain during pregnancy causes a shift in the biomechanics of posture and gait, which can potentially increase the mechanical workload of daily tasks leading to higher metabolic costs for physically active pursuits providing an additional challenge for women. Clearly understanding the physiological strain to a given workload is essential prior to recommending appropriate PA programs. The purpose of this study is to quantify the changes in metabolic cost, external work, and mechanical efficiency for a given treadmill task over the course of pregnancy.

Methods

Preliminary data is presented here from five pregnant women (31.0 ± 2.7 years) who visited the lab on three separate occasions (14–16 week gestation, 24–26 week gestation, 34–36 week gestation). At each study visit, body mass was measured to track GWG, and O2 uptake and CO2 production were measured at rest and during a 7-stage, graded exercise test. Metabolic rate (VO2) and external work (Wext) were used to calculate mechanical efficiency, which was compared across early-, mid-, and late-pregnancy.

Results

All women had a normal BMI pre-pregnancy (22.0 ± 1.7), and gained an average of 11.9 ± 4.3 kg. The total amount of oxygen required to complete the given treadmill task increased from 7.3 ± 0.7 L/O2 to 8.0 ± 1.0 L/O2 from early- to late- pregnancy (p = .022). The amount of external work completed increased over the course of pregnancy from 5105.2 ± 911.8 kg-m to 6044.5 ± 1113.6 kg-m from early- to late- pregnancy (p = .004). The percent change in body mass was proportional to the increase in VO2 and external work during. Overall, there was no change in mechanical efficiency for the given treadmill task throughout pregnancy (p = .644).

Conclusion

These preliminary results indicate an increase in metabolic cost and amount of external work for a given treadmill task from early-, mid- to late-pregnancy, which is driven exclusively by increases in weight. However, there was no change in mechanical efficiency, indicating that while more energy is required for a given movement (due to a higher body mass), the body does not become less efficient when pregnant.

Obes Facts. 2018 May 26;11(Suppl 1):94.

T1P90 Gum chewing while walking affects physical and physiological functions

Y Hamada 1, T Yanaoka 1, K Kashiwabara 1, K Kurata 2, R Yamamoto 1, S Kanno 3, T Ando 3, M Miyashita 4

Introduction

Gum chewing stimulates sympathetic nervous activity, and increases heart rate and energy expenditure (N Engl J Med. 1999;341:2100, Eur J Oral Sci. 2009;117:470–473). Although these studies have examined the effects of gum chewing while at rest on physiological functions, to date, no studies have focused specifically on the effects of gum chewing while walking. Therefore, the present study examined the effects of gum chewing while walking on physical and physiological functions.

Methods

46 male and female participants aged 21–69 were completed two trials in a random order. In the gum trial, participants walked at a natural pace for 15 minutes while chewing 2 pellets of gum (1.5 g and 3 kcal per pellet) after a 1-hour rest period. In the control trial, participants rested for an hour before walking, and then they walked at a natural pace for 15 minutes after ingesting powder containing the same ingredient as the chewing gum. Resting heart rate and heart rate (i.e., during walking), walking distance and cadence were measured. The mean walking speed was calculated based on walking distance and time (15 minutes). The mean step counts were calculated based on the cadence value. Stride was calculated based on the mean walking speed and mean step counts. Energy expenditure during a 15-min walk was estimated based on the mean walking speed and body mass.

Results

In the all participants, the mean heart rate and changes in heart rate (i.e., from the rest to during walking) were significantly higher in the gum trial than in the control trial. The stratified analysis by sex showed that the walking distance, mean walking speed, mean heart rate and changes in heart rate among male participants, and mean heart rate and changes in heart rate among female participants were significantly higher in the gum trial than in the control trial. The stratified analysis by generation showed that the changes in heart rate among young participants (age: &le;39 years), and mean heart rate and changes in heart rate among middle-aged and elderly participants (age: &ge;40 years) were significantly higher in the gum trial than in the control trial. The stratified analysis by sex and generation showed that the walking distance, mean walking speed, mean step counts, mean heart rate, changes in heart rate and energy expenditure among middle-aged and elderly male participants were significantly higher in the gum trial than in the control trial (Table).

Conclusion

The present study demonstrates that gum chewing while walking affected on physical and physiological functions. The findings of the present study also indicate that gum chewing while walking increased the walking distance and energy expenditure of middle-aged and elderly male participants in particular.

Conflicts of Interest

This study was supported by a research grant from Lotte Co., Ltd. S.K. and T.A. were not involved in data acquisition, statistical analysis, and interpretation of results. M.M. has no professional relationships with the company involved in this study.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):94–95.

T1P91 Effect of endurance and endurance-strength training on calcium, iron, magnesium, zinc and copper balance in women with abdominal obesity

D Skrypnik 1, J Karolkiewicz 2, K Skrypnik 3, E Mądry 4, M Szulińska 1, D Pupek-Musialik 5, J Suliburska 3, J Walkowiak 6, P Bogdański 1

Introduction

Obesity is associated with a wide range of calcium, iron, magnesium, zinc and copper metabolism disorders, both in causal and consequential mode. Also exercise leads to alterations in mineral balance and, on the other hand, disrupted mineral homeostasis influences physical fitness. The effect of training on mineral metabolism in obesity has not been comprehensively studied so far and training modalities exerting the most favorable effect on macro and microelements balance in patients with excess body weight are currently investigated worldwide. The aim of our study was to compare the influence of endurance and endurance-strength training on calcium, iron, magnesium, zinc and copper status in women with abdominal obesity.

Methods

38 women with body mass index ≥ 30 kg/m2 and waist circumference > 80 cm were randomized into groups A or B. Both groups underwent three-months long training comparable in exercise volume, with training session lasting 60 minutes. Group A performed endurance training on cycle ergometers. Group B underwent endurance-strength training with endurance component performed on cycle ergometers and strength component performed with the use of a neck barbell and a gymnastic ball. The total caloric, minerals and nutrients consumption were comparable between the groups and constant. Before and after the training anthropometric and body composition measurements and Graded Exercise Test (GXT) were performed. Also blood, urine and hair samples were collected at baseline and at completion of the trial due to mineral content analysis.

Results

Endurance training led to decrease in serum Fe and Zn concentration, decrease in hair Zn and Cu content, and increase in urine Zn concentration. Endurance-strength training led to increase in serum Mg and Cu concentration, decrease in serum Fe and Zn concentration, decrease in hair Ca and Mg content, and increase in urine Ca and Zn concentration. After the training serum and urine Fe concentration was higher in group A, and urine Ca concentration was higher in group B. A number of significant correlations between mineral parameters and anthropometric, body composition and GXT parameters have been found.

Conclusion

Both endurance and endurance-strength training exert significant influence on calcium, iron, magnesium, zinc, and copper metabolism in obese women with predominance of favourable effect of mixed endurance-strength exercise in the range of iron, magnesium, zinc, and copper balance. These findings should be taken into consideration in future guidelines on mineral supplementation in obese patients undergoing physical training.

Obes Facts. 2018 May 26;11(Suppl 1):95.

T1P92 Intake of nutritional supplements among people exercising regularly

O Yesildemir 1, N Acar Tek 2

Introduction

Nutritional supplements that aim to improve physical performance and change body composition are quickly becoming readily available worldwide. The most frequent users of nutritional supplements are the athletes. Inaddition, it is thought that exercising individuals in the gyms usually use supplements. Although there are many studies examining the use of supplements among athletes, the studies carried out on individuals who are members of different jobs and who continue the exercise program in their daily life style are limited. In this study, we aimed to examine the use of nutritional supplements in individuals exercising regularly.

Methods

The research was made with the 206 volunteers in total, 102 male and 104 female between the ages 19 and 55. Individuals exercise at least twice a week in the gym. By generating a questionary form, data of their supplements usage are taken. In this questionary form, we questioned using of supplements, reasons for using them, who recommended their supplements. The statistical analysis was conducted with SPSS 15.0. Numerical variables are expressed in number (n) and percentage (%).

Results

Table shows the use of supplements by individuals exercising regularly. It has been determined that 9.8% of males and 3.8% of females often use supplements. In addition, 6.9% of males and 2.9% of females sometimes use supplements. When we asked people who are commed the use of supplements to participants, 52.9% of males said that they use supplements on their own behalf. Also, 32.3% of males use supplements, which are recommended by sports counselors. Most of the females (57.1%) stated that they use supplements with the suggestion of a doctor/dietitian. The main reason for supplement use was to increase muscle mass (70.6%) in males. Other reasons included to not feel tired (17.6%) and to be healthier (11.8%) in males. In females, the reasons for supplements use were to be healthier (71.4%), to prevent future diseases (14.3%) and to increase muscle mass (14.3%).

Conclusion

This study aimed to determine the use of supplements among individuals exercising regularly. Generally, individuals who exercise in the gym use supplements without the necessities and at a high level. However, in this study, the use of supplements is low compared to other studies. There is a dietitian in this gym and this may be because most of the exercisers are careful to get advice from dietitian. The data obtained in this research will be supportive of the study to be done on the use of supplements in other gym users.

Tab. 1.

 Male (n= 102)
 Female (n= 104)
 Total (n= 206)
Nutritional supplements n % n % n %
Using status
Yes 10 9.8 4 3.8 14 6.8
No 85 83.3 97 93.3 182 88.3
Sometimes 7 6.9 3 2.9 10 4.9
Reason for use
To be healthier 2 11.8 5 71.4 7 29.2
To prevent future diseases 0 0.0 1 14.3 1 4.2
To increase muscle mass 12 70.6 1 14.3 13 54.1
To not feel tired 3 17.6 0 0.0 3 12.5
Suggested people
Doctor/dietitian 0 0.0 4 57.1 4 16.7
Friends 1 5.9 0 0.0 1 4.1
Sport counselors 6 32.3 1 14.3 7 29.2
Family 1 5.9 0 0.0 1 4.2
His/her own behalf 9 52.9 2 28.6 11 45.8
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Obes Facts. 2018 May 26;11(Suppl 1):95–96.

T1P94 Quantifying Changes in Heat Strain during Light to Moderate Exercise throughout Pregnancy

P Akbari 1, KM Denize 1, F Haman 1, K B Adamo 1

Introduction

Weight gain is an expected outcome of pregnancy, however many women experience excessive gestational weight gain (eGWG) over the course of their pregnancy. Physical activity (PA) is recommended as part of a healthy pregnancy and may help to mitigate eGWG. However, concerns related to exercise-induced heat strain and the potential danger in pregnancy remain unresolved. While non-pregnant individuals with higher % body fat exhibit greater increases in core body temperature for a given work load, it is unknown whether pregnant women are at a higher risk of developing heat-related injuries as they progress through pregnancy. In the present study we aimed to quantify the metabolic heat production (Hprod) resulting from light to moderate PA (intensity recommended during pregnancy) over the course of pregnancy. We also aimed to compare the thermal compensability (both physiological and perceptual) of the exercise protocol and examine the change over the course of pregnancy.

Methods

Five pregnant women (31 ± 3 yrs; BMI = 22.1 ± 1.7) performed a seven stage submaximal walking test during their 1st, 2nd and 3rd trimester of pregnancy in a thermal controlled chamber (23°C). Hprod (indirect calorimetry) and Rate of Perceived Exertion (RPE, 20 point scale) were monitored throughout the test. In four participants (35 ± 2 yrs; BMI = 22.5 ± 1.2), tympanic temperature and thermal sensation (9 point scale) were also assessed.

Results

For the same external activity, Hprod in pregnant women was greater during the 2nd (2642 ± 328W) and 3rd trimester (2834 ± 411W) relative to the 1st (2447 ± 249W, both P≤0.04). Consistent with this, in the final stage of exercise, RPE was higher in the 3rd (17 ± 2) trimester of pregnancy relative to the 1st (15 ± 2, P = 0.03). However, for this given exercise, changes in tympanic temperature (all P > 0.05) and thermal sensation were not significantly different between all three trimesters (all P > 0.05).

Conclusion

Our preliminary findings show that while the same activity stimuli results in greater levels of Hprod as pregnancy progresses, they are not paralleled by changes in thermal strain; neither physiologically nor perceptually. However, further work is still required to support these findings and understand the reasons behind the observed differences.

Funding

Research relating to this abstract was funded by the Canadian Institute of Health Research (Adamo; MOP-142298).

Obes Facts. 2018 May 26;11(Suppl 1):96.

T1P95 Effect of resistance and aerobic exercise on BDNF in circulation and skeletal muscle of middle-aged non-diabetic obese individuals

D Maderova 1, T Kurdiova 1, M Balaz 1, I Jelok 2, E Zemkova 3, D Hamar 3, M Sedliak 3, B Ukropcova 4, J Ukropec

Introduction

Brain derived neurotrophic factor (BDNF) is involved in cognitive functioning, muscle metabolism and adaptive response to exercise in both muscle and brain. Reduced levels of BDNF are linked to obesity, type 2 diabetes, dementia and depression. We aimed to investigate effects of acute and 3-month aerobic or resistance exercise on BDNF in circulation and skeletal muscle of obese non-diabetic adults. Associations with physical fitness and metabolic health were examined.

Methods

Sedentary middle-aged obese non-diabetic individuals (n = 22, 36.8yrs, BMI 31.6kg/m2, n = 7 with impaired glucose tolerance, IGT) underwent 3-month aerobic or resistance training. Samples of skeletal muscle (vastus lateralis) were obtained by Bergstrom needle biopsy. BDNF levels in serum & plasma (ELISA), BDNF, PGC1a (mitochondrial biogenesis) & MYH7 (type I muscle fibers) gene expression in skeletal muscle (qPCR), maximal aerobic capacity (VO2max, bicycle ergometry) and glucose tolerance (oGTT) were assessed.

Results

Acute aerobic exercise increased serum BDNF in sedentary obese adults by 35% (p = 0.02), with no effect of an acute exercise bout after 3-month intervention (p = 0.62). Three-month aerobic training led to an increase of baseline, resting BDNF levels in serum and BDNF gene expression in skeletal muscle (p = 0.01 both). Neither aerobic nor resistance training affected resting BDNF levels in plasma. However, resistance training decreased serum BDNF levels specifically in individuals with IGT (n = 5, p = 0.03), with no change in NGT individuals (n = 7, p = 0.65). Interestingly, NGT individuals displayed higher serum BDNF levels in response to training compared to IGT individuals, regardless of the type of training (p = 0.04). Change in BDNF gene expression was positively associated with PGC1α and MYH7 mRNA levels in muscle (R = 0.56, p = 0.02; R = 0.49, p = 0.01). Resting serum BDNF positively correlated with VO2max (R = 0.38; p = 0.02).

Conclusion

Our observations point at a distinct role for aerobic and strength exercise in the regulation of neurotrophin BDNF in skeletal muscle and circulation in middle-aged obese non-diabetic individuals. Impairment of glucose metabolism seems to modulate circulating levels of BDNF and the response to training. Associations of serum and muscle BDNF with aerobic fitness and muscle mitochondrial biogenesis in obese adults suggest the involvement of BDNF in exercise-induced adaptive response. Grant support: EFSD-Lilly 2013, APVV 15/0253

Obes Facts. 2018 May 26;11(Suppl 1):96.

T1P96 Effect of Aerobic-Strength Training on Body Composition and Gait Speed in Seniors

L Slobodova 1, V Tirpáková 2, P Krumpolec 3, M Vajda 4, S Vallová 1, S Šutovský 5, P Turčáni 5, J Cvečka 4, P Valkovič 6, M Sedliak 4, J Ukropec 7, B Ukropcova 8

Introduction

Elderly population is at risk to develop obesity and sarcopenia which contribute to lower physical fitness, increased morbidity and mortality. Gait speed < 1,2m/s is associated with a higher risk of falls, functional impairment and cognitive decline, and has a prognostic and predictive value in the assessment of functional capabilities in seniors. Regular physical exercise can improve body composition and gait speed, thus lowering health-related risks.

Methods

To assess effects of aerobic-strength training on body composition and gait speed, we recruited 62 seniors (age 68 ± 6yrs; 17M/45F). Body weight, body composition (bioimpedance, Omron, Japan), muscle strength (chair dynamometry: knee extension), motor performance (10-Meter Walk Speed Test: maximal speed, MWS; preferred speed, PWS) and physical fitness (Rockport 1-mile Walk Test; VO2max) were assessed before/after intervention. Volunteers were asked not to change their diet composition. Twelve-week intervention consisted of (i) aerobic-strength training (n = 50, M13/F37) 3×1h/week, 60–70%VO2max or 60–70%1RM (work load increased gradually) and (ii) stretching (control group, n = 12, M4/F8) 2×45min/week.

Results

We observed an increase in lean body mass (p = 0.02) and a reduction in visceral fat (p = 0.01) and total fat mass (p = 0.06) in the training group, with no change in controls (p = 0.2). Walking speed (PWS, p < 0.0001; MWS, p = 0.01) and VO2max improved (p < 0.0001) with aerobic-strength training. Stretching did not improve VO2max (p = 0.3) nor MWS (p = 0.1). However, we observed a significant, albeit smaller, improvement in PWS (p = 0.01). Importantly, intervention-induced change in PWS was lower in controls compared to trained individuals (0,06m/s vs 0,13m/s). Muscle strength increased with training (+18.2%; p < 0.0001), with a smaller increase in controls (+9.9%; p = 0.02). PWS and intervention-induced change in PWS were not associated with age (p > 0.1). However, MWS was negatively correlated with age (n = 96, r = 0.36; p = 0.0003), with no correlation for the intervention-induced change in MWS (r = 0.22; p = 0.1). Aerobic-strength training improved PWS in 52% of volunteers, who transferred to a higher performance group (gait speed >1,2m/s), compared to 33,3% in a control, stretching group.

Conclusion

Twelve-week aerobic-strength training improved body composition, muscle strength and gait speed of elderly individuals, with a much smaller or missing effect in the control stretching group. It can be assumed that different types of physical activity, including stretching, could be beneficial for seniors, but only training with a higher intensity has a potential to prevent obesity.

Grant support

SAS–MOST Joint Research Cooperation Grant, VEGA 2/0107/18, APVV 15/0253

Obes Facts. 2018 May 26;11(Suppl 1):96.

T1P97 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):97.

T1P98 An in vitro study of non-caloric sweeteners using Caco-2 cells as a model of gut barrier

PS Santos 1, CREP Caria 1, JJ Pedrazzoli 1, A Gambero 1

Introduction

Consumption of non-caloric sweeteners is a dietary practice used by those who wish to loose body weight. Although these substances are safe, possible biological interactions with the digestive tract, particularly in relation to intestinal permeability, have not been studied. Beside to alterations in gut microbiota and metabolic endotoxemia, the increase of intestinal permeability is pointed to play a role in the development of a chronic low-grade inflammatory state in the host that contributes to the development of obesity and associated chronic metabolic diseases such as nonalcoholic fatty liver disease. Thus, in this work we investigate the action of different non-caloric sweeteners on intestinal permeability using an in vitro Caco-2 cell model.

Methods

Human adenocarcinoma Caco-2 cells were incubated with acesulfame K, aspartame, saccharin, or sucralose at equimolar concentrations (10 mM) during 3.5 h in a transwell cell culture system. Integrity of cell monolayer was assessed by measuring transepithelial electric resistance (TEER) every 0.5 h. Paracellular permeability was evaluated by measuring FITC-dextran in the lower compartment of transwell culture system also every 0.5 h. Tight junction (TJ) proteins was evaluated and additional experiments were performed with inhibitors of protein kinase C (GO6983), phosphatidylinositol 3-kinase (LY294002), NF-kB (CAY10470) and ubiquitin ligase activity (thalidomide).

Results

Acesulfame K, aspartame, and sucralose did not alter integrity in the Caco-2 cell model. However, saccharin increased paracellular permeability (75613 and 654520 AUC for control and saccharin, respectively; p < 0.05) and decreased TEER (2242 and 578 AUC for control and saccharin, respectively; p < 0.05) via a non-cytotoxic mechanism. Levels of the TJ protein claudin-1 were reduced in Caco-2 cells that had previously been exposed to saccharin. The inhibition of protein kinase C, phosphatidylinositol 3-kinase, or nuclear factor-kB was able to prevent the reductions in TEER induced by saccharin. Thalidomide, as an inhibitor of ubiquitin ligase, was able to prevent the decrease in claudin-1 and the TEER in Caco-2 cells.

Conclusion

Saccharin disrupts monolayer integrity and alters paracellular permeability in a Caco-2 cell monolayer model, via a mechanism involving PKC, PI3K, and NF-kB activation, resulting in ubiquitination of the tight junction protein claudin-1. Saccharin consumption may potentially alter intestinal integrity in humans.

Obes Facts. 2018 May 26;11(Suppl 1):97.

T1P99 Levels of GIP, GLP-1, insulin and glucagon in type 2 diabetes and healthy subjects after a mixed meal tolerance test

D Öberg-Arendt 1, C Gäredal 1, J Palmred 1, H Stenberg 1, J Presto 1, H Ritzén 1

Introduction

Glucose-dependent insulinotropic polypeptide (GIP) is an incretin hormone released by the K cells in the small intestinal mucosa upon food intake. The most pronounced function of the incretins (GIP and glucagon-like peptide-1 (GLP-1)) is to increase the insulin secretion from the b-cells in the pancreas. In addition, GIP receptors are also located in the brain, adrenal glands and adipose tissue and GIP has been found to be increased in obesity. Diabetes mellitus type 2 (T2DM) is associated with altered production and release of metabolic hormones, and the interplay between different hormones can be studied during a mixed-meal tolerance testing (MMTT). To expand the available metabolic hormone immunoassays, a Total GIP ELISA has recently been developed by Mercodia. Since before, the Mercodia insulin ELISA is a well-established and robust assay often used to determine insulin release, and assays for intact glucagon(1–29) and total GLP-1 have been established and validated according to CLSI and FDA guidelines.

Methods

In the present study, we sought to investigate how preprandial and postprandial levels of insulin, glucagon, GIP and GLP-1 in plasma are affected by an MMTT, using the thoroughly characterized Mercodia assays. MMTT was carried out in cohorts of healthy individuals, and volunteers diagnosed with T2DM. Sampling was performed preprandially and 30 and 120 minutes after the individual had begun consuming the meal.

Results

Preprandial GIP levels did not differ between the groups, but individuals with T2DM exhibited elevated preprandial levels of GLP-1, glucagon and insulin ([GLP]Pre = 7.4 pM, [Gcg]Pre = 11 pM, [Ins]Pre = 10 pM) compared to healthy controls ([GLP]Pre = 4.6 pM, [Gcg]Pre = 6.9 pM, [Ins]Pre = 4.6 pM). For healthy individuals, GIP levels decreased between 30 min and 120 min postprandially ([GIP]30 = 105 vs [GIP]120 = 85 pM), while for the T2DM group the mean concentration did not decrease ([GIP]30 = 96 vs [GIP]120 = 98 pM). Moreover, T2DM was associated with a sustained insulin release, with higher insulin levels detected at 120 minutes compared with 30 minutes ([Ins]30 = 29 vs [Ins]120 = 39 pM), in contrast to healthy controls where the insulin concentrations peak after 30 minutes([Ins]30 = 38 vs [Ins]120 = 14 pM).

Conclusion

We conclude that the Mercodia ELISAs for the incretins GIP and GLP-1 and islet hormones insulin and glucagon performs with high sensitivity and specificity, when determining the levels of these hormones under physiological conditions, both in healthy and diabetic subjects.

Conflicts of Interest

The authors of this abstract are all employees at Mercodia AB, Uppsala, Sweden.

Obes Facts. 2018 May 26;11(Suppl 1):97–98.

T1P100 A novel GIP ELISA for deeper understanding of the incretin effects

D Öberg-Arendt 1, C Gäredal 2, J Palmred 2, H Stenberg 2, J Presto 2, H Ritzén 2

Introduction

Glucose-dependent insulinotropic peptide (GIP) is an incretin that is produced by K cells in the small intestinal mucosa. The incretins GIP and GLP-1 are secreted following food ingestion and stimulate insulin secretion and of the two incretins, GIP seems to have the most pronounced incretin effect in healthy individuals. In addition of its insulinotrophic effect, GIP can affect glucagon secretion and moreover, GIP receptors are located in brain, adrenal glands and adipose tissue. In type 2 diabetes mellitus (T2DM), patients have an impaired incretin effect and appears to only respond to GLP-1 administration, but not to GIP and the physiological role of GIP metabolic health and disease needs to be further inverstigated.

Methods

Our aim was to develop a highly specific assay for measuring GIP and due to its fast degradation, an assay detecting both active GIP and its DPP-4 degradation products was constructed. The assay should have an easy-to-use format, require a low sample volume and be sensitive enough to measure fasting levels of GIP in different kind of patient groups.

Results

We succeeded to develop an assay with 25 μL sample volume and a dynamic range of 1.5 − 1000 pmol/L. The method is specific for GIP(1–42) and GIP(3–42) with less than 1% cross-reactivity to many homologous proteins including glucagon, GLP-1, GLP-2, glicentin, oxyntomodulin, MPGF and PACAP-38. The assay showed excellent precision and accuracy; within assay variation below 7% and total assay variation below 10% and accuracy within 95–106%. The method can be used to measure fasting levels of GIP in healthy individuals (< 1.5–26 pmol/L) as well as in T2DM subjects (< 1.5 − 20 pmol/L).

Conclusion

This novel GIP assay is sensitive and specific for determination of human total GIP. It is an easy-to-use assay with good performance that will be helpful for scientists in the metabolic field as it will help us deepen our understanding of the physiological functions of GIP.

Conflicts of Interest

All authors of the abstract are employees at Mercodia AB.

Obes Facts. 2018 May 26;11(Suppl 1):98.

T1P101 Changes in ghrelin and PYY and weight status in children after a one year follow up

N Petricevic 1

Introduction

Ghrelin is a hunger hormone, produced mainly by the stomach and is usually lower in obesity. PYY is a satiety hormone, secreted mainly in small intestine and research is not that conclusive about its levels in obesity. Aim was to investigate ghrelin and PYY levels, their association with weight status, anthropometric measures, obesity, puberty and living habits at the baseline and after a one year follow up.

Methods

Prospective study in free-living conditions with one year follow up. Sample of 100 children (56 female, mean age 13.3 ± 0.33 years) was selected by a randomized procedure of children born on the same year from the area of one school health service in Zagreb, Croatia. Cohort of 83 children (45 female, mean age 14.4 ± 0.28 years) completed assessment at baseline and at one-year follow up. methods on both occasions included physical examination with anthropometric measures done by school doctors, fasting ghrelin and PYY hormone analysis and parents and children’s questionnaire on living habits. Data were analysed by multivariate logistic regression models by gender.

Results

At the baseline, 76% of children were normal weight, 19% were overweight and 4% were obese, using the WHO charts. Ghrelin was negatively correlated with BMI z-score (r = −0.25; p = 0.012). There was no correlation between PYY and BMI z-score. After a one year follow up, there was significant decrease in ghrelin levels (T = 4.68; p < 0.001), however there was no change in PYY levels after a follow up (T = 1.18; p = 0.239). After a follow up there was no change in nutritional status among children, but there was a significant change in puberty status (p < 0.001). The greatest decrease of ghrelin level after a follow up was in children with lower puberty stage at the baseline (F = 3.142; p = 0.018). Ghrelin correlates negatively with puberty. PYY levels are not correlated with weight status, anthropometric measurements or puberty. Significant predictors for ghrelin change are change of height and hip circumference and BMI z-score change (R = 0,614; R2 = 0,376; Adjusted R2 = 0,317; F = 6,297; p < 0,001).

Conclusion

Ghrelin is lower among overweight and obese children and PYY does not correlate with weight status. After a one year follow up in free living conditions, there is significant change in ghrelin levels (significantly lower) and no change in PYY levels.

Obes Facts. 2018 May 26;11(Suppl 1):98.

T1P102 ATP released from skeletal myofibers to extracellular medium induces an inflammatory state linked to insulin resistance in obese mice

G Jorquera 1, R Meneses-Valdés 2, P Llanos 3, M Casas 2, E Jaimovich 2

Introduction

Skeletal muscle is one of the most important target organ for insulin actions and therefore a key regulator of glycemia. In obese individuals has been described a chronic low-grade inflammatory state affecting adipose tissue, liver, and skeletal muscle. This inflammatory response has been associated to the development of insulin resistance. We have previously described, after electrical stimulation, adult myofibers can release precise quantities of ATP to extracellular medium (ECM) through pannexin channels. Extracellular ATP and its metabolites can act in an autocrine and paracrine way regulating gene expression and muscle adaptation. It is also known that high concentration of ATP in ECM can be a potent inflammatory signal. We propose myofibers from obese animals release high ATP levels through pannexin channels, promoting activation of gene expression associated to inflammation and insulin resistance.

Methods

We fed C57BL/6 mice with regular or high fat diet (HFD) for 8–12 weeks. We performed fasting glycemia measurement and glucose tolerance test in our animals. We also obtained insulinemia values by ELISA. We used adult isolated myofibers derived from Flexor Digitorium Brevis (FDB) muscle. Isolated fibers were obtained by enzymatic digestion with collagenase type II (90 min with 400 U/ml), and mechanic dissociation with fire-polished Pasteur pipettes. Myofibers were seeded in Matrigel-coated dishes and used 20 h after seeding. For obtaining pannexin-1 knockdown FDB we electroporated in vivo a sh-pannexin1/mcherry or just mcherry codifying plasmids. We analyzed ATP release in a luciferine/luciferase assay. Gene expression was studied with RT-qPCR. Protein expression was evaluated by WB.

Results

Mice fed with a HFD showed an important weight gain compared with control diet fed animals. In addition, HFD-fed mice showed significantly altered glucose tolerance test, elevated fasting serum glucose and serum insulin levels. We found TLR4, IL-6, IL-1β, TNF-α genes, which are associated to inflammation and insulin resistance, were upregulated in obese mice FDB muscle. We observed higher ATP release in myofibers from obese mice, in basal state and after electrical stimulation, compared to control ones. Oleamide 100 μM, a pannexin inhibitor, blocked ATP release in obese mice myofibers. Gene expression linked to inflammation was inhibited using oleamide and apyrase 2 U/ml, an ATP to AMP nucleotidase enzyme. Using a molecular biology approach, we inhibited pannexin channel expression in FDB muscle using in vivo electroporation of sh-RNA against pannexin-1. In knockdown myofibers we observed a much diminished ATP release and inflammatory gene expression was also inhibited. Finally, we were able to upregulate inflammatory gene expression in myofibers from control fed mice incubated with a single pulse of 300 μM ATP for 4 h.

Conclusion

In this work we propose a novel mechanism for the development of inflammation associated to insulin resistance in skeletal muscle from obese mice. We have found that ATP is released to ECM in an uncontrolled way, by pannexin channels, leading to a high concentration of ATP in the extracellular compartment. This stimulus is able to activate gene expression of classic inflammatory factors found in metabolic tissues of obese individuals.

Obes Facts. 2018 May 26;11(Suppl 1):99.

T1P103 The effect of macronutrient composition on immunometabolism in obese mice

E Vercalsteren 1, C Vranckx 1, T Suprikyan 1, B Hemmeryckx 1, R Lijnen 1, I Scroyen 1

Introduction

Obesity is a risk factor for many co-morbidities including insulin resistance and cardiovascular disease. Immune cells reside in both healthy and obese adipose tissue. In non-pathological conditions these immune cells are anti-inflammatory. A western diet (WD), fat- and carbohydrate (CHO)-rich, causes an influx of pro-inflammatory cells resulting in adipose tissue (AT) inflammation. A WD also modulates the gut microbiome, increasing intestinal permeability. This causes a higher translocation of bacterial endotoxins and even entire bacteria to the blood, further contributing to systemic inflammation. Even though it is established that a WD can cause a chronic, systemic inflammation, it is still unclear which macronutrient, fat or CHO, plays the most important role. We hypothesize that different macronutrients affect immunometabolism in different ways.

Methods

10-week-old wild type, male C57B6/J mice were kept on a diet high in CHO (HCD), a western diet which is high in both fat and CHO (WD) or a control diet (SFD) for 15 weeks (n = 10/group). Body weight and food intake were monitored weekly and a CT scan was used to evaluate the total body AT percentage. After 15 weeks the adipocyte size, metabolic parameters and inflammation were analyzed.

Results

The mice on HCD had a significantly lower bodyweight and lower AT depots mass compared to mice on WD. Total adipose tissue percentage also was lower in mice on HCD than in mice on WD. Strikingly, we found no significant difference in daily caloric intake between groups. The adipocytes of HCD-fed mice were significantly smaller than those of WD-fed mice. The homeostatic model assessment (HOMA-) index, a surrogate for insulin resistance, as well as the cholesterol levels of HCD-fed mice were significantly lower as compared to WD-fed mice. Relative mRNA expression of the macrophage marker F4/80, the general T lymphocyte marker CD3, the T helper cell marker CD4, the cytotoxic T cell marker CD8 and the chemokine MCP-1 (mono-chemoattractant protein-1) was significantly lower in mesenteric AT of HCD-fed mice compared to WD-fed mice.

Conclusion

A HCD induced a lower body weight, smaller adipocytes, less insulin-resistance, lower cholesterol and a better inflammatory profile in AT. These data suggest that a HCD is less harmful than a WD in mice. We will further investigate whether the better health state of mice on HCD might be due to a healthier gut microbiota.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):99.

T1P104 Structured lipids containing behenic acid reduce postprandial inflammation in mice

A Gambero 1, CREP Caria 1, RM Silva 1, ML Zarricueta 1, DKT Moreira 1, GA Macedo 2

Introduction

Structured lipids (SLi) are modified triacylglycerols (TG) obtained by chemical or enzymatic interesterification aiming nutraceutical or altered chemico-physical properties. In this work, we formulated a SLi using immobilized lipase from Thermomyces lanuginosa (Lipozyme®TL IM) and a blend of olive oil, soy oil and fully hydrogenated crambe oil. The final SLi is rich in behenic acid and present anti-obesity properties, problably due its ability to reduce intestinal lipid absorption. The SLi was tested about its ability to modify post-prandial inflammation and gut signaling in normal mice. The post-prandial inflammation was defined as homeostasis challenge due to the increase of lipid, oxidative stress and pro-inflammatory molecules released by blood and endothelial cells after a single high-fat meal.

Methods

Fasted male Swiss mice were subjected to an oral meal tolerance test by administration of 10mL/kg of SLi: Ensure-H® (3:17 v/v). A blend of olive oil, soy oil and fully hydrogenated crambe (OSC) oil or only olive oil and soy oil (control) were employed as controls. Blood samples were collected at 0, 0.5, 1, 2 and 4 h after oral gavage of the liquid meal. Area under curve (AUC) of serum TG and glucose was calculated. At 2h post-test, IL-6, insulin and gut hormones were measured in serum. All experiments were approved by the animal ethics committee of Universidade Sao Francisco (CEUA/USF Protocol 001.03.2017vII).

Results

The TG AUC obtained from control group was 1565 ± 109, whereas from OSC was 1238 ± 96 (p = 0.08) and from SLi was 1178 ± 93 (p < 0.05). The glucose AUC was not different between groups. IL-6 serum levels were reduced only in SLi group (47 ± 14, 19 ± 6 and 13 ± 3 pg/mL for control, OSC and SLi, respectively, p < 0.05). Ghrelin, GIP, GLP-1, PYY, PP and leptin was not altered, but insulin levels were significantly reduced in SLi group (245 ± 29, 156 ± 56 and 93 ± 12 pg/mL for control, OSC and SLi, respectively, p < 0.05).

Conclusion

SLi containing behenic acid reduces TG absorption confirming the hypothesis that behenic acid could inhibit pancreatic lipase. However, gut hormones release was not altered and probably, satiety signaling is not modified. Post-prandial insulinemic and inflammatory response was lower than observed by oils blend, suggesting that SLi containing behenic acid has a good potential as a health fat source.

Obes Facts. 2018 May 26;11(Suppl 1):99–100.

T1P105 Long-term consumption of sugar-sweetened water induces immune dysfunctions and tissue damages in mice

Y Chiu 1, Y Liu 1, H Chien 2, W Li 3

Introduction

Sugar-sweetened beverages were believed to have the effect on low-grade chronic inflammation which linked to metabolic disorders such as obesity, metabolic syndromes, cardiovascular disorders and cancers. These Conclusions were based on many studies used extremely high portion or high concentration of sugar consumptions for relatively short period of time. However, the study design only represented that extremely high levels of carbohydrates can be toxic as many other macronutrients, and might also underestimated the long-term effect of simple sugar consumption.

Methods

The C57BL/6J mice were divided into four groups. The mice were received either with standard chow and RO water (ND group), or standard chow and 8% fructose-sweetened water (HFr group), or standard chow and sucrose-sweetened water (HS group), or with high fat chow and RO water (HF group). Both the diet and drinking water were given ad libitum. The liver, muscle, subcutaneous and visceral abdominal adipose tissues were harvested after 20–25 weeks of feeding. The histological characteristics and mRNA expression levels of pro-inflammatory cytokines, metabolic related proteins and hormones were analyzed.

Results

Mice fed with high-fat diets (HF group) and sugar-sweetened water (HFr and HS groups) represented increasing body fat, reducing lean mass and also liver fibrosis. But, fatty liver was only observed in mice fed with high-fat diet. In mice fed with sugar-sweetened water, the expression of Slc2a5 gene, but not Slc2a1 gene, was increased in all tissues analyzed. Gene related to lipolysis, Cpt11b, was decreased and gene related to fatty acid synthesis, Fasn, was increased in liver. The mRNA levels of Cpt11b, Fasn, Adipoq (adiponectin), Lep (leptin) and Insr (insulin receptor) genes were decreased in subcutaneous adipose tissues, but no significant difference or mild increase in visceral adipose tissues. Moreover, the gene expression of pro-inflammatory cytokines, particularly IL-6 and MCP-1, were ~30–50% lower in all tissues analyzed in HFr and HS groups, but not in high-fat diet group.

Conclusion

Without obvious fat accumulation in hepatic tissue, mice fed with 8% fructose and sucrose-sweetened water represented liver fibrosis and the reduction of pro-inflammatory cytokines. We suggested that long-term consumption of sugar-sweetened water might hinder the immune functions and reduce the regeneration capacity of tissues which leads to tissue damages.

Obes Facts. 2018 May 26;11(Suppl 1):100.

T1P106 The effect of pomegranate extract on survival and peritoneal bacterial load in cecal ligation and perforation model of sepsis rats

S Eghtesadi 1, S Tavasoli 2, M Vafa 3, M Moradi-Lakeh 4, A Sadeghipour 5, A Zarnani 6, M Eghtesadi 7

Introduction

Sepsis is one of the major causes of death in intensive care units. Oxidative stress and hyper-inflammation has been shown to be major cause of mortality and morbidity in septic cases. Pomegranate is a fruit which is considered for its antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the effect of POMx, a standard pomegranate extract, on mortality and peritoneal bacterial load in cecal ligation and perforation (CLP) model of sepsis in rats.

Methods

Male wistar rats were divided into four groups: sham; CLP; prevention [consumed POMx (250mg of polyphenols/kg/day) for 4 weeks and subjected to CLP]; treatment [subjected to CLP and then received a single drink of POMx (250mg of polyphenols/kg)]. Sepsis was induced by CLP surgery. Ten day survival rate of all groups (subdivided into with and without antibiotics subgroups) were recorded. Peritoneal bacterial load of animal were also assessed. Data were analysed using log-rank and Kruskal-Wallis tests

Results

There were no significant differences in survival rates of CLP, prevention and treatment groups, in subgroups without antibiotics. However, in subgroups with antibiotics, the prevention group had significantly lower survival rate than sham group (p < 0.05). Conversely, the bacterial load of prevention and treatment group were significantly higher than sham group (p < 0.01).

Conclusion

our study demonstrated that pomegranate extract could increase mortality rate via increasing peritoneal cavity bacterial load, in CLP model of sepsis. More studies to assess mechanisms of this effect are warranted.

Obes Facts. 2018 May 26;11(Suppl 1):100.

T1P107 The Effects of Bariatric Surgery on Platelet Function and Endothelial Progenitor Cell Level and Function

Y Yadgarov 1, R Garinkol Avrahami 1, D Leshem-Lev 2, E Lev 3, D Marcoviciu 1, D Dicker 1

Introduction

BMI ≥ 30kg/m2 is associated with metabolic derangements and chronic inflammation. Bariatric surgery (BS) provides numerous health benefits, including a sharp reduction in cardiovascular (CV) disease risk. The mechanism by which BS modifies CV risk is unclear. In patients with CV diseases or risk factors, levels of circulating endothelial progenitor cells (EPCs) are reduced; this is associated with an increased risk for the development of CV events. Data are scarce regarding the effects of BS performed in morbidly obese patients, on platelet (PLT) function and on the level and function of EPCs. Stromal derived factor-1α (SDF-1α) is a chemokine that stimulates bone marrow mobilization of EPCs, and that has demonstrated CV protection. The aims of this study were to assess PLT reactivity, EPC level and viability, and SDF-1α level, before and after BS, in morbidly obese individuals.

Methods

We enrolled 25 individuals who were morbidly obese (BMI ≥40 kg/m2) or BMI ≥35 kg/m2 with risk factors, aged 18–65 years, who were candidates to undergo BS. Blood samples were taken 3 times: before BS, and one and three months after BS, for platelet reactivity; for EPC circulating level, as identified by the expression of combinations of cell surface antigenic markers: CD133 and CD34; and for function and plasma concentrations of SDF-1α.

Results

We analyzed data of the 12 patients who completed the follow-up after BS; 10 (83%) were females. Body weight decreased from 119.54 ± 15.45 kg pre-BS to 107.5 ± 15.48 kg at 1-month post-BS (a 10% reduction) (p = 0.03), and to 95.45 ± 12.75 kg at 3 months (a 20% reduction) (p = 0.0002). PLT function was higher at 3 months post-BS than at baseline: 275.77 ± 28.53 RU vs. 250 ± 41.12 RU; p = 0.097. At 1-month post-BS, the level of EPC with CD34 was higher than at baseline: 6.11 ± 5.98% vs. 2.62 ± 2.04%, p = 0.03, yet decreased at 3 months to 1.92 ± 1.27%, p = 0.04. At 1-month post-BS the EPC capacity to form colonies on a culture was significantly higher than at baseline, p = 0.009; and reduced at 3 months post-BS. EPC viability did not change significantly in the 1- and 3-month post-BS. The SDF1α level increased at 1-month post-BS compared to baseline: 7,0792.41 ± 209121.1ng/ml vs. 178.73 ± 132.38 ng/ml, p = 0.06; and decreased at 3 months to 577.03 ± 763.20 ng/ml, p = 0.10.

Conclusion

We report higher EPC level and capacity to form colonies after 1 month, and lower EPC level and capacity to form colonies after 3 months, and higher PLT function after 3 months, in morbidly obese patients. who underwent BS, and subsequently lost weight.

Obes Facts. 2018 May 26;11(Suppl 1):100–101.

T1P108 The role of the adaptor protein ASC in the inflammatory profile of diet obese mice

DJS Ribeiro 1, G Araújo 1, G Heyn 1, L Sant’Ana 1, LHC Corrêa 1, R Côrrea 1, KG Magalhães 1

Introduction

Background: Obesity and related metabolic disorders are associated with the presence of chronic inflammatory response, especially in adipose tissue and liver. However the inflammatory process can be characterized with several pathways, so the molecular mechanisms associated with obesity still needs to be fully elucidated. Associations among the multiprotein complex characteristics of the innate immune response, called inflammasomes, and obesity were made highlighting the role of the NLRP3 and the caspases 1 proteins. The apoptosis-associated speck like (ASC) protein is an essential part for the assembly of some inflammasomes, therefore the central question of this work was if the absence of this protein could influence in the inflammatory profile, mostly in the liver, of diet induced obese mice.

Methods

C57/BL6 and ASC -/- females mice with 8 weeks were submitted with two different diets, a standard fat diet (SFD) for the control group and a high fat diet (HFD) with high levels of lipids (45%) to induce obesity. After 90 days the animals were euthanized for subsequent analyzes. The fasting blood sugar was checked and levels of cytokines in the blood were measured by ELISA. The liver was harvested and the cytokines levels in the tissue were verified and also the amount of steatosis.

Results

The increase in liver weight of mice fed with HFD were more significantly between ASC -/- animals than WT and the levels of steatosis were higher in ASC -/- HFD group in comparison with WT. The blood glucose increased in animals of the ASC -/- HFD group when compared with ASC -/- SFD. Serum levels of the interleukin 33 cytokine were already higher in ASC -/- mice fed with standard diet and increased even more in the ASC -/- HFD animals. In the liver we observed that knockout mice fed with the lipid rich diet presented a significant decrease in the levels of IL-33, CCL2, TNF-α and IL-1β compared to ASC -/- in the standard diet and WT animals in the HFD.

Conclusion

Taken together our data suggest that diet induced obese animals knockout for the protein ASC are more susceptible for alterations in the immunometabolism, specially on the liver. With changes some cytokine profile and the levels of steatosis.

Obes Facts. 2018 May 26;11(Suppl 1):101.

T1P109 Cytokines involved in the amelioration of Inflammation and cardiovascular risk after bariatric surgery. An approach

J Carmona-Maurici 1, E Pardina 1, D Ricart-Jané 1, JA Baena 2, A Lecube 3, J Peinado-Onsurbe 4

Introduction

Some of the beneficial effects of bariatric surgery on cardiovascular risk associated with obesity might be achieved by preventing the progression of the initial stages of atheromatosis. Cytokines, chemokines and growth factors are potential cardiovascular risk modulators. Progress in the knowledge of this highly complex network of molecules will open the way for effective therapeutic interventions. The aim of this study is to make a preliminary evaluation of the main molecules that could be involved in the initial phases of atherosclerosis by comparing molecules related with inflammation and angiogenesis in morbid obese without atherosclerotic plaques prior to bariatric surgery and after six months.

Methods

We evaluated the presence and behaviour of 105 inflammation markers in plasma from 4 morbidly obese patients (BMI ≥ 40 kg/m2) who underwent bariatric surgery, before and after a six-month follow-up period. The relative amount of proteins was measured by a membrane-based sandwich immunoassay (R&D Systems).

Results

In general, there was a decrease in the pro-inflammatory markers, such as TNF-α, leptin, IL-2, IL-3, IL23, IL-17A, Dkk-1 and LIF, surprisingly there were not changes in IL1β and both IL-12 and IL-18 increased. Most of the anti-inflammatory interleukins like IL-5, IL-10, IL-11, IL-13 and IL-15 were increased at six months but unexpectedly, IL-4 did not change. Both IL-19 and IL-22 were reduced after surgery. Angiogenic proteins like Ang-1, Ang-2, basic FGF, PDGF, TGF-α, VEGF and myeloperoxidase decreased at six months.

Conclusion

The decrease in pro-inflammatory mediators, the increase in some anti-inflammatory markers, and the reduction of angiogenic cytokines associated with bariatric surgery sets the starting point for a deeper analysis about the involvement of these molecules in the progression and improvement of cardiovascular risk in morbidly obese patients.

Obes Facts. 2018 May 26;11(Suppl 1):101.

T1P110 Relationship between DNA damage response and metabolic profile in overweight/obese individuals

V Guglielmi 1, S Laterza 1, P Fortini 2, L Nisticò 3, F Marcon 2, V Simonelli 2, E Iorio 4, T Morretti 1, M Morazzini 1, M D’Adamo 1, M Signore 5, C Ferreri 6, MA Stazi 3, E Dogliotti 2, P Sbraccia 1

Introduction

Obesity-associated low-grade chronic inflammation is a main risk factor for cancer development. Recent studies suggest that an excessive caloric intake could lead to the production of metabolic byproducts, such as reactive oxygen species and lipid peroxides, and finally to accumulation of unrepairable DNA damage and chronic DNA damage response (DDR). DDR activation leads to the senescence associated secretory phenotype, which if persistent, may promote age-related diseases. We aim to investigate whether the DDR is differently activated in obese and lean subjects, if it is correlated to inflammatory markers and affected by diet- or bariatric surgery-induced weight loss.

Methods

We have studied pairs of monozygotic (MZ) twins discordant for BMI before and after the heavier has undergone diet-induced weight-loss and obese patients before and 6 and 12 months after bariatric surgery. So far, we have enrolled 14 MZ pairs (BMI difference 6 ± 1.4 kg/m2) and 13 bariatric patients and collected clinical, anthropometric and biochemical parameters and biological samples (blood, urine, feces, buccal wash, and in bariatric patients omental and subcutaneous fat).

Results

We are currently carrying out lipid profiles in erythrocytes membranes and NMR-metabolic profiles of serum and fat tissue, phosphoproteomics analysis of DDR markers in isolated peripheral blood mononuclear cells (PBMCs) by RPPA, as well as, mitochondrial/nuclear DNA molecular ratio and mitochondrial function. Preliminary data show that the overweight/obese twins and bariatric patients have distinctive profiles of fatty acids methyl esters, increased VLDL, LDL, glucose, insulin, lactate, C reactive protein and IL6 levels which decrease after weight loss. ATM and H2AX phosphorylation profile is similar in blood and adipose tissue so that PBMCs might be used as surrogate tissue to identify DDR players as potential predictive biomarkers of obesity-related cancer risk.

Conclusion

Final data in BMI-discordant MZ twins will allow to detect the impact of environmental component on the onset and progression of obesity-related metabolic and cellular dysfunctions and, more importantly, to disclose if obesity and DDR are causally related.

Obes Facts. 2018 May 26;11(Suppl 1):101–102.

T1P111 The role of vitamin A in cold-mediated adipose tissue thermogenesis

A Fenzl 1, OC Hedesan 1, G Mitulovic 2, L Quadro 3, FW Kiefer 1

Introduction

Obesity is a complex metabolic disorder resulting from imbalanced energy intake and energy expenditure. Brown adipose tissue [BAT] in contrast to white adipose tissue [WAT] uses significant amounts of chemical energy as fuel for oxidative phosphorylation and heat production [thermogenesis]. Consequently, promotion of BAT function or transformation of white adipocytes into BAT-like or beige cells increases energy expenditure and counteracts weight gain in numerous experimental models. There are several known potent transcriptional activators of thermogenic fat cells including vitamin A and its metabolites (retinoids). The liver serves as the main reservoir of vitamin A, but hepatic retinoid stores can be mobilized and shuttled to tissues in demand. However, the physiologic importance of intact retinoid metabolism for adipose tissue thermogenesis has never been studied.

Methods

In vivo cold exposure and retinol-binding protein deficient [Rbp-KO] mice, a genetic mouse model with defective hepatic retinoid mobilization and systemic transport, were used to study the relevance of retinoid metabolism for adipose thermogenesis.

Results

Here we show that cold stimulation in mice shifts vitamin A abundance from liver towards adipose tissue. Increased vitamin A levels in subcutaneous WAT were accompanied by enhanced thermogenic gene expression. Cold-mediated retinoid flux and WAT browning was mitigated in Rbp deficiency. Defective retinol transport also impaired the cold-induced increase of mitochondrial gene expression and protein levels of oxidative enzymes in subcutaneous WAT. As a consequence, Rbp deficient mice had significantly lower core body temperature when exposed to chronic cold. Rbp-KO mice also attenuated cold-induced triglyceride clearance most likely due to decreased oxidative capacity.

Conclusion

These data establish that systemic vitamin A abundance is tightly regulated by cold exposure and that intact retinoid shuttling is essential for adipose tissue browning which may have potential therapeutic implications.

Obes Facts. 2018 May 26;11(Suppl 1):102.

T1P112 Exosome-like vesicles amplify the deleterious effects of high-fat diet during the development of type 2 diabetes and obesity and modify organ crosstalks … an exemple from palm oil-enriched diet

S Rome 1, A Jalabert 1, G Vial 1, C Guay 2, E Meugnier 1, S Pesenti 1, H Vidal 1, J Rieusset 1, S Rome 1

Introduction

We have found that Skeletal muscle (SkM) insulin-resistance (IR) associated with diabetes induced by palm oil-enriched diet, is associated with an increase of SkM-released exosome-like vesicles (ELVs) that are able to transfer the deleterious effects of palmitate between muscle cells. These data supported the notion that SkM releases specific ELVs that act as ‘paracrine-like’ signals (Aswad et al. 2014, Diabetologia). Interestingly, we have previously observed that muscle cell-derived ELVs, intravenously injected into mice, are transferred to other tissues strongly suggesting that SkM-derived ELVs could also represent a mode of systemic communication. As SkM is responsible for whole-body metabolism and energy homeostasis, determining whether muscle-released ELVs can be involved in the development of IR is now emerging as a major research topic. The cross-talk between skeletal muscle (SkM) and beta cells plays a role in diabetes etiology. In this second study, we have investigated whether SkM-released ELVs can be taken up by pancreas in vivo and in vitro and can deliver functional cargoes.

Methods

Mice were fed for 16 weeks with standard diet (SD) or with SD enriched with 20% palmitate (HPD) (from palm oil) and ELVs were purified from quadriceps. Fluorescent-ELVs from HPD or SD quadriceps were injected intravenously or intramuscularly into mice to determine their biodistribution. MiRNA quantification in ELVs was determined using qRT–PCR-based Taqman Low-density Array. Microarray analyses were performed to determine whether SD-ELVs and HPD-ELVs induced specific transcriptional signatures in MIN6B1.

Results

In vivo, muscle-ELVs were taken up by pancreas, 24h post-injection. In vitro, both SD-ELVs and HPD-ELVs transferred proteins and miRNAs into beta cells MIN6B1 and modulated gene expressions whereas only HPD-ELVs induced proliferation of MIN6B1 and isolated pancreatic islets. Bioinformatic analyses suggested that transferred HPD-ELV miRNAs may participate to these effects. To validate this we demonstrated that miR-16, which is over-expressed in HPD-ELVs, was transferred into MIN6B1 and regulated Ptch1 involved in pancreas development. In vivo, islets from HPD mice showed increased size and altered expression of genes involved in development, including Ptch1, suggesting that the effect of palm oil on islet size in vivo was reproduced in vitro by treating beta cells with HPD-ELVs.

Conclusion

Our data provide a proof-of-concept that muscle-ELVs have an endocrine effect and might participate in adaptations in beta cell mass during IR associated with the development of obesity-induced type 2 diabetes, induced by high-fat diets. Although palmitate treatment does not reproduce exactly the in vivo situation where a mixture of fatty acids exists provided by the diet, these results support the notion that excessive concentration of circulating saturated fatty acids might modify ELVs secretion and composition and consequently organ cross-talks

Obes Facts. 2018 May 26;11(Suppl 1):102.

T1P114 Exendin-4 improves ER stress-induced lipid accumulation and regulates lipin-1 signaling in HepG2 cells

W Lee 1, S Yoo 2, E Rhee 3, J Lee 4, S Hong 4

Introduction

Lipin-1 performs dual function during lipid metabolism, i.e., it functions as a transcriptional coactivator and as a phosphatidate phosphatase during triglyceride biosynthesis. We investigated whether exendin-4 prevented endoplasmic reticulum (ER) stress-induced hepatic steatosis and whether the protective effects of exendin-4 were associated with lipin-1 signaling.

Methods

To determine whether ER stress induced hepatic steatosis, HepG2 cells were treated with 3 μg/ml tunicamycin or 0.5 μM thapsigargin. Tunicamycin and thapsigargin treatment increased intracellular TG levels. Next, we examined the effects of tunicamycin and thapsigargin on the expression of genes encoding lipid droplet surface proteins perilipin 1 (PLIN1), perilipin 2 (PLIN2), perilipin 3 (PLIN3), and cell death-inducing DFFA-like effector c.

Results

Tunicamycin and thapsigargin, ER stress inducers, increased TG content and expression of genes encoding lipid droplet surface proteins. Exendin-4 decreased the expression of ER stress markers phosphorylated PERK, phosphorylated IRE1α, and GRP78 proteins and spliced XBP-1 (XBP-1s) mRNA and increased the expression of genes encoding lipolytic enzymes HSL and MGL and VLDL assembly-associated proteins MTP and APOB in tunicamycinpretreated cells. Moreover, exendin-4 significantly decreased lipin-1β/α ratio by increasing SFRP10 and increased lipin-1 nuclear localization. The decrease in lipin1β/α ratio was also observed in SIRT1 and AMPK agonist-treated cells.

Conclusion

These data suggest that exendin-4 improves ER stress-induced hepatic lipid accumulation by increasing lipolysis and VLDL assembly, which is partially mediated by the regulation of lipin-1 signaling.

Obes Facts. 2018 May 26;11(Suppl 1):102–103.

T1P115 Branched-chain amino acids, ectopic fat deposition and lipid partitioning in adults with obesity

E Poggiogalle 1, M Fontana 1, C Lubrano 1, L Gnessi 1, A Giusti 1, S Mariani 1, M Di Martino 1, C Catalano 1, A Lenzi 1, L M Donini 1

Introduction

Branched-chain amino acids (BCAAs) play a pivotal role in metabolic signaling. However, their role in the pathogenesis of obesity is controversial: on one hand, BCAAs appeared to mediate anti-obesity effects; on the other hand, recently BCAAs seemed to be associated with insulin resistance. The aim of our study was to examine the relationship between BCAAs and ectopic fat and lipid partitioning in adult subjects with obesity.

Methods

Participants were enrolled among subjects referring to the High Specialization Center for the Care of Obesity (CASCO) at the “Policlinico Umberto I” University Hospital, Sapienza University, Rome, Italy. Inclusion criteria were Body Mass Index (BMI) ≥ 30 kg/m2, and age: 18–65 years. Body composition was evaluated by DXA; Hepatic steatosis (HFF: hepatic fat fraction) was quantitatively assessed through magnetic resonance (MR) imaging, and MR-spectroscopy was used to assess intramyocellular (IMCL) and extramyocellular (EMCL) lipid content. Circulating BCAAs and free-fatty acids (FFAs) were measured. HOMA-IR was calculated.

Results

80 participants were included (15 men and 65 women), age: 48.3 ± 12.6 years, BMI: 37.69 ± 4.94 kg/m2. Circulating BCAA levels were significantly positively correlated with hepatic fat (HFF, r = 0.25, p = 0.04) and IMCL (r = 0.31, p = 0.03), but not with EMCL. Multiple regression analyses confirmed the association between plasma BCAA concentrations and ectopic fat in the liver and in skeletal muscle. Moreover, plasma BCAA levels were negatively associated with FFA concentrations (p = 0.03), independent of HOMA-IR and body fat.

Conclusion

BCAAs levels were positively associated with ectopic fat depots and inversely associated with circulating FFAs regardless of insulin resistance and total adiposity. The role of BCAAs in lipid partitioning in obesity needs to be further elucidated.

Obes Facts. 2018 May 26;11(Suppl 1):103.

T1P116 Effect of obesity in critically ill patients; Muscle Quality as an explanatory outcome for the “Obesity Paradox”

J Molinger 1, D Gommers 2

Introduction

Obesity and overweight are associated with an increased risk of death in the general population, but in specific disease conditions, a decrease in mortality has been reported. The ‘obesity paradox’ of critical illness refers to better survival with a higher body mass index. Hypercatabolism in the acute phase of the critical illness is presumed to be an adaptive response providing the essential fuel for energy production in vital organs. However, when hypercatabolism persists it may result in muscle wasting and weakness. Skeletal muscle quality is recognized as a marker of function in healthy individuals and critically ill patients. To determine muscle histology on an ICU; a muscle biopsy is needed. However, this procedure is invasive. By using a novel non-invasive assessment of muscle histology we aim to study muscle quality in obese and non-obese critically ill patients.

Methods

Muscle Quality index will be determined using traditional non-invasive ultrasound, which involves pacing a probe over e predefined area of the quadriceps muscle (rectus femoris, vastus lateralis, vastus medialis and intermedius). The pixel-intensity-complex of the muscle fibers was measured to quantify the amount of contractile versus non-contractile structures within the region of interest. The mean pixel intensity was averaged from the 6 cropped and segmented scans (3 long-axis and 3 short axis scans) and scaled to create the Muscle Quality Index with MuscleSound® software. This non-invasive assessment is called Virtual Muscle Histology. Fig. Heatmap Muscle Quality Index of septic patient.

Results

In the total group (N = 26) were 9 patients defined as obese by a BMI >30kg/m2. In this obese subgroup, the wasting patterns were distinctly different than the non-obese group, when comparing sepsis and neurotrauma. The obese group had a higher muscle quality index by volume in regard to the non-obese, by admittance ICU. The speed of wasting, as defined in decline in muscle quality, was lower in the first 4–5 days in the obese group in comparison with the non-obese.

Conclusion

Critically ill patients with obesity seem to have higher muscle quality, as measured by the virtual muscle histology assessment, at admittance compared to non-obese ICU patients. This might be the metabolic protective shield also described as the “obesity paradox”.

Conflicts of Interest

Advisor to Science Committee MuslceSound

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):103.

T1P117 Metabolic syndrome and serum osteocalcin in Korean adult women

J Kang 1

Introduction

Serum osteocalcin level has been widely used as a bone turnover marker in clinical setting. In this study, we analyzed the relationship between serum osteocalcin concentration and metabolic syndrome as a cardiovascular risk factor in adult women.

Methods

We retrospectively reviewed the medical records of 89 adult women (29 premenopausal, 60 postmenopausal) who voluntarily measured serum osteocalcin concentration and lumbar spine bone mineral density (BMD) for the purpose of screening. The definition of metabolic syndrome was used NCEP-ATP III (National Cholesterol Education Program’s Adult Treatment Panel III) criteria except waist circumference which was adopted the Korean standard.

Results

The serum osteocalcin concentration with metabolic syndrome was significantly lower than those without metabolic syndrome (15.4 ± 8.0 ng/mL vs. 22.4 ± 12.2 ng/mL; P = 0.001) The osteocalcin level was significantly lower in the groups with more than 4 risk factors for metabolic syndrome (10.1 ± 6.7 ng / mL) than the groups with more than 3 (18.0 ± 7.6 ng / mL) or 2 (23.6 ± 7.1 ng / mL) risk factors. As a result of logistic regression analysis using serum osteocalcin, age, menopausal status, lumbar spine BMD and body mass index as independent variables, the presence of metabolic syndrome was independently associated with the serum osteocalcin level. (β = −0.151, P = 0.018)

Conclusion

The serum osteocalcin levels in adult women were significantly lower in the metabolic syndrome group, and also lower in the group with higher clustering of individual risk factors of metabolic syndrome.

Obes Facts. 2018 May 26;11(Suppl 1):104.

T1P118 The role of circulating acetate in human insulin sensitivity

M A Gonzalez Hernandez 1, EE Canfora 1, K Pasmans 1, A Astrup 2, W Saris 1, EE Blaak 1

Introduction

Microbially produced acetate has reported positive effects on metabolic health through effects on satiety, energy expenditure and substrate utilization. However, whether this translates into beneficial effects on insulin sensitivity in humans remains unknown. Of note, there are indications from cross-sectional studies that the gut microbiome may be associated to insulin sensitivity in a sex-specific manner. Here, we investigated the association between sex-specific changes in fasting plasma acetate concentrations and changes in insulin sensitivity indices during weight loss by a low-calorie diet (LCD) and during weight maintenance on diets varying in protein content (P) and glycemic index (GI) in the DiOGenes study.

Methods

First, 692 subjects (BMI >27 kg/m2) underwent a LCD (800 kcal/d) for 8 weeks. Thereafter, 447 successful participants were randomly allocated to diets varying in P and GI: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet for 6 months. A linear mixed model was used to investigate the associations between changes in acetate with changes in insulin resistance (HOMA-IR), insulin sensitivity (Matsuda index) and circulating fasting levels of glucose and insulin. This model was adjusted for center (random factor), age, weight loss, fat free mass and the mean acetate concentration. The model for the weight maintenance period was additionally adjusted for weight regain. Variables not normally distributed were Ln-transformed and changes (deltas) were calculated by the difference between before and after intervention.

Results

At baseline, acetate showed higher levels in men than women (1.35 ± 1.39 vs. 1.13 ± 0.97 mmol/L, respectively Independent T test P = 0.030). However, a cross-sectional analysis did not show associations between acetate and insulin sensitivity indices. LCD increased acetate (without differences between men and women; 1.35 ± 1.39 to 1.45 ± 1.16 and 1.13 ± 0.97 to 1.25 ± 1.03 mmol/L, respectively, P = 0.852) and improved insulin sensitivity more in men than in women (Matsuda index units: 4.20 ± 2.54 to 7.02 ± 3.78 vs 5.78 ± 3.40 to 7.40 ± 3.60, P = 0.001, respectively). Interestingly, we observed positive associations between delta values of acetate and HOMA-IR (stdß 0.130, P = 0.033) and insulin levels (stdß0.119, P = 0.051) in women, but not in men (stdß −0.072, P = 0.310 and stdß −0.066, P = 0.359, respectively). In weight maintenance, no associations were found and acetate levels did not change as compared to after LCD on all diets.

Conclusion

These results suggest an association of acetate and insulin resistance in women, but not in men. Exact mechanisms behind this sex-specific relationship with acetate remain to be elucidated.

Obes Facts. 2018 May 26;11(Suppl 1):104.

T1P119 Low 24-hour core body temperature as a thrifty metabolic trait contributing to the enhanced efficiency of fat deposition during weight regain

J Calonne 1, D Arsenijevic 1, I Scerri 1, J Miles-Chan 1, J Montani 1, A Dulloo 1

Introduction

The recovery of body weight after substantial weight loss (or growth retardation) is characterized by a disproportionately higher rate of fat mass vs lean mass recovery, this phenomenon of preferential ‘catch-up fat’ being partly explained by an energy conservation (thrifty) metabolism due to suppressed thermogenesis persisting during weight regain. We tested in the rat the hypothesis that a low core body temperature constitutes a thrifty metabolic trait underlying the high metabolic efficiency driving catch-up fat.

Methods

The Anipill® DSI system was used for continuous monitoring of core body temperature (Tc) in a validated rat model of catch-up fat driven solely by suppressed thermogenesis. After ex-vivo calibration against mercury thermometers, the telemetry capsules were implanted in the peritoneal cavity. Continuous monitoring of Tc at 5 min intervals was performed in the rats (housed at 22 °C or 29°C and fed a standard chow diet) during an adaptation period of 1 week, followed by 2 weeks of semi-starvation, and followed by 3 weeks of calorie-controlled refeeding, and compared to both age-matched (AM) and weight-matched (WM) controls. Locomotory activity, assessed by infrared diode system, was recorded continuously for 2 consecutive days at different time points during each period.

Results

No differences were found between AM and WM controls in daily Tc. By contrast, 24h Tc was lower during semi-starvation (−0.77°C, p < 0.001), and it remained significantly lower than in controls during the refeeding phase of catch-up fat (−0.27°C, p < 0.001). No significant differences in locomotory activity were observed between refed and control groups. These low Tc during calorie-restriction persisting during catch-up fat upon refeeding is also observed when rats are at thermoneutrality (29°C).

Conclusion

The reduced energy cost of homeothermy in response to caloric restriction persists during the dynamic phase of weight recovery, and constitutes a thrifty metabolic trait that contributes to the high metabolic efficiency directed at the rapid restoration of the body’s fat stores during weight regain − with implications for obesity relapse and the mechanisms by which low birth weight followed by catch-up growth predisposes to later obesity.

Obes Facts. 2018 May 26;11(Suppl 1):104–105.

T1P120 The effects of dietary macronutrients and body composition on glucose homeostasis in C57BL/6 mice

S Hu 1, D Yang 2, J Togo 3, Y Wu 3, L Wang 1, JR Speakman 4

Introduction

Obesity is a major health issue, linked to insulin resistance and elevated risk of type 2 diabetes. Obesity may be caused by variations in the dietary macronutrient profile. However, whether disrupted glucose homeostasis is due altered body composition alone, or whether dietary macronutrients play an additional role independent of their impact on body composition remains unclear. The objectives of the present study were to investigate the associations between dietary macronutrients, body fat mass and lean mass, blood hormone levels and glucose homeostasis.

Methods

We fed C57BL/6 mice 30 different diets with variable macronutrient contents for 12 weeks. After 10 weeks of dietary manipulation, following measurement of fasting blood glucose levels, intraperitoneal glucose tolerance tests (IPGTT) were performed and blood glucose levels were measured over 2 h period. Fasting blood hormone levels were measured. GLM models were used to evaluate the impacts of macronutrients, body composition and blood hormone levels on glucose homeostasis.

Results

The AUC of the glucose tolerance test was strongly associated with body fat mass, but not lean mass, or macronutrient content of the diet. However, fasting blood glucose levels were associated with both body fatness and independently with dietary fat content. In parallel, fasting blood glucose levels were significantly associated with both blood leptin and insulin levels, and AUC were significantly associated with only insulin levels. The residuals from the GLM model with AUC against insulin showed a positive regression with body fat mass, explaining 9.4% of the residuals excluding the insulin effect. Six genes which encode a signal peptide from transcriptomic analysis of eWAT and sWAT, with insulin levels together were significantly associated with AUC of the glucose curve in the GLM models. These genes may be potential genes that play important roles in glucose homeostasis, which may underpin the role of body fat mass in glucose control.

Conclusion

The main impacts of dietary macronutrients on glucose homeostasis were mediated via body fatness. However, dietary fat had an independent impact on fasting blood glucose levels. Body fatness mediated glucose homeostasis mainly by blood insulin levels, while blood leptin levels impacted on fasting blood glucose only.

Obes Facts. 2018 May 26;11(Suppl 1):105.

T1P121 The association between sleep pattern and metabolic syndrome

M Chen 1, D Li 1, H Xue 1, X Lv 1, X Zhang 2, L Quan 1, G Cheng 1

Introduction

Previous studies have suggested that sleep pattern may be involved in the regulation of metabolic syndrome (MS). And the increasing prevalence of metabolic syndrome has become one of the most serious threats to public health in China. Existing researches are more focused on sleep duration, but less on sleep quality and daytime napping habit. We aim to examine whether sleep duration and siesta are related to metabolic syndrome among adults in southwest China.

Methods

A total of 1,273 adults (64.50% women) aged 20–70 years were randomly selected in. Using PSQI questionnaire, we obtained main sleep information. The total score of questionnaire ranged from 0 to 21: the lower the score was, the better the quality of sleep was. Poor sleep quality is defined on global PSQI score >5. And the daytime napping habit of subjects were collected according to the answer by the question, “How many days do you have a nap in a week?” MS was defined according to criterion by International Diabetes Federation. Central obesity (Chinese) plus two or more of the following Factors: Triglycerides ≥ 1.7 mmol/L or medication; HDL-C < 1.03 mmol/L in males and < 1.29 mmol/L in females or medication; Blood pressure>130/85 mm Hg or medication; Fasting plasma glucose>5.6 mmol/l or type 2 diabetes. Logistic regression models were used to estimate the odd ratio (OR) and 95% confidence interval (95% CI) of MS, with adjustment for age, gender, energy intake, physical activity.

Results

The median of PSQI score is 6.28. The incidence rate of MS was approximately 30.56%. After adjustment for potential confounders, OR (95% CI) of MS, central obesity, raised blood pressure and raised fasting plasma glucose were 0.77 (0.60, 0.99), 0.70 (0.54, 0.89), 0.68 (0.52, 0.87), 0.74 (0.59, 0.94) for nap takers compared with individuals without daytime napping habit.

Conclusion

Individuals with daytime napping habit had lower risk of MS. Sleep quality as self-reported may not associated with MS.

Obes Facts. 2018 May 26;11(Suppl 1):105.

T1P122 Telmisartan increases gluconeogenesis by inducing PKCζ-Thr410 phosphorylation in hyperglycemia-treated HepG2 cells and high-fat diet-fed mouse liver

D Cho 1, KW Cho 2, K Song 3

Introduction

Telmisartan, an angiotensin II type 1 receptor blocker (ARB), is widely prescribed for the treatment of hypertensive patients with simultaneous diabetes mellitus (DM). Unlike other ARBs, telmisartan is reported to have various ancillary effects as well as common blood pressure-lowering effect. In this regard, telmisartan improves endothelial dysfunction and cardiovascular complications in DM patients and is recently reported to reduce new-onset DM incidence. However, effects and mechanism of telmisartan on gluconeogenesis in hepatocytes and liver remain elusive. Here, we investigated effects and a molecular mechanism of telmisartan on gluconeogenesis in hyperglycemia-treated HepG2 cells and high-fat diet (HFD)-fed mouse liver.

Methods

We performed glucose production assay, glucose uptake assay, western blot analyses, RT-PCR, transfection of dominant-negative (dn)-protein kinase C ζ (PKCζ) constructs, and HFD-fed mouse in vivo studies.

Results

Telmisartan dose-dependently increased gluconeogenesis in hyperglycemia-treated HepG2 cells and accompanied an increase of phosphoenolpyruvate carboxykinase (PEPCK) expression without change of glucose-6-phosphatase (G6Pase) expression. Furthermore, telmisartan dose-dependently increased insulin receptor substrate-1 (IRS-1)-Ser302phosphorylation and decreased IRS-1-Tyr632 phosphorylation, indicating that telmisartan impairs insulin action in HepG2 cells. Because PKCζ is reported to reduce insulin action by inducing IRS-1 serine phosphorylations, we tested its phosphorylation and found that telmisartan dose-dependently increased PKCζ-Thr410 phosphorylation. Ectopic expression of dn-PKCζ constructs significantly attenuated the telmisartan-induced gluconeogenesis and the telmisartan-induced IRS-1-Ser302 phosphorylation and -inhibited IRS-1-Tyr632 phosphorylation, although it did not alter PEPCK expression, showing that gluconeogenesis, when insulin is acutely treated, is largely regulated by changes of IRS-1 phosphorylations. Among ARBs, including losartan and fimasartan, only telmisartan induced IRS-1-Ser302 phosphorylation and decreased IRS-1-Tyr632 phosphorylation. Furthermore, effects of telmisartan on IRS-1 phosphorylations were not altered by pretreatment with GW9662, a specific and irreversible peroxisome proliferator-activated receptor γ antagonist. Finally, in the liver from HFD-fed mice, telmisartan increased PEPCK and G6Pase expressions and PKCζ-Thr410 phosphorylation, and accompanied an increase and a decrease of IRS-1-Ser302 and -Tyr632 phosphorylations, respectively. In spite of these Results, telmisartan ameliorated glucose intolerance in HFD-fed mice, and decreased glucose contents in liver of HFD-fed mice.

Conclusion

Taken together, our findings suggest that although telmisartan increases gluconeogenesis by inducing PKCζ-Thr410 phosphorylation that consequently impairs insulin action in hepatocytes, telmisartan decreases glucose contents in liver and improves insulin resistance in a whole animal level. These results also support that insulin-sensitizing effects of telmisartan may be stemmed from actions of other organs including skeletal muscles and adipose tissues rather than liver.

Obes Facts. 2018 May 26;11(Suppl 1):105–106.

T1P123 Basic pharmacodynamic effects of extracts of cranberries, cowberries and blueberries on the model of metabolic syndrome

E Belova 1, L Kovalenko 1, A Gulyaev 1

Introduction

The purpose of this study is to determine the main pharmacodynamic effects of extracts of cranberries, cowberries, blueberries on the metabolic syndrome model. The probability of the effect of the investigated water-alcohol polyphenolic extracts of northern berries on the severity of metabolic syndrome manifestations was assessed by the change in some indicators of blood biochemistry.

Methods

The pathophysiological model of the metabolic syndrome in rats, caused by ovariectomy and carbohydrate-fat diet, was used as the object of the study. 100 Sprague-Dawley (SD) female rats, weighing 160–180 g, were taken for the experiment. The control group consisted of 10 intact female rats. The group for the modeling of metabolic syndrome consisted of 90 rats that had underwent oophorectomy, and a week later, they were prescribed a diet with a high content of carbohydrates and fats for 16 weeks. A solution of 10% fructose was used instead of drinking water as a source of excess carbohydrates. Food with high fat content was used as a diet with a high content of fat.

After receiving evidence of metabolic syndrome formation, animals were randomly divided into four following groups. The first group of animals received the test substance “cranberry polyphenol extract” daily, inward 0.5 ml through a catheter − 18 heads. The second group of animals received the investigated substance “cowberry polyphenol extract”, inside 0.5 ml − 17 heads. The third group of animals received the test substance “blueberry polyphenol extract”, inside 0.5 ml − 17 heads; a group of animals receiving daily 0.5 ml of saline (placebo) daily − 17 heads. The drugs were injected for 2 weeks.

Conclusion

The decrease in the level of triglycerides and LDL cholesterol in the blood of rats with a metabolic syndrome model under the influence of cranberry, cowberry and blueberry extracts, established under the conditions of our experiment, can be considered a cardinal sign of the interference of the extracts of berries used in the pathophysiology of the metabolic syndrome.

Results

 

Tab. 1.

Options
 Placebo (n = 17)
 Cranberry (n = 17)
 Cowberry (n = 17)
 Blueberry (n = 17)
Triglycerides, mg/dl 181,5 ± 9,43 131,0 ± 7,62* 126,8 ± 8,50* 123,4 ± 6,w26*
Cholesterol, mg/dl 150,2 ± 11,47 144,2 ± 6,33 154,8 ± 10,39 137,5 ± 8,72
LDL, mg/dl 50,11 ± 4,12 43,7 ± 2,36 40,7 ± 3,38 31,4 ± 2,67*
HDL, mg/dl 49,36 ± 8,44 50,4 ± 3,24 47,9 ± 5,21 52,7 ± 4,62
Glucose, µmol/l 6,25 ± 1,27 5,30 ± 2,44 6,10 ± 3,18 5,80 ± 2,79
Bilirubin, µmol/l 5,28 ± 0,82 6,11 ± 0,78 6,40 ± 0,91 4,88 ± 0,51
ALT, μ-cat / l 0,72 ± 0,11 0,41 ± 0,09* 0,36 ± 0,05* 0,40 ± 0,08*
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*

Note: p < 0,05 Changes in the biochemical parameters of blood serum of rats with the model of the metabolic syndrome reflected in the table and occurring with the use of cranberry, cowberry and blueberry extracts, suggest that the active corrective role of the extracts under investigation is valid during development of typical signs of this pathology.

Obes Facts. 2018 May 26;11(Suppl 1):106.

T1P124 Extract of the Rhizophora mangle L. (Rhizophoraceae) reverse insulin resistance and hepatic steatosis in obese mice

C REP Caria 1, PS Santos 1, CC Ruy 1, LMS Mesquita 2, W Vilegas 2, A Gambero 1

Introduction

Extracts obtained from plants of Rhizophora genus have demonstrated hypoglycemic, antidiabetic and anti-inflammatory activity. In Brazil, Rhizophora mangle L. is commonly found in mangroves of coastal zones and its pharmacological properties are poorly studied. Thus, the aim of this study was investigated the potential of bark extract of R. mangle in a model of obesity induced by high-fat diet in mice, where insulin resistance and hepatic steatosis are present.

Methods

Swiss mice were fed with a high-fat diet (Obese group) for 8 weeks. After that, obese mice received orally R. mangle bark extract (50 mg/kg/day – RM50) during the next 4 weeks. Glucose homeostasis was evaluated by insulin tolerance test and basal serum insulin and glucose. Visceral adipose tissue inflammation was assessed. Hepatic steatosis, triglycerides levels and gene expression were evaluated in the liver. All experimnts were approved by the animal ethics committee of Universidade Sao Francisco (CEUA/USF Protocol 001.02.2016).

Results

The treatment with R. mangle extract resulted in reductions in glucose (226 ± 11 and 197 ± 6 mg/dL for obese and RM50 group, respectively; p < 0.05) and insulin blood levels (176 ± 34 and 127 ± 9 pg/mL for obese and RM50 group, respectively; p < 0.05). Insulin tolerance test was improved (2.0 ± 0.4 and 3.2 ± 0.3 kITT for obese and RM50 group, respectively; p < 0.05). In visceral adipose tissue, mRNA levels of leptin, TNF-α and MCP-1 were reduced. Hepatic steatosis (19.1 ± 0.5 and 9.3 ± 1.3% of area for obese and RM50 group, respectively; p < 0.05) and triglycerides content (82 ± 16 and 57 ± 5 mg/g tissue for obese and RM50, respectively; p < 0.05) was reduced by R. mangle extract associated to a inhibition of hepatic mRNA levels of PPAR-α, PPAR-γ, CD36 and Fasn.

Conclusion

Our results suggested that Rhizophora mangle reverses insulin resistance and hepatic steatosis induced by obesity, which was proportional to a downregulation of genes associated with inflammation in the visceral adipose tissue and associated with fatty acid uptake in the liver.

Obes Facts. 2018 May 26;11(Suppl 1):106.

T1P125 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):106–107.

T1P126 Peroxisome proliferator-activated receptor-α agonist treatment ameliorates obesity and obesity-related glucose metabolism disorders in obese mice via FGF21

M Iwase 1, M Hirata 1, H Takahashi 1, HF Jheng 1, W Nomura 1, N Takahashi 1, T Kawada 1, T Goto 1

Introduction

Obesity causes excess fat accumulation in white adipose tissues (WAT) and also in other insulin-responsive organs such as the skeletal muscle, increasing the risk for insulin resistance, which can lead to obesity-related metabolic disorders. Peroxisome proliferator-activated receptor-α (PPARα) is a master regulator of fatty acid oxidation whose activator is known to improve hyperlipidemia. However, the molecular mechanisms underlying PPARα activator-mediated reduction in adiposity and improvement of metabolic disorders are largely unknown. In this study we investigated the effects of PPARα agonist (fenofibrate) on glucose metabolism dysfunction in obese mice.

Methods

For the diet-induced obese model, 7–8-week-old wild type C57BL/6J mice or fibroblast growth factor 21 (FGF21) -deficient mice were fed a 60%kcal high-fat diet (HFD). After 8–12 weeks of HFD feeding, vehicle (0.5% carboxymethylcellulose) or fenofibrate was orally administrated to HFD-fed mice for 4 weeks. As a lipodystrophic model, 12–20-week-old A-Zip/F1 mice and their WT littermates were treated with 50 mg/kg/day fenofibrate or vehicle for 4 weeks.

Results

Fenofibrate treatment reduced adiposity and attenuated obesity-induced dysfunctions of glucose metabolism in obese mice fed a HFD. However, fenofibrate treatment did not improve glucose metabolism in lipodystrophic A-Zip/F1 mice, suggesting that adipose tissue is important for the fenofibrate-mediated amelioration of glucose metabolism. Moreover, we investigated the role of the hepatokine FGF21, which regulates energy metabolism in adipose tissue. In WAT of WT mice, but not of FGF21-deficient mice, fenofibrate enhanced the expression of genes related to brown adipocyte functions, such as Ucp1, Pgc1a, and Cpt1b. Fenofibrate increased energy expenditure and attenuated obesity, whole body insulin resistance, and adipocyte dysfunctions in WAT in HFD-fed WT mice but not in FGF21-deficient mice.

Conclusion

These findings indicate that FGF21 is crucial for the fenofibrate-mediated improvement of whole body glucose metabolism in obese mice via the amelioration of WAT dysfunctions.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):107.

T1P127 Effects of olive oil consumption on mice liver proteome

I F De Sousa 1, AP Pedroso 1, IS De Andrade 1, V Boldarine 1, AK Tashima 2, EB Ribeiro 1

Introduction

Diet composition is highly relevant to food intake control and the amount and type of dietary fat may modify central and peripheral parameters. We propose to assess if the long term feeding with normolipidic or high fat diet enriched with olive oil (n-9 polyunsaturated fatty acids) can alter liver protein expression as evaluated by proteomic analysis.

Methods

Mice were randomized distributed in three groups and feed for 12 weeks with: a balanced diet with soy oil as fat source (control group; C), a balanced diet which n-6 PUFA was partially replaced to n-9 PUFA from olive oil (olive normolipidic group, NO) and a high fat diet, which n-6 PUFA was almost totally replaced by n-9 PUFA (olive high fat diet group, HO). The body weight and food intake were measured along the 12 weeks of treatment. Hepatic proteins were analyzed by liquid chromatography – tandem mass spectrometry. String database was used to perform the analysis of affected pathways. Data were analyzed by two-way Anova followed by Tukey or LSD post-test, with significance set at p < 0.05.

Results

NO group presented a significant reduced body weight gain in comparison with other groups (p = 0.0057 vs C; p = 0.000021 vs HO). HO group presented reduced caloric intake than other groups in almost all weeks of treatment. Glycemia was reduced on NO group in comparison with HO group (p = 0.045). Total cholesterol was elevated on HO group (p = 0.046 vs C; p = 0.028 vs NO group). Serum triglycerides were reduced on both olive oil groups (p = 0.0027 NO vs C; p = 0.0007 HO vs C). Comparison between C and NO groups showed 2 altered proteins. Comparison between C and HO groups showed 81 altered proteins. Most part of these proteins are involved in carbohydrates and fatty acids metabolism (alcohol dehydrogenase, acetyl-CoA acetyltransferase, long and short chain acyl-CoA dehydrogenase) and oxidative phosphorylation (ATP synthase, cytochrome C oxidase and succinate dehydrogenase). Moreover, comparison between NO and HO groups showed 59 altered proteins.

Conclusion

High fat olive oil diet affects liver proteomic profile which may have contributed to altered parameters seen on HO group as body weight, glycemia and serum total cholesterol, through mechanisms not yet completely elucidated.

Obes Facts. 2018 May 26;11(Suppl 1):107.

T1P128 The role of serine threonine kinase PKR1 in type 2 diabetes in association with obesity

A Yeramian 1, F Herrerias 1, L Gutiérrez 1, JA Baena 1, M Bueno 1, C López-Cano 1, E Sánchez 1, E Cuello 1, A Lecube 1

Introduction

The close relationship between obesity, insulin resistance and the development of type 2 diabetes (T2D) is well established. However, still little is known about the mechanisms controlling the complex signaling pathways that promote the interplay between these conditions. In this work we aimed to assess the role of the Serine/ Threonine Kinase PRK1 (PRK1), in the establishment of the diabetic condition. PRK1 kinase has been shown to control different biological processes other than diabetes.

Methods

PRK1 total levels and its activation levels were determined by Western Blot, in samples of visceral adipose tissue from 17 morbidly obese patients (5 of them with T2D) undergoing bariatric surgery. Gels were transferred to nitrocellulose membranes that were incubated with rabbit primary antibody against either total PRK1 or the phosphorylated form of PRK1 and further incubated with goat anti rabbit horseradish peroxidase-conjugated secondary antibody. Finally, proteins were visualized using the enhanced chemiluminescence detection system (Inmobilon, Millipore, MA). Densitometric analysis was performed with a GS-800 calibrated densitometer (Bio-Rad Laboratories, Hercules, CA) and analysed with the Quantity One 4.6.2 software (Bio-Rad Laboratories, Hercules, CA).

Results

The analysis of either phosphorylated levels of PRK1 or total PRK1 levels in visceral adipose tissue samples by Western Blot, showed lower total PRK1 levels in T2D samples compared to the non-diabetic patients. Moreover, the decrease in total levels of PRK1 correlated with a decrease of the phosphorylated form of this Kinase, and a decrease in the activation of the PI3K/Akt pathway, assessed by the antiobody against pAkt (Ser 473).

Conclusion

We have identified a new potential candidate that could be involved in the pathogenesis of T2D in subjects with obesity. Further studies addressed to investigate the precise role of this “kinase” in the pathogenesis of glucose abnormalities and their potential therapeutic implications are needed.

Obes Facts. 2018 May 26;11(Suppl 1):107.

T1P129 Secretogranin-3 contributes to insulin resistance in obesity

H Wu 1, C Hu 2, H Ou 3, Y Yang 4, J Wu 1, C Chang 1

Introduction

Obesity and non-alcoholic fatty liver disease are highly correlated with insulin resistance and type 2 diabetes. Cytokines that secreted from liver and adipose tissue to circulation play important roles in the development of insulin resistance. Secretogranin-3 (SCG3) is a novel protein that exerts an angiogenesis activity and responsible for the diabetic retinopathy. However, the role of SCG3 in the development of insulin resistance is still obscure. Thus, the aim of this study is to investigate the role of SCG3 in the development of insulin resistance.

Methods

Obesity in mice was induced using a high fat diet containing 35% fat. Serum SCG3 concentrations were determined by ELISA kits. The expression of SCG3 was determined using western blots. Lenti-viral vectors containing SCG3 gene, short hairpin RNA targeted to SCG3 (shSCG3) or green fluorescent protein (GFP, as control) were used to overexpress or knockdown hepatic SCG3 expression in mice. Insulin sensitivity and glucose utility in mice were evaluated by glucose and insulin tolerance tests, as well as the detection of downstream insulin signaling.

Results

Elevated plasma glucose and insulin levels were significantly increased in mice fed with a high fat diet, and the plasma SCG3 concentrations were significantly increased in mice fed with a high fat diet. The expressions of SCG3 were detected in both liver and adipose tissue. Overexpression of hepatic SCG3 increased fasting plasma glucose value and decreased insulin sensitivity, whereas deletion of hepatic SCG3 improved high fat diet-induced insulin resistance. In addition, we found that SCG3 disrupted insulin signaling to induce insulin resistance.

Conclusion

Increased SCG3 expression might play an important role in the development of insulin resistance in obesity.

Obes Facts. 2018 May 26;11(Suppl 1):107–108.

T1P131 Assessment of the relationship between nutritional status and allostatic load in patients with diabetes

MS Macit 1, N Acar Tek 1

Introduction

Allostasis and allostatic load are concepts emerging to explain the physiological response given to the stress. However, studies investigating the relationship between diabetes and allostatic load are limited.

Methods

This study was conducted to determine the relationship between nutritional status and allostatic load in patients with type 2 diabetes. The sample was consist of 30 men and 73 women between 20–55 years. Individuals were tip 2 diabetes 7,9 ± 6,17 for years. Allostatic load scores compute with two methods by using; The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) (method A) and World Health Organization (WHO) (method B) metabolic syndrome criteria. A total of 12 parameters were questioned and we’ve obtained an allostatic load score between 0–12; values that above the cut offs were given 1, values at the normal range were given 0.

Results

In method A %90,3, in method B %79,6 of patients have high allostatic load scores. In the first method, we’ve found that increased age is associated with the high allostatic load (p < 0,01), while in the second method increase in diabetes duration is associated with high allostatic load scores (p < 0,05). Vegetable consumption is lower and fruit consumption is higher statistically significantly in the high allostatic load group (p < 0,05). BMI, waist circumference, neck circumference, waist/height ratio correlated with allostatic load scores in both two methods (p < 0,05). Serum fasting blood glucose, HbA1c, CRP, and cortisol also correlated with allostatic load scores in both two methods (p < 0,05). Risk factors that increase allostatic load body weight (1,09 times), BMI (1,20 times), neck circumference (1,21 times), waist circumference (1,17 times), hip circumference (1,07 times) in method A, body weight (1,09 times), BMI (1,20 times), waist circumference (1,15 times), hip around (1.12 times) in method B. High blood pressure increases the risk for high allostatic load 1,07 times in method A, 1,04 times in method B. Otherwise increase in fasting blood glucose and HbA1c increase the risk for high allostatic load, respectively 1,02 and 1,64 times.

Conclusion

Appropriate diet may help to decrease the allostatic load scores by reducing body weight, waist ratio, systolic blood pressure, fasting blood glucose and prevent the negative effects of stress on the metabolic processes in the long-term malnutrition.

Obes Facts. 2018 May 26;11(Suppl 1):108.

T1P132 The effect of mixed meal tolerance test on serum osteocalcin in obese volunteers

M Malczewska-Malec 1, U Razny 1, J Goralska 1, A Dembinska-Kiec 1, B Solnica 1

Introduction

It was reported that mixed meal, calcium, glucose, fat, or protein ingestion leads to suppression of bone resorption within hours of nutrient ingestion. Markers of osteoblastic bone formation are less affected by food intake. Carboxylated osteocalcin (Gla-OC) participates in bone formation by interacting with hydroxyapatite crystals whereas its undercarboxylated form (Glu-OC)acts as hormone in glucose metabolizm. The aim of the study was to investigate the effect of 6-hour oral mixed meal tolerance test on carboxylated (Gla-OC), undercarboxylated (Glu-OC) and total osteocalcin in obese and non-obese volunteers.

Methods

Non-obese (body mass index [BMI] < 30 kg/m2; n = 24) and obese subjects (30 < BMI < 40 kg/m2; n = 70), both sexes, aged 25 to 65 years underwent an 6-hour oral mixed meal tolerance test (MMTT). Test breakfast meal (caloric content 1018 kcal), consisted of: 73% of fat, 16% of protein and 11% of carbohydrates. Fasting and postprandial blood samples (2 hours and 6 hours after breakfast) were drawn and analyzed for concentrations of carboxylated (Gla-OC) and undercarboxylated (Glu-OC) osteocalcin.

Results

In non obese subjects after 6 hours but not after 2 hours of MMT, Gla-OC concentration was significantly reduced in comparison to baseline value (P < 0.01). This effect was suppressed in obese participants. Total areas under Gla-OC curve during MMTT were similar in non obese and obese patients (P > 0.05). However, absolute value of net incremental area under Gla-OC curve was lower in obese subjects than non –obese ones (P < 0.05). Plasma concentrations of Glu-OC were decreased after 2 hours of MMT in nonobese and obese subjects (P < 0.001). Glu-OC concentrations expressed as percentage of change between 2 hours and baseline as well as between 6 hours and 2 hours did not differ between studied groups of patients. There was a tendency for lower total area under Glu-OC curve in obese subjects compared to nonobese ones (P = 0.0623) and for absolute value of net incremental area for Glu-OC curve (P = 0.0806). After 2 and 6 hours plasma concentration of total osteocalcin (calculated as the sum of Gla-OC and Glu-OC) was gradually reduced in nonobese subjects (P < 0.01) but not in obese volunteers. Value of total area under total osteocalcin curve during MMT as well as absolute value of net incremental area under total osteocalcin curve were lower in obese than nonobese subjects (P < 0.05, P < 0.01). Total area under total osteocalcin curve during MMTT was positively associated with age (r = 0.309, P = 0.003) and inversely with hsCRP (−0.238, P = 0.024). BMI positively correlated with net incremental area under total and Gla osteocalcin (r = 0.284, P = 0.007; r = 0.258, P = 0.014). Net incremental total osteocalcin area under curve was positively associated with fasting insulin (r = 0.300, P = 0.007) and HOMA-IR (r = 0.284, P = 0.008). There was positive association of net incremental Gla-OC area under curve with fasting insulin (r = 0.227, P = 0.042) and inversely with adiponectin level (r = −0.348, P = 0.001).

Conclusion

Suppression of Gla-OC and total osteocalcin within 6 hours of mixed meal ingestion is less affected in obese volunteers, what seems to be in part connected with low grade inflammation and insulin resistance in obesity.

Obes Facts. 2018 May 26;11(Suppl 1):108.

T1P133 Plasma cytokeratin-18 fragment levels in obese patients

AZ Zdzienicka 1, J Goralska 1, U Razny 1, A Micek 2, A Gruca 1, B Solnica 1, M Malczewska-Malec 1

Introduction

There is growing interest in non-invasive identification and monitoring the outcome of liver damage in obese patients. Plasma cytokeratin-18 (CK-18) fragment levels correlate with the magnitude of hepatocyte apoptosis and is recently proposed to independently predict the presence of NASH. The aim of the present study was to analyze the potential associations of cytokeratine with anthropometric parameters, insulin resistance, incretin hormones and lipid metabolism in obesity.

Methods

The study involved 151 overweight or obese patients (BMI 27–40), without diabetes, dyslipidemia or apparent liver diseases. Liver function was assessed by alanine aminotransferase (ALT) activity, gamma-glutamyl transferase (GGT) activity and fatty liver index (FLI) was calculated. Cytokeratin-18 M30 plasma levels were determined by ELISA test.

Results

Cytokeratin-18 correlated with ALT (r = 0.45), GGT (r = 0.34) and FLI (r = 0.36). Mild correlation with hsCRP (r = 0.19) was also observed. ALT activity was the strongest, independent factor influencing high CK-18 plasma levels [β coefficient (95%CI): 0.54(0.37–0.71)]. After adjustment for ALT, the age, sex, BMI, glucose and triglicerydes were not associated with CK-18 plasma levels. Obese, insulin resistant patients with high glucose-dependent insulinotropic peptide (GIP) plasma levels had elevated plasma ALT but not cytokeratine compared to patients with low GIP levels.

Conclusion

Circulating cytokeratin-18 levels were strongly associated with ALT activity. Newertheless, disturbance of insulin sensitivity and incretin homeostasis in obesity was associated with elevated ALT and FLI but not CK-18, pointing to the development of steatosis not steatohepatitis /cirrhosis. Supported by the National Science Centre (PL) (grant number DEC- 2011/02/A/NZ2/00022), the EU FP7 BIOCLAMS (Grant agreement no. 244995) and CMUJ grant K/ZDS/007158.

Obes Facts. 2018 May 26;11(Suppl 1):109.

T1P134 Insulin sensitivity is affected by the dietary supplementation with milk of different animal species

G Trinchese 1, C De Filippo 1, E Penna 1, R Borrelli 1, A Catapano 1, F Cimmino 1, E Giardinelli 1, P Leva 1, G Pisani 1, A Zoppi 1, G Smaldone 1, A Speranza 1, HM Bottu 1, G Cavaliere 1, M P Mollica 1

Introduction

Human milk (HM), the best and easiest source of the nutrients required for growth and development of newborns, provides immunoregulatory components and plays a key role in preventing overweight throughout the life. However, breastfeeding rates vary widely, and some women even have to stop it after few weeks of trial for diverse reasons, often replacing human milk with the components of cow milk (CM). However, several data suggest that excessive consumption of CM early in life may be linked to obesity and metabolic disorders. In this regard, it is noteworthy that donkey milk (DM) has been suggested as a better substitute for HM based on its physicochemical properties. In this study, we have compared the physiological effects of CM, DM, and HM as dietary supplements in a rat animal model. In particular, we have focused on their effects on glucose and lipid metabolism in the skeletal muscle, which is the major target organ of insulin towards glucose disposal from the body. Skeletal muscle is also a chief determinant of the resting metabolic rate whose reduction is clearly associated with body weight gain. Since mitochondrial dysfunction plays an important role in insulin sensitivity, we also tracked down the effects of different milks supplementation on skeletal muscle mitochondrial function.

Methods

Male Wistar rats were individually caged. Control group was fed with standard diet. Three groups were supplemented with iso-energetic amount of raw CM, DM or HM (21, 48 or 22 ml/day, respectively) for 4 weeks. Pro-inflammatory cytokines, HOMA index, glucose and insulin tolerance test were measured in blood serum. Skeletal muscle mitochondrial oxidation rates, efficiency, dynamics, and oxidative stress were determined.

Results

Our data indicate that DM outdoes CM in approaching HM by alleviating the inflammatory status and improving lipid and glucose metabolism. Furthermore, our results show that the beneficial effects elicited by HM and DM are in part mediated by their ability to improve redox status and to modulate mitochondrial uncoupling and dynamics.

Conclusion

By displaying novel mechanisms linking insulin sensitivity with cellular metabolic responses according to the milk used, this study adds novel significant perspectives and suggests that selected milks may provide protection against specific metabolic disorders.

Obes Facts. 2018 May 26;11(Suppl 1):109.

T1P135 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):109.

T1P136 Effects of three types of diets in the induction of NAFLD and on renal function in Wistar male rats: An experimental study

N Fakhoury-Sayegh 1, V Trak-Smayra 2, R Sayegh 3, F Haidar 1, O Obeid 4, A Khazzaka 5

Introduction

Diet has an essential role in the induction of nonalcoholic fatty liver disease (NAFLD) and on the perturbations of renal function. A high intake of fat and carbohydrates, especially fructose, can lead to fatty liver, steatohepatitis and renal fibrosis. Our objective was to study, within 16 weeks, the change in hepatic and renal cells using three different diets enriched in varying levels of fructose and fat, and to compare the results to those of a control diet.

Methods

Forty (6 weeks old) Wistar male rats, weighing an average of 150g were randomly divided into four groups of ten, and each group assigned diets of equal quantity (20g/rat) but of varying composition in fructose and fat. The first group was fed a standardized diet (16.9% of fat, 21.3% of proteins, 61.8% of carbohydrates). The second group was fed a high fat diet (51% fat), while the third and the fourth group were fed a 35% fructose enriched diet and a high fat, high fructose diet respectively (30% fructose, 40% fat). At week 16, the rats were sacrificed, and liver and kidneys excised

Results

At week 16, the second group (51% fat enriched diet) had the highest percentage of cells enriched in fat (31%), and the highest liver, epidydimal fat and body weight (P < 0.05). The third and the fourth group had the highest kidney weight, a significant increase in triglycerides and TNF-alpha level versus a significant decrease in adiponectin (P < 0.05). The third and the fourth groups showed interstitial fibrosis and mild and significant renal inflammation. The group 1 showed no change in any of the above-mentioned parameters

Conclusion

Thirty five percent fructose of the total energy intake were more deleterious than 51% fat in inducing biochemical disorders and renal damage.

Obes Facts. 2018 May 26;11(Suppl 1):109–110.

T1P137 The effect of mixed meal tolerance test and oral glucose overload on serum osteocalcin in subjects with glucose tolerance disturbances

U Razny 1, J Goralska 1, A Zdzienicka 1, A Dembinska-Kiec 1, B Solnica 2, M Malczewska-Malec 1

Introduction

Bone turnover is influenced by food intake. Nutrient ingestion could decrease markers of bone resorption of up to 50% from baseline. Markers of bone formation as osteocalcin are also influenced by feeding, but the decrease in formation markers is less than the decrease in resorption markers. Carboxylated osteocalcin (Gla-OC) participates in bone remodeling, whereas the undercarboxylated form (Glu-OC) takes part in glucose metabolism. Both forms of osteocalcins are detectable in circulation. The aim of the study was to compare the effect of mixed meal to glucose on carboxylated (Gla-OC), undercarboxylated (Glu-OC) and total osteocalcin in subjects with different oral glucose insulin sensitivity index (OGIS) value within 2 hours of nutrients oral intake.

Methods

Volunteers of the study (body mass index [BMI]: 25–40, n = 80) both sexes, aged 25 to 65 years underwent an oral glucose tolerance test and on another day mixed meal tolerance test (MMT). An oral glucose tolerance test (OGTT; 75 g glucose load) was performed according to WHO guidelines. Blood samples (0, 1 and 2 hours) were drawn and analyzed for concentrations of glucose and insulin to calculate post oral glucose load insulin sensitivity which was determined using an oral glucose insulin sensitivity index (OGIS) proposed by Mari et al., Diabetes Care 2001. Mixed meal tolerance test (1018kcal) consisted of: 73% of fat, 16% of protein and 11% of carbohydrates. Fasting and postprandial blood samples (1 hour and 2 hours after OGTT, 2 hours after mixed meal) were collected and determined for concentrations of carboxylated (Gla-OC) and undercarboxylated (Glu-OC) osteocalcin.

Results

Volunteers of the study were divided into 2 groups depending on calculated median value of OGIS. After 2 hours of both tests (OGTT or MMT) suppression of blood Glu-OC level was observed independently on OGIS value (P < 0.001). As regards 2 hour postprandial inhibition of serum Gla-OC, it depended on OGIS value and nutrient intake (P value for time x OGIS median x test = 0.041). namely, serum Gla-OC level was lower after 2 hours of glucose intake versus baseline value in subjects with higher than median value of OGIS (P < 0.01). Contrary to volunteers with OGIS value lower than median, subjects with higher OGIS level presented statistically significant suppression of Gla-OC also after 1 hour of oral glucose intake in comparison to baseline value (P < 0.01). Postprandial suppression of total osteocalcin serum concentration calculated as the sum of Gla-OC and Glu-OC also was influenced by the type of nutrient and OGIS value (P value of interaction time x test x OGIS = 0.030). Blood total osteocalcin level was suppressed significantly after 2 hours of oral glucose intake in subjects with higher OGIS value (P < 0.01).

Conclusion

Subjects with defects in glucose tolerance seem to present disturbances in bone turnover, determined by marker of bone formation – Gla-OC, within 2 hours of glucose overload but not after 2 hours of mixed meal intake. Supported by: the European Commission through its Seventh Framework Programme “BIOmarkers of Robustness of Metabolic Homeostasis for Nutrigenomics-derived Health CLAIMS Made on Food” (BIOCLAMS, grant agreement no. 244995) and Ministry of Science and Higher Education (PL) funding (K/ZDS/007160).

Obes Facts. 2018 May 26;11(Suppl 1):110.

T1P138 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):110.

T1P139 Hepatic histological alterations induced by a high-fat diet are potentiated by sedentarism

A F Bovolini 1, MDA Andrade 2, JAR Duarte 3

Introduction

High caloric intake and macronutrients overconsumption have a well-known ability to induce metabolic disorders independently of obesity. As well, the sedentarism also has a recognized pathogenic influence on many health outcomes, mainly in those obesity-related. The liver is vital to glucose/lipid metabolism and energy storage, becoming a core for metabolic balance and health. Considering the liver metabolic role and the sedentarism capacity to promote metabolic disturbances, this study aimed to observe the influence of sedentary behavior on the high-fat-diet-induced hepatic histological alterations.

Methods

28 Wistar rats were divided into four groups: sedentary standard diet (SSD, n = 7), active standard diet (ASD, n = 7), sedentary high-fat diet (SHFD, n = 7) and active high-fat diet (AHFD, n = 7). The rats were fed with a standard or a high-fat diet (70% calories from fat; Research Diets, Inc.) for 21 weeks. The active groups had free access to voluntary physical activity wheel while the sedentary groups remained restricted to their cage space. At the end of the protocol, the animals were weighed, euthanized and liver samples collected for histological analysis and thus stained with Hematoxylin-Eosin and Sirius Red to analyze hepatic steatosis and collagen deposition evaluation, respectively. The NIH ImageJ and Image Pro Plus 6 (USA) software were used to analyze histological liver profile (steatosis and collagen quantification respectively). Caloric intake (CI) and animals body weight (BW) were weekly recorded.

Results

No differences in animals CI and BW were unexpectedly found after 21 weeks. As well, HFD fed groups presented a relative liver weight decrease with an accentuated hepatic lipid and collagen deposition (P < 0.05vs. SSD). It is important to emphasize that the sedentarism accentuated both lipid and collagen deposition as can be seen in the histological images.

Conclusion

The results suggest that the caloric and fat overconsumption have harmful effects on the hepatic histological profile even without obesity. They also suggest that the sedentarism aggravates the harmful hepatic alterations induced by a high-fat diet in rodents.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):110–111.

T1P140 Evaluation of functional snack with carob and wakame on glucose homeostasis

AB Martin-Diana 1, MT Macarulla 2, D Rico 1, D De Luis 3, E Peñas 4, I Milton 5, A Fernández-Quintela 2, J Miranda 2

Introduction

Insulin resistance is a well-defined cardiometabolic risk factor in the Metabolic Syndrome (MetS). In the last years, several functional foods that possess hypoglycemic properties have been used for diabetes treatment with significant results in controlling hyperglycemia. It seems that seaweeds and pulses could have this benefit. The aim of the study was to assess the potential use of functional snack formulated with Ceratonia siliqua L. (carob fruit) and Undaria pinnatifida (wakame seaweed) on glucose homeostasis in rats with MetS.

Methods

Based on previous results two bread snack were formulated with oat and wheat flour including 8% of wakame and carob’s pod in 1/5 or 1/50 ratio. Thirty adult male Wistar rats were fed with a commercial high-fat high-fructose diet for 8 weeks in order to generate the MetS. After this period, animals were divided into 3 groups. All groups were fed with a semi-purified adequate-calorie diet for 4 additional weeks. The groups were the control group (C) and two snack groups where all the complex carbohydrates of the diet were replaced by a snack formulation with combination of 1/50 (1/50 group) or 1/5 of wakame/carob pod (1/5 group). One week before sacrifice, glucose tolerance test(GTT) was carried out on all animals and the Area Under the Curve (AUC) calculated. At the end of the experimental period, animals were sacrificed under fasting conditions and serum glucose and non-esterified fatty acids (NEFAs) were determined spectrophotometrically, as well as serum insulin by ELISA. HOMA-IR was used as an indirect index of insulin resistance.

Results

Although no significant reduction on GGT was observed with any functional snack, the 1/50 group showed 7% lower value of AUC than C group. After four weeks of treatment with 1/50 snack, animals revealed a significant improvement of insulin resistance with respect to other two groups of animals (HOMA-IR values 5.06 ± 0.42 1/50 group vs. 7.87 ± 0.86 C group and 7.10 ± 0.77 1/5 group). Higher levels of NEFAs were observed in C animals than in treated animals (0.39 ± 0.42 C group vs. 0.30 ± 0.02 1/50 group and 0.29 ± 0.02 1/5 group expressed as mmol/L).

Conclusion

The formulated bread snack with 1/50 combination of wakame and carob’s pod can be considered an interesting functional food to control glucose homeostasis in metabolic syndrome. This study has been supported by INIA: RTA2014–0037-C02.

Obes Facts. 2018 May 26;11(Suppl 1):111.

T1P141 AdipomiR editing related to loss of insulin sensitivity with aging

N Santanam 1, J Page 1, A Seidler 1, S Martin 1, S Al-Qawasami 1, A Marcello 1, M Buchanan 1

Introduction

Aging increases risk to insulin resistance. Adipose dysfunction alters insulin sensitivity. Our previous studies have shown loss of pre-adipocyte differentiation during normal aging resulting in abnormal adipose function. This loss of differentiation was attributed to alterations in microRNAs involved in adipocyte differentiation. We hypothesized that the insulin resistance observed during normal aging is attributed to dysfunctional adipomiRs.

Methods

Metabolic changes, and adipocyte dysfunction was studied in Fisher 344 x Brown Norway hybrid rats (FBN) at ages 3mo, 6mo, 15mo, 25mo and 30mo (male and females, n = 4–7). Fat red-O staining was performed for measuring adipocyte differentiation. Circulating levels of lipid profile, glucose and insulin were determined using Cholestech kits or ELISAs. qPCR was used to measure the mRNA expression of biogenesis and editing genes in the epididymal or gonadal fat. Sanger sequencing followed by alignment using Bio-Edit was used to determine editing in adipomiRs with aging.

Results

Body weights of both male and female rats significantly increased with age, with almost doubling in males. This corresponded to increase in body fat weights. The increase was observed in both sexes around 15 mo of age. Blood triglyceride increased significantly around 15 mo in male rats but not much increase was observed in females until the age of 30 mo. Blood glucose levels increased with age with a slight dip at 30 mo. However, insulin levels in both the sexes dropped significantly around 15 mo of age. A decrease in pre-adipocyte differentiation as seen by Fat-red-O staining was observed with age in both sexes. Differential expression of adipomiRs involved in differentiation was altered with aging. In males, the levels of DROSHA and DICER involved in microRNA biogenesis decreased but editing enzymes increased with age. Key adipomiRs such as miR-143 underwent increased editing with age.

Conclusion

Increased adipomiR editing with age might be contributing to the adipose dysfunction and insulin resistance seen with normal aging.

Obes Facts. 2018 May 26;11(Suppl 1):111.

T1P142 Evaluation of nutritional status of vitamin D and its relationship with anthropometric variables in individuals with obesity classified as metabollicaly healthy or unhealthy

A Cordeiro 1, BC Rodrigues 2, SE Pereira 2, CJ Saboya 2, A Ramalho 2

Introduction

There is a subgroup of individuals with obesity that may be more protected from metabolic disorders, called metabolically healthy obesity (MHO). Vitamin D deficiency (VDD) has been observed in individuals with obesity, particularly associated with abdominal obesity. Measures as body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are usually used to diagnose abdominal obesity.

Methods

A descriptive cross-sectional study was conducted with individuals of both genders, aged 20 to 59 years. Were evaluated anthropometric data as weight, height, WC, WHtR, BMI, body adiposity index (BAI), visceral adiposity index (VAI) and body roundeness index (BRI), blood pressure and metabolic parameters [blood glucose, insulin, HOMA-IR, high-density lipoprotein cholesterol (HDL-c) and triglycerides (TG)] and vitamin D [25(OH)D] were obtained. The cut-off points for VDD and insufficiency were ≤20 and 21–29 ng/mL, respectively. Individuals were classified as MHO according to the four different definitions: National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII), HOMA-IR (< 2.5), Wildman and Karelis.

Results

This study comprised 232 individuals with obesity (BMI ≥ 35 Kg/m2); 178 female (76.7%). MHO phenotype was observed in 32.3%, 23.3%, 28.5% and 17.3% of the population for NCEP/ATPIII, HOMA-IR, Wildman and Karelis definitions, respectively. So, highest percentage of individuals with MHO phenotype was demonstrated through NCEP/ATPIII. BRI and BAI mean values were higher in the MUHO than in the MHO groups when classified by HOMA-IR (p = 0.029; p = 0.010) and Wildman (p = 0.032; p = 0.035) definitions, respectively. Mean values of VAI (NCEP/ATPIII: p = 0.010; HOMA-IR: p = 0.040; Wildman: p = 0.004 and Karelis: p = 0.028) were significantly higher in the MUHO than in the MHO phenotype group. Only for the HOMA-IR definition, mean value of 25(OH)D showed a significant difference between both phenotype groups (p = 0.011); and the majority of anthropometric parameters (WC: p = 0.041; WHtR: p = 0.014; BRI: p = 0.029; VAI: p = 0.040; BAI: p = 0.010) presented highest values in MUHO with VDD. Only HOMA-IR definition presented predictors of MUHO phenotype in individuals with VDD, as WC, WHtR, BRI and BAI (p = 0.034; p = 0.007; p = 0.028; p = 0.011), respectively. Besides, was observed only in this definition, an increase of 1 ng/mL of 25(OH)D increased in 1.051 [(95%CI: 1.011–1.093), p = 0.012] the odds of the healthy phenotype.

Conclusion

Our study found a high prevalence of inadequacy nutritional status of vitamin D and its severity in individuals with MUHO phenotype. VDD were associated with highest mean values of anthropometric variables in MUHO individuals classified by HOMA-IR. BMI, WC, WHtR, BRI and BAI were predictors of MUHO phenotype in individuals with VDD classified by HOMA-IR.

Obes Facts. 2018 May 26;11(Suppl 1):111.

T1P143 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):111–112.

T1P144 Effect of multispecies probiotic in two doses on body composition, serum lipid profile and serum glucose in rats

K Skrypnik 1, J Suliburska 1, E Żuk 1, J Reguła 1, M Szulińska 2, D Skrypnik 2, I Łoniewski 3, P Bogdański 2

Introduction

Recently probiotics are considered as an intervention in obesity treatment. It has been shown that supplementation with probiotics significantly decreases body weight, body mass index (BMI), waist circumference, fat percentage, serum total cholesterol (TCH), and serum low-density lipoprotein (LDL). However, studies on impact of probiotics on body composition and lipid profile performed so far have failed to document favorable effect of probiotics on body fat mass, serum high-density lipoprotein (HDL), and serum triglycerides (TG). What is more, effect of probiotics on lean mass and free body liquid mass remains unknown. Moreover, in the great majority of trials one or two-species probiotics were implemented leaving influence of multispecies probiotic still uninvestigated. The aim of our study was to compare the effect of oral supplementation with multispecies probiotic in a daily doses of 2,5×109CFU vs. 1×1010CFU on body composition, serum lipid profile and serum glucose in rats.

Methods

30 male Wistar rats, 10 weeks old, were divided into 3 groups and received: standard diet (control group KK, n = 10), standard diet and multispecies probiotic 2,5×109CFU daily (study group PA, n = 10) or standard diet and multispecies probiotic 1×1010CFU (study group PB, n = 10) for 42 days. After 42 days body composition analysis with dual X-ray absorptiometry (DXA) was performed and body mass, total body fat mass, lean mass, free body liquid mass and obesity index were estimated. Also, after 42 days fasting blood samples were collected and the serum concentration of total cholesterol, low-density lipoproteins, high-density lipoproteins, triglycerides and glucose (GLU) were determined. Diet and water intake were monitored daily and rats’ body mass was monitored weekly. Statistical analysis was performed with Statistica ver. 12.

Results

After 42 days of experiment there were no significant differences in body mass, total body fat mass, lean mass, free body liquid mass, obesity index, and serum TCH, LDL, HDL and GLU between all three analyzed groups. In group PB significantly lower serum concentration of TG compared to KK group was registered.

Conclusion

42 days oral supplementation with multispecies probiotic in a daily dose of 1×1010CFU, contrary to a lower daily dose of 2,5×109CFU, favorably modifies lipid profile by decreasing serum TG concentration in rats on a standard diet.

Obes Facts. 2018 May 26;11(Suppl 1):112.

T1P145 The dose-dependent influence of multispecies probiotic supplementation on serum osteocalcin and hair calcium in obese postmenopausal female patients

K Skrypnik 1, J Suliburska 1, M Sobieska 2, M Szulińska 3, D Skrypnik 3, I Łoniewski 4, P Bogdański 3

Introduction

Obesity significantly influences calcium (Ca) metabolism and bone health. However, studies on this topic brings inconsistent Results. Protective effect of excess body mass on bone mineral density, named “obesity paradox”, have been shown. On the other hand a range of studies have proven unfavorable influence of excess body fat on bone tissue quality and bone turnover. Probiotics have been documented to improve bone tissue quality in obese subjects and ameliorate calcium homeostasis in postmenopausal women. Mechanisms of this favorable impact remain unclear. Osteocalcin (OC) is a protein hormone secreted by osteoblasts in vitamin K dependent manner. Vitamin K is synthesized in the large intestine by gut microbiota. OC is a pro-osteoblastic marker for bone formation. It also stimulates beta-cells to release insulin and adipocytes to secrete adiponectin - two hormones involved in obesity development. Moreover, OC promotes energy availability and utilization in myocytes. Thus, OC seems to act as a link between probiotics, calcium metabolism, bone quality and obesity. The aim of the study was to compare the effect of multispecies probiotic supplement in two doses on serum OC concentration and hair Ca content in obese postmenopausal female subjects.

Methods

73 female postmenopausal patients with body mass index (BMI) ≥ 30 kg/m2 were enrolled and randomly assigned to receive multispecies probiotic 2,5×109CFU daily (low dose group – LD, n = 26); 1×1010CFU daily (original group–O, n = 23) and placebo (placebo group – P, n = 24) for 3 months. Anthropometric parameters: body mass and BMI were quantified at baseline and at completion of the trial. Also at baseline and after 3-months intervention blood samples and hair samples were collected. OC concentration in serum with enzyme-linked immunosorbent assay (ELISA) and Ca content in hair with flame atomic absorption spectrometry (AAS) were determined. Subjects’ diet was monitored.

Results

All three groups were similar in body mass, BMI, calories and calcium intake in diet at baseline and after 3-months intervention. In LD group there was a significant decrease in hair Ca content after the probiotic supplementation. In O group significant decrease in serum OC concentration after the intervention was registered. Positive correlation between serum OC concentration at baseline and Ca hair content at completion of the study in group O was documented.

Conclusion

Multispecies probiotic supplement shows dose-dependent influence on OC serum concentration and hair Ca content. Thus, OC seems to be an important link between probiotics, gut microbiota, calcium homeostasis and bone health in obesity.

Obes Facts. 2018 May 26;11(Suppl 1):112.

T1P146 The Effects of three types of diet on intestinal microbiota in Wistar male rats: An experimental study

N Fakhoury-Sayegh 1, T Itani 2, F Haidar 1, A Khazzaka 3, R Sayegh 4, D Karam-Sarkis 2

Introduction

It is not clear how the complex interactions between diet and the intestinal microbiota affect the development of certain clinical condition such as nonalcoholic fatty liver disease (NAFLD), obesity and metabolic syndrome. Many of these conditions are influenced by diet. Our objective was to study, within 16 weeks, the change in the intestinal microbiota using three different diets enriched in varying levels of fructose and fat, and to compare the results to those of a control diet.

Methods

Forty (6 weeks old) Wistar male rats, weighing an average of 150g were randomly divided into four groups of ten, and each group assigned diets of equal quantity (20g/rat) but of varying composition in fructose and fat. The first group was fed 15g of a standardized diet (16.9% of fat, 21.3% of proteins, 61.8% of carbohydrates). The second group was fed a high fat diet (51% fat), while the third and the fourth group were fed a 35% fructose enriched diet and a high fat, high fructose diet respectively (30% fructose, 40% fat). Fecal samples were collected at the end of week 1 and at week 16 and were analyzed by real-time PCR to detect the main bacterial intestinal groups.

Results

We found differences in the intestinal microbiota composition within groups throughout the studied period (week1-week16). The second group showed a significant decrease in the total bacterial count (TBC) and colonization by Lactobacillus and Clostridium coccoides group (P < 0.05). The third group showed a significant increase in the colonization by Clostridium leptum group and a decrease in Lactobacillus (P < 0.05). The fourth group showed a significant decrease in TBC and in the colonization by Lactobacillus and C. coccoides group with a significant increase in C. leptum group (P < 0.05). For the variation between groups at week 16, a significant decrease in colonization by C. leptum group was present between the control and the second group as well as for Lactobacillus in all groups as compared to the control group. A significant decrease in TBC and C. coccoides group were reported between the first and the fourth group (P < 0.05).

Conclusion

The consumption of a high fat, high fructose or a combination of high fat/high fructose diet significantly affected the intestinal microbiota. The second and the fourth group had the most deleterious effect on the composition of the microbiota.

Obes Facts. 2018 May 26;11(Suppl 1):112–113.

T1P147 Could a test discriminate between the “good” and “bad” fecal dysbiosis? A study in subjects with morbid obesity

P G Farup 1, AS Kvehaugen 2, M Aasbrenn 2

Introduction

Fecal dysbiosis (an imbalance in the fecal microbiota) has been associated with disorders such as obesity and Irritable bowel syndrome (IBS), and with the use of Metformin and non-nutritive sweeteners (NNS). The dysbiosis associated with Metformin and NNS have been considered as favourable (“good”) and unfavourable (“bad”) respectively. Aims: Study the diagnostic properties of a commercially available test for fecal dysbiosis in subjects with morbid obesity, and explore the test's ability to discriminate between different bacteria profiles in subjects with “good” and “bad” dysbiosis.

Methods

Consecutive subjects with morbid obesity (BMI ≥ 40 kg/m2 or ≥35 kg/m2 with obesity-related complications) referred to a hospital unit for obesity were included in this cross-sectional study. A medical history was taken, the dietary intake was assessed with a food frequency questionnaire, gastrointestinal complaints including IBS were scored according to the Rome III criteria and the severity with Irritable Bowel Severity Scoring System (IBSSS), a physical examination was performed, a blood sample was collected, and fecal dysbiosis was assessed with GA-map™ Dysbiosis Test (Genetic Analysis AS, Oslo, Norway). The results of the dysbiosis test were given as Dysbiosis Index (DI) 1–5, values ≤ 2 = no dysbiosis. To discriminate between the dysbiosis associated with NNS and Metformin, an alternative dysbiosis index (ADI) (score – 10; 10) was constructed based on exploratory analyses of the changes in a selection of the 54 DNA probes used in the test. Positive ADI scores were associated with the “good” dysbiosis and negative ones with the “bad” dysbiosis.

Results

Out of 350 consecutive subjects, 90 (76 women and 14 men with a mean age of 44.7 years (SD 8.6) and BMI 41.8 kg/m2 (SD 3.6)) were included. Dysbiosis was present in 59 (66%) of the subjects with a mean DI score of 3.0 (SD 1.3). The DI scores 1–5 were present in 16 (18%), 15 (17%), 30 (33%), 13 (14%), and 16 (18%) subjects respectively. Dysbiosis was associated with smoking (p = 0.046), coffee (p = 0.026), Metformin (p = 0.002) and NNS (p < 0.001), but not with IBS or IBSSS. ADI was positively associated with Metformin (p = 0.002) (the “good” dysbiosis) and negatively associated with NNS (p = 0.001) and IBSSS (p = 0.004) (the “bad” dysbiosis).

Conclusion

The test demonstrated the expected associations between dysbiosis and NNS and Metformin, but not with IBS or IBSSS. The ADI showed the significant differences between the dysbiosis associated with Metformin (the “good” one) and with NNS and IBSSS (the “bad” one). Research should focus on changes in the different bacteria profiles in subjects with dysbiosis and not only on dysbiosis per se.

Obes Facts. 2018 May 26;11(Suppl 1):113.

T1P148 Current issues in nutrition: Circadian rhythm and gut microbiota

MS Macit 1, E Koksal 1

Introduction

Metabolism has a rhythmic, daily pattern which is directed by the hypothalamic suprachiasmatic nucleus (SCN), the main biological clock which is also named as circadian clock. In conformity with circadian rhythm, nearly 20% of the gut microbes exhibit diurnal variations, whereby the day and night gut microbiota can be different. In this review, it was aimed to assess the relationship between circadian rhythm and gut microbiota.

Methods

A literarute review was conducted on several databases (Pubmed, Science Direct, Web of Sience, Liliacs).

Results

Circadian rhythm is mainly synchronized with light and dark cycle of 24 h. Besides the master clock, peripheral clocks exist in tissues such as the liver, gut, heart, and retina. In case, general locomotor activity and food intake are two of the behavioral outputs of the endogenous circadian system. Various studies have shown that feeding rhythms can be disrupted by obesity, high-energy diets. High energy intake alters clock gene expression in peripheral organs such as the liver and adipose tissue. Perturbations to circadian rhythms are accompanied by changes in metabolism, behavior and physiological functions. The microbes release bioactive molecules which have a role in the maintenance of energy balance synchronous with this diurnal variation. The daily oscillation of microbial structure needs a functional circadian clock in the host. Some of the detected taxonomical units undergo daily oscillation in their relative abundance, including Lactobacillus reuteri, Dehalobacterium spp. and other species belonging to Clostridiales, Lactobacillales, and Bacteroidales. Diet and feeding also influence the rhythmicity of the gut microbial composition. Diet is the main regulator of microbiota; eating behavior, dietary fat and fiber composition have several impacts. Consequentially, not only the type of food but also the time of eating affects gut microbiota. Current data suggest that high-fat diet combined with circadian disruption may be caused drives microbial dysbiosis. In the light of this information, the literature indicates that there is a bi-directional relationship between circadian rhythm and microbiota. However, it should not be ruled out the direct effects of host metabolism and also dietary patterns. Thereby, it would be beneficial for the literature to tackle together these main regulators and their possible effects.

Conclusion

The relationship between circadian rhythm and microbiota appear to show up clearly, however, there is still need to clarify the mechanisms running circadian oscillations in bacteria, signals effecting circadian rhythm and microbiota by the host and specific dietary patterns.

Obes Facts. 2018 May 26;11(Suppl 1):113.

T1P149 Probiotic and symbiotic products shown to control body fat mass induce changes in gut microbiota composition and metabolism – follow-up of a randomized controlled trial

P Rasinkangas 1, K Airaksinen 1, AA Hibberd 2, CC Yde 3, ML Ziegler 2, AH Honoré 3, MT Saarinen 1, S Lahtinen 1, B Stahl 2, HM Jensen 3, L K Stenman 1

Introduction

Gut microbiota composition can be modified by probiotics and prebiotics, and the effects of these modifications on different physiological parameters are under intensive research. Especially the effect of gut microbiota on metabolic health has been of interest in recent years due to increasing prevalence of obesity and metabolic syndrome. Recently, we performed a randomized controlled trial (Clinicaltrials.gov NCT01978691) in which it was shown that by consuming probiotic strain Bifidobacterium animalis subsp. lactis 420 (B420™) and especially its combination with prebiotic Litesse® Ultra™ polydextrose (LU), it is possible to control the increase of body fat mass. Studies with animal models have shown similar findings. To study further the mechanism of action behind the findings, the effect of the intervention on the gut microbiota and metabolites was studied.

Methods

Fecal and plasma samples were collected from trial participants who were compliant with the study protocol (Per Protocol population) to analyze the effect of the intervention on the gut microbiota composition and fecal and plasma metabolites. The participants had been randomized to receive one of the 4 study products: 1) Placebo, 2) LU, 3) B420, 4) LU+B420. The study consisted of a 6-month intervention and a 1-month follow-up. The samples were collected at baseline, 2 months, 4 months, 6 months and after 1-month follow-up. For gut microbiota analysis, DNA from faecal samples was sequenced with Illumina MiSeq technology and the sequence data was processed using the QIIME software and Greengenes reference database. Functional metagenome predictions were performed using the PICRUSt software. Fecal metabolites and plasma bile acids were analyzed using NMR and UHPLC-MS/MS, respectively.

Results

It was discovered that B420 intervention increased the abundance of Lactobacillus spp. and Akkermansia spp., while LU+B420 increased Akkermansia spp., Christensenellaceae spp. and Methanobrevibacter spp. and reduced Paraprevotella spp. Increase in the abundance of Christensenellaceae spp. in the LU and LU+B420 groups was consistent throughout the intervention, and in the LU+B420 group it correlated negatively with waist-area body fat mass at the end of intervention. Alterations in KEGG pathways related to cellular processes and metabolism were predicted for both B420 and LU+B420 groups. Plasma bile acids GCA, GUDCA and THDCA+TUDCA were reduced in LU+B420 group.

Conclusion

B420 and its combination with LU altered the gut microbiota and plasma metabolites. Both B420 and B420+LU increased the abundance of bacterial genera which have previously been shown to be associated with lean phenotype. This might in part explain the previous findings regarding body fat mass control.

Conflicts of Interest

This research was funded by DuPont Nutrition & Health.

Obes Facts. 2018 May 26;11(Suppl 1):114.

T1P150 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):114.

T1P151 Inhibition of PIKfyve improves cardiometabolic phenotype in chronic diet-induced obesity through activation of SIRT3

M Cinato 1, H Tronchere 1, A Timotin 1, L Guitou 1, C Villedieu 2, H Thibault 2, D Baetz 2, B Payrastre 1, P Valet 1, A Parini 1, O Kunduzova 1, F Boal 1

Introduction

Obesity is closely associated with cardiovascular and metabolic complications. The present study was designed to explore the role of the lipid kinase PIKfyve in myocardial damage associated with obesity, combining in vitro and in vivo approaches. PIKfyve is an evolutionarily conserved phosphoinositide 5-kinase that regulates pleiotropic cellular functions.

Methods

Inhibition of the kinase was performed using STA-5326 (Apilimod), a new potent and highly selective inhibitor, and siRNA-mediated silencing of endogenous PIKfyve.

Results

In vitro, we show that STA-5326 treatment reduced hypoxia-mediated cellular hypertrophy, apoptosis and mitochondrial ROS production. In addition, we report that chronic STA-treatment improves cardiometabolic profile in a mouse model of cardiomyopathy linked to obesity, improving left ventricular function and attenuating cardiac hypertrophy. Furthermore, we provide evidence that inhibition of PIKfyve drives SIRT3 pathways both in vitro and in vivo models.

Conclusion

Altogether, these results unravel a novel role for PIKfyve in obesity-associated cardiomyopathy and provide a promising therapeutic strategy to combat cardiometabolic complications in obesity.

Obes Facts. 2018 May 26;11(Suppl 1):114.

T1P152 Quercetin reduces obesity-related skeletal muscle atrophy

Y Kim 1, C Kim 1, Y Joe 2, HT Chung 3, TY Ha 4, R Yu

Introduction

Obesity-induced muscle inflammation causes protein degradation, and is implicated in obesity-related skeletal muscle atrophy and age-related sarcopenia. Quercetin is an abundant flavonoid in various vegetables and fruits and elicits beneficial actions against metabolic diseases.

Methods

In this study, we investigated the effect of quercetin on TN-Fα-induced atrophic responses in myotube/skeletal muscle and its potential mechanism of action.

Results

We observed that quercetin suppressed expression of TNFα-induced atrophic factors such as MAFbx/Atrogin-1 and MuRF1 in myotubes, and it enhanced HO-1 protein level accompanied by increased nuclear translocation of Nrf2 in myotubes. The HO-1 inhibitor ZnPP suppressed the inhibitory actions of quercetin on TNFα-induced atrophic responses and degradation of IkB-α in myotubes. Moreover, quercetin supplementation to HFD-fed obese mice inhibited obesity-induced atrophic responses in skeletal muscle, accompanied by up-regulation of HO-1 and inactivation of NF-κB, and the quercetin actions were attenuated in Nrf2-deficient mice.

Conclusion

These findings suggest that quercetin protects against TN-Fα-induced muscle atrophy in myotubes and obese skeletal muscle through Nrf2/HO-1 pathway accompanied by inactivation of NF-κB. Quercetin may be used as a dietary supplement to protect against obesity-induced skeletal muscle atrophy.

Obes Facts. 2018 May 26;11(Suppl 1):114.

T1P153 Efficacy and Safety of HSG4112, a Novel Anti-Obesity Oral Agent in Diet-Induced Obesity (DIO) Mice

K Lim 1, S Yoo 1, K Kim 2, IG Jo 3

Introduction

HSG4112 is an Investigational New Drug (IND) discovered by Glaceum Inc. through Quantitative Structure-Activity Relationship (QSAR) study on Glabridin and its derivatives. It is currently in Phase 1 study as a treatment for obesity. In nonclinical studies, HSG4112 showed a significant body-weight reduction effect with excellent safety profiles in Diet-Induced Obesity (DIO) mice.

Methods

The test consisted of a normal control group (normal diet), a vehicle control group (high fat diet), a test group (HSG4112 100mg/kg) and a pair-fed group. HSG4112 was given orally once daily for 7 days for 6 consecutive weeks (qd×7×6).

Results

After 6 weeks, the total mean weight loss was 10.2g (-26.0%) in the test group. The contribution made by reduced food intake was 38.0% and the energy expenditure effect was 62.0%. Increase of O2 consuming and CO2 generating rates, and decrease of 5’ Adenosine Monophosphate-activated Protein Kinase (AMPK) activity in hypothalamus after oral administration of HSG4112 to DIO mice were observed. Single oral dose toxicity study of HSG4112 was performed with rat and dog. The Maximum Tolerated Dose (MTD) 2,000mg/kg was observed from both rat and dog.

Conclusion

In conclusion, in nonclinical studies, HSG4112 demonstrated sufficient efficacy and safety as an anti-obesity drug supporting further clinical development.

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Obes Facts. 2018 May 26;11(Suppl 1):114–115.

T1P154 A new functional sweetener D-Allulose prevents the commencement and progression of obesity and type 2 diabetes mellitus in T2DM model OLETF rats

A Hossain 1, K Kamitori 1, T Iida 2, M Tokuda 1

Introduction

Prevalence of global obesity has emerged as the single most life-style related health problem. The inextricably interlinked pathological progression from excessive weight gain, obesity, and hyperglycemia to type two diabetes mellitus (T2DM), typically originates from the overconsumption of sugar and high-fat diets. This situation warrants attentive consideration of alternative medicines that provide better protection with lesser side effects. Recently, we have developed and discovered the advantages of a rare sugar d-allulose, a zero-calorie sweetener which has been identified as a non-toxic compound having strong anti-dyslipidemic and anti-hyperglycemic effects and thus represents to maintain blood glucose levels. D-allulose which is named rare sugar since it's availability in nature is very rare, and is being synthesized through enzymatic conversion from the mixture of natural sugars in Kagawa University, Japan.

Methods

In this study 5% D-allulose mixed in drinking water was fed to OLETF (Otsuka Long-Evans Tokushima Fatty) rats, a type 2 diabetes model, where control OLETF and non-diabetic healthy control, LETO were fed water only. Body weight, food and drink intake were measured weekly, blood glucose and insulin monthly. Oral glucose tolerance test was performed. Liver, pancreas and other organs were preserved and stained.

Results

5% D-allulose fed for 60 weeks significantly maintained body weight (p < 0.01), blood glucose (p < 0.05) and insulin (p < 0.05) levels than control rats. Oral glucose tolerance tests also showed significant reduction (p < 0.01) of glucose rise by D-allulose at 30 and 60 weeks. D-allulose significantly reduced both body fat levels (p < 0.5) and abdominal fat accumulation (p < 0.01), also markedly attenuated progressive β-islet fibrosis evaluated by HE, Masson's trichrome staining and immuno-staining for insulin, glucagon and α-smooth muscle actin. Serum pro- and anti-inflammatory adipocytokines were also controlled well.

Conclusion

It is concluded that rare sugar D-allulose might be a promising strategy for the prevention of life-style related diseases through controlling obesity, maintaining blood sugar, and preserving pancreatic β-cells.

Obes Facts. 2018 May 26;11(Suppl 1):115.

T1P155 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):115.

T1P156 The effect of soy isoflavones on diabetic nephropathy

HF Jheng 1, M Hirotsuka 1, Y Matsumura 2, T Goto 3, T Kawada 3

Introduction

Diabetic nephropathy is one of major cause of end-stage of renal disease. Accumulating evidence now indicates that immunologic and inflammatory mechanisms play a significatnt role in diabetic nephrpathy (DN) development and progression. Soybean's protective effects on kidney function in patients with type 1 and type 2 diabetes have been previously discussed. Lines of evidecne reveal the mechanism by pure components of soybeans protect kidney fucntion in insulin-dependent diabetes mellitus. However, to our knowldge, lack of information about the effects of soybeans on DN in obesity-induced diabetes. Here, we observed the effect of long-term consumption of different soy mixtures contained different amount of isoflavones, and observed their effects on renal inflammation and DN in type 2 diabeic mouse model.

Methods

KKAy mice were fed with casein-based diet (control), high soy-isoflavones and soy-proteins diet (Soy-HIHP), high soy-isoflavones diet (Soy-IP), and high soy-protein diet (Soy-HP) from 5-weeks old for 3 months. Histopathology was used to evaluate the pathologic change in kidney, renal inflammation. ELISA were used to observe albumin and cytokine excreted in urine.

Results

All Soy-based diet group, but not control group showed less increases of water intake, urine output, urinary albumin and glucose excretion, suggesting renal function was maintained better in diabetic mice fed with soy-based diet. Dual protective effect were shown in Soy-HIHP group, evidenced as less mesangial sclerosis, less renal interstitial fibrosis and less tubular and glomerular injury marker detection, with well tubular and glomerular structural protein preservation. In these data, Soy-HI showed the tendency of protecting renal tubules. Highly urinary cytokine excretion observed in the control group, whereas only low level of cytokine were detected in urine in Soy-HIHP and Soy-HI, but not Soy-HP group. Furthermore, F4/80 and toll-like receptor 4 (TLR4) were less expressed in both Soy-HIHP and Soy-HI groups compared with the control and Soy-HP group.

Conclusion

Our data suggest us dietary soy isoflavones has potential effect of anti-renal inflammation in diabetes and contribute to retard the progression of diabetic nephropathy.

Conflicts of Interest

M. Hirotsuka have been funded by the Fuji Oil Company.

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Obes Facts. 2018 May 26;11(Suppl 1):115–116.

T1P157 Association of obesity gene variants with metabolic phenotypes and development of a genetic risk score for obesity in Thai adults

C Chaichana 1, N Khumkhana 1, K Pimsen 1, C Chanprasert 2, N Plengvidhya 2, PT Yenchitsomanus 3, W Tangjittipokin 4, M Homsanit 5, N Densupsoontorn 6, J Santiprabhob 6, P Yamwong 1, P Pramyothin 1

Introduction

The prevalence of obesity in Thailand have increased exponentially in the past few decades. Genome-wide association studies (GWAS) have clearly demonstrated the role of genetics in obesity pathogenesis in other populations, however limited data is available in Thais. The goal of this study is to explore the association between genetic variants and obesity-related phenotypes, and to develop a genetic risk score for use in prediction of such phenotypes in Thai adults.

Methods

Obese (BMI ≥30 kg/m2) and lean adults (BMI 18–23 kg/m2) were enrolled in a case-control study. All participants were subjected to careful evaluation including personal and family history, anthropometry and biochemical profiles. Thirteen common variants of BMI-associated loci were screened by high resolution melting (HRM) analysis. Genetic risk score (GRS) was generated by scoring each variant as 0, 1 and 2 according to number of risk alleles and summing all scores in each subject. Prediction accuracy of GRS was tested using receiver-operating characteristics (ROC) curve analysis.

Results

The study consisted of 302 obese subjects (age 39.5 ± 13.0 years, 62% female, BMI 40.2 ± 6.7 kg/m2) and 306 lean controls (age 31.9 ± 7.1 years, 86% female, BMI 19.5 ± 1.5 kg/m2). Logistic regression analysis using codominant models demonstrated that homozygous genotypes of 5 loci including BDNF rs6265 (G/G), FTO rs17817449 (G/G), GNPDA2 rs10938397 (G/G), TFAP2B rs4715210 (T/T) and CDKAL1 rs9356744 (T/T) were significantly associated with obesity with odds ratios of 1.70 (95%CI: 1.08–2.68, p = 0.023), 2.43 (95%CI: 1.34–4.40, p = 0.004), 3.54 (95%CI: 2.04–6.14, p < 0.001), 2.31 (95%CI: 1.13–4.73, p = 0.022) and 3.06 (95%CI: 1.79–5.22, p < 0.001), respectively. The genotype of BDNF and GNPDA2 was significantly correlated with higher levels of Insulin (p = 0.009 and 0.023) and high-sensitivity C-reactive protein (p = 0.008 and 0.013), while TFAP2B and FTO variants correlated with higher level of fasting plasma glucose (p = 0.001 and 0.018) in the obese group. GRS combining these 5 SNPs was significantly higher in obese than lean adults (mean 4.3 ± 1.6 vs. 3.5 ± 1.4, p < 0.001) and was significantly correlated with BMI (r = 0.251, p < 0.001), wait-hip ratio (r = 0.256, p < 0.001), HbA1c (r = 0.235, p < 0.001), fasting plasma glucose (r = 0.184, p < 0.001), fasting insulin (r = 0.285, p < 0.001), triglyceride (r = 0.281, p < 0.001), and inversely correlated with HDL-c (r = −0.257, p < 0.001). Accuracy of GRS for disease classification (obese vs. lean) was fair with ROC area under the curve (AUC) of 0.62 (0.56–0.68, p < 0.001).

Conclusion

Multiple variants SNP may contribute to the risk of obesity and may predict obesity-related metabolic traits in Thai subjects. Burden of genetic risk as represented by GRS proved to be significantly correlated with obesity and associated phenotypes, however clinical utility of the proposed GRS remains limited.

Obes Facts. 2018 May 26;11(Suppl 1):116.

T1P158 Study design and rationale for BARICO: A longitudinal study to evaluate the effects of excessive weight loss on brain function and structure

D Vreeken 1, M Wiesmann 2, LN Deden 1, IAc Arnoldussen 2, F Schuren 3, E Aarts 4, RPc Kessels 5, R Kleemann 6, EJ Hazebroek 1, EO Aarts 1, AJ Kiliaan 2

Introduction

Mid-life obesity is associated with structural brain changes, cognitive problems and neurodegenerative diseases. Body mass can be immediately decreased by rapid weight loss via bariatric surgery (BS) and has been found to be associated with improved cognitive function. However, cognitive benefit after BS is not equally exhibited across patients and decline of cognitive function and increase in body weight are reported as well. Due to the relatively short length of follow-up and small numbers of BS recipients described in literature, it is not revealed till now how weight loss may impact underlying degenerative processes in cognitive decline and Alzheimer's disease. We aim to determine the longitudinal effect of weight loss after BS on different measures of cognition, brain function and structure investigated with neuropsychological tests and (functional) MRI parameters. Secondary, we want to determine health and inflammation status of adipose tissue, liver and gut, in relation to brain structure and function and whether weight loss affects gut microbiota composition and whether these changes correlate with neuropsychological measures.

Methods

150 Dutch patients (age 35–55, both men and women) will be tested at different time-points using neuropsychological tests, questionnaires, blood and feces analyses before and after RYGB and analyses on several tissues collected during the surgery in order to measure cognition, health and inflammation status overtime (Figure 1). A subgroup of 75 participants will (in addition to the other parameters) be examined using (functional) MRI scanning. Various MRI parameters will be examined, such as changes in BOLD signal during the Stroop task measured with fMRI, fractional anisotropy and mean diffusivity measured with diffusion tensor imaging and cerebral blood flow measured with arterial spin labelling. After two years patients will be divided in two groups based on their excess weight loss (< 50% or >50% loss of excess weight) to compare the two groups and determine the effect of weight loss.

Results

Not applicable

Conclusion

The BARICO study has the potential to be the first to demonstrate whether brain structure and function changes occur after weight loss and relate this to the health status of different tissues and changes in gut-microbiota. More information on the mechanisms underlying obesity and cognitive problems can lead to better health campaigns and more targeted actions against obesity. Our data might ultimately support the development of personalized treatments against obesity in combination with BS and herewith the prevention/inhibition of neurodegenerative diseases.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):116–117.

T1P159 Repeat length variations in polyglutamine disease-associated genes affect body mass index

S L Gardiner 1, R De Mutsert 2, S Trompet 3, M Boogaard 4, K Willems Van Dijk 3, PJ W Jukema 5, PE Slagboom 6, RAc Roos 1, H Pijl 3, FR Rosendaal 2, NA Aziz 7

Introduction

The worldwide prevalence of obesity, a major risk factor for numerous debilitating chronic disorders, is increasing rapidly. Although a substantial amount of the variation in body mass index (BMI) is estimated to be heritable, the largest meta-analysis of genome-wide association studies (GWAS) to date explained only ~2·7% of the variation. To tackle this ‘missing heritability’ problem of obesity, here we focused on the contribution of DNA repeat length polymorphisms which are not detectable by GWAS.

Methods

We determined the cytosine-adenine-guanine(CAG) repeat length in the nine known polyglutamine disease-associated genes (ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7, TBP, HTT, ATN1 and AR) in two large cohorts consisting of 12 457 individuals and analysed their association with BMI and using generalized linear mixed-effect models.

Results

We found a significant association between BMI and the length of CAG repeats in seven polyglutamine disease-associated genes (including ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7, TBP and AR). Importantly, these repeat variations could account for 0.75% of the total BMI variation.

Conclusion

Our findings incriminate repeat polymorphisms as an important novel class of genetic risk factors of obesity and highlight the role of the brain in its pathophysiology.

Obes Facts. 2018 May 26;11(Suppl 1):117.

T1P160 Vitamin D Deficiency in Obstructive Sleep Apnea Syndrome Patients

F Ayyıldız 1, H Yıldıran 1, O Köktürk 2, M S Karacil Ermumcu 1

Introduction

Vitamin D deficiency has roles in development of autoimmune diseases, bone diseases, inflammatory bowel disease, diabetes, many types of cancer and cardiac diseases. Recently the association between OSAS (obstructive sleep apnea syndrome) and vitamin D has gained research interest.

Methods

This review aims to explain vitamin D deficiency in obstructive sleep apnea syndrome patients.

Results

Obstructive sleep apnea syndrome (OSAS) is a disorder which has many risk factors as age, gender, genetic and inflammation. Today, vitamin D deficiency is examined in these risk factors, too. Some studies indicated that 25(OH)D level is lower in OSAS patients than control group. However the mechanism of vitamin D deficiency in OSAS has not been identified clearly. Vitamin D is associated with inflammation. Inflammation markers (Tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin (IL)- 6, −8 and −10) are believed to have a role in sleepiness observed in OSAS. Besides, it is known that obesity is related with vitamin D deficiency. The prevalence of obesity in OSAS patients is higher (%67.3). Some studies showed that there was negative correlation between vitamin D level and body mass index (BMI) in OSAS patients. Vitamin D supplementation can affect disease progress in many diseases by reducing inflammation. It is believed that this treatment may be efficient in OSAS patients, too.

Conclusion

Thus, it is needed large samples and randomized studies with control groups are needed for further studies to understand serum 25(OH)D deficiency in OSAS.

Obes Facts. 2018 May 26;11(Suppl 1):117.

T1P161 Do Scores on the Power of Food Scale Reflect Brain Food-cue Reactivity in People with Obesity?

M Binks 1, C Kahathuduwa 2, T Davis 3

Introduction

The Power of Food Scale (PFS) is a commonly used, validated, self-report measure that examines the psychological effects of exposure to abundance of food. However, the association between PFS and functional changes occurring in the human brain in the presence of food cues (i.e. food-cue reactivity) has not been studied. Using archival data of a 3-week calorie restriction intervention conducted in individuals with obesity, we aimed to explore whether pre-intervention and post- vs. pre-intervention change scores of PFS will correlate with pre-intervention functional magnetic resonance imaging food-cue reactivity (fMRI-FCR) and post- vs. pre-intervention change in fMRI-FCR respectively.

Methods

Thirty-two male and female adults with obesity (19–60 years; 30–39.9 kg/m2) participated in a 3-week dietary intervention (1120 kcal/d from either 1) total meal replacement shakes, 2) portion-controlled typical food. PFS and fMRI-FCR were measured pre- and post-intervention. Correlations between pre-intervention fMRI-FCR and standardized pre-intervention PFS subscales; and also post- vs. pre-intervention change in fMRI-FCR and standardized changes in PFS subscales were examined at the whole brain level using tools in FMRIB Software Library and a 3-level model. Final brain images were thresholded using a permutation-based approach (i.e. randomise).

Results

Twenty-eight subjects completed the intervention. At the pre-intervention stage (N = 32), the aggregated domain of PFS or its 3 subdomains (i.e. food available, FA; food present, FP; and food tasted, FT) did not correlate with fMRI-FCR of individuals with obesity (P > 0.595; P > 0.656; P > 0.408; and P > 0.629 respectively). Similarly, the post- vs. pre-intervention change (N = 28) of the aggregated domain of PFS or the 3 subdomains (i.e. FA, FP and FT) did not correlate with corresponding changes in fMRI-FCR (P > 0.324; P > 0.243; P > 0.150; and P > 0.558 respectively).

Conclusion

Our negative findings suggest that the aggregate domain or the subdomains of PFS do not appear to be robust indicators of neurophysiological processes occurring when individuals with obesity are exposed to food cues. Furthermore, our findings indicate that changes in domains of PFS do not appear to be reliably reflecting the corresponding changes occurring in the brain food-cue reactivity of individuals with obesity. However, we cannot completely rule out the presence of weak associations between PFS domains and fMRI-FCR of the brain.

Conflicts of Interest

The study was funded by Nestle Health Science. Dr. Binks has also served as a speaker for Nestle Health science.

Obes Facts. 2018 May 26;11(Suppl 1):117–118.

T1P162 Hypoalbuminemia in obese rats is not responsive to higher dietary protein intakes

C Guillet 1, F Rossignon 1, A Carayon 1, J Salles 1, V Patrac 1, O Le Bacquer 1, C Giraudet 1, J Rigaudiere 1, C Domingues-Faria 1, S Warland 1, Y Boirie 1

Introduction

Few recent evidences suggest that unexpected low serum albumin concentrations may occur in severely obese patients without liver disease or renal failure1. In addition, low serum albumin might be amplified in obese older people since ageing is often associated with poor nutritional state. So, inadequate dietary protein intake of obese people might explain this lower albumin concentration. Regarding this hypothesis, we investigated in young and old rats the response of serum albumin to two levels of either protein or fat intakes.

Methods

Male Wistar rats aged 9 months (adult) and 19 months (old) were fed during 10 weeks either with a standard diet (STD) with normal lipid intake (13.8% of total energy intake (TEI)) or with a high fat diet (HFD) (45% of TEI). For each diet, two levels of protein intakes were tested: 12% of TEI (STD12 and HFD12) and 25% of TEI (STD25 and HFD25). Body weight for each animal was measured weekly. Serum albumin was quantified by photometric analysis (Konelab 20, Thermo Fisher Scientific). The data are presented as mean ± standard error and analyzed by two-way ANOVA (diet and protein intake) and a Duncan's Multiple-Comparison Post-hoc Test.

Results

After 10 weeks of diets, body weight was significantly higher in HFD groups compared to STD groups in both age groups. Body weight in adult HFD25 group was lower than in HFD12 group. Serum albumin concentrations were significantly lower in obese adult rats and the higher protein intake in HFD25 did not restore the hypoalbuminemia. For old rats, serum albumin levels were significantly lower than in adult rats except for HFD12 and were significantly lower in HFD25 compared to the other groups.

Conclusion

Adult diet-induced obese rats have a low albumin concentration which is not restored by higher dietary protein intake as well as in old obese rats. This observation confirms that albumin metabolism is altered in obesity and suggests that albumin may not be a reliable marker of nutritional state in clinical situations. 1. Mosli RH, Mosli HH. Obesity and morbid obesity associated with higher odds of hypoalbuminemia in adults without liver disease or renal failure. Diabetes Metab Syndr Obes. 2017 Nov 8;10:467–472.

Tab. 1.

 

 STH12
 STH25
 HFD12
 HFD25
Body weight (grams)
Adult rats 682.6 ± 66.8 664.3 ± 71.5 767.0 ± 70.1*# 722.9 ± 62.7*#§
Old rats 623.5 ± 71.7 625.3 ± 42.7 702.6 ± 44.9*# 682.3 ± 66.4*#
Albumin (g/L)
Adult rats 35.0 ± 1.6 34.2 ± 1.5 33.4 ± 1.6* 32.7 ± 1.7*#
Old rats 33.3 ± 1.8$ 32.0 ± 1.7$ 32.1 ± 1.6 30.2 ± 1.4*§$
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*

P < 0.05 vs STD12;

#

P < 0.05 vs STD25;

§

P < 0.05 vs HFD12.

$

P < 0.05 old vs adult (Student test)

Obes Facts. 2018 May 26;11(Suppl 1):118.

T1P163 Prolonged intake of a hyperproteic casein-based diet promotes a molecular environment leading to liver triacylglycerol deposition and increases markers of hepatic damage in rats

R Díaz-Rúa 1, J Keijer 2, EM Van Schothorst 2, A Palou 1, P Oliver 1

Introduction

High protein (HP) diets have been associated to body weight loss and positive metabolic effects on obese subjects. However, controversy exists on the effects of long-term intake of these diets, as more recent reports point to health risk and higher mortality. Liver is a key organ involved in macronutrient handling, thus, we aimed to analyse the effects of HP diets on liver metabolism and health.

Methods

We performed a transcriptome analysis on liver of healthy adult male Wistar rats fed for 4 months with a casein-rich HP diet and analysed adiposity and molecular parameters related to metabolic syndrome and liver injury.

Results

Compared to rats on a control diet, HP-fed animals, that ingested 2.3 times higher amount of protein than controls, showed a lower cumulative food intake and lower body weight; although this lower body weight was not related to decreased adiposity. HP-fed animals presented lower serum cholesterol levels and were apparently healthy according to parameters related to metabolic syndrome: no differences were found in circulating non-esterified fatty acids or triaclyglicerols (TG) in comparison to controls. In liver, long-term intake of the casein-rich diet had an impact on metabolic pathways related with amino acid uptake/metabolism and lipid synthesis, indicative of higher TG deposition. Liver transcriptomic analysis also revealed up-regulation of immune-related genes and changes in expression of genes involved in acid-base maintenance and oxidative stress, pointing to alterations in the pH balance due to the high acid load of the diet, which has been linked to liver/health damage. In line with these transcriptomic changes, clear functional signs of unhealthy effects, such increased liver TG content and increased serum markers of hepatic injury/inflammation (aspartate transaminase, C-reactive protein and TNF-alpha) were observed. Moreover, chronic intake of the HP diet produced a dramatic increase of hepatic HSP90, a marker of liver injury.

Conclusion

A drastic and prolonged increase in diet protein intake, resulting in a high acid load, induces a hepatic transcriptome signature reflecting increased TG deposition and increased levels of markers of liver/health injury.

Obes Facts. 2018 May 26;11(Suppl 1):118.

T1P164 Bariatric surgery reverses obesity-induced alterations in MMP-9 activity, pAMPK and oxidative stress correlating with p53 expression

CF García-Prieto 1, M Gil-Ortega 1, M Martín-Ramos 1, D Ramiro-Cortijo 2, E Bordiú 3, MÁ Rubio 3, A Torres 4, MS Fernández-Alfonso 5, B Somoza 1

Introduction

Obesity has been recently identified as a major risk factor for cancer in humans. Indeed, a variety of pathophysiological mechanisms that take place during the onset of obesity like metabolic and endocrine abnormalities, chronic inflammation and oxidative stress have been proposed to favor the development of cancer. Bariatric surgery results in sustained excess weight loss and may have a protective effect on overall cancer risk, mainly in women. Several mechanisms have been proposed to explain the protective effect of surgery, but the exact mechanisms have not been elucidated yet. In this regard, two proteins normally altered in obesity, matrix metalloproteinases (MMPs) and adenosine monophos-phate-activated protein kinase (AMPK) have been also associated with cancer. Whereas MMPs appear to stimulate tumorigenesis, cancer cell invasion and metastasis, AMPK has recently emerged as a potential metabolic tumor suppressor. Therefore, the aim of this study was to assess the impact of bariatric surgery on MMPs activity and AMPK phosphorylation as potential biomarkers of obesity-associated cancer.

Methods

Seventeen obese patients (female 11/male 6; 46.7 ± 2.0 years old; BMI = 42.66 ± 0.9687 Kg/m2) were studied before and 12 months after bariatric surgery [elective gastric bypass (9) or laparoscopic sleeve gastrectomy (8)] and 7 non-obese patients (female 7; 45.0 ± 4.5 years old; BMI = 22.7 ± 0.6 Kg/m2).

Results

Total and active MMP-9 activity determined by gelatin zymography and ELISA, respectively were significantly increased in obese patients (p < 0.01). In addition, protein carbonyls (as index of oxidative stress on proteins) analyzed by 2,4-dinitrophenylhydrazine (DNPH)-based assay and p53 (the most commonly mutated gene in human cancer) expression were significantly higher in obese patients compared to the non-obese group (p < 0.001). Bariatric surgery significantly reduced MMP-9 activity, carbonyls and p53 expression thus reaching values like non-obese patients (p < 0.001 vs pre-surgery), as well as body weight (31.8% vs pre-surgery; p < 0.001). Contrarily, AMPK phosphorylation (p-AMPKThr-172) was significantly reduced in obese patients compared with non-obese (p < 0.01) but also re-established after surgery. Interestingly, MMP-9 activity and p-AMPKThr-172 correlated with p53 expression (p < 0.01). Similarly, BMI also correlated with all the parameters analyzed (p < 0.05).

Conclusion

These data show that bariatric surgery is associated with a reversion of obesity-induced alterations in both MMP-9 activity and AMPK phosphorylation, oxidative stress and p53 expression. Since those changes have been associated with an increased incidence of cancer, bariatric surgery could constitute a potential therapeutic intervention to prevent the development of cancer in obese patients. (Supported by Fundación Mutua Madrileña, BFU2011–25303, GR921641, FUSP-CEU, and SESCAMET).

Obes Facts. 2018 May 26;11(Suppl 1):119.

T1P165 The effect of acute continuous normobaric hypoxia on triglyceride levels in constantly fed healthy men

P Imbeault 1, É Chassé 2, B Mahat 1, J Mauger 2

Introduction

Recent animal studies reported that hypoxia has a quick, strong adverse effect on postprandial circulating triglycerides (TG). Whether hypoxia has the same effect in humans is unclear. Using differentiated human preadipocytes, we have recently shown that acute exposure to hypoxic conditions (3% O2) 1) strongly inhibits the activity of lipoprotein lipase, a key enzyme involved in triglyceride clearance and 2) increases basal lipolysis, which supplies systemic free fatty acids that contribute to hepatic very low-density lipoprotein (VLDL) production. Based on these findings, we tested whether an acute exposure to continuous normobaric hypoxia would increase TG levels in constantly fed healthy men.

Methods

Total plasma TG concentrations as well as TG in plasma density fraction < 1.006g/ml (chylomicrons) were measured in nine healthy young men (1.79(0.04) m; 77.8(8.0) kg; 24(5) y) kept in a constantly fed state in either control (FiO2 = 0.2093) or hypoxic (FiO2 = 0.1200) conditions for 6 hours assigned in a randomized crossover fashion. Energy expenditure and substrate oxidation rate, assessed by indirect calorimetry, plasma nonesterified fatty acids (NEFA) concentrations and total plasma post-heparin lipolytic activity (PHLA) were also measured.

Results

There was no statistical difference in energy expenditure or substrate oxidation rate between control and hypoxia sessions. Exposure to acute hypoxia led to statistically significant increases in plasma NEFA (+30%) and total TG (+7%) levels (p < 0.05) compared to control. There was no statistical differences neither in PHLA nor TG content of the d < 1.006g/ml fraction between conditions.

Conclusion

Acute normobaric hypoxia negatively affects postprandial TG concentrations without seemingly affecting total lipolytic activity and chylomicrons metabolism in healthy men. Studies are needed to determine if hypoxia affects postprandial VLDL metabolism. Our results suggest that hypoxia as experienced during high altitude sojourn or obstructive sleep apnea may negatively, but subtly, affect postprandial TG concentrations in humans.

Obes Facts. 2018 May 26;11(Suppl 1):119.

T2P2 Long term mortality in Anorexia Nervosa: results of a 10-year follow-up and a an updated review of the literature

E Speranza 1, L Santarpia 1, E De Filippo 1, C De Caprio 1, R Sammarco 1, O Di Vincenzo 2, M Marra 2, F Pasanisi 1, F Contaldo 1

Introduction

The prevalence of anorexia nervosa (AN) has steadily increased over the past decades. The standardized mortality ratio (SMR) observed in young people with AN substantially varies from 0.72 to 12.8, about three times higher than other psychiatric disorders. The aims of this study are to update the long-term mortality as SMR, both from AN-related and AN-unrelated diseases, in a Southern Italy population of restrictive Anorexia Nervous patients and to compare our findings with the most recently published reports on this topic.

Methods

117 AN outpatients visited since January 2000 to December 2005 were considered with a minimum of 10 years follow-up. A questionnaire was administered by telephone interview or directly to assess each patient's current clinical and socio-economic (study degree, civil status, pregnancies) conditions. Follow up data have been collected since January to September 2015. Our 10-year follow-up data have been compared with those published in 9 studies on mortality rate published from 2006 to 2016 selected after a a systematic literature search.

Results

Considering all the selected studies, we observed three hundred and ninety-eight deaths in 8517 patients, amounting to a total mortality rate of 3.72%. Deaths due to suicide, AN-related and AN-unrelated diseases were 0.16, 0.89 and 1.61%, respectively. After correcting for unrelated deaths, mortality rate was 2.11% . In our 10-year follow-up, we found a mortality rate of 0.85%, one died was ascertain on total sample. Standardized mortality ratio was 6.9 . The questionnaire has been administered to 40 patients, in our long-term observation the high level of cultural degree is confirmed: 54.5% (n = 22) achieved a university degree; diploma was recorded in 24.2% (n = 10), and more than half had steady employment (54,5%; n = 22). The rate of unemployment was very low, around 6.1% (n = 2). After at least 10 years of follow up (12.7 ± 2.1 range 7–16), 69.1% (n = 28) of the interviewed presented a discreet remission of clinical symptoms.

Conclusion

In conclusion, these results compared with our-and by other authors (Signorini et al 2007) previous observations, suggest a declining path of the mortality rate associated with restrictive type of Anorexia Nervosa possibly due to an earlier diagnosis, more specialized therapies and training of the clinical nutritional and psychiatry teams. However, mortality rate still results high when compared to age matched female population. As a matter of fact, and from clinical practice experience these patients maintain borderline behaviors: for example, meticulous and perfectionist personality treats as evidenced by questionnaire's Results.

Obes Facts. 2018 May 26;11(Suppl 1):119–120.

T2P3 Does implementation of guidelines for healthier school canteens result in changes in canteens and healthier purchase behaviour of students?

I J Evenhuis 1, E L Vyth 1, S Jacobs 2, L Veldhuis 2, JC Seidell 1, CM Renders 1

Introduction

To stimulate healthy food and drink choices the Netherlands Nutrition Centre developed the ‘Guidelines for Healthier Canteens’. These guidelines describe how to improve the availability and accessibility of healthier products. To support stakeholders to implement these guidelines in secondary schools, we developed/adapted implementation activities in collaboration with experts of science, policy and practice. This study investigated the effectiveness of these implementation activities on (a) the availability and accessibility of healthier food and drink products in the school canteen; and (b) the effect on food purchasing behaviour of students.

Methods

We conducted a quasi-experimental study with 10 intervention and 10 control secondary schools. The intervention schools received support to implement the ‘Guidelines for Healthier Canteens’; i.e. an advisory meeting and report, communication materials, newsletters, an online community and a factsheet with student's wishes/needs. Control schools only received the guidelines. Measurements were conducted at baseline and after the intervention (after 5–6 months). Changes in the school canteen were assessed using the ‘Canteen Scan’, an online tool to measure product availability on displays (counter, racks, shelfs) and vending machines, and product accessibility (e.g. promotion and placement of products). Changes in students purchasing behaviour were assessed by online questionnaires. Purchasing behaviour was defined as number of purchases a week, differentiated in purchases from the canteen and from vending machines, and categorized in number of healthier and less healthier products. We conducted linear and logistic regression analyses and used a two-level regression analysis (students, nested within schools) to determine the effectiveness on purchasing behaviour, with gender as an effect modifier.

Results

Preliminary analyses showed statistically significant positive differences in availability of products on display (p = 0.007) and accessibility criteria (p = 0.03) in the intervention group and not in the control group. In addition, results among 1858 students (mean age = 13.4y) revealed that students in intervention schools significantly decreased their purchases of less healthier products in vending machines (p = 0.02) and marginally on display (p = 0.07). More extensive regression analyses has to be performed and will be showed on the conference. Table 1. Preliminary Results.

Conclusion

Preliminary results showed that the offered implementation activities resulted in positive changes in the availability and accessibility of healthier food and drinks offered, and in less purchases of unhealthier products in the school canteen. This study shows the importance of offering implementation activities to support stakeholders in creating healthier school canteens.

Tab. 1.

 

 Intervention
 Control
T0 Mean (SD) T1 Mean (SD) T0 Mean (SD) T1 Mean (SD)
Availability of healthier products on display 45.80 (27.12) 77.29 (13.41)* 50.40 (23.00) 60.10 (15.67)
Accessibility criteria 44.00 (20.66) 60.00 (21.60)* 43.00 (20.58) 50.00 (14.91)
N N N N
Purchase of less healthier products on display 1.15 0.93* 0.87 1.01
Purchase of less healthier products in vending machines 1.20 1.00* 0.99 1.05
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Obes Facts. 2018 May 26;11(Suppl 1):120.

T2P4 The cost of meeting the 2015–2020 Dietary Guidelines for Americans using an online grocery-shopping platform

G Sweeney 1, H Green 1

Introduction

Online grocery shopping sales were estimated to generate 7 billion U.S dollars in 2017, and forecast to generate 29.7 billion U.S dollars in the United States by 2021 (Statistica 2017) with total grocery spending estimated to reach 20% from online resources by 2025 (Food Marketing Institute 2017). The aim of this study was to estimate the cost of healthy 2-week menu plans for each of the three dietary patterns; Vegetarian, Mediterranean and US-healthy aligned with the 2015–2020 Dietary guidelines for Americans by sourcing food and beverage items from an online food-shopping platform.

Methods

All items from three exemplary 2 week-menu plans were assessed for nutritional quality using the Nutrient Balance Concept (Fern et al 2015), and mapped to the most affordable retail price ($/gram) sourced from the online shopping platform Amazon Grocery and Gourmet Food. All items were considered ‘food as purchased’. Online sales, discounts and deals were avoided. Food and beverage prices were converted from the online advertised $/item or $/ounce to $/gram. Additionally, food group cost per cup/oz food group recommendation were calculated.

Results

The vegetarian dietary pattern was estimated to be significantly more affordable than that of the Mediterranean (< 0.05), however no significant difference was found between the Mean (SD) Nutrient Balance scores; vegetarian 85.3 (1.4); US-healthy: 84.3 (1.7); Mediterranean: 82.4 (2.6), a representative of diet healthiness. The estimated average cost ($/day) for each menu plan were as follows; vegetarian: 15.4; US-healthy: 17.0; Mediterranean: 17.2. Although significantly less meat and poultry were used in the vegetarian menu plan (< 0.05), this did not affect nutritional quality but may contribute to making this the most affordable menu plan.

Conclusion

A vegetarian diet aligned with the 2015–2020 US dietary guidelines may be the most affordable dietary pattern to follow when purchasing food and beverage items from online grocery shopping platforms.

Conflicts of Interest

Nestlé manufactures and sells food and beverages, but there was no corporate influence on this research

Reference

Obes Facts. 2018 May 26;11(Suppl 1):120.

T2P5 Exploring Nunavut Public Health System's Readiness to Implement Obesity Prevention Policies and Programs in the Canadian Arctic

V Akande 1, S Kremers 1, R Ruiter 2

Introduction

Rapid changes in the food and built environments in the Canadian Arctic have contributed to a dramatic increase in prevalence rates of obesity in the predominantly Inuit population of Nunavut. The aim of this study was to explore the determinants of Nunavut public health system's commitment to implement obesity prevention policies and programs.

Methods

In total, 78 program managers, program officers and policy analysts who are responsible for program and policy development and implementation within Nunavut Department of Health (NDH) were randomly recruited and asked to complete a modified form of the validated Organizational Readiness for Implementing Change (ORIC) questionnaire. Organization-level readiness (commitment) was determined based on aggregated individual-level data using bivariate correlations and hierarchical linear regression analyses.

Results

Approximately 72% (n = 67) of the public health workers fully completed the survey for analysis. Organisation-level commitment to implement obesity prevention policies and programs was low. Only 2.9% of respondents strongly agreed that NDH was committed to implementing obesity prevention policies and programs. This study showed a strong positive correlation between NDH's commitment and perceived valence (.73), efficacy (.50), and resource availability (.25). However, there was no correlation between commitment and knowledge. We found a strong positive correlation between perceived valence and efficacy (.55) and between efficacy and resource availability (.60). In the multivariate linear regression model, valence was the only significant predictor of NDH's readiness for implementing obesity prevention policies and programs (0.66).

Conclusion

Successful adoption and implementation of obesity prevention policies and programs in the Canadian Arctic largely depends on the perception of value, benefits for, and believe in, the change efforts among employees of the Nunavut Department of Health. Convincing policy makers of the valence of preventive policies and programs is an important and necessary first step towards decreasing the prevalence of obesity in the Inuit population.

Obes Facts. 2018 May 26;11(Suppl 1):121.

T2P6 Do the associations of height and body mass index with type 2 diabetes differ by levels of intelligence and education as indicators of socio economic status?

ML Damborg 1, L G Bjerregaard 1, M Osler 1, TIA Sørensen 2, J L Baker 1

Introduction

Socioeconomic status (SES) is inversely associated with risks of type 2 diabetes (T2D). We investigated whether the inverse associations of height with T2D and the positive associations of body mass index (BMI) with T2D are modified by cognitive ability and educational level as indicators of SES.

Methods

We studied 369,989 young men born from 1939–1959 in the Danish Conscription Database that contains information on measured height, weight, intelligence test scores and educational level in early adulthood (17–26 years). The men were followed in the Danish National Patient Register for information on T2D (n = 32,188; age ≥30 years) until 2015. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals for the associations and to investigate potential interactions of intelligence test scores and educational level with height and BMI in their associations with risk of T2D.

Results

Intelligence test scores and educational level were each strongly inversely associated with risks of T2D. After adjustment for these factors, height showed an inverse association with T2D (HR = 0.95; 0.94–0.96) that did not vary by intelligence test scores or education (all pinteraction-values>0.5). BMIs below-average (z-scores < 0) were not related to risks of T2D and did not vary by intelligence test scores or education (pinteraction-values>0.18). For BMIs above-average (z-scores>0), there were positive associations of BMI with risks of T2D, which were stronger among men with higher intelligence test scores or longer educations compared with men with low intelligence test scores or short educations (pinteraction-values < 0.001). The differences were relatively small; for instance the HR for T2D of above-average BMI was 2.01 (1.96–2.07) for men in the lowest quintile of intelligence, while it was 2.28 (2.19–2.38) for men in the highest quintile of intelligence. Yet, despite the directions of the interactions, incidence rates of T2D were higher among men with low intelligence test scores and short educations than among men with high scores or longer educations.

Conclusion

The inverse associations of height with risks of T2D did not vary by cognitive ability or education as indictors of SES. However, contrary to our hypothesis, associations of above-average BMIs with risks of T2D were stronger among men with high levels of these SES indicators. Nonetheless, the incidence of T2D was higher among men with low levels of intelligence and education irrespective of BMI. Our results suggest that public health actions should focus on preventing exposure to adiposity early in life irrespective of cognitive abilities or educational levels.

Obes Facts. 2018 May 26;11(Suppl 1):121.

T2P7 Socio-demographic characteristics of patients referred to a National Health Service Adult Weight Management Service: a retrospective observational study

E M Di Battista 1, D Behrens 2, T Filipponi 3

Introduction

In the last thirty years, the number of people with obesity has more than doubled worldwide (World Health Organisation, 2014). The latest figures from the Welsh Health Survey (2015) suggests average obesity rates of 24% with increased obesity rates of up to 29% in urban areas of lower-socioeconomic status (LSES; Public Health Wales Observatory, 2015). In response, ABUHB implemented an Adult Weight Management Service (AWMS) in January 2014. In order to inform service provision and support the development of an equitable obesity strategy for ABUHB, the aim of this study was to understand the socio-demographic characteristics of those adult citizens attending the AWMS.

Methods

Permission to conduct the study was granted by ABUHB's Research Risk Review Committee. Patients who were referred into ABUHB's AWMS and attended the first appointment (n = 2606) between January 2014 and December 2016 were included in the analysis. The majority of these patients (n = 2,557) resided in Gwent and South Powys. Data cleansing was carried out and 106 invalid records removed. Units of analysis for the study were (i) the Lower Super Output Area (LSOA) derived from the postcode of AWMS patient residence, and (ii) patient Body Mass Index (BMI). For the 2,500 valid patient records LSOAs were related to Welsh Index of Multiple Deprivation (WIMD) ranks (Welsh Government, 2015) – with rank 1 being assigned to the most deprived LSOA, and rank 1909 to the least deprived LSOA. To test for correlation with patient BMI, both the WIMD ranks from 1–1909 and an aggregation into quintiles were used (with the first quintile corresponding to the most deprived regions, quintile 5 to the least deprived ones); performing a One-Way ANOVA for the latter

Results

The majority of patients (n = 2312; 92.5%) identified themselves as White British. Total number of males and females attending the AWMS and included in the analyses were 726 (29%) and 1774 (71%), respectively. Overall, patient age was normally distributed with a mean of 50.2 years - gender analysis suggests average male age of AWMS patients was however significantly older than females (53.7 years ± 14.2 and 48.8 years ± 14.9; p < 0.001), respectively. Average BMI for both males and females was 43.5kg/m2 ± 8.7; the most frequently observed BMI was however gender sensitive at 33.1kg/m2 for female and 41.6kg/m2 for male patients. The relationship between patient BMI and patient WIMD rank illustrates that these two quantities were not correlated among AWMS patients (Graph 1; r = 0.03; significant at the 10% level).

Conclusion

Findings suggest that patients referred into a weight management service implemented in urban areas may not have a low-socioeconomic background according to the WIMD rank. The AWMS may therefore not favour LSES groups to access the service, so in order to address these inequalities, the AWMS could benefit from service reconfiguration of location planning and referral pathways. Additionally, the results indicate that males are currently less likely to attend the AWMS. Our results support the case for gender specific, equity-focused, weight management interventions in South Wales.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):122.

T2P8 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):122.

T2P9 Evaluation Of Relationship Between Intuitive Eating, Eating Attitude, Quality Of Diet and Body Mass Index

S Atalay 1, M Bas 1

Introduction

This study has been performed in order to evaluate the relationships between intuitive eating, eating attitude, quality of diet and body mass index.

Methods

The study has been conducted on 400 adult women individuals who are studying in Acıbadem University between the dates of December 2016 and May 2017. The individuals’ socio-demographic characteristics, intuitive eating behavior, eating attitudes behavior ve quality of diet have been gathered by a questionnaire. The body-mass index (BMI) values of the individuals their intuitive eating scale-2 scores, eating attitudes test (EAT-26) scores ve healthy eating index-2010 (HEI-2010) scores were calculated.

Results

The mean age of the individuals has been determined as 20.19 ± 1.77 years. Intuitive eating behaviors were found to be low in 46.7% of the individuals, whereas intuitive eating behaviors were found to be high in 53.3% of the individuals. It was observed that 84.3% of the individuals showed positive eating behaviors and 15.7% of the individuals showed negative eating behavior. 19% of the individuals were in underweight, 68.2% of them were in the normal, 10% of them were in the overweight and 2.8% of them were in the obese groups. It has been determined that 74.3% of the individuals have “poor diet quality”, 21.75% of them have “improved diet quality” and 4% of them have “good diet quality”. The relationship between intuitive eating scores and BMI groups was statistically significant (p < 0,05). The relationship between intiuitive eating scores and eating attitudes test scores was not statistically significant (p > 0.05). The relationship between intuitive eating scores and healthy eating index scores was not statistically significant (p > 0.05).

Conclusion

The results of this study indicated that there was significantly relation between for intuitive eating and body mass in healthy young women. The future studies investigating the association between interoceptive sensitivity and intuitive eating and its significance for further health associated behaviors and general indicators of well-being.

Obes Facts. 2018 May 26;11(Suppl 1):122.

T2P10 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):122.

T2P11 Food for thought – an exploration of a university food environment and a survey of on-campus purchasing behaviors, choice determinants, and opinions on the food environment

R Roy 1, D Soo 1, D Conroy 2, CR Wall 1, B Swinburn 3

Introduction

The relationship between food environment and diet quality is one of the key contributors to the current obesity epidemic. As a large proportion of a population is either enrolled or work in tertiary education, research in this setting is particularly important. This study aimed to gain insight and identify strategies for encouraging healthy eating in university.

Methods

A validated food environment-quality index was used to assess 57 outlets located across campuses of a large university. Information on availability, accessibility, promotion, and cost of food/ beverages were collated and a composite score (maximum = 199), calculated. Outlets were categorised and ranked based on their scores, with higher scores depicting healthier outlets. Additionally, over 8 wk., staff and students (n = 1954) from the same university completed an anonymous researcher-designed survey with closed (n = 42) and open-ended (n = 2) questions assessing food purchasing, food choice determinants, and opinions about the campus food environment.

Results

Overall, six outlets were categorised as ‘healthy’, two as ‘unhealthy’, and the remaining as, ‘intermediate’. Median score across all outlets was 79 (IQR = 7). The most frequently available food/beverages were water (67% of outlets), fruit drinks (60%), sugar-sweetened soft drinks (58%), diet soft drinks (56%) and hot mixed dishes without vegetables (53%). Healthy food/beverages were less available, accessible, promoted and cost more than unhealthy food/beverages. The majority purchased food/beverages on campus (79%), with hot beverages such as coffees and teas being the most frequently purchased. Value for money, healthiness, and taste determined food choice. The most common improvements suggested by staff and students, were increasing value for money and healthy food options.

Conclusion

The audit shows a need for food environment interventions to increase the availability, accessibility, and promotion of healthy food/beverages whilst reducing its purchasing cost. The staff and student survey also indicates a demand for healthy food, and that price manipulation is an important lever for change. The findings from this study are being incorporated into the university public health food policy and need to be implemented in future, university wide to encourage a dietary behaviour change in a tertiary education setting.

Obes Facts. 2018 May 26;11(Suppl 1):122–123.

T2P12 How to create healthy environments in kindergartens and schools? Lessons from 16 European countries

VA Kovacs 1, K Abu-Omar 2, E Tecklenburg 3, M Hassapidou 4, P Sandu 5, C Kaposvári 1, E Sarkadi-Nagy 1, K Brukalo 6, S Messing 2

Introduction

Currently, numerous programs and policies aim at counteracting the increasing obesity level by promoting healthy nutrition and activity in kindergartens or schools. Some of these programs or program elements have been shown to be more efficient in preventing obesity and/or its risk factors and thus can serve as a good example for other countries to adopt. This work aims to present these approaches collected from 16 European countries following a strict and standardized protocol within the framework of the EU Joint Action on Nutrition and Physical Activity (JANPA).

Methods

These lessons were learnt from the experiences of programme planners and decision makers working on the ground via semi-structured interviews and online questionnaires carried out in 16 European countries. The work started with the development of a good practice definition together with a set of good practice criteria from which nine were considered as ‘core criteria’. These criteria served as a frame for further work. Country representatives were then asked to identify and provide good practice programmes and policies from their counties. To ensure a better understanding of the context in which the selected practices were implemented, data related to the school nutrition and physical activity environment were also collected. In parallel, 17 semi-structured interviews and 187 online questionnaires with European, national and local level stakeholders from nutrition, health, sport and education sectors were conducted to understand the facilitators and barriers as well as to assess the capacities for childhood obesity prevention.

Results

The importance of integrated approaches, especially in fighting against social inequalities, was commonly agreed. An integrated approach has to fulfil these criteria: multi-component, inclusive, intersectoral, or multi-level. Beyond actions in schools and kindergartens, families and public catering appears to be important. It is commonly agreed that there is still room for improvement in the use of integrated approaches. Moreover, despite the rigorous selection, several actions are still focusing on one single determinant of childhood obesity or targeting only one setting. Only a minority of the selected practices and policies have been rigorously assessed even if, during the planning phase, the political, social and cultural context was taken into account. Actions within the school settings cannot be considered in isolation from the more global context. This view leads one to consider that many conditions hinder reaching results a general lack of awareness of the importance of healthy nutrition and physical activity, improper nutrition habits at home with parental support, the generally higher costs of healthy food, and the massive

food marketing through mass media for unhealthy food. Regarding the existing policy capacities, the main barriers are insufficiently skilled professionals and financial resources. As facilitators, the overall regulations on food advertisement and on restriction of food marketing in schools come out in first position. In contrast, none of the selected good practices addressed marketing in schools.

Conclusion

School-wide messages must be coherent, consistent and mutually reinforcing to reach children and their families.

Obes Facts. 2018 May 26;11(Suppl 1):123.

T2P13 Associations of Sarcopenic Obesity with the Metabolic Syndrome and Insulin Resistance over Five Years in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project

V Hirani 1, D Scott 2, R Cumming 3

Introduction

Sarcopenia and obesity may independently contribute to risk of metabolic syndrome (MetS) and insulin resistance in older age, but it is unclear whether sarcopenic obesity has synergistic effects. The aim of the present study was to determine cross sectional and 5-year longitudinal associations between sarcopenic obesity, MetS and insulin resistance in community-dwelling older men.

Methods

1,057 community-dwelling men aged ≥70 years that had measures of appendicular lean mass (ALM) and body fat percentage assessed by whole-body dual-energy X-ray absorptiometry (DXA), completed grip strength assessments, and had MetS measures at baseline. Sarcopenia was defined as low ALM relative to BMI and/or low grip strength (Foundations for the National Institutes of Health definition). Obesity was defined body fat percentage ≥30%. MetS components (waist circumference, systolic (SBP) and diastolic blood pressure (DBP), fasting glucose, triglycerides, and high-density lipoprotein [HDL] cholesterol) were assessed at baseline and 5-years later. Fasting insulin and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were assessed at 5 years only.

Results

394 (37%) men were non-sarcopenic non-obese, 125 (12%) were non-sarcopenic obese, 197 (19%) were sarcopenic non-obese, and 341 (32%) were classified as sarcopenic obese. The overall prevalence of MetS at baseline was 38%, with sarcopenic obese (odds ratio, 95% CI: 5.1, 3.6–7.3) non-sarcopenic obese (5.2, 3.3–8.2) and sarcopenic non-obese (2.0, 1.3–3.0) all demonstrating higher likelihood for MetS than non-sarcopenic non-obese men after multivariable adjustment. However, there were no differences in likelihood of incident MetS, or changes in components of MetS over five years for any category. Amongst components of body composition, change in body fat (per kg) over five years was a predictor of incident MetS (1.2, 1.1–1.3) and of deleterious changes in MetS components (DBP, glucose, HDL, triglycerides; all P < 0.05). Compared with non-sarcopenic non-obese men, estimated marginal means for HOMA IR at five years were significantly higher in sarcopenic obese (1.1, 0.8–1.4 vs 0.7, 0.4–1.0; P < 0.001), but not other groups.

Conclusion

Sarcopenic obese older men have increased likelihood of prevalent MetS and its components, and increased insulin resistance, compared with older counterparts with healthy body habitus. However, increases in body fat, rather than sarcopenia-associated decreases in low lean mass or hand grip strength, appear to be the most important predictor of incident MetS.

Obes Facts. 2018 May 26;11(Suppl 1):123.

T2P14 BMI, weight change, and obesity-related cancer risk in the Norwegian Women and Cancer (NOWAC) study

M Da Silva 1, E Weiderpass 2, I Licaj 3, L Lissner 4, C Rylander 1

Introduction

Obesity and weight gain are well established to independently increase the risk of several types of cancer referred to as “obesity-related” cancers. However, few large prospective studies of women have assessed the role of weight gain and subsequent risk of specific “obesity-related” cancers. This study was conducted to assess the respective roles of BMI and weight change on total and site-specific obesity-related cancer risk in a large Norwegian cohort of women.

Methods

We used self-reported individual questionnaire data from the Norwegian Women and Cancer study linked to information on cancer diagnosis extracted from the Cancer Registry of Norway. Baseline and follow-up questionnaires were completed in 1991–2011 and included information on body weight, height, reproductive history, use of medication and life-style. We prospectively assessed BMI status, weight change over six years, and subsequent risk of obesity-related cancers using multivariable Cox proportional hazard models adjusting for potential confounding factors.

Results

137,205 women were included in the BMI analysis. Average follow-up time was 18 years, with 9,963 diagnosed obesity-related cancer cases. Obesity increased the risk of overall obesity-related cancer, post-menopausal breast cancer, colorectal, colon, endometrial and kidney cancer, of which endometrial displayed the highest risk estimate with a twofold increase in risk (hazard ratio [HR] = 2.09, 95% CI: 1.53–2.86). 82,001 women were included in the weight change analysis. Average follow-up time was 13.7 years with 5,329 diagnosed obesity-related cancer cases. High weight gain (≥10 kg) increased the risk of overall obesity-related cancer, postmenopausal breast cancer, colorectal, rectal, and pancreatic cancer. The strongest association with high weight gain was for pancreatic cancer with a 76% increased risk (HR = 1.76, 95% CI: 1.02–3.01), although no association between BMI and pancreatic cancer was identified.

Conclusion

Maintaining stable weight in middle adulthood, irrespective of baseline BMI status, as well as avoiding excess body weight are both of importance for prevention of several obesity-related cancers in women. Our finding of increased risk of pancreatic cancer by high weight gain is of special importance as this has not been assessed in such detail in women before.

Obes Facts. 2018 May 26;11(Suppl 1):123–124.

T2P15 Metabolite Profiles Associated with Variation in Visceral Fat Distribution: Results from the Netherlands Epidemiology of Obesity Study

S C Boone 1, D Mook-Kanamori 2, JW Jukema 2, FR Rosendaal 3, HJ Lamb 2, K Willems Van Dijk 2, R De Mutsert 3

Introduction

Excess visceral adipose tissue (VAT) is associated with an increased risk of cardiometabolic diseases. Metabolomics might allow for easier quantification of visceral fat, instead of using invasive imaging studies or imprecise approximations such as waist circumference. Here, we related metabolites to VAT to identify potential biomarkers of VAT.

Methods

In this cross-sectional analysis of the Netherlands Epidemiology of Obesity, a high-throughput proton NMR metabolomics platform (Nightingale Health Ltd., Helsinki, Finland) was used to quantify 159 lipid and metabolite measures in 225 variables. VAT was quantified with magnetic resonance imaging in 2,569 middle-aged men and women. We examined associations between the metabolites and VAT with linear regressions, adjusting for age, sex, ethnicity, education, smoking, physical activity, and body mass index. To examine which metabolites contribute above fasting glucose and triglyceride concentrations, and waist circumference, we additionally adjusted for these factors. We use a false discovery rate method to correct for multiple comparisons.

Results

In the multivariate model, 165 of the 225 metabolite measures were significantly associated with VAT. In particular, all very large density lipoproteins (VLDL) measures, as well as most measures of intermediate (IDL), low-density (LDL) and small high-density (S HDL) lipoproteins were positively associated with VAT at estimates ranging from 2.9 (95% CI: 0.9, 5.0) to 11.6 (95% CI: 9.8, 13.5) cm2 VAT per SD of metabolite concentration. Conversely, most extra-large (XL), large (L) and medium (M) HDL measurements were negatively associated from −11.1 (95% CI: −13.2, −9.0) to −3.4 (95% CI: 5.4, 1.4) cm2 per SD. Of the small molecular compounds, glycoprotein acetyls, alanine, glutamine, isoleucine, leucine, valine, phenylalanine, tyrosine, glucose, lactate and acetoacetate were associated from −3.6 (95% CI: −5.3, −1.9) to 12.9 (95% CI 10.9, 15.0) cm2/SD. In our final model, 30 metabolites remained significantly associated. This included most XL and L HDL measures from 4.6 (95% CI: −6.9, −2.2) to −3.0 (95% CI: −4.8, −1.1) cm2 per SD, as well as glycoprotein acetyls, isoleucine, leucine, valine and phenylalanine from 3.1 (95% CI: 1.4, 4.8) to 6.2 (95% CI 3.3, 9.1) and acetate at 3.3 (95% CI: −4.9, −1.8) cm2 per SD.

Conclusion

Even after adjusting for fasting glucose and triglyceride concentrations, and waist circumference, we observed associations of HDL measures as well as glycoprotein acetyls and amino acids with VAT. These observations may provide insight in the pathophysiology of obesity and provide interesting candidates for potential non-invasive quantification of VAT, but first need replication in other cohort studies.

Obes Facts. 2018 May 26;11(Suppl 1):124.

T2P16 BMI and obesity in association with ovarian reserve: A systematic review and meta-analysis

N Moslehi 1, S Shab-Bidar 2, F Ramezani Tehrani 3, P Mirmiran 4, F Azizi 5

Introduction

The numbers of primordial ovarian follicles, which is called ovarian reserve, shows the potential of reproduction in women. This pool reduces gradually from puberty to onset of menopause but rate of its decline over time are highly variable among women of similar ages. Obesity is associated with different reproduction sequelae through its effects on various reproductive process. However, inconsistent findings have been reported for the associations of BMI or obesity with ovarian reserve. Therefore, this systematic review of human studies was conducted to answer the question whether BMI or obesity are associated with ovarian reserve in reproductive aged women.

Methods

PubMed and Scopus databases were searched up to December 2016. Original studies on the association of BMI with different ovarian reserve markers, including Anti-Mullerian hormone (AMH), Follicle Stimulating Hormone (FSH), inhibin β, and Antral Follicle Count (AFC), either according to BMI categories or a continuous variable, were selected. The following search terms were used: “ovarian reserve”, “ovarian aging”, “follicle stimulating hormone”, FSH, “anti mullerian hormone”, “Müllerian-inhibiting”, AMH, “antral follicle count», AFC, and Inhibin for ovarian reserve and “body mass index», BMI, overweight, obesity OR anthropometr*, “fat mass”, “waist circumference”, adiposity, and weight for anthropometric measures. Meta-analyses of mean differences (MDs) and correlation coefficients were done. Analyses were stratified according to the PCOS and fertility status into three groups of normal, infertile, and PCOS women.

Results

Of 4055 records identified, 47 studies were eligible for inclusion. Comparing the obese with non-obese, the pooled MDs (95%CIs) were −0.83 (-1.23, −0.42) ng/ml for AMH, −0.24 (-0.40, −0.09) mIU/ml for FSH, −0.09 (-0.60, 0.42) for AFC, and −21.06 (-41.18, −0.85) pg/ml for inhibin β in overall population. Although inverse associations of AMH and FSH with obesity were observed in all three subgroups of women, the estimates were significant for AMH in normal and PCOS women, and for FSH only in PCOS women. Fisher's Z (95%CIs) showed significant correlations of BMI with AMH in the overall population (-0.14(-0.19, −0.09)) and in all subgroups (Figure), and with FSH in the normal subgroup (–0.16 (–0.28, –0.04).

Conclusion

Ovarian reserve markers of AMH and FSH are significantly lower in obese than in non-obese women, and BMI is negatively correlated with AMH in all study populations, and with FSH in normal women. PCOS and fertility status do not appear to affect the associations.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):124–125.

T2P17 Understanding obesity and weight loss interventions: effect of online education on physician knowledge and confidence

J Trier 1, RF Kushner 2, R McCarthy 1

Introduction

The purpose of this activity was to determine if online medical education for diabetologists/endocrinologists (diabs/endos) and cardiologists (cards) can improve knowledge regarding the epidemiology of obesity, the difficulties of sustained weight loss and the efficacy of novel weight loss medications as part of a comprehensive weight management plan.

Methods

The educational activity consisted of a 30-min online video panel Discussion with synchronized slides. Educational effect was assessed with a repeated pairs pre- and post-assessment study with a 3-item, multiple-choice, knowledge questionnaire plus a confidence assessment question. For all questions, each participant acts as their his/her control. A χi-squared test assessed statistical significance at the P < 0.05 level. The activity launched December 19, 2016; data were collected until January 24, 2017.

Results

Participation in the activity significantly improved knowledge of diabs/endos (n = 99) and cards (n = 46) with respect to the global trends in the prevalence of obesity (diabs/endos from 41% to 64%, p = 0.002; cards from 37% to 67%, p = 0.003), the concept of the body weight set point describing the energy intake and expenditure levels that stabilize weight at a given point (diabs/endos from 44% to 72%, p < 0.001; cards from 33% to 57%, p = 0.021), and the proportion of patients maintaining at least a 5% weight loss after extended treatment with the novel weight loss drug liraglutide 3mg in the SCALE Maintenance trial (diabs/endos from 58% to 72%, p = 0.037; cards from 41% to 57%, p = 0.144, n.s.). Confidence levels in determining whether to initiate pharmacotherapy in the treatment of obesity also improved (31% in diabs/endos, 43% in cards).

Conclusion

Participation in online education in the form of a 30- minute online video panel Discussion with synchronized slides had a significant positive impact on diabs/endos as well as on cards regarding their awareness of the current global epidemic of obesity, concepts of physiologic weight regulation and the long-term efficacy of novel weight loss pharmacotherapy. Further education is warranted on the dramatic increase in obesity and associated comorbidities, its impact on global health, the physiologic exchange that mediates weight control, as well as the clinical evidence for novel weight loss therapies and use of these agents in practice to enhance weight management strategies.

Obes Facts. 2018 May 26;11(Suppl 1):125.

T2P18 Sugar coating beverages: how television advertisements position sugar-sweetened beverages as healthy

A Brownbill 1, C Miller 1, L Smithers 2, A Braunack-Mayer 2

Introduction

Reducing population consumption of sugar-sweetened beverages has become a public health priority in many countries due to correlations between high consumption, weight gain and non-communicable diseases. Previous research has indicated that many sugar-sweetened beverages are currently being positioned as better-for-you through advertising on product labels. This study examines the ways in which sugar-sweetened beverages are being positioned as better-for-you in television advertisements.

Methods

Advertisements on free-to-air television from the Australian nine-network (4 channels) were collected throughout the year of 2016. Advertisements featuring beverages were extracted for this study. Duplicate (n = 21), supermarket (n = 8) and quick serve restaurant (n = 5) advertisements featuring beverages were excluded, resulting in 37 advertisements for analysis. Advertisements were transcribed in NVivo for text, oral, audio and visual information. Data were analysed inductively using a multimodal discourse method to identify health and better-for-you discourses present in advertisements. Analysis was conducted with a social constructionist view in which advertisements were not viewed solely as a reflection of reality, but for their active role in constructing meanings within our social world.

Results

Sugar-sweetened beverage advertisements communicated health messages using a holistic view of health. This included advertising not only prevention of disease but also promotion of mental and social wellbeing. Such messages align with the World Health Organization's definition of health used in health promotion approaches to reduce obesity. Sugar-sweetened beverage advertisements positioned as assisting in obtaining these broader aspects of health are well communicated via television advertisements as they combine visual, text and audio cues that can illicit emotional responses. Sugar-sweetened beverage advertisements also communicated personal choice and responsibility to health which deflects responsibility from corporations.

Conclusion

The holistic definition of health that includes social and mental wellbeing is ambiguous. Sugar-sweetened beverage advertisements capitalise on this ambiguity through defining problems of which their products are the solution. By communicating messaging using the health promotion definition of health, advertisers may be enhancing the promotion of sugar-sweetened beverages as healthy, or better-for-you, and weakening health promotion messages for obesity prevention.

Obes Facts. 2018 May 26;11(Suppl 1):125.

T2P19 Investigation of Label Reading Habits in Adults

S Bilici 1, B Ayhan 2, S Demir 2, NN Süme 2

Introduction

The labeling in the Turkish Food Codex is defined as follows: “These are text, information, trademark, brand name, pictorial feature or other marks on materials, like package, document, notification, that are served with food or introducing food”. Because of valuable information on product composition, price, expiration date, usage period, origin and nutrition value, nutrition labels make it easier for consumers to healthy and informed choice.

Methods

The study were made on 148 males (28.1 ± 9.99 years) and 252 women (23.2 ± 7.03 years), who lives in different regions of Turkey. The research data were gathered by the researcher using face-to-face interview technique with questionnaire. In addition to the socio-demographic characteristics of the participants, the habit of reading labels according to the food groups of the participants, attitudes towards food labels, know the meaning of logo / abbreviations in labels and read food label correctly were also questioned in the questionnaire. SPSS 21.0 statistical program was used in the evaluation of research data.

Results

According to the study Results, 90% of the participants read the food label during shopping. The information that the participants pay attention to most on the label are price of product (56.3%), expiration (57.0%) and brand (51.5%). Participants most misunderstood logo of contacting with food (205 people), logo of average weight of product volume or weight (131 people) and logo of gluten free (107 people). Participants stated that while reading label information, they were looking logo of free trans fatty acid for milk (25.5%) and oils (48.8%), TSE logo for yoghurt (52.8%), cheese (46%) and egg (43.5%), halal food logo for red meat (60.3%), fish (32.5%) and chicken (55.3%). While 58.8% of participants indicated that the information on the label was very useful, 23% stated that it was difficult to understand the nutrition information on the label. Percent of 24.8% stated that the information on the label was inadequate.

Conclusion

Label and labeling are an important tool in today's life. Nutrition and labeling information education should be given to the students starting from early ages for healthy and conscious food selection to make these labels understandable and usable. These trainings, which are held at regular intervals in the following years, can help to increase the level of general knowledge of the individual about food value, contents and additives of foods.

Obes Facts. 2018 May 26;11(Suppl 1):340.

T2P20 Effects of Public and Visual Press in Food Purchase Behavior in Adults

S Bilici 1, B Ayhan 2, S Demir 2, NN Süme 2

Introduction

Radio, television and other media have an important place in food advertisement. These media that people benefit from in many ways should provide accurate and continuous information on the importance of nutrition and food advertisement. Researches have shown that mass media, especially advertisements, affect children. When it is thought that the product being advertised and tried to be made attractive for consumption is a food, advertisements can indirectly affect the eating habits of the individual, either positively or negatively.

Methods

The study was conducted in 4 different provinces of Turkey (Ankara, Istanbul, Izmir, Isparta) and a total of 400 adults (37% male, 63% female). The average age of the individuals, who have participated in the survey, is 25.08 ± 8.57. The research data were gathered by the researcher using face-to-face interview technique and questionnaire. The questionnaire included questions about socio-demographic characteristics of individuals, the effect of written and visual media on food purchasing and effect of advertisements on food purchase behavior. SPSS 21.0 statistical program was used in the evaluation of research data.

Results

According to the results of the study 96.4% of the women and 96.0% of the men are watching less than 2 hours of TV a day. While 43.2% of men use internet less than 2 hours, 48.0% of women use internet for 3 - 5 hours. Percent of 52.5 said that they were affected by advertisements and bought food in case they do not intend to buy, while 86.2% said they were more or less affected by advertisements in the press and in the media when they were doing food shopping. 72.8% of respondents reported that TV commercials were lasting and impressive in the first place. Following the TV advertising, Internet advertising (12%) comes. 34.5% of the participants always, 37.5% often pay attention to the mark in food advertisements. food advertising is extraordinary, 29% of participants are sometimes influenced and leads to purchasing behavior. 33.8% of respondents gave a response these expression that is “When you buy a food product, advertising the product affects the buying behavior of the product positively”. 29.3% of participants gave a response these expression that is “I wonder and buy the foods I watched their advertisements”. 33.8% of respondents gave a response these expression that is “‘When buying a food, information about the food on the internet affects my buying behavior”.

Conclusion

As press and media become easily accessible in many areas of life, it is observed that the purchasing behavior is affected by news in the print and visual press, especially the food advertisements. Nowadays, obesity is becoming an epidemic and this situation makes it a necessity for written and visual media to create a mission that can influence, improve and direct the health of the society positively.

Obes Facts. 2018 May 26;11(Suppl 1):126.

T2P21 Evaluating awareness of obesity using google trends

A S Pawar 1, SJ Nagpal 2, AE Massat 1

Introduction

The global epidemic of overweight and obesity, often termed ‘Globesity’ has become a major public health concern, especially over the last few decades. The overall prevalence of, and complications resulting from obesity have been increasing steadily. At least 2.8 million adults die each year as a result of being overweight or obese. In children, according to a study by World Health Organization, up to 49.0% of boys and 42.5% of girls were overweight. While recent studies have shed light on the ‘normalization’ of obesity in the society, there are no studies formally evaluating public interest and awareness in the topic. Using Google Trends as a surrogate for public interest, we aimed to study the trends of awareness about obesity over the last 12 years.

Methods

Google Trends is a public web facility of Google Inc. based on Google Search, using which we compared the relative frequency of search terms ‘Obesity’, ‘Weight loss ‘and ‘Obese’ between 1st January 2006 and 31st December 2017 (n = 144 months) worldwide. The program assigns a reference value of 100 for the point of maximum popularity among the search terms, and provides relative monthly scores for all terms, which we termed relative interest scores (RIS). Therefore, the RIS is a surrogate for the popularity of the term. The mean RIS was then compared between each 3-year period (Quartile 1,2,3 &4) between January 1, 2006 to December 31, 2017.

For the search term ‘Obesity’, the mean RIS consistently decreased with each quartile (Table 1). On the contrary, the RIS of the search term ‘Weight loss’ consistently increased with time. The term ‘weight loss’ appeared to be especially popular during the month of January and its median RIS for January (n = 12) as compared to other months (n = 122) was significantly higher during the entire study period (p < 0.001*) (Figure 1). The RIS for term ‘Obese’ did not change significantly over the study period.

Conclusion

Our novel study suggests that despite an increase in the prevalence of obesity, its popularity on the Internet continues to decrease with time as reflected by the RIS score, thereby suggestive of ‘normalization’ of obesity in our society. Reassuringly however, the frequency of the search term ‘weight loss’ has increased significantly overtime, with significant interest in the January every year. While this may be secondary to New Year resolutions centered around a healthy lifestyle, the specific reasons for the increased interest in certain months should be explored and applied to awareness campaigns for better effectiveness. While formal studies are required to best characterize these phenomena, the use of Google trends certainly provides valuable data to assess the public awareness and possibly health related campaigns, which are vital to the success of managing obesity at the global level.

Results

 

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Tab. 1.

Mean RIS Score of search term ‘Obesity’, ‘Weight Loss’, and ‘Obese’ over time worldwide

Search Term
 Quartile 1 (January 2006–December 2008)
 Quartile 2(January 2009–December 2011)
 Quartile 3 (January 2012–December 2014)
 Quartile 4 (January 2015–December 2017)
 P value
Obesity 70.0 ± 15.3 52.1 ± 10.2 41.5 ± 7.2 34.2 ± 5.6 <0.0001
Weight loss 62.0 ± 7.9 70.1 ± 8.3 81.1 ± 8.3 82.6 ± 8.3 <0.0001
Obese 70.7 ± 9.5 66.7 ± 7.2 69.6 ± 5.4 65.7 ± 5.1 <0.008
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Obes Facts. 2018 May 26;11(Suppl 1):127.

T2P22 Habit-based interventions for weight loss maintenance in overweight and obese adults: A Randomised Clinical Trial

G Cleo 1

Introduction

The majority of weight-management patients regain approximately 40% of the weight they lose in the first 12-months post-treatment. Habit-based weight-loss interventions could provide a valuable alternative to conventional programs for weight-loss maintenance. Objective: Determine whether habit-based interventions are clinically beneficial in achieving and maintaining long-term weight loss and assess whether making new habits, or breaking old habits is more effective.

Methods

A single-blind, 3-arm, randomized clinical trial. Ten Top Tips (TTT), Do Something Different (DSD) and the waitlist (WL) control groups were conducted for 12 weeks from July to October 2015. Computer generated randomization was used. Participants were followed up post-intervention (all groups), and at 6 and 12-months post-intervention (Ten Top Tips and Do Something Different only). Setting: Bond University, Australia. Participants: Volunteer community members aged 18–75 years who were overweight or obese (BMI 325kg/m2). Interventions: Ten Top Tips (habit formation); Do Something Different (habit disruption); or waitlist control. Main Outcomes and Measures: Primary outcome was weight-loss maintenance at 12-month follow-up. Secondary outcomes included weight loss at all time points, fruit and vegetable consumption, exercise, wellbeing, depression, anxiety, habit strength and openness to change.

Results

Of 130 participants assessed for eligibility, 75 adults (mean BMI 34.5 kg/m2 [SD 6.2]), with a mean age of 51 years were recruited. Assessments were completed post-intervention by 66/75 (88%) of participants and by 43/50 (86%) at 12-months. At post-intervention, participants in the Ten Top Tips (-3.3kg) and Do Something Different (-2.9kg) interventions lost significantly more weight (P = < 0.001) than those on the waitlist control (-0.4kg). Both intervention groups continued to lose further weight to the 12-month follow-up; TTT lost an additional −2.4kg and DSD lost −1.7kg. At 12-months post-intervention, 28/43 (65%) of participants reduced their total body weight by ≥5%, a clinically important change.

Conclusion

Habit-based weight-loss interventions - forming new habits (TTT) and breaking old habits (DSD), resulted in clinically important weight-loss maintenance at 12-month follow-up.

Obes Facts. 2018 May 26;11(Suppl 1):90.

T2P23 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):127.

T2P24 The features of eating behavior and nutrition among women depending on the body mass index and carbohydrate metabolism disorders

I Mokhova 1, D Deev 1, B Pinkhasov 1, V Selyatitskaya 1

Introduction

One of the main approaches of treatment of obesity and diabetes mellitus is life style modification, especially dietary stereotype. Aim: to investigate eating behavior disorders (EBD) and nutrition among women with overweight and diabetes mellitus.

Methods

205 women aged 18–70 were investigated, 180 women with obesity and overweight were divided into two groups: 1 group n = 153-with-out carbohydrate metabolism disorders, BMI −32,4 ± 4,2 kg/m2, 2 group n = 27- with diabetes mellitus, BMI −34,5 ± 5,3 kg/m2. Group 3 n = 25 were women with normal weight, BMI −22,9 ± 1,4 kg/m2. Anthropometric measurements, eating behavior estimation with DEBQ, estimation of nutrition diary were performed.

Results

EBD were in all groups. Women from 1 group compare to women 2 group had more expressed external eating behavior 2,4 ± 0,7 vs. 1,8 ± 0,7 score p = 0,0001, emotional EBD 1,2 ± 0,8 vs.0,7 ± 0,7 score p = 0,005, compulsive EBD 2,0 ± 0,9 vs. 1,3 ± 0,8 score p = 0,001 respectively. Women 3 group had more expressed external EBD: 2,3 ± 0,7 vs.1,8 ± 0,7 score p = 0,001 respectively. It was shown, that women 1 group consumed more fats 120,3 ± 53,5 g/day vs. 79,1 ± 87,0 g/ day p = 0,0001, carbohydrates 232,9 ± 94,9 g/day vs. 173,7 ± 73,6 g/day p = 0,0005 and calories 2345,5 ± 812,4 kkal/day vs. 1690,7 ± 1019,1 kkal/day p = 0,0001, than women 2 group. Women 1 group consume more fats, carbohydrates and calories than women 3 group. The diet of women from comparison group had more fats and calories, than women 2 group. Correlation analyses revealed positive associations between emotional, external, compulsive EBD and fats, carbohydrates consumption, calories among women 1 group. Restrictive EBD in the 1 group had negative association with carbohydrate consumption. Restrictive EBD in the 2 group had negative association with proteins, fats consumption and calories. There was no reliable association in 3 group.

Conclusion

EBD can be determined in patients with normal weight and overweight. The presence of diabetes mellitus among women with overweight is associated with changes in diet (consumption restriction of fats and carbohydrates) and increasing control on eating behavior.

Obes Facts. 2018 May 26;11(Suppl 1):127–128.

T2P26 Short-term effects of CBT and Chromium picolinate on intake of “sweet calories”

A Kondrashov 1, R Tyutev 2

Introduction

It is known that Cognitive-Behavioral Therapy (CBT) can be effective against overeating, obesity and eating disorders. But it takes long time (several months and more) to be successful. In this survey we would like to know, if dietary supplement Chromium picolinate (CrPic) can help to increase the speed of reducing appetite and amount of “sweet calories” (fast carbohydrates) intake.

Methods

23 women were included in the survey. During week 1 all participants counted calories, including “sweet calories”, without restriction. During week 2 all patients were divided into 4 groups of 5–6 participants. Group 1 was a control group without any CBT interventions and/or CrPic intake. Group 2 was a CBT-group, participants were trained to use some simple behavioral methods to control appetite. Group 3 was a CrPic-group, patients were prescribed CrPic (doses according to the instruction). Group 4 was a CBT+CrPic group.

Results

Group 1: initial average amount of “sweet calories” was 260.1 per week 1; after week 2, the average amount of “sweet calories” was 245.3 (decrease of 5.69% from baseline). Group 2: initial average amount of “sweet calories” was 123.33 per week 1; after week 2, the average amount of “sweet calories” was 103.42 (decrease of 16.14% from baseline). Group 3: initial average amount of “sweet calories” was 229.57 per week 1; after week 2, the average amount of “sweet calories” was 176.44 (decrease of 23.14% from baseline). Group 4: initial average amount of “sweet calories” was 316.66 per week 1; after week 2, the average amount of “sweet calories” was 208.93 (decrease of 34.02% from baseline).

Conclusion

Both CBT and Chromium picolinate can reduce consumption of fast carbohydrates in a short period of time. Combined use of CBT and Chromium picolinate can give faster results in decreasing of appetite and consumption of fast carbohydrates. Limitations: this is an initial part of the bigger survey, so it has several limitations. The size of the group is relatively small From the baseline all little groups had different initial level of “sweet calories” consumption; perhaps, the reason was in initial heterogeneity due to point 1 Small period of monitoring We did not include others possible factors, such as possible presence of somatic diagnosis (i.e. diabetes type 2) or mental disorders (i.e. eating disorders). In this initial period, we did not estimate possible placebo-effect of Chromium picolinate intake.

Conflict of Interest

None Disclosed

Funding

No Funding

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Obes Facts. 2018 May 26;11(Suppl 1):128.

T2P27 Does Bariatric Surgery lead to an increase in the frequency of alcoholism? Outcomes of a high-volume university hospital in Brazil

EC Cândido 1, DAO Modena 1, AM Neder 2, L Baltieri 2, J E Poletto 1, RC Gobato 1, E Cazzo 1, É A Chaim 1

Introduction

Since obesity is a chronic disease with a multifactorial etiology, its treatment also involves several types of approaches: dietary treatment, physical activity and use of anti-obesity drugs. Bariatric surgery is warranted for individuals with morbid obesity whose initial treatment was not successful. The surgical process demands an intense adhesion of the patients in the postoperative period, since it requires changes in the eating, behavioral and lifestyle habits, which can lead to several disorders. One of the most prominent and feared disorders observed after surgery has been alcoholism. Objective: To evaluate the incidence of alcoholism in individuals who undergo bariatric surgery.

Methods

This is a cross-sectional study which included patients from a tertiary university hospital (Hospital de Clínicas – Unicamp) outpatient clinic who underwent pre and postoperative follow-up of bariatric surgery (Roux-en-Y gastric bypass. Alcoholism was identified and classified according to the Alcohol Use Disorders Identification Test (AUDIT); it was applied on individuals who were at three distinct phases: 1) at the beginning of the preoperative treatment, when they had no guidance whatsoever on the alcohol in relation to surgery; 2) more immediately prior to surgery, when patients underwent preoperative follow-up for bariatric surgery for more than thirty days and received weekly guidelines on change of compulsion and risks in relation to alcohol; 3) at the postoperative phase (at least 30 days after surgery), when they begin to describe changes in psychosocial behavior.

Results

Overall, there were 150 individuals enrolled in the study: 50 (43 female) in the initial preoperative phase, 50 (37 female) in the immediately prior to surgery phase, and 50 (35 female) post-operatively. In both preoperative groups all the individuals presented scores ranging from 0 to 7, indicating a low risk of alcoholism; in the post-operative group, 10% of the individuals presented scores ranging from 16 to 19, which indicates hazardous and harmful alcohol use; one individual presented the score of 24, which demonstrates a highly probable alcohol dependence. The number of individuals with scores above 8 was significantly higher after surgery (p = 0.003).

Conclusion

There was a tendency to increase in the alcoholism among the individuals who underwent surgery. Since the number of bariatric surgeries is increasing worldwide, the early identification of this issue is relevant to avoid further complications and to propose strategies to intervene in this regard.

Obes Facts. 2018 May 26;11(Suppl 1):128.

T2P28 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):128.

T2P29 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):128.

T2P30 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):128.

T2P31 Relationship Between Body Image and BMI in University Students

H Yıldıran 1, F Ayyıldız 1, MS Karacil Ermumcu 1, M Gezmen Karadag 1

Introduction

Body image dissatisfaction is very important problem for risk of eating disorders. Recently, university students were affected on their body image by a lot of socio-cultural factors as aesthetic appearance, media (television, magazine etc). This study was planned to determine the relationship body image and BMI (body mass index).

Methods

This study was conducted among 442 individuals (136 male and 306 female) aged between 17–25 years. The Figural Stimuli Survey was used to assess body disturbance based on perceived and desired body images. Perceived BMI values were classified four groups. Body weight and height were measured and BMI was calculated. Beside actual BMI measures of individuals were assessed according to World Health Organization (WHO) BMI classification.

Results

It was seen that although perceived body image of individuals was underweight, the mean BMI was normal both females and males (19.7 ± 2.62 and 21.2 ± 2.93 respectively). Although mean BMI was normal, perceived body image of individuals was overweight both gender. Similarly, although mean BMI was overweight, perceived body image of individuals was obese.

Conclusion

Body image in university students may have associated with both social and culturally pressures to achieve a certain body shape. Body image dissatisfaction is related with eating disorders. Therefore it may take a place education programs for preventing body image dissatisfaction at university.

Obes Facts. 2018 May 26;11(Suppl 1):129.

T2P32 Evaluation of motivational stages and processes of change for weight management in obesity and after bariatric surgery

E Sánchez 1, A Andres 2, MJ Morales 3, A Calañas 4, I Miñambres 5, S Pellitero 6, F Cordido 7, M Bueno 1, A Caixàs 8, C Saldaña 9, N Vilarrasa 10, A Lecube 1

Introduction

Motivation is an essential tool in the management of obesity. The possibility of evaluating the different motivational stages and the processes of change for weight management could be useful for health professionals and patients to achieve greater weight losses. Our objective was to evaluate the relationship of both parameters according different degrees of obesity, as well as the effect of bariatric surgery.

Methods

Multicenter cross-sectional study in which the S-Weight (stages) and P-Weight (processes for weight control) questionnaires were administered to 204 non-obese controls, 257 obese patients (BMI ≥ 30 kg/m2), and 93 patients after bariatric surgery, matched by age and sex.

Results

The S-Weight questionnaire showed that 80.9% of the obese patients and 73.4% of subjects after BS make efforts to control their weight compared to 37.8% of the non-obese controls (p < 0.001). In addition, there are significant differences in the results of P-Weight between obese subjects and controls: emotional re-evaluation (82.2 ± 11.7 vs. 53.9 ± 16.7, p < 0.001), weight consequences evaluation (74.8 ± 15.4 vs. 37.5 ± 14.4, p < 0.001), weight managements actions (66.7 ± 14.7 vs. 51.0 ± 16.8, p < 0.001), and environmental restructuring (56.4 ± 18.4 vs. 38.6 ± 16.1, p < 0.001). The score of patients who underwent BS was intermediate between the other 2 groups. In addition, overall evaluation of the entire population (n = 554) establishes a positive correlation between BMI and the score of questionnaires. Finally, the greater the weight loss after BS, the lower the score obtained.

Conclusion

Subjects with obesity perform many more actions for weight control than non-obese subjects. This result denies the idea that obese subjects do not care about their situation or future consequences; however, they do it so ineffectively. We suggest the idea that new strategies that conveniently take advantage of good predisposition of obese patients should be established. In addition, the evaluation of the motivational stages and the processes of change for weight management could be useful identifying those patients with better weight-response before and after BS.

Acknowledgement

Grupo de Obesidad de la Sociedad Española de Endocrinología y Nutrición

Obes Facts. 2018 May 26;11(Suppl 1):129.

T2P33 Playing with food - Development and evaluation of sensory experiments and a training concept for kindergarten teachers

B Fuchs-Neuhold 1, M Peterseil 1, M Konrad 1, W Gunzer 1, M Wallner 1, D Grach 2, A Kronberger 1, S Maunz 1, E Pail 1

Introduction

Familiarity with food is one of the main factors influencing the willingness of children to consume it. Already in early childhood, access to different food may lay the foundation for a varied, health-promoting diet and can influence preferences in a long-lasting way. In order to facilitate a broader sensory experience at early stage, the aim was to develop and evaluate a training program for pedagogical staff regarding sensory and nutritional content for children in kindergarten.

Methods

Sensory experiments were developed by an interdisciplinary team based on literature research and creativity meetings. Furthermore, a training concept was framed for and with kindergarten teachers in order to provide adequate and evidence-based knowledge in the field of health-oriented sensory science. Training materials included designed maps describing individual experiments as well as a booklet of scientifically founded content on sensory science and child nutrition. First, trainings took place with 28 kindergarten teachers in October 2015. In the subsequent evaluation phase, the same participants tested selected experiments in their setting. Afterwards the participants assessed practicability, acceptability and feasibility, as well as the design and content of the experiment cards via mailed questionnaire. Finally, a focus group Discussion took place for final exchange and collecting additional suggestions.

Results

The feasibility of the experiments as well as the descriptions and contents of the training were rated positive. Improvements were suggested regarding design of the cards, which were adopted. According to the pedagogical staff, the experiments can be well integrate into the setting. In addition, neophobia degradation and an increased willingness to taste new food could be observed by the trained participants. Furthermore, positive feedback was given from parents during the implementation phase in terms of an increased openness towards accepting new food and enhanced food vocabulary.

Conclusion

According to the evaluation Results, sensory experiments are an encouraging way to teach playfully a variety of nutrition to children in kindergarten and make them tasty. However, a regular implementation of the training with kindergarten teachers as well as an advanced training course focusing on “snacks for children” was suggested from the participants.

Obes Facts. 2018 May 26;11(Suppl 1):129.

T2P34 A systematic review of the effectiveness of workplace dietary interventions

S Smith 1, A Lake 2, V Araujo-Soares 1, CD Summerbell 3, F Hillier-Brown 3

Introduction

The lack of evidence of the role of workplaces as settings for behaviour change delivery and the failure to recognise and address the complexity of the work environment has been acknowledged. The aim of this work was to review the effectiveness of dietary interventions in the workplace, facilitating an understanding of what works, why and how by identifying key components of and examining the theoretical models of behaviour change underpinning successful dietary interventions in the workplace.

Methods

Six databases were searched (MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL and PubMed) for randomised controlled trials (RCTs) that assessed dietary interventions based within workplace settings in any country, with a study duration of 12 months or more. Reference lists of included studies and relevant systematic reviews were also searched and known topic experts were contacted to identify additional interventions. Interventions were coded using the CALO-RE Taxonomy. Risk of bias of the included studies was assessed using the Cochrane risk of bias tool.

Results

Thirty studies were included, of which 18 showed beneficial effects on dietary outcomes including increased fruit, vegetable and fibre intake, and decreased fat, saturated fat and energy intake. Successful interventions used more behaviour change techniques on average compared with interventions that had no effect on diet (mean = 6.3, SD ± 2.9 vs mean = 4, SD ± 2.1). A high proportion of both successful and unsuccessful interventions provided information on general consequences of healthy and unhealthy diets, and instructions on how to achieve a healthier diet; however, a high number of successful interventions provided feedback to participants on their dietary intake during the intervention. The risk of bias was unclear for a number of domains across all of the studies, and the majority had at least one domain rated as high risk of bias; mainly in relation to the validity of the dietary assessment method used.

Conclusion

This review identified a number of workplace interventions that were effective at improving the diet of employees suggesting that workplaces are appropriate settings for behaviour change. Successful strategies are using a number of different behaviour change techniques, and providing feedback to participants.

Obes Facts. 2018 May 26;11(Suppl 1):130.

T2P35 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):130.

T2P36 Exploring Internet users’ knowledge about health-promoting behaviors in Poland

M Jarosz 1, M Siuba-Strzelińska 1

Introduction

The Internet is currently one of the most important communication and education tools. In Poland, about 80% of people use the Internet, looking also for information about food and nutrition. The aim of the study was to get to know the level of knowledge of Internet users about healthy eating and physical activity that will help build effective education and communication on the website of the National Center for Nutritional Education financed by the Ministry of Health in Poland.

Methods

The study was conducted in August 2016 among a randomly selected 1042 adults – men (48%) and women (52%). Research technique CAWI (Computer Assisted Web Interviews) was used. A specially prepared questionnaire, which was completed by on-line, included questions about knowledge of the principles of healthy nutrition, factors important for maintaining health, reading labels, control of consumed ingredients like fat, sugar, salt.

Results

Healthy eating (77% of respondents) and physical activity (77% of respondents) were indicated as the most important factors for maintaining health. Another important factor was avoiding stress indicated by 70% of respondents. The use of vitamins and minerals and being on a diet was the least important factor, indicated by 25% and 28% respectively. 58% of respondents declared that they always or almost always read labels of food products, only 6% never read them or almost never. The most attention is paid to the content of sugar (75%) and fat (71%) in products. The majority of respondents try to control or limit the content of sugar (71%), fat (69%) and salt (69%) in the diet. Knowledge about selected issues related to healthy nutrition is quite high among Internet users. The majority of respondents (91%) correctly indicated vegetable fats and fish as sources in the diet of unsaturated fatty acids, milk and milk products - source of calcium (89%) and vegetables and fruits - source of vitamin C (87%). 80% of respondents know that daily salt intake should not exceed 5–6 g. Least respondents (32%) correctly indicated cereal products (carbohydrates) as the main source of energy in the diet. Men most often indicated meat, fish, eggs (46%), and women - vegetables and fruits (40%). BMI (Body Mass index) rates were correctly interpreted by 50% of respondents.

Conclusion

The knowledge of Internet users about healthy nutrition is quite high, however, general and superficial, concerning the most known and most frequently discussed issues in the media. Further education of Internet users should be focused on topics of more detailed, clear and precise recommendations provided in a simple and interesting way.

Obes Facts. 2018 May 26;11(Suppl 1):130.

T2P37 High Endogenous Catalase Modifies Behavior in High-fat Fed Mice

N Santanam 1, A Seidler 1, L Grover 1, D Amos 1

Introduction

Obesity, as defined by a body mass index above 25, is a major health crisis in the Appalachian region. Being obese not only increases risk to chronic diseases such as heart disease, diabetes and cancer, but also promotes behavior modifications. Behavior changes such as excess food consumption, stress, depression is very commonly observed among obese individuals. Hypothesis: Lowering oxidative stress by modulating appetite regulation will lower obesity associated behavioral stress.

Methods

In order to assess behavior modifications during diet-induced obesity, we measured behavior changes in C57Bl/6 mice (control) and Bob-cat mice that express high antioxidant enzyme catalase in an obese (Ob/Ob) background. These mice (n = 4–5) were either fed normal rodent diet or high-fat-high caloric (45% lard) diet for eight weeks. Weekly body weights were monitored. Fat mass changes were determined using ECHO-MRI. Motor and anxiety-like behavior was tested using Open Field (locomotor behavior) and Rota-Rod (motor coordination and strength) testing systems at baseline and 8 weeks.

Results

Our results showed that catalase overexpression lowered levels of anxiety (Open-Field test) but had less endurance levels (Rota-Rod test). The C57Bl/6 mice on the normal chow stayed longer on the Rota-Rod as the weeks progressed compared to the mice on high-fat where the effect was more dependent on the trial (learning) rather on endurance. The Open Field test showed that the C57Bl/6 mice on high-fat diet were more anxious (spent more time in the edges rather than center) compared to the mice on normal chow. The overexpression of catalase lowered the anxiety behavior in the high fat fed Bob-Cat mice.

Conclusion

Our results indicate that oxidative stress plays a key role in the behavior modification associated with obesity. Modulation of redox stress may be beneficial in lowering these behavior changes.

Obes Facts. 2018 May 26;11(Suppl 1):130.

T2P38 Assessment of the Effect of Weight Management over Eating Behavior in Overweight and Obese Women

M Guzey Akansel 1, M Saka 1

Introduction

Present study has been conducted to measure the effect of weight management on the eating behavior of overweight and obese women. The study took place at the Diet Polyclinic of Istanbul University's Faculty of Medicine's Department of Internal Medicine between December 2013 and February 2014 and on 50 overweight or obese women between the ages of 19 and 64.

Methods

During the initial interview, the individuals’ demographic characteristics and anthropometric measurements were collected and their levels of physical activity and dietary habits were determined through a purpose designed questionnaire. Following this, the Dutch Eating Behavior Questionnaire (DEBQ), evaluating three distinct eating behaviors (restrained eating, emotional eating and external eating) of these individuals, was conducted. Following the initial interview, a personalized weight loss dietary program was developed for every individual alongside provision of nutritional education. At the end of 12 weeks of study, changes in body weight and anthropometric measurements were recorded and Dutch Eating Behavior Questionnaire re-applied in order to find out if there have been any changes in the individuals’ eating behaviors.

Results

Average age of individuals participating in the study was determined as 37.8 ± 11.4 years. Prior to the start of dietary program, average body weight of the individuals was 92,5 ± 17,55 kg and body mass index was 34,6 ± 5,9 kg/m2. At the end of the 12-week dietary program the average body weight of the individuals dropped to 85,3 ± 16,8 kg and the average body mass index to 32 ± 5,82 kg/m2. All anthropometric changes were found to be statistically significant (p < 0.05). During collection of information regarding dietary habits, it was found that 80% of the individuals had dieted at least once in the past prior to study. The number of diets that the individuals had applied in their past, their initial emotional and their external scores were all positively correlated and this was found to be statistically significant (p < 0.05). However, no significant statistical relationship was found between the initial DEBQ restrained score and the number of diets applied in the past (p > 0.05). Following the analysis of presence of family support during past diet experiences and initial DEBQ scores, it was found with statistical significance (p < 0.05) that the individuals who had not received family support during their dieting experiences had higher emotional and external scores compared to the individuals who had received such support. The individuals’ macronutrient intakes were compared with their respective DEBQ scores and no statistically significant correlation was found between these scores and the amount of energy and macronutrient intakes of the individuals during the 12 weeks of the diet (p > 0.05). Differences were observed between the scores of the two Dutch Eating Behavior Questionnaires applied before the start of diet and at end of the 12-week period and these were found to be statistically significant (p < 0.05).

Conclusion

It can be concluded that body weight loss at the end of the 12 week diet results in an improvement in eating behavior.

Obes Facts. 2018 May 26;11(Suppl 1):131.

T2P39 Consumers’ choice of healthy food in grocery stores: A review of experimental field studies

H Slapo 1, S Lekhal 2, KI Karevold 3, AB Bugge 4

Introduction

Unhealthy diets are among the main risk factors for overweight and non-communicable diseases. Recently, behavioral interventions focused on changing the context where food is sold or consumed have been proposed as a preventive strategy. Such interventions have been conceptualized as behavioral economics or nudges, and focus on re-designing food micro contexts to influence consumers to select more of the healthy options, less of the unhealthy options, or less food in general. In all western countries, most of the food people consume comes from grocery stores. The question is how these stores can be designed to promote healthier choices. The purpose of this paper is to review which contextual interventions that most effectively influence consumers to make healthier food choices in grocery stores.

Methods

Based on a rapid review approach, we will identify two categories of studies that investigate how contextual changes can influence food choices; review studies/meta-analysis and original empirical field studies. The rapid review approach is well suited for providing an overview for the purpose of communication or decision-making. The aim of our study is to identify which contextual changes that can influence guests to make healthier choices.

Results

The results will be presented in two sections, drawing on a recent report on how contextual and behavioral interventions can influence food choices (Karevold et al, 2017). The first section shows the results from a total of 9 review studies that we have identified the 10 recent years, and will analyze the specific reviews on the grocery store setting. This analysis will focus on identifying how many of the studies included in the review papers that demonstrate a clearly significant impact of contextual interventions on food choices. The second section will present an in-depth analysis of 42 original empirical studies, particularly focused on which mechanisms involved in producing the changes of choice. We will classify the interventions based on how they change the decision architecture of the food contexts, and make the observable changes in the food micro context salient. We will group each study based on the P's of marketing (Chandon and Wansink 2012; Wansink 2016): Placement, Price, Prompting and Portioning, and we will compare how strongly these relatively work.

Conclusion

The paper will conclude with a Discussion of how changes of the design of grocery stores can influence healthy food choices, and how grocery store managers can use placing, prompts, price and portioning to stimulate guests to eat healthier. The paper will also discuss strengths and limitations of the included studies, and suggest directions for future research.

Obes Facts. 2018 May 26;11(Suppl 1):131–132.

T2P40 Long-term effectiveness of Cognitive Behavioral Treatment of Obesity

I Majercak 1

Introduction

STOB program, based on CBT principles, eliminate inappropriate eating habits and teach an obese patient to replace inappropriate thoughts and self-blaming with a positive approach to a new lifestyle. Despite the indisputable benefits of group CBT, comparable results can also be achieved by individual approach. CBT techniques are most effective when applied over a longer period, the usual duration of STOB program is 12-week structured program used in overweight reduction courses. Participants meet once a week for 3 hours, 2 theoretical hours with CBT based techniques and one hour is dedicated to physical activity.

Methods

The first two lessons are devoted to the diagnosis of obesity, motivation, the real goals, profits and losses during weigh reduction program and patients start they work with food diary. In the 3rd and 4th lesson patients learn how to change the energy value of food, the composition of food and about the modern technological modification of meals. Next lesson is targeted to ordination of physical activity and leads patients to increase energy expenditure and to improved use of the energy they received. Apart from the beneficial effect on the “obesitological equation”, there are also many positive psychological impacts. It helps to increase the sense of well-being and improves self-control of the patient. In general, aerobic exercise is recommended and the degree of exercise is adjusted according to the body mass index and patient co-morbidities. Next four lessons works with identification and active control of external meal triggers, internal meal triggers self-çontrol techniques, negative automatic thoughts suppression and identification of mistakes in thinking which lead to undesirable behavior. Last two lessons are about learning how to like your body, reward yourself, weight regain prevention, feedback about the most helpful techniques and tools learned during the STOB course. Retrospective analysis via questionare was performed 1–5 years after course completion.

Results

The advantage of patients group is the fact that clients encounter similar problems in the course and encourage each other to gradually change their lifestyle. The average weight loss is 6.5 kg / 12 weeks. In combination with diet, they not only reduce weight, 65–70% of the weight reduction remain one year after treatment. In contrast to other weight reduction programs, it does not only concern what patient eat but also how to apply theoretical knowledge in everyday practice. 5% weight loss maintenance 1–5 years after course in retrospective analysis confirm 45% of patient undergoing course.

Conclusion

The STOB methodology, based on the CBT principles, applied in overweight reduction courses is a complex weight management tool. Practical skills gain during course lead to weight loss maintenance. A cognitive-behavioral approach to obesity treatment built on diet, physical activity and lifestyle changes is the ideal tool for long-term effectiveness of obesity treatment. Cognitive behavioral treatment of obesity changing the lifestyle of an obese patient.

Obes Facts. 2018 May 26;11(Suppl 1):132.

T2P41 Differences in body image perception between morbidly obese patients and a normal-weight control group

V Parzer 1, J Brix 1, B Ludvik 1

Introduction

Morbidly obese patients (MO) suffer from distorted body image perception which promotes the development of eating disorders and adversely affects weight loss. Our study is intended to investigate differences in body image perception between MO and a normal-weight control group(CO).

Methods

111 MO (BMI 44.7 ± 5.8kg/m2, age 42 ± 13 from 18 to 68 years) and 24 CO (BMI 22.7 ± 2.2kg/m2, age 38 ± 17 from 19 to 60 years) were included. To assess body image perception, Stunkard's Nine Figure Outline Scale was used. This scale comprises 9 female and 9 male body figures (BF) organised in an increasing order in relation to body size. The participants estimated a normal woman's/man's BF and their own BF by using Stunkard's scale.

Results

MO chose an average BF of 3.8 ± 0.68 for a normal-weight woman and 4.1 ± 0.81 for a normal-weight men. Estimating a normal-weight woman BF2 was chosen by 5 MO (4.5%), BF 2.5 by 1 (0.9%), BF3 by 21 (18.9%), BF3.5 by 9 (8.1%), BF4 by 61 (55.0%), BF4.5 by 4 (3.6%) and BF5 by 10 (9.0%). Estimating a normal-weight man BF2 was chosen by 5 MO (4.5%), BF3 by 11 (9.9%), BF3.5 by 7 (6.3%), BF4 by 48 (43.2%), BF4.5 by 11 (9.9%), BF5 by 27 (24.3%), BF6 by 1 (0.9%) and BF6.5 by 1 (0.9%). CO chose an average BF of 4.3 ± 0.55 for a normal-weight woman and 4.5 ± 0.60 for a normal-weight man. Estimating a normal-weight woman BF3.5 was chosen by 1 CO (4.2%), BF4 by 15 (62.5%), BF5 by 7 (29.2%) and BF5.5 by 1 (4.2%). Estimating a normal-weight man BF3 was chosen by 1 CO (4.2%), BF4 by 10 (41.7%), BF4.5 by 2(8.3%), BF5 by 10 (41.7%) and BF5.5 by 1 (4.2%). The difference in body image perception between MO and CO was significant for the perception of a normal-weight woman (p < 0.001) as well as for a normal-weight man (p = 0.003). These results show that MO seem to have slimmer body ideals compared with CO. Furthermore, the body perception index (BPI) was calculated by dividing the estimated body size by the actual BMI. The MO's BPI was 0.80 ± 0.10 indicating that they underestimate their own body size. The CO's BPI was 1.11 ± 0.08 which leads to the Conclusion that they rather overestimate their body size.

Conclusion

MO perceive slimmer body sizes to be normal. Their distorted body image perception of a normal-weight body could cause a discrepancy between their own body image and their desired ideal. They try to achieve a greater weight loss than they actually need in order to achieve an acceptable body figure.

Obes Facts. 2018 May 26;11(Suppl 1):132.

T2P44 Non-vitamin carotenoids: dependence on macular pigments optical density on presence in the diets of students with overweight and obesity

A Korolev 1, E Kirpichenkova 1, E Nikitenko 1, E Denisova 1, D Lipatov 2, A Kuzmin 2, Y Dyskin 2, R Fetisov 1

Introduction

The study aimed to analyze food choices rich in lutein and zeaxanthin and to assess the dependence on macular pigments optical density (MPOD) on the amount of non-vitamin carotenoids in diets of students of medical university.

Methods

The study included 263 students (57 men and 206 women), 37 of them with overweight and obesity. These 37 students were divided into two groups: overweight students (27 persons, BMI 25–30) and obesity students (10 persons, BMI >30). The dietary intakes of non-vitamin carotenoids were evaluated using 24-hour recall method. The unique questionnaire included anthropometric measurements and list of the food products that are sources of lutein and zeaxanthin. The MPOD evaluated using optical coherence tomography (OCT). The study was conducted using “Cirrus” HD-OCT and 15 students (9 overweight and 6 obesity).

Results

The mean age of students with overweight was 22.04+2.4 years, mean BMI 26.73+1.31, obesity students – 22.2+1.62 years, mean BMI 33.01+2.59. Among overweight students the dietary intake of lutein and zeaxanthin was optimum for 2 students (10.77+3.34 mg) and insufficient for 20 students (1.12+1.1 mg). Diets of 5 respondents do not include sources of non-vitamin carotenoids. The study shows that major sources of lutein and zeaxanthin for overweight students are eggs (18.5%), red tomatoes (14.8%), orange juice (11.1%). Only 3.7% students include in diet zucchini, persimmon, lettuce, spinach, pumpkin. None of the students included in diets such sources of lutein and zeaxanthin as sprout, corn and kiwifruit. Among obesity students the consumption of lutein and zeaxanthin was too deficiency for 8 students (1.68+1.67 mg) and adequately for 2 persons (7.21+.02 mg). The major food sources of non-vitamin carotenoids are persimmon (20%), broccoli, red tomatoes, ketchup, eggs, lettuce, orange juice, pasta, peas (10% each). There were no students whose diets contained such sources of lutein and zeaxanthin as pumpkin, spinach, corn, parsley. OCT results show no relation between dietary intake of sources of lutein and zeaxanthin and MPOD.

Conclusion

The study found that overweight and obesity students diets don’t include the major sources of non-vitamin carotenoids. In addition, there is no correlation between MPOD and amount of non-vitamin carotenoids in diets.

Obes Facts. 2018 May 26;11(Suppl 1):132–133.

T2P45 Dietary habits in Swedish obese subjects and their adherence to the Nordic nutrition recommendations

L Cloetens 1, Å Sedin 1, M Landin-Olsson 2

Introduction

Food habits have a great impact on well-being and health and play a crucial role in the prevention of obesity and obesity-related metabolic disorders. This study aimed to evaluate food habits and food intake of Swedish obese subjects and their adherence to the Nordic nutrition recommendations.

Methods

Subjects with obesity were instructed to fill in a questionnaire about food habits and a 3-day food diary. Mean intake of macronutrients and micronutrients of the 3 consecutive recorded days were calculated using DietistNet and the Nordic nutrition recommended values were used to evaluate dietary intake. Body weight, BMI, waist circumference and body composition (BIA-device) were measured for each subject.

Results

87 subjects filled in the food diary and 5 of them were excluded for further analyses due to low-energy reporting using the Goldberg cutoff. Subjects had a mean age of 53 ± 10y, (28% male) and BMI 34.3 ± 3.0 kg/m2, waist circumference 108.7 ± 9.6 cm and fat mass 40.8 ± 6.8%. The food habit questionnaire showed that 74% and 62% eat daily vegetables and fruits, respectively. 29% eat fish once a week or more rarely. Candy is consumed daily by 23%.

Only 19.5% of the subjects has a sodium intake as recommended (<2400 mg; mean 3315 (960) mg). Mean vitamin D intake was 6.5 (3.9) μg with 11.0% within the recommended dose i.e. >10μg/d. Mean calcium intake was 887 (320) mg and the recommendation of 800mg was met by 59.7%.

Conclusion

These results show that Swedish obese people has a rather low adherence to the Nordic nutrition recommendations with high intake of total fat, saturated fat and sodium and a low intake of carbohydrates and vitamin D. More effort is needed to change dietary habits in obese people towards a healthier lifestyle aiming to prevent obesity and obesity-

Tab. 1.

Macronutrient intake and adherence to the recommendations

 Reference value
 Mean (SD)
 Within reference value (%)
Energy (kcal) - 2257 (538) -
Protein (E%) 10–20 16.5 (3.5) 75.7
Carbohydrates (E%) 45–60 40.6 (7.9) 29.2
Sucrose (E%) ≤ 10 6.7 (3.8) 13.4
Dietary fibre (g) 25–35 19.7 (6.4) 19.5
Dietary fibre(g/MJ) ≥ 3 2.1 (0.7) 13.4
Total fat (E%) 25–40 40.1 (7.1) 57.3
SFA (E%) ≤ 10 16.2 (3.4) 4.9
MUFA (E%) 10–20 14.7 (3.2) 92.7
PUFA (E%) 5–10 5.8 (2.2) 62.1
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Obes Facts. 2018 May 26;11(Suppl 1):133.

T2P46 Relationships between body mass index and dietary patterns, body temperature, and activity levels

K Kimura 1, D Akiyama 1

Introduction

Maintenance of good metabolic function is important for good health. Lifestyle and dietary content affect metabolism. It is also important to maintain body temperature, but reports in recent years have shown a decreasing trend in body temperature in Japan. This study aimed to investigate the relationships between body mass index (BMI) and activity levels, dietary patterns, and axillary temperature.

Methods

The subjects were 68 healthy females (average age: 18.2 ± 0.4 years). We used a questionnaire format to survey the dietary patterns and activity levels of the subjects. The dietary patterns were assessed by examining the average meal content consumed per week over the last 1–2 months and meal consumption, including nutritional content and other factors, using analysis software. The activity levels represented the average duration of physical activity per day and exercise duration per week (4 intensity levels: 3≤ metabolic equivalents (METs) < 4, 4≤ METs < 6, 6≤ METs < 8, 8 ≤ METs ≤15). The subjects measured their axillary temperature using a thermometer for 10 min after waking up. Pearson's correlation coefficient was calculated to determine correlations between BMI and each item.

Results

The average BMI for all subjects was 21.4 ± 2.1 kg/m2 (average height: 157.8 ± 6.1 cm, average weight: 53.3 ± 6.8 kg). There were significant correlations between BMI and working while sitting (r = 0.271, P < 0.05), consumption of confectionery and beverages containing sugar (r = –0.251, P < 0.05; r = 0.348, P < 0.05, respectively), and axillary temperature (r = –0.254, P < 0.05).

Three subjects had BMI ≥25.0 kg/m2 (overweight group, O), 59 had BMI ≥18.5 kg/m2 but < 25.0 kg/m2 (normal range group, N), and six subjects had BMI < 18.5 kg/m2 (underweight group, U).

There was a significant difference between BMI and molybdenum levels (N and U; F = 7.416, 113 ± 37 μg vs. 66 ± 40 μg, respectively; P < 0.05).

Conclusion

This study showed that there was a significant correlation between BMI and working while sitting, consumption of confectionery, and axillary temperature. Molybdenum was significantly higher in the normal BMI range group than in the underweight BMI group.

Obes Facts. 2018 May 26;11(Suppl 1):133.

T2P47 The effect of meeting physical activity recommendation on hydration status in Czech elderly people

I Klimesova 1, J Wittmannova 1, R Varekova 1

Introduction

Dehydration is the most common fluid and electrolyte problem among elderly people. The elderly leading an active lifestyle may be a risk group vulnerable to dehydration. The goals of the study were: 1) to assess hydration status and the fluid intake, and 2) to determine the role of physical activity on hydration status in elderly people.

Methods

The research sample included 55 participants aged 60–80 (53% women) living independently in their own homes. Urine specific gravity was used to evaluate the hydration status, 4-day food record was used to monitor fluid intake and the International Physical Activity Questionnaires (IPAQ) – Short Form assessed physical activity.

Results

of the study showed that 42% of participants were dehydrated with a lower incidence in women. Average daily beverage intake was 1124.5 ± 444.9 ml. There was no gender difference in fluid intake. The recommended daily fluid intake fulfilled 27.6% of women and 4% of men. Participants with adequate or high levels of physical activity (PA) had a better hydration status compared to their low-PA peers.

Conclusion

These results indicate that being physically active can help people lead a healthier lifestyle including better fluid replenishment.

Obes Facts. 2018 May 26;11(Suppl 1):133–134.

T2P48 Dietitians’ perspectives on patient barriers and facilitators to weight management and factors affecting nutrition counselling in multidisciplinary health care settings – Ontario, Canada

S Aboueid 1, C Pouliot 2, T Nur 1, I Bourgeault 3, I Giroux 2

Introduction

Obesity and its co-morbidities can have negative consequences at the individual and population health levels. Registered Dietitians are nutrition experts who provide nutrition assessment and ongoing support to patients seeking to manage their weight. Studies evaluating dietitians’ perspectives on barriers and facilitators encountered by patients during their weight management journey are lacking. Factors affecting weight management counseling provided by dietitians are also unclear. As such, the objectives of this study were to 1) elucidate the barriers and enablers encountered by patients during their weight management journey as perceived by dietitians, and 2) factors affecting nutrition-related weight management counseling with dietitians. Elucidating these factors is important in order to mitigate barriers to weight management.

Methods

Fourteen individual semi-structured interviews were conducted with dietitians providing care to adults. All dietitians worked in multidisciplinary primary healthcare settings in Ontario, Canada. Interviews were audio-recorded and transcribed verbatim. Three researchers analyzed the data independently using an inductive approach. The research team discussed the themes to minimize bias and allow for investigator triangulation. The factors mentioned were classified at various levels of the socio-ecological framework.

Results

Barriers encountered by patients as perceived by dietitians included: low socio-economic status, “go big or go home approach”, lack of knowledge, lack of time to cook, emotional eating, unsupportive home and work environments, discrimination and weight bias, lack of communication between health professionals, and low accessibility to healthy foods. All dietitians reported that making healthier dietary choices is abnormal in today's society. As such, even if a patient was educated about the importance of healthy eating patterns for weight management, it was not always sufficient to translate into behavioural change. It seemed that this was due to the food environment that encouraged unhealthier food options (e.g. low nutrient energy dense foods at work meetings). Facilitators included: community programs, long-term follow up visits to ensure accountability, and workplaces promoting healthy behaviours. Cooking classes are offered through community programs and seemed to be appreciated by patients seeking to manage their weight. Factors affecting nutrition-related weight management counseling included: patient perception of dietitians, patients losing motivation due to failed past attempts, and lack of time during clinical visits. Participating dietitians mentioned that most patients encounter many barriers that co-exist which hinders their weight management attempts.

Conclusion

Addressing obesity is complex and requires a concerted effort from many sectors. In terms of the clinical setting, communication between health professionals and long-term support to patients are needed. Also, comprehensive population health approaches need to be multi-faceted and should address the barriers mentioned (e.g. food environment). Similarly, the enablers elucidated in this study can inform initiatives that aim to support adults achieve healthier weights.

Obes Facts. 2018 May 26;11(Suppl 1):134.

T2P49 A 6-week very low-calorie diet as short-term weight-loss method: effects on anthropometry and blood clinical chemistry parameters in subjects with obesity

L Cloetens 1, Å Sedin 1, M Landin-Olsson 2

Introduction

Obesity is global health problem contributing to increased prevalence of noncommunicable diseases. Treatment is often based on weight loss and many dietary weight loss programmes have been proposed. In the present study, a very low-calorie diet (VLCD) is used to investigate short-term weight loss in obese subjects.

Methods

After a medical screening, obese subjects followed a very low-calorie diet (VLCD) (650 kcal/day) for 6 weeks. During these 6 weeks the study subjects visited the study centre biweekly for a weight and health control and the other weeks there was telephone contact with all subjects. Anthropometric characteristics including body composition using a BIA-device and fasting blood clinical chemistry parameters were measured before and after VLCD. This study is part of an ongoing study investigating long-term weight-maintenance after weight-loss in which subjects are randomised into different types of diets. Statistical significance was set at p-value < 0.05.

Results

85 obese subjects (BMI 34.4 ± 3.0kg/m2, 53 ± 10y, 68% female) were included in the study and 77 subjects (90%) completed successfully the 6-week VLCD-period. Five subjects ended the study during the VLCD-period because of personal reasons and one subject showed adverse effects. Two subjects had to be excluded because one did not reach the aim (-5% of weight) and one subject because of diagnosed diabetes. After VLCD significant decreases (all p < 0.0001) compared to baseline were observed in weight (-10.9 ± 3.0kg), BMI (-3.7 ± 0.8kg/m2), waist circumference (-10.1 ± 4.2cm), sagittal abdominal diameter (-3.3 ± 1.7cm) and body fat (-3.5 ± 1.6%), fat-free mass (-3.3 ± 2.1kg) and total body water (-2.7 ± 2.0kg). Insulin (-5.8 ± 6.3mIE/L, p < 0.001), Hb1Ac (-2.0 ± 2.0 mmol/mol, p < 0.001), total cholesterol (-1.3 ± 0.8 mmol/L, p < 0.001), triglycerides (-0.4 ± 0.6mmol/L, p < 0.001), HDL-cholesterol (-0.2 ± 0.3mmol/L, p = 0.001) and LDL-cholesterol (1.1 ± 0.8mmol/L, p < 0.001) were significantly different from baseline. Mean systolic blood pressure was significantly reduced from 125.2 ± 13.8 to 115.7 ± 12.4mmHg (p < 0.001) and diastolic blood pressure from 79.6 ± 8.7 to 72.9 ± 9.2mmHg (p < 0.001). Liver enzymes ALP and GT were significantly decreased compared to baseline (-0.07 ± 0.16μkat/L, p < 0.001 and −0.15 ± 0.28μkat/L, p < 0.001 respectively), whereas ASAT and ALAT were significantly increased (0.1 ± 0.1µkat/L, p = 0.005 and 0.13 ± 0.37μkat/L, p = 0.002). Framingham risk score was reduced from 10.6 ± 7.7 to 8.5 ± 6.3 (p < 0.001). Fasting glucose, ApoB/ApoA1 and CRP remained unchanged.

Conclusion

A 6-week VLCD is an attractive and efficient short-term weight-loss method for healthy obese subjects. Weight-loss induced by VLCD might also contribute to the prevention of cardiovascular disease and diabetes.

Acknowledgement

We would like to thank Cambridge Viktprogram for sponsoring the study.

Obes Facts. 2018 May 26;11(Suppl 1):134.

T2P52 Evaluation Of Relationship Between Willingness To Eat Whole Grain, Dietary Fiber Knowledge And Whole Grain Consumption With Depression In Adults

E Abdurrahmanoğlu 1, M Bas 1

Introduction

Main purpose of this dissertation is to examine willingness to eat whole grain foods, knowledge level of dietary fiber and evaluate the relationship between whole grain foods consumption and depression in adults.

Methods

310 women and 90 men individuals who are in Acıbadem University have been included to the survey. Willingness to eat whole grain food questionnaries confirmatory and exploratory analysis have been completed and found that this scale might be convinient for deteremining the willingness level of eating whole grain foods (x2 = 4,83, RMSEA = 0,09, CFI = 0,89, NFI = 0,87, GFI = 0,87, SRMR = 0,07).

Results

Individuals who included to the study, %50 of them have low inclination to eat whole grain and rest of the individuals desire to eat it. %62,5 of participants have a high level knowledge about dietary fiber, %37,5 of the individuals have low information about it. Average consumption of whole grain foods is 43,38 ± 25,06 g/day for women and 42,22 ± 28,69 g/day for men. There was no statistically meaningfull difference between quantity of consumption according to gender. There is no relationship between individual's consumption frequency and consumption amount of whole grain food. But there is a meaningfull statistically relationship between willigness to eat whole grain and individuals consumption frequency and amount. Average consumption of dietary fiber is 20,5 ± 9,11 g/day for women and 21,4 ± 8,93 g/day for men. %70,8 of the individuals dietary fiber consumption is inadequate, %29,3 of them consume adequately. %54 of participants have minimal, %28 of them have mild, %15 of them have modarate and %2,5 of them have severe depression.

Conclusion

There is a inverse relationship between individuals daily consumption of dietary fiber and their depression level. But it couldn’t demonstrate a significant result. There is no meaningfull difference between both individuals willingness to eat whole grain and level of dietary fiber knowledge with depression levels.

Obes Facts. 2018 May 26;11(Suppl 1):134–135.

T2P53 Regularity and diet composition of normal weight, overweight and obese adolescent girls

L Plavšić 1, S Todorović 2, K Mitrović 2, R Vuković 2, T Milenković 2

Introduction

The increase in the incidence of obesity in adolescents is associated with poor eating habits such as omitting meals, frequent high-calorie snacks, eating out of the house, the consumption of sugary drinks.

Methods

The aim of our study was to examine normal weight, overweight and obese adolescent girls’ eating habits. The research included the normal, overweight and obese adolescent girls, aged 14.6 ± 2.2 years, who filled in a questionnaire about dietary habits at first examination of nutritionist. Body mass index of normal weight adolescent girls was between the 10th and 85th percentile, overweight between the 85th and 95th percentile, and obese above the 95th percentile.

Results

Out of 144 patients, there were 42 (29.2%) of normal weight, 26 (18.0%) overweight and 76 (52.8%) obese adolescent girls. Five meals a day had 26.2% of normal weight, 38.5% overweight and 18.5% obese adolescent girls, while regular breakfast had 92.9% normal weight, 84.6% overweight and 89.5% obese ones. Regular, daily intake of vegetables and fruits had 69% and 73.8% normal weight, 65.4% and 84.6% overweight and 67.1% and 65.8% obese adolescent girls. Meat, eggs and milk regularly took 66.7%, 31% and 81% normal weight, 61.5%, 34.6% and 73.1% overweight and 53.9%, 34.2% and 68.4% obese adolescent girls.

Conclusion

There was no statistically significant association in regularity and diet composition between normal weight, overweight and obese adolescent girls. Obese adolescent girls didn’t have regular meals, more often omitted breakfast, had irregular intake of vegetables, fruits, meat and milk compared to normal and overweight adolescents.

Obes Facts. 2018 May 26;11(Suppl 1):135.

T2P54 Food category purchase and expenditure of shoppers from high- middle- and low- South African income communities: Grocery receipt analysis

F Odunitan-Wayas 1, KJ Okop 2, R Dover 3, O Alaba 4, L Micklesfield 2, T Puoane 5, M Uys 2, L Tsolekile 5, N Levitt 6, J Battersby 7, H Victor 2, S Meltzer 8, EV Lambert 1

Introduction

There is increasing evidence that neighbourhood food environments may exacerbate issues of social justice in terms of access to healthy, affordable food and explain, in part, the juxtaposition of obesity with food insecurity in socioeconomically disadvantaged settings. In South Africa, more than 66% of women and 30% of men are overweight or obese, and nearly 50% of households experience food insecurity. The objective of this study was to characterize food-purchasing behaviour of retail supermarket shoppers in high-, middle- and low-income communities in South Africa.

Methods

Intercept interviews concerning shopping practices, demographics, perceptions of neighbourhood food environments, and food security status were conducted on 395 shoppers, recruited from 11 purposively-selected stores, representing 3 retail supermarket chains, in low-, middle- and high-income areas in urban Cape Town. Grocery receipts were collected or photographed. Food purchases were coded by dieticians and quantified according to frequency of purchase and as % of total expenditure by food categories (fruit, vegetables, dairy, meat, grains and potatoes, sugar-sweetened beverages (SSBs), snack foods). Shoppers and supermarkets were classified by residential area and location. Out-shoppers” were defined as persons from low- or middle-income areas shopping in higher-income areas, compared to “in-shoppers” (persons living and shopping in the same area). Adjusted multilevel model analyses were used to explain food purchasing behaviour.

Results

Respondents were predominantly weekly, in-shoppers. Those from low-income areas were more likely to be food insecure (68% vs. 42%), unemployed (41% vs. 22%) and less well educated (52% vs. 6%), than those from high-income areas. Overall, shoppers spent less than 5% of total expenditure on fruits or vegetables; and those from low- and middle-income areas spent less than those from high-income areas (2.5% vs. 4.5%) for fruits (p = 0.001) and 3.0% vs. 4.4% for vegetables (p = 0.02). Middle- and low-income shoppers spent more on snack food items (12% vs. < 7%, p < 0.0001) and grains and potatoes (9% vs. < 6%, p < 0.001) respectively compared to those from other income areas. The % expenditure on SSBs and snacks was higher than fruits and vegetables, in all income areas. Out-shoppers were more likely to be employed/retired (73% vs. 57%), perceive the quality of fruits and vegetables in their area to be poor (p < 0.001) and spend more (p = 0.02) on fruits and vegetables than in-shoppers

Conclusion

In urban South Africa, shoppers from high-income neighbourhoods spend more on healthier food items, than those from lower-income areas. However, all shoppers spend more on unhealthy food choices. Interventions to address the complex problem of obesity and food insecurity may need to include improving access to healthy, affordable food, and disincentivising the purchase of less healthy food items.

Obes Facts. 2018 May 26;11(Suppl 1):135.

T2P55 Relationship between Skipping Meals and Metabolic Syndrome in Korean Adults Based on 6th KNHANES

Y Suh 1, K Seok 2

Introduction

Eating habit is related to prevalence of metabolic syndrome that reflects risks of chronic diseases and cardiovascular disease. There have been several studies on the relationship between dietary frequency, metabolic syndrome and chronic diseases, but they have not been consistently related. This study was examined the relationship between skipping meals and metabolic syndrome in Korean adults.

Methods

Data were obtained from 6th Korea National Health and Nutrition Examination Survey from 2013 to 2015. 7,147 adults over 30 years old were divided into two groups that skipping meals and not skipping meals. After propensity score matching, 1,930 participants of each groups were included respectively. Logistic regression models were used to evaluate the relationship between skipping meals and metabolic syndrome.

Results

The subjects included 7,147 subjects who were not included in the pre-match analysis. A total of 1,930 subjects were included in each group after propensity score matching. Be compared with the group of no skipping meal, meal skipping group was related to higher risks of central obesity, increased triglyceride, elevated blood pressure[odds ratio 1.61(95% CI 1.40~1.86), 1.19(1.03~1.37), 1.23(1.06~1.43)]. The risk of high blood glucose and high HDL cholesterol lipid before and after propensity score matching were not significantly different between groups. Skipping meals group after matching was associated with increased risks of metabolic syndrome after adjustment for age, sex, smoking, alcohol drinking, physical activity, and daily total energy intake[OR 1.30(95% CI 1.12~1.49)].

Conclusion

This study suggests that skipping meals may be associated with increased risks of metabolic syndrome. Further studies should be conducted to evaluate the relationship between skipping meals and metabolic syndrome.

Obes Facts. 2018 May 26;11(Suppl 1):135.

T2P56 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):135–136.

T2P57 Short-term effects of different dietary approaches on body weight and body composition among obese female

YR Varaeva 1, AV Starodubova 1, SD Kosyura 1, E N Livantsova 1

Introduction

The problem of obesity is becoming an actual concern for Russian population. According to official data up to a third of Russian women are obese and more than two-thirds are overweight. The short-term effects of three well-known dietary approaches were investigated.

Methods

Sixty women with average BMI 35.3 kg/m2 participated in the one-month outpatient weight management program. After randomisation they were divided into three group: standard low-calorie diet (Group 1), lacto-ovo vegetarian diet (Group 2) and meal replacement diet (Group 3). For all groups, the daily energy intake reduction was 500 kcal per day. During the follow-up period changes in anthropometry, bioimpedance analysis data and biochemical markers were assessed.

Results

The average body weight loss during one-month follow-up was 4.15 kg (± 0.65 kg): 4.07 kg (± 0.9 kg) for Group 1; 3.93 kg (± 1.2 kg) for Group 2 and 4.44 kg (± 0.9 kg) for Group 3 respectively with p-value less than 0.05. The observed intergroup difference was statistically non-significant. Impressive results were also revealed decreased waist and hip circumferences (5.04 ± 0.80 and 3.91 ± 0.80 cm respectively) with the greatest result in Group 2 (5.29 ± 1.5 cm and 3.71 ± 1.5 cm) and Group 1 (4.71 ± 1.4 cm and 4.43 ± 1.5 cm). Changes in body composition included significant reduction of fat mass (2.99 ± 0.47 kg with p-value less than 10–5 in all groups and the highest result in Group 3: 3.60 ± 0.5 kg) and body liquid values reduction (1.47 ± 0.62 kg with p-value less than 0.05 in all groups and the highest result in Group 1: 1.47 ± 0.62 kg). On the other hand, muscle mass levels were maintained (-0.06 ± 0.27 kg) and even non-significantly increased in Group 2 (0.30 ± 0.52 kg). Significant improvements in blood lipids (such as tendency to serum total and LDL-cholesterol levels reduction with even reliable dynamics in Group 3), insulin and glucose levels were also detected.

Conclusion

The daily energy intake restriction caused a significant reduction of body weight, BMI, waist and hip circumferences and an improvement in body composition and biochemical markers. There were investigated differences between various dietary patterns but further research is required to obtain reliable data.

Obes Facts. 2018 May 26;11(Suppl 1):136.

T2P58 Gene variant rs925946 near BDNF gene is associated with dietary calcium intake in adolescents

M Vaňková 1, I Aldhoon-Hainerová 2, M Kunesova 3, V Hainer 3, H Zamrazilova 3

Introduction

Some candidate genes for obesity-susceptibility are often highly expressed in the hypothalamus, indicating their role in energy homeostasis. BDNF (Brain-derived neurotrophic factor) is a member of the nerve growth factor family and has been shown to be a downstream effector of MC4R anorexigenic actions. Mutations in BDNF gene have been reported in rare cases of severe early-onset obesity manifested with hyperphagia and cognitive impairment. We hypothesized that the mechanism of some candidate gene for obesity-susceptibility is mediated through the effect on dietary intake.

Methods

The present study included 1953 adolescents (877 boys and 1076 girls) aged 10 to 18 years who participated in the Childhood Obesity Prevalence And Treatment project. The cohort included 1035 non-overweight subjects (BMI < 90th percentile) and 918 overweight/obese subjects (BMI ≥ 90th percentile, 76% obese with BMI ≥ 97th percentile) according to the Czech BMI references specified for sex and age. Genotyping of BDNF variants (rs925946, rs4923461) was performed using the TaqMan SNP Genotyping Assays (Applied Biosystems) on LightCycler 480 (Roche). Dietary characteristics were evaluated using a selfreported 3-day dietary record that was filled out by each participant with the assistance of a family member and were calculated from the records using NutriMaster software (Abbott Laboratories).

Results

Overweight adolescents had a lower total energy intake (p < 0.001) but a higher percentage of fat (p = 0.009) and protein intake (p < 0.001) compared with the nonoverweight subjects. There was also a lower calcium intake in the overweight group (p < 0.001). BDNF gene variants did not show on a relation to body adiposity traits, but the minor allele T of rs925946 was related to a lower calcium intake (p = 0.001) even after an adjustment for BMI.

Conclusion

Our results suggest that rs925946 variant near BDNF gene may be related to dietary calcium intake independent of BMI in adolescents. AZV 17–31670A, MH CZ-DRO (Institute of Endocrinology – EÚ 00023761)

Obes Facts. 2018 May 26;11(Suppl 1):136.

T2P59 Role of tryptophan intake in sleep duration and modulation of sleep in adults

N Acar Tek 1, Y Ertaş Öztürk 1, M S Karacil Ermumcu 2, S Navruz Varlı 1

Introduction

Little data is known about nutritional impact on sleep duration and modulation of sleep in adults, particularly with regard to specific nutrients. There is increasing evidence showing that nutrients such as tryptophan seem to impact sleep duration. This study was conducted to evaluate tryptophan intake and effects of on sleep duration and efficiency of individuals.

Methods

Sixty healthy adults (30 male, 30 female) were included in this cross-sectional study. Sleep duration and efficiency of individuals were assessed with metabolic holter (SenseWear Armband®) in 180 days. Daily sleep duration was evaluated according to National Sleep Foundation recommendations (7 hours for adults) and divided into two groups. The cut off point of percentage of sleep efficiency was determined 50th percentile (79.1%) and classified as high or low. Dietary energy, protein and tryptophan intakes were calculated with Nutrition information system for Turkey (BeBiS). Comparisons between groups were analyzed by using SPSS.

Results

The mean age of the male and female subjects were 25.7 ± 2.89 and 26.4 ± 2.57 years respectively (p > 0.05) and sleep efficiency of females (80.6 ± 9.8) was significantly higher than males (76.2 ± 7.2). Dietary energy intakes of individuals were not statistically significant in sleep duration groups according to gender (p > 0.05). In males, daily dietary protein and tryptophan intakes were higher in individuals whose more than 7 hours (84.4 ± 14.83 g and 932.4 ± 152.20 mg) than whose sleep duration less than 7 hours (72.0 ± 21.28 g and 814.6 ± 250.96 mg) (p < 0.05). There was no significant differences in female sleep duration groups. According to sleep efficiency groups, no significant differences were found in terms of dietary energy, protein and tryptophan intakes in both gender (p > 0.05).

Conclusion

In conclusion, it was found that dietary protein and tryptophan intake are related with sleep duration but not sleep efficiency in males. Tryptophan has effects on sleep duration via its precursor role in serotonin synthesis. There are studies proven that dietary tryptophan-rich protein diets may efficiently restores sleep duration in rats and humans. Although sleep duration is related with tryptophan intake, there are conflicting results have been shown in studies between tryptophan intakes and sleep efficiency. Therefore, further studies are needed to investigate the relationships.

Obes Facts. 2018 May 26;11(Suppl 1):137.

T2P60 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):137.

T2P61 Associations of Polymorphisms of LEPr and FTO Genes with dietary consumption in severely obese individuals

J DC Horvath 1, N Kops 1, M Heredia 2, A Souza 3, E Fulber 3, R Friedman 2

Introduction

The global prevalence of obesity is of great concern, as obesity associates with several co-morbidities. Genetic factors play an important role in the pathogenesis of obesity. Observations studies indicates that FTO and LEP genes are related to the variation of the satiety sensation and also are involved in the regulation of dietary intake (DI). Thus, by its action in the regulation of DI it is possible these genes play a role in the genesis of obesity and seem to add further difficulty in the management of excess body weight. This study aimed at assessing the associations of polymorphisms of LEPr and FTO genes with DI in severely obese individuals.

Methods

A cross-sectional study of 222 severely obese, adult patients was carried out. Two SNPs of LEPr (rs1137101 and rs8179183), and one SNP of FTO (rs9939609) were genotyped and analyzed. Subjects were interviewed and answered to a series of questionnaires about health and food consumption. The DI were obtained through three days food records (all DI were recorded and weighed on a digital scale during three days). Dietary consumption was analyzed in the software Nutribase®. We used generalized linear models (GLMz) in SPSS 21 to analyze the additive effect of each SNP to eating; body mass index (BMI), gender and calories consumption were entered as covariates when outcomes variables were macronutrients. When outcome were calories only BMI and gender were covariates. All participants gave written, informed consent. The Ethics Committee of Hospital de Clínicas de Porto Alegre approved the study and registered it under number 110068. The National Research Ethics Commission registered the study as CONEP/CAAE: 0015.0.001.000–11.

Results

174 participants completed all evaluations. When analyzed together, the genotypes of the 3 genes associated with DI. The main effect was based on the interaction of the two SNPS of LEPr, rs1137101 and rs8179183 (p < 0,037). The mean (± standard deviation) of the caloric intake in the LEPr 223 (AA) genotype was 2780.2 (± 1147.9) kcal / day; while in the LEPr 656 (GC) genotype was 2811.2 (± 1012.6) kcal / day. In both cases, the caloric intake was higher than all others genotypes (150 kcal to 350 kcal). When analyzing the recessive and dominant inheritance models of SNPs LEPr 223 and LEPr 656 and their interactions in food consumption per kcal / kg, we observed associations in recessive model (p = 0.028 - GLMz). Regarding macronutrients, only protein intake was influenced by the SNPs evaluated (p = 0.023). There were no differences in macronutrient consumption among each SNPs (Table 1). Removing SNP rs9939609 of FTO from all models had no impact on the statistical significance (p = 0,071).

Conclusion

SNPs of the LEPr gene seem to play a potential role in the DI in obese patients, and they may help to predict those individuals who are at higher risk, and, therefore, with poorer outcomes. High risk obese, perhaps, have different genetic foundation that renders them more vulnerable to weight gain in an abundant environment in calorie-dense, easily accessible foods. These findings have to be confirmed in prospective studies.

Tab. 1.

ALL LEPr223 (G) LEPR 656 (C) FTO rs9939609 (T)
Calories 2673.40 (1051.99) 2573 07 (1026.28) 2677.69 (1070.09) 2515.91 (984.25)
Calories /kg 21.24 (8.25) 20.95 (8,08) 21.23 (8.57) 20.65 (8.59)
PTN (g) 124.45 (61.64) 114.93 (50.25) 122.53 (55.85) 117.94 (65.46)
PTN (g/kg) 0.98 (0.46) 0.93 (0 39) 0.96 (0.44) 0.95 (0.49)
CHO (g] 334.21 (153.14) 334.22 (150.33) 353.81 (160.60) 324.83 (146.79)
CHO (g/kg) 2.73 (1.21) 2.71 (1.18) 2.79 (1.27) 2.67 (1.27)
UP (g) 90.03 (40.53) 87.19 (40.40) 87.44 (38.93) 81.93 (35.52)
UP (g/kg) 0.71 (0.32) 0.71 (0.32) 0.69 (0.31) 0.67 (0.32)
UP.SAT (%) 9.10 (4.83) 9.23 (5.49) 9.09 (5.71) 9.00 (5.85)
UP.INSAT (%) 8.23 (2.34) 8.30 (2.40) 7.90 (2.25) 7.90 (2.31)
UP.MONO (%) 10.56 (3.99) 10.36 (3.22) 10.66 (3.10) 10.03 (2.83)
COL (g) 283.00 (162.35) 264.48 (144.10) 272.71 (167.70) 264.95 (143 83)
ω6 / ω3 8.52 (2.94) 8.57 (3.16) 8.47 (2.46) 8.74 (3.45)
Fiber (g) 26.37 (13.26) 25.25 (13.07) 26.75 (13.24) 25.56 (12.89)
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Legend: PTN: Proteins: CHO: Carbohydrates: LIP: Lipids: LIP.SAT: Saturated Lipids. LIP.INSAT: Unsaturated lipids; LIP.MONO: Monounsatu rated lipids; COL: Cholesterol. «6 /«3: Omega 6 ratio by omega 3. Data presented in Frequencies and averages (± standard deviation).

Obes Facts. 2018 May 26;11(Suppl 1):137–138.

T2P63 Association of HDL cholesterol, triglycerides and fasting blood glucose levels with the consumption of antioxidant vitamins in metabolically healthy Lebanese obese: a cross-sectional study

J Zalaket 1, L Hanna Wakim 1, R Berkachy 2, J Matta 3

Introduction

Obesity has been associated with a markedly increased oxidative stress. Antioxidant vitamins (vitamin A, C and E), among other components, play a big role in the protection against oxidative stress. Literature shows that obese have lower rates of antioxidant defenses (vitamins) than normal weight counterparts. Moreover, obesity is a principal causative factor in the development of metabolic syndrome. Increased oxidative stress in accumulated fat is an important pathogenic mechanism of obesity-associated metabolic syndrome, which is a constellation of risk factors characterized by central obesity, dyslipidemia, hypertension and hyperglycemia associated with insulin resistance. In this study, metabolic parameters (HDL cholesterol, triglycerides and fasting blood glucose) and antioxidant vitamins intake were measured in 112 healthy Lebanese obese.

Methods

A valid thirty-four items semi-quantitative food frequency questionnaire (SQFFQ) was used on 112 healthy Lebanese obese (40 males and 72 females) aged 18–62 years old, to test their antioxidant vitamins intake. Anthropometric parameters (weight and height) were measured according to standardized protocols. Blood samples were collected and metabolic parameters (HDL cholesterol, triglycerides and fasting blood glucose) were tested. The subjects were recruited from the database of dietary clinics.

Results

Spearman and Pearson correlation coefficients were used to measure the strength of the relationship between vitamins consumption and the metabolic parameters. There was a significant positive correlation between the vitamin A consumption and the serum levels of HDL cholesterol in obese participants who never smoked; when vitamin A levels decrease, HDL levels decrease in women more than men participants. However, no significant correlation between vitamin A and the serum levels of triglycerides and fasting blood glucose, and vitamin C and E and the serum levels of triglycerides, HDL cholesterol and fasting blood glucose even after correcting the smoking cofounding factor, gender and socio-economic status. These results were confirmed too after studying the regression model based on the different components.

Conclusion

In this study, metabolic parameters (HDL cholesterol, triglycerides and fasting blood glucose) were not associated with antioxidant vitamins intake in healthy Lebanese obese. However HDL levels tend to decrease when vitamin A levels decrease. Furthermore, the present results should be considered as primary and additional investigations are needed.

Obes Facts. 2018 May 26;11(Suppl 1):138.

T2P64 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):138.

T2P65 Eating Attitudes and Dietary Intakes of University Students

MS Karacil Ermumcu 1, M Gezmen Karadag 1, F Ayyıldız 1, H Yıldıran 1

Introduction

Adolescents usually tend to be influenced by the perception of their body shape and size. This situation can affect their dietary intake. This study was planned and conducted to evaluate eating attitudes and dietary intakes of adolescents.

Methods

This cross-sectional study was conducted including 17–24 years of ages 420 University Students (379 males and 288 females). Questionnaire including the demographic and general characteristics were recorded with face to face interview. Anthropometric measurements (body weight (kg) and height (cm) of university students were taken according to the rules and body mass index (BMI) was calculated. Daily food consumption was assessed using 24-hour dietary recall. Forty-items Eating Attitudes Test (EAT-40) was used to evaluate eating attitudes of students.

Results

EAT-40 scores for all students ranged between 4 and 66 (mean score: 20.3 ± 15.42, female: 14.6 ± 0.86; male: 17.0 ± 1.48). According to EAT-40 scores categorization, 19.3% (men: 16.7%; female: 20.5%) of students have 30 or above scores and they categorized as having abnormal eating attitudes. Having abnormal eating attitudes students dietary intake less energy (kcal) and carbohydrate intake (g) than having normal eating attitudes. (energy: 1877.1 ± 632.94 kcal; 1674.6 ± 618.44 kcal; carbohydrate 216.6 ± 90.81 g; 184.7 ± 81.05 g respectively). There was negative correlation between EAT-40 scores and daily dietary energy intake (r:-0.139; p: 0.004), protein (r:-0.120; p: 0.014), carbohydrate (r:-0.151; p:0.002), fiber (r:-0.134; p:0.006). There wasn’t any correlation between EAT-40 scores with body weight and BMI.

Conclusion

Dietitians play an important role in the treatment of eating disorders. Because intake of nutrients from individuals with a tendency abnormal eating attitudes should be followed by nutrition professionals. So necessary intervention can be done at the appropriate time.

Obes Facts. 2018 May 26;11(Suppl 1):138.

T2P66 Fruit and vegetable consumption in healthcare students and its relationship with subjective well-being

PL Martinez 1, A L Armendariz 1

Introduction

It has been studied that a low consumption of fruits and vegetables is linked with different physiological health conditions, but there are also a small number of studies that have shown a relationship between the consumption of fruits and vegetables with happiness and well-being. Objective: Identify prevalence of fruit and vegetable consumption in the university student population of the Autonomous University of Baja California and the University Iberoamericana, and assess whether there is a relationship between the consumption of fruits and vegetables with the state of subjective well-being.

Methods

Cross-sectional study, where information was collected of 857 students (511 women) with 20 years of age as mean. An anthropometric assessment was taken focused on taking weight and height; and with calculation of body mass index (BMI). A fruit and vegetable consumption frequency questionnaire was applied, such as the Self-Reported Subjective Well-being test (BIARE) in its basic presentation. The students that participated are part of the following programs: Bachelor of Medicine, Bachelor of Nursing, Bachelor of Nutrition and Bachelor of Psychology.

Results

The average fruit consumption among the students was 1.14 daily servings. In the case of vegetable consumption the average among students was 1.43 daily servings. Statistically significant relationships were observed between Subjective Well-being and Weekly Fruit Consumption (r = 0.475, p = 0.000), as well as Subjective Well-being and Weekly Vegetable Consumption (r = 0.367; p = 0.000). Statistically significant relationships were observed also by gender, between Subjective Well-being and Weekly Fruit Consumption in the Female population (r = 498, p = 0.000) and Vegetables (r = 0.415, p = 0.000); in the Male population the results of Subjective Well-being and Weekly Fruit Consumption (r = 0.443; p = 0.000) and Vegetables (r = 0.289; p = 0.000). There are no significant differences in consumption of Fruit and vegetables by gender. The average fruit and vegetable consumption per week in students with a BMI > 30 was lower compared to students with a normal BMI 8.3 vs 10.89 servings of fruit (r = –0.113; p = 0.001) and 10.87 vs 14.09 servings of vegetables (r = –0.133; p = 0.000) respectively.

Conclusion

The consumption of fruits and vegetables resulted in a statistically significant relationship with Subjective Well-being, as the consumption of fruits and vegetables increases students showed higher scores on the well-being test and the other way around, the smaller amount of fruit and vegetables consumed showed a lower score if the well-being test. Students with a BMI normal showed a higher consumption of fruits and vegetables compared to students with BMI 30 of higher.

Obes Facts. 2018 May 26;11(Suppl 1):138–139.

T2P67 Is Body Mass Index Effective on Diet with Low Energy Products?

B Yılmaz 1, M Gezmen Karadag 1, H Yıldıran 1

Introduction

Energy density may have a strong influence on energy balance. Regulating the energy density of food could be used as a novel approach for successful body weight reduction in clinical practice.

Methods

The study was conducted with 800 individuals aged 18–65 years for the gender and age distributions of the individuals to be similar, 80 males and 80 females from each age group were included in the study. Anthropometric measurements were taken by researchers to be appropriate for measurement techniques. The Body Mass Index (BMI) was calculated the body mass divided by the square of the body height (kg/m2). A questionnaire about the use of low-energy products was developed and filled out by face to face interviews with individuals.

Results

The BMI values of the female subjects ranged from 21.2 to 29.4 kg/m2 according to age groups and it was determined that body weight, BMI, waist circumference and hip circumference increase with age. The BMI values of male subjects vary between 24,4–27,6 kg/m2 according to age groups. When low-energy product choices of individuals were examined according to BMI, 35.7% of women have 18,5–24.9 with normal BMI and 31.4% of women who are overweight preferred low-energy products. In males, the group with the most preference for low energy products was found to be obese (41.8%), followed by individuals with normal BMI (21.5%).

Conclusion

BMI can affect differently low-energy food choices according to gender. While female individuals with normal BMI prefer these products, the overweight male individuals prefer the products. More studies is needed to clarify the relationship of energy intensity to BMI and anthropometric measurements.

Obes Facts. 2018 May 26;11(Suppl 1):139.

T2P68 Effect of nuts consumption on anthropometric parameters and lipid profile

K Pastusiak 1, J Michałowska 2, D Skrypnik 3, D Pupek-Musialik 4, P Bogdański 3

Introduction

Despite significant progress in diagnosis and treatment of the cardiovascular diseases (CVD), they remain main cause of premature deaths. An increasing number of scientific reports suggests that regular nuts consumption may reduce the risk of CVD by 30%. The aim of the study was to find the correlation between the nuts intake and selected anthropometric and biochemical parameters.

Methods

The study was conducted on 306 volunteers (216 female and 90 male), aged 19–89. At the beginning subjects were asked to complete a questionnaire on their health and lifestyle. Then, patients’ height, weight, waist circumference were measured and biochemical tests were performed. The statistical analysis of collected data was performed with Statistica program.

Results

The mean values of serum concentration in the study group were: 196.85 (±38.35) mg/dl for total cholesterol, 66.63 (±16.57) mg/dl for LDL cholesterol, 106.9 (±49.68) mg/dl for HDL cholesterol and for triglycerides 149.11 (±72.58) mg/dl. The mean body mass index (BMI) in the study group was 27.53 (±5.24) kg/m2, while the main waist circumference was 91.1 (±14.82) cm. There were no statistically significant relationships between the frequency of nuts intake and lipid profile parameters. However, more frequent nut intake negatively correlated with BMI values and waist circumference of the subjects.

Conclusion

High nut consumption exerts favourable influence on BMI and waist circumference. High nut consumption exerts no effect on the lipid profile in human subjects. Evaluation of the cardioprotective mechanism of nuts intake requires further research.

Obes Facts. 2018 May 26;11(Suppl 1):139.

T2P69 Effects of L-arginine supplementation in the elderly

J Michałowska 1, K Pastusiak 2, D Skrypnik 3, D Pupek-Musialik 4, P Bogdański 3

Introduction

L-arginine is a conditional essential amino-acid which takes part in the biosynthesis of proteins. The average dietary intake of L-arginine is 4–5 grams daily and it naturally occurs in such food products as seafood, meat, nuts and seeds. This amino acid can be endogenously synthesized, mainly in the kidney. An increasing number of evidence suggest that L-arginine supplementation has beneficial effect on human health.

Methods

Arginine is takes part in nitric oxide (NO) synthesis- an important modulator of vascular tone. Increasing concentration of NO causes smooth muscle relaxation, resulting in arterial vasolidation and increased blood flow. Aging is associated with progressive endothelial dysfunction as NO bioavailability is reduced. Recent studies have demonstrated that supplementation with L-arginine in elderly patients has beneficial effect on cardiovascular system by improving endothelial function and lowering blood pressure.

Results

Recent studies investigated the effect of L-arginine supplementation on performance and physical function in humans. Some results suggest that supplementation of L-arginine in elderly patients results in improvement of performance, muscle mass and strength. There is considerable interest in potential role of L-arginine in wound healing process and it's positive effect on immune system. Previous studies suggest that exogenous L-arginine administration may have beneficial effect in pressure ulcers treatment. This medical condition is associated with many adverse health outcomes and it is frequently presented in elderly bedridden patients. Recent studies presented that L-arginine supplementation may result in other health benefits such as lowering serum triglycerides and total cholesterol concentration and has positive effect on erectile dysfunction treatment.

Conclusion

It must be noted that many studies were performed with limited number of patients, very often with administration of other oral supplements. More studies are needed to draw a firm Conclusion on the beneficial effects of L-arginine supplementation in the elderly.

Obes Facts. 2018 May 26;11(Suppl 1):139–140.

T2P70 Dietary Inflammatory Index and its association with body weight and metabolic indices in Indonesian adults

H FL Muhammad 1, M AV Baak 2, EC Mariman 2, DC Sulistyoningrum 1, E Huriyati 1, YY Lee 3, WAMW Muda 4

Introduction

There is an increasing rate of non-communicable diseases (NCDs) in developing countries. Systemic inflammation is one of the early indicators for the development of several NCDs, including heart diseases, type 2 diabetes mellitus, and obesity. It was previously reported that dietary intake is an important trigger for systemic inflammation and an algorithm to evaluate the inflammatory properties of diet, the Dietary inflammatory index (DII), has been developed. It was shown to be associated with systemic inflammation in Western countries. Currently, there is no study that evaluates the application of DII in Asian developing countries. The aim of this study was to evaluate the association between DII and body weight and metabolic indices in an Indonesian population.

Methods

This is a cross-sectional study conducted in 504 Indonesian adults (21–56 years old, BMI range 15.1–46.4 kg/m2, M/F: 253/251) living in the city of Yogyakarta, Indonesia. Subjects were selected using cluster sampling method from 5 subdistricts and informed consent was obtained. Dietary intake was recorded using a semi-quantitative food frequency questionnaire and DII was calculated based on data of 27 nutrients. Anthropometric measures (body weight, percent body fat, waist-hip circumferences), blood pressure and metabolic profile (plasma triglycerides, high-density lipoprotein (HDL) cholesterol and leptin) were measured.

Results

The mean DII of adults in this study was 7.9 ± 0.1 (range −2.9 to 12.8) which was relatively high compared to studies in Western populations. DII was positively correlated with the intake of bread, cereals, cassava and potatoes (r = 0.435, p < 0.001), palm oil and coconut milk (r = 0.339, p < 0.001) and sugar (r = 0.129, p = 0.004) and negatively correlated with intake of fish and seafood (r = −0.112, p = 0.012), vegetables (r = −0.318, p < 0.001) and fruits (r = −0.283, p < 0.001). DII was not correlated with body weight (r = −0.015, p = 0.736), systolic blood pressure (r = −0.025, p = 0.580), diastolic blood pressure (r = −0.023, p = 0.614) and triglycerides (r = −0.004, p = 0.929). Interestingly, DII was negatively correlated with plasma HDL (r = −0.091, p = 0.047) and leptin (r = −0.125, p = 0.011).

Conclusion

We found that DII represented poor dietary behavior in an Indonesian population since it was associated with lower intake of fish, fruits, and vegetables as well as higher intake of cereals, oil, and sugar. DII was negatively correlated with HDL and leptin. Whether systemic inflammation mediates this association remains to be studied.

Obes Facts. 2018 May 26;11(Suppl 1):140.

T2P71 Does living status associated with poor dietary intake among healthy elderly?

M S Karacil Ermumcu 1, N Acar Tek 1

Introduction

There has been an increase in elderly population recently so the prevalence of living alone increases. Living along in elderly has implications for nutrition and health outcomes. The aim of the present study was to examine the relationship between living alone or with family with dietary intake in elderly.

Methods

This is a cross-sectional population-based study consisted of 405 elderly (141 men and 264 women) mean aged 71.6 ± 6.54 years. Questionnaire including the demographic and general characteristics, health information, living status, nutritional habits, were performed by face-to-face interviews. Daily food consumption was assessed using 24 hour dietary recall.

Results

According to living status, 85.2% of elderly was living with their family but only 14.8% of them was living alone. There was a significant difference in number of main meal between elderly living alone (2.5 ± 0.57) or not (2.7 ± 0.45), (p < 0.05). Mean body mass index of elderly was 28.9 ± 5.41 kg/m2. Daily mean energy, protein, fibre intake was found higher in elderly living with family (1736 ± 539.60 kcal; 61.9 ± 26.84 g; 24.2 ± 9.86 g respectively) than living alone (1706 ± 748.23 kcal; 58.3 ± 29.66 g; 22.9 ± 10.54g respectively) (p > 0.05). But percentage of energy from fat was higher in energy elderly living alone (38.5 ± 7.80%) than living with family (37.0 ± 8.27%) (p > 0.05). When the daily water consumption was evaluated, it was found to be lower in living alone (2273.0 ± 516 ± 54 ml) than living with family (2725.2 ± 945.68 ml) (p > 0.05).

Conclusion

Living status affect dietary energy and macronutrient intake of elderly. Living status could negatively affect intake of food amount and diversity, also cause malnutrition and sarcopenic obesity. So food choices and skills for food preparation have to improve for healthy eating in elderly living alone.

Obes Facts. 2018 May 26;11(Suppl 1):140.

T2P72 The effect of living alone on malnutrition in elderly population

M S Karacil Ermumcu 1, N Acar Tek 1

Introduction

Nutrition plays an important role in maintaining health of elderly population. More than 50% of elderly are suffering from malnutrition. So older people are potentially vulnerable groups at risk of malnutrition. Living alone is a another big problem for their helath and nutrition in elderly. This study was planned to determine differences in nutritional status of elderly people living alone compared to living with family.

Methods

The study stated a total of 359 elderly (95 men;264 women) (aged between 60–92). Questionnaire including the demographic and general characteristics, health information was recorded by face-to-face interviews. Anthropometric measurements, including weight, height, were measured by well-trained investigators and body mass index (BMI) was calculated. Mini Nutrition Assessment (MNA) and Mini Nutrition Assessment-Short Form (MNA-SF) were used for assessment of nutritional status.

Results

According to living status, 83.3% of elderly was living with their family but only 16.7% of them was living alone. The mean age was 71.3 ± 6.43 years (living alone: 74.1 ± 6.68 years; living with family: 70.7 ± 6.24 years) in elderly. According to MNA test 6.7% of elderly living alone, 6.1% of elderly living with family had malnutrition and about 38.3%; 40.6% of them were at risk of malnutrition respectively. There was a negative association between age and MNA scores in elderly living with family and alone (r: −0.096, p: 0.468; –0.275, p: 0.000) And also there wasn’t any significant difference between BMI values of elderly living alone (29.0 ± 4.76 kg/m2) and living with family (29.0 ± 5.55 kg/m2) (p > 0.05).

Conclusion

The prevalence of malnutrition was found similar in both elderly groups in this study conducted in healthy elderly people. However, as age increases living alone increases the risk of malnutrition in elderly. Living alone can affect nutritional status of elderly so it can be a significant predictor of risk of malnutrition and malnutrition. Evaluation of nutritional status of elderly living alone can be done more frequently.

Obes Facts. 2018 May 26;11(Suppl 1):140.

T2P73 The Dutch Healthy Diet Index and its components in relation to visceral fat area and liver fat content in middle-aged men and women: the NEO study

E Van Eekelen 1, A Geelen 2, HJ Lamb 3, A De Roos 3, FR Rosendaal 4, R De Mutsert 3

Introduction

It is unclear to what extent adherence to dietary guidelines may specifically affect visceral fat and liver fat. Therefore, our aim was to study the association between the Dutch Healthy Diet Index (DHIDI) and visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) in middle-aged men and women.

Methods

In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, VAT was assessed by magnetic resonance imaging (MRI), and HTGC by proton-MR spectroscopy. Habitual dietary intake and physical activity were estimated by questionnaire. We calculated the DHDI score based on eight components (dietary intake of vegetables, fruit, fish, fibre, saturated fatty acids, trans-fatty acids, alcohol, and physical activity), ranging between 0 and 80, with a higher score indicating a healthier diet and/or lifestyle. With linear regression we examined associations between the DHDI and VAT and HTGC, adjusted for age, smoking, education, ethnicity, basal metabolic rate, energy restricted diet, menopausal state and total energy intake, stratified by sex. We additionally adjusted the associations for total body fat to examine whether the associations did not merely reflect effects on overall adiposity. To examine which component contributed most to the associations, the eight components were excluded one by one from the model.

Results

In total, 2,304 participants (47% men) were analysed with a mean (SD) age of 55 (6) years. After adjustment for potential confounding factors, a 5-point higher score on the DHDI was associated with less visceral fat (-4.4 cm2; 95% confidence interval −6.4, −2.4 for men and −1.8 cm2; −3.0, −0.6 for women) and less liver fat (0.92 times lower; 0.87, 0.96 in men and 0.94; 0.90, 0.98 in women). After additional adjustment for total body fat the associations with VAT (-2.6 cm2; −4.5, −0.8 for men and −1.3; −2.5, −0.1 for women) and HTGC (0.95; 0.90, 0.99 for men and 0.95; 0.91, 0.99 for women) remained. Of all eight components, exclusion of alcohol consumption most strongly attenuated the associations with VAT in men (-1.6 cm2; −2.7, −0.6) and women (-1.0 cm2; −2.2, 0.2).

Conclusion

Adherence to a healthy diet and lifestyle as estimated by the Dutch Healthy Diet Index was associated with less visceral fat and liver fat in middle-aged men and women. Prospective studies need to further investigate this association in relation to cardiometabolic outcomes.

Obes Facts. 2018 May 26;11(Suppl 1):141.

T2P74 The association between dietary pattern for the non-fast food remainder of intake and obesity among South Korean adults

D Kim 1, H Lee 1, A Ahn 2, J Choi 2, H Lim 1

Introduction

Although it is generally known that fast food consumption is associated with obesity, it remains unclear in South Korea. In addition, the study on the effect of eating habits or dietary pattern except for fast foods on obesity was insufficient. We examined the association of dietary factors and dietary pattern for the non-fast food remainder of intake with overweight/obesity.

Methods

This cross-sectional analysis studied 19,012 South Korean adults aged 19–64 y from the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2010. Cluster analysis identified 3 dietary patterns for the non-fast food remainder of intake: pattern 1 (other grain, nuts, fruit, eggs, milk, oils, and soda), pattern 2 (white rice, kimchi, and seaweeds), and pattern 3 (meat and alcohol). Multivariable-adjusted linear and logistic regression models were fit to assess the association of fast food consumption and dietary pattern for the remainder of intake and examine the association between each dietary pattern and obesity.

Results

The proportion of fast food consumer on the surveyed day were about 10%. Compared with non-consumers, fast food consumers had a significantly higher intake of meat and its products, milk, dairy, oils, soda, alcohol even excluding fast foods items. The fast food consumers had higher total energy intake (2741 kcal/d [including approximately 510 kcal/d from fast food items]) derived from protein and fat than that of non-consumers (2048 kcal/d). Consuming a dietary pattern 1 and 3 for the remainder of intake were more likely among fast food consumers (pattern 1: OR: 2.00; 95% CI: 1.76, 2.27, pattern 3: OR: 1.21; 95% CI: 1.02, 1.43) than nonconsumers. The dietary pattern 2 and 3 for the remainder of diet was independently associated with overweight/obesity (pattern 2: OR: 0.88; 95% CI: 0.82, 0.96, pattern 3: OR: 1.14; 95% CI: 1.01, 1.28), whereas fast food consumption was not.

Conclusion

Dietary pattern for the non-fast food reminder of intake might have associations with overweight/obesity and poor dietary outcome, whereas fast food consumption itself was not. In addition, future prospective and randomized clinical studies are needed to assess the clearer causality.

Obes Facts. 2018 May 26;11(Suppl 1):141.

T2P75 Assessment of Obesity and Diet Sugar Consumption in Young Adults

N Acar Tek 1, B Deniz Günes 1, G Akbulut 1

Introduction

In this study, it was aimed to determine the consumption of sugar and sugary foods by young adults and to investigate their relation with obesity.

Methods

The research was conducted on 325 individuals, 101 of them male and 224 female. The data were collected by interview using the questionnaire form. Individuals were questioned about sugar and sugary food consumption. Height, body weight, neck circumference were measured and body mass index (BMI) was calculated.

Results

The average age of the individuals was 22.2 ± 1.87 years for males and 21.4 ± 1.61 years for females. While 80.2% of male individuals were normal, 14.9% were overweight, 4% were obese and 1% were underweight, 85.3% of female individuals were normal, 8.5% were underweight, 5.8% were overweight, 0.4% were obese. The difference between the groups was statistically significant (x2 = 19.388; p = 0,001). It was found that 79.1% of the individuals added sugar to beverages and sugar added drinks were the most common Turkish coffee and nescafe (granule). There was no significant difference between BMI classification and adding sugars to beverages (p > 0.05). Consumption of cola (68.0 ± 48.1 ml), fruity soda (56.2 ± 65.56 ml) and ready-made fruit juice (53.9 ± 59.03 ml) were found to be the most common when daily consumption of sugary foods and drinks were calculated. In addition, average daily consumption of chocolate in individuals was 22.2 ± 17.06 g and consumption of tea sugar was 12.2 ± 11.42 g. There was a positive correlation between body weight, tea sugar consumption and cola consumption (r = 0.155, p < 0.05; r = 0.195, p < 0.01). There was a positive relationship between the neck circumference and consumption of tea sugar, chocolate, cola (r = 0.305, p < 0.01; r = 0.162, p < 0.01;r = 0.259, p < 0.01, respectively).

Conclusion

Sugar and sugary food consumption was associated with anthropometric measurements in young adults. It is known that consumption of more sugar than the requirements of the individuals in this period will increase the risk of chronic illness later on. Adequate and balanced nutrition should be taught so that individuals can have a healthy adult and old age.

Obes Facts. 2018 May 26;11(Suppl 1):141–142.

T2P76 The Roles of Milk-Derived Bioactive Peptides in the Body Weight

G Özata Uyar 1, B Deniz Güneş 2, G Akbulut 2, N Acar Tek 2

Introduction

Increasing evidence supports importance of nutrition in the development of chronic diseases such as cardiovascular disease, cancer, insulin resistance, and obesity. Recently, consumption of dairy products has been associated with beneficial effects on obesity. Milk and dairy products have functional compounds with many health benefits such as calcium, fat soluble vitamins, bioactive peptides, free fatty acids, sphingolipids. In this review was planned to evaluate the association of bioactive peptides in milk with body weight.

Methods

A literature review was conducted on several databases (Pubmed, Science Direct, Web of Science)

Results

Milk proteins constituting 3.5% of cow's milk are classified as casein and whey proteins. Casein and whey proteins from milk-derived bioactive peptides have important roles in health. Bioactive peptides can provide diverse activities; including opioid-like, mineral binding, immunomodulatory, antimicrobial, antioxidant, antithrombotic, hypocholesterolemic and antihypertensive properties. A high intake of milk proteins, especially whey proteins, has been indicated to exert the beneficial effects on obesity and obesity related diseases in both humans and animals via unknown mechanisms. The whey protein has an insulinotropic effect when compared to casein. The consumption of protein have a thermogenic effect by increasing thermogenesis through the activation of mTOR due to the increase in protein synthesis and the high leucine content of the whey protein. As another mechanism, differences in the kinetics of absorption of casein and whey proteins are thought to be important. While whey proteins are rapidly absorbed and cause a rapid, high but transient postprandial rise in plasma amino acids, the casein precipitates in the stomach causing a slower rise and long lasting plateau of plasma amino acids. High whey protein isolates have been shown to inhibit PPARγ expression and lipid accumulation in 3T3-L1 preadiposides and reduce weight gain in rats fed high fat diets. Proteolysis of casein in milk results in the release of bioactive peptides containing casomorphins and caseinoglycoprotein. Casomorphins are peptides with opioid-like activities that interact with gastric opioid receptors and prevent further food intake by slowing gastrointestinal motility. Caseinoglycomacropeptites and whey proteins suppress appetite and increase satiety by stimulating the release of cholecystokinin and activating the glucagon-like peptide-1 (GLP-1) pathway. A high fat diet enriched with especially β-lactoglobulin has been reported to reduce body weight.

Conclusion

As a result, proteins are the most satiating macronutrient and sufficient intake is important to control body weight. Human studies are limited in the literature and optimal plasma levels of bioactive peptides have not been determined. Therefore, recommendation of age and sex-specific dairy product consumption of individuals is important in terms of bioactive peptides. More work is needed to determine the potential therapeutic dose of bioactive peptides in humans. further research is needed in order to reveal the relevance and potential therapeutic role of bioactive peptides in humans.

Obes Facts. 2018 May 26;11(Suppl 1):142.

T2P77 Dietary Adequacy and BMI Relation among Reproductive Age Women

MS Karacil Ermumcu 1, E Koksal 1, B Kocaadam 1, E Karabudak 1, S Bilici 1

Introduction

Examining dietary patterns enables an alternative approach to obesity. The study aim was to investigate relationship between dietary adequacy and body mass index (BMI) of Turkish women.

Methods

The participants group consisted of 636 healthy women (aged 18–49 years). Pregnant, lactating and smoking women were excluded. Nutritional status of women was identified with dietary intake record of three sequential days, one day of which falls into weekend. The nutritional status of the individuals were assessed using BMI. BMI calculated and classified accordance to WHO classification. For the evaluation of dietary adequacy, Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were used. NAR was calculated by dividing daily intake of a nutrient by Dietary Reference Intake (DRI) levels categorized under age and gender. In this study, NAR were obtained for twelve nutrients in total as protein, fiber, vitamin B6, folate, vitamin B12, vitamin C, calcium, phosphor, potassium, magnesium, iron and zinc. MAR was obtained by dividing the total NARs by the number of nutrients (for twelve nutrients). The diets of the participants were classified as ‘insufficient’ for ≤50%, as ‘needs improvement’ for 51–80% and as ‘good’ for >80%. Differences in median MAR values between groups were analyzed with the Kruskal-Wallis test.

Results

The mean (± SD) age of the women was 26.8 ± 0.32 years. Majority of the participants had normal BMI (64.6%, mean 22.9 ± 4.16 kg/m2). While 38.4.0% of the participants were in good classification, 10.2% were insufficient according to the MAR scores. There was no correlation between BMI and MAR scores (r = 0.016, p = 0.683). Also, there was no difference among MAR scores according to BMI classification (p = 0.541) (Table 1).

Conclusion

In this study, there was no relationship between MAR score and BMI. This may be due to the fact that most of the participants were included in the normal classification. In addition, dietary quality can be increased by increasing the consumption of iron, calcium, potassium sources which were insufficient in participants’ diets.

Tab. 1.

Differences in MAR median values according to BMI classification

BMI classification Underweight Normal Overweight Obese p
MAR scores (Median (IQR) 76.5 (19.9) 74.1 (22.2) 76.5 (25.3) 79.2 (20.3) 0.541
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Obes Facts. 2018 May 26;11(Suppl 1):392.

T2P78 Vitamin B12 deficiency in renal transplant recipients: frequency and association with body adiposity and dietary intake

KSDS Pontes 1, MI Barreto Silva 1, MS Costa 1, AP Menna Barreto 1, JV Pires 1, FG Abrantes 1, S Giannini 1, MDLG Rodrigues 1, D CT Valença 1, MRST Klein 1, S Rioja 1

Introduction

After kidney transplantation weight gain is frequent and cardiovascular diseases (CVD) are an important cause of morbidity and mortality. There is evidence that, in general population, obesity is associated with vitamin B12 (B12) deficiency, which can favor hyperhomocysteinemia, a risk factor for CVD. However, to date in renal transplant recipients (RTR) the prevalence of B12 deficiency and its association with body adiposity is not known. The aim of the present study was to evaluate the serum concentration of B12 in RTR determining the frequency of vitamin B12 deficiency and the association with body adiposity and dietary intake.

Methods

Cross-sectional study performed with adult RTR submitted to RT for at least six months. RTR undergoing dialysis, presenting AIDS, cancer, autoimmune diseases or acute illness were excluded. Anthropometric evaluation: body mass index (BMI), body adiposity index (BAI), waist circumference (WC) and waist to height ratio (WhtR). Percentage of total body adiposity (%TBA) was estimated by dual energy x-ray absorptiometry (DXA). The dietary intake of B12 was evaluated through 3 24h food recalls. B12 deficiency was defined as serum values < 200 pg/mL. Glomerular filtration rate was estimated (eGFR) by CKD-EPI equation. The study was approved by local Committee on Ethics and Research and all patients signed informed consent. Statistical analyses were performed using STATA12.0 software.

Results

A total of 161 RTR were evaluated, 57% (n = 91) of male gender, 47.1 ± 10.9 years old, 111.3 ± 88.8 months post-transplant, eGFR = 55.2 ± 20.6 ml/min. The frequency of vitamin B12 deficiency was 11% (n = 17). RTR with B12 deficiency compared with those without deficiency presented significantly higher values (p < 0.05) of BMI (28.9 ± 1.3 vs. 26.1 ± 0.4 kg/m2), BAI (33.7 ± 2.2 vs. 29.7 ± 0.5%), WC (100.2 ± 2.8 vs. 91.4 ± 1.1 cm) and WhtR (0.62 ± 0.02 vs. 0.56 ± 0.01). %TBA was higher in the participants with B12 deficiency without reaching statistical significance (38.3 ± 2.9 vs. 34.0 ± 0.8%; p = 0.09). In multivariate analyses controlling for age, gender, eGFR and time from transplant the differences between groups were similar to the observed in univariate analysis. In the comparative analyses between groups including only women all anthropometric parameters remained significantly higher (p < 0.02) in the deficient group: BMI (31.2 ± 26.4 vs. 26.4 ± 0.7 kg/m2), BAI (39.7 ± 3.1 vs. 34.0 ± 0.7%), WC (103.5 ± 3.5 vs. 88.8 ± 1.7 cm) and WhtR (0.66 ± 0.03 vs. 0.57 ± 0.01) and %TBA was also significantly higher (47.9 ± 2.3 vs. 41.0 ± 0.8%; p = 0.007), even after controlling for confounders. The mean intake of B12 was not significantly different in patients with (3.14 ± 0.97 mcg/day) and without deficiency (5.47 ± 0.97 mcg/day), being above of recommended daily intake for adults (2.4 mcg / day).

Conclusion

This pilot study suggests that in RTR, despite adequate B12 intake, there is a high frequency of B12 deficiency and that B12 deficiency may be associated with higher body adiposity especially in women.

Obes Facts. 2018 May 26;11(Suppl 1):393.

T2P79 Assessment of food group consumption in young female adults according to Turkey Dietary Guideline

MS Macit 1, E Koksal 1, G Özata Uyar 1, H Yıldıran 1

Introduction

Young adults have sub-optimal nutrition and physical activity behaviors, which may lead to excess energy intake and they consume excessive amounts of sugar, sweetened beverages, and energy-dense meals. These eating patterns are associated with weight gain and obesity. Also, young adults may fail to follow the national dietary and physical activity recommendations. In order to improve dietary intakes, firstly it needs to explore the determinants of dietary behaviors and their influence on diet quality. The present study aimed to evaluate young adults’ adherence to Turkey Dietary Guideline (2015) recommendations and its relation to body mass index (BMI).

Methods

This study was planned as a cross-sectional study with young female adults (aged 18–35). Sample characteristics and dietary intake were assessed using a self-administered questionnaire including a dietary record (24-h dietary recall). Consumption of food groups was calculated with a computer programme (Nutrition Information System/BeBis). Body Mass Index (BMI) was calculated by dividing the body weight (kg) by the height squared (BMI = weight (kg)/length (m2).

Results

Most of the participants (74.8%) have normal BMI values, 10.1% of them were underweight and 15.1% of them were overweight. Food groups’ percent of recommendation were presented in Figure 1. Accordingly, young adults consume 75.4% of bread and grain foods of recommendations which is the highest and 29.5% of nuts and seeds which is the lowest ratio in all food groups. Correlations (r) between amounts of consumed food groups with BMI was given at Table 1 and no correlation was found (p > 0.05).

Conclusion

In the present study, no association found between BMI and food group consumption, which may be related to that most of the participants (74.8%) have normal BMI values. Partridge et al. reported that young adults’ did not meet the dietary recommendations, however, intervention (personalized coaching calls with a dietitian) improved to meet requirements in their study. The present study supports the literature and provides proofs about young adults non-adherence to healthy eating recommendations. Besides, some food-related behaviors may be developed by young adults including irregular meal patterns, such as meal skipping and frequent snacking which results in a low intake of healthy food groups. In short, young adults may fail to meet the dietary requirements. However, nutritional programmes help to improve their eating habits. Accordingly, a step-by-step goal may be targeted to food group consumption to the recommended level.

Fig. 1.

Fig. 1

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Tab. 1.

Correlation between amounts of consumed food groups and BMI

Bread and grain foods (g) Fruits (g) Vegetables (g) Milk, yoghurt, cheese and alternatives (g) Meat, poultry, fish, eggs (g) Legumes and beans (g) Nuts and seeds (g)
BMI r -0.011 0.007 0.049 0.041 0.039 0.058 -0.022
p 0.742 0.842 0.150 0.228 0.254 0.086 0.520
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Obes Facts. 2018 May 26;11(Suppl 1):394.

T2P80 Balanced diet or personalized diet through genetic tests?

M Nitescu 1, D Pitigoi 2, FL Furtunescu 2, M Otelea 2

Introduction

Worldwide, according to the World Health Organization, in 2016, more than 1.9 billion adults were overweight and 650 million of them were obese. Lifestyle modification through a balanced hypocaloric diet and modest increases in physical activity, represents the first way in management of obese patient, according to the European Guidelines for Obesity Management in Adults (2015). The study aim was to assess the frequency of dietary patterns recommended based on the genetic risk profile for metabolic health and the response to different types of macronutrients.

Methods

We have conducted a descriptive transversal study on a group of 51 adult obese patients who expressed their consent to DNA testing in order to personalize the diet. The study was conducted between March and November 2017 at a nutrition clinic in Bucharest. The data collected by the nutritionist (demographic, anthropometric, medical history, para-clinical and genetic) were analyzed descriptively.

Results

Of the 51 patients included in the study, aged between 23 and 62 years, 28 (55%) were female. Based on DNA tests, the following patterns of low calorie diets were recommended: balanced diet –B (15/51), Mediterranean diet-M (10/51), low fat diet-LF (21/51), low carbohydrate diet-LC (5 / 51). Gender distribution showed that men have a genetic profile for LF diet equal to B diet (34%). In the case of women, 46,4% of them have a genetic profile for LF and 25% for B diet. In 36 (70.5%) out of 51patients, the optimal dietary pattern was different from the one recommended by the EASO Guidelines (2015), respectively balanced diet, while balanced diet pattern was only found in 15 (29.5%) patients. Gender analysis showed that the genetic profile for responding to a different type of diet than the balanced one is 75% among women and 65% among men.

Conclusion

We believe that testing the genetic profile for personalizing the diet is especially important in people with stage 2 and 3 obesity, where weight loss is a lengthy process, and lifestyle changes must be kept all of ones life. The failure of nutritional intervention in terms of weight loss can demotivate the patient, encouraging him to return to unhealthy behavior. Prospective studies are needed to assess the effect of personalized diets compared to the general recommendations of balanced diet regarding the success of nutritional therapy, the weight loss maintenance and metabolic health.

Conflicts of Interest

I am the nutritionist of the clinic, The patients learn about genetic tests from various sources. If they ask, I give them information about tests, and after, they choose to do or not. I do not sell the tests or advertise them. I do not get money for that.

Obes Facts. 2018 May 26;11(Suppl 1):395.

T2P81 Evaluation of anthropometric measurements and blood lipids of individuals who were applied diet with physical activity

G Akbulut 1, N Acar Tek 1, B Deniz Güneş 1, G Özata Uyar 2

Introduction

The aim of this study was to determine the effects of weight loss to body composition and some biochemical parameters in adult obese women.

Methods

This is a prospective cohort study, conducted on adult women aged between 20–45 years, living in Ankara. The participants were divided into two groups according to their body mass index (BMI) >27 kg/m2. While the first group has performed diet therapy alone, the second group has performed both diet therapy and physical activity. Both of the groups has performed diet and behavioral therapy in the period of 12 weeks.

Results

At the end of the study, the weight loss of the participants in the diet alone and diet+physical activity group have found75.3 ± 1.77 kg (BMI: 30.4 ± 0.50 kg/m2) to 70.7 ± 1.90 kg (BMI: 28.5 ± 0.53 kg/m2); and 82.5 ± 2.02 kg (BMI: 31.8 ± 0.75 kg/m2) to 73.9 ± 2.16 kg (BMI: 28.4 ± 0.70 kg/m2) respectively (p = 0.000). It has found statistically significant reductions on serum total cholesterol (TC) (p = 0.000), low-density lipoprotein cholesterol (LDL-C) (p = 0.001), very low-density lipoprotein cholesterol (VLDL-C) (p = 0.040), triglycerides (TG) (p = 0.036), systolic blood pressure (SBP) (p = 0.040), diastolic blood pressure (DBP) (p = 0.043) of the diet+physical activity group, and there was a significant reduction on the TC (p = 0.033) of the diet alone group.

Conclusion

As a result of this study, the diet and physical activity together have positive effects on weight loss, biochemical parameters and energy expenditure.

Obes Facts. 2018 May 26;11(Suppl 1):396.

T2P82 Total fluid and plain water intakes and its correlation with BMI

E Koksal 1, B Kocaadam 1, S Bilici 1, MS Karacil Ermumcu 2, E Karabudak 1

Introduction

Sugar-sweetened beverages have been associated with obesity; however, there is paucity of studies that have examined the effects of plain or total fluid intake on obesity. For this reasons, the aim of the study was to determine plain and total fluid intake in adults, and evaluate relation with body mass index (BMI).

Methods

This study consisted of 901 (male 21.1%; female 78.9%) healthy adults (age range 18–60 years). Plain water and total fluid intake (the sum of from drinking water, beverages and foods moisture) in a day were questioned with 24 hour fluid-specific recall by face-to-face Methods. In order to assess foods moisture, 24-h dietary recall was taken from individuals. DRI recommendations were used for total water requirement (male 3.7 L/d; female 2.7 L/d). The EFSA assumes that foods usually contribute about 20% of total water intake Therefore, we used the requirement of plain water 2.96 L/day for men and 2.16 L/day for women. Anthropometric measurements (body weight and height) of the individuals were taken by the researchers in accordance with measurement techniques. BMI calculated and classified accordance to WHO classification. Differences in median values among groups were analyzed with the Mann Whitney U test or the Kruskal-Wallis test.

Results

The mean age of the participants were 29.3 ± 10.81 years (male 30.7 ± 10.9; female 28.9 ± 10.8 years p < 0.05). The median (IQR) plain water and total fluid intake were 1.2 (1.0); 2.34 (1.18) L/d for male, 1.0 (1.0); 2.28 (1.05) L/d for female, respectively. 88.9% of the male and %69.9 of the female were under the total fluid requirement and 93.7% male and 94.1% female plain water intake were under the requirements. There was no difference between gender in terms of plain water and total fluid intake. Also, there was no correlation between BMI and plain/total fluid intake. However, underweight male consumed plain water higher than female ones (Table 1).

Conclusion

In this study, it has been shown that total fluid intake was not met the requirements. For increasing total fluid intake, plain water consumption should be increased. In addition, we didn’t find significant relation between BMI and plain/total fluid intake. However, as BMI increased, plain water and total fluid water consumption tended to decrease in male.

Obes Facts. 2018 May 26;11(Suppl 1):397.

T2P83 Is Nutrition Knowledge Associated with Obesity in Turkish Adult Population?

E Karabudak 1, MS Karacil Ermumcu 2, S Bilici 1, B Kocaadam 1, E Koksal 1

Introduction

Nutrition plays an important role in human health; nutrition is considered the most controllable risk factor affecting long-term health and chronic disease. Increased nutritional information has been associated with improved nutritional habits and lower obesity rates. The study was planned to evaluate the level of general nutrition knowledge of Turkish adult population and examine association between nutrition knowledge of individuals and obesity status of them.

Methods

A total of 1219 individuals aged 18–64 years (289 men and 930 women) participated in this study. General nutrition knowledge questionnaire (GNKQ) was used to examine nutrition knowledge. Anthropometric measurements (weight, height and waist circumference) were taken by the researcher. Body mass index (BMI) was calculated and participants categorized as underweight, normal and obese according to The World Health Organization (WHO) obesity classification system.

Results

Obese individuals (n: 394; 74.0 ± 15.09 scores) have lowest score from GNKQ according to normal (n: 727; 81.5 ± 15.5 scores) and underweight (n: 89; 80.8 ± 17.51 scores) participants and difference between groups was found significant (p < 0.05). There was negative association between nutrition knowledge scores of individuals with their body weight (r:-0.189; p:0.000), waist circumference (r:-0.185; p:0.000), and BMI (r:-0.240; p:0.000).

Conclusion

Nutrition knowledge differs between obese and non-obese adults. Previous research has indicated that individuals with greater nutrition knowledge are more likely to consume healthier diets. And increase in nutrition knowledge may promote healthy nutrition behaviours in obese individuals.

Obes Facts. 2018 May 26;11(Suppl 1):398.

T2P84 Exploring Demographic Influences on Nutrition Knowledge Levels in Adults

S Bilici 1, B Kocaadam 2, E Koksal 2, M S Karacil Ermumcu 3, E Karabudak 2

Introduction

Nutrition knowledge is necessary although not sufficient for dietary change. The factors of diet related behaviors include biologically determined behavioral predispositions, experience with food, person-to-person and interpersonal factors, and environmental factors. Knowledge is the main determinant of behavior, categorized between interpersonal and environmental factors. The study was planned to explore general nutrition knowledge and demographic influences on nutrition knowledge levels in Turkish community sample

Methods

This nutrition knowledge study carried out on a cross-section of the adult population of Turkey (n = 1030 and aged 20–50 years; 23.2% men and 76.8% women). General nutrition knowledge questionnaire was used to examine nutrition knowledge and also this questionnaire has four sections relating to current dietary recommendations, nutrient knowledge, food choice and the relationships between diet and disease. Demographic variations such as age, gender, work status, occupation, education duration, and marital status were asked.

Results

Women (80.6 ± 16.27 scores) have significantly higher nutrition knowledge scores than men (77.3 ± 14.74 scores) (p < 0.05). And women especially have significantly higher scores at food choice and the relationships between diet and disease sections of questionnaire. Single individuals (82.5 ± 16.24 scores) have significantly higher nutrition knowledge scores than married (74.5 ± 14.14 scores) (p < 0.05). There was positive association between nutrition knowledge scores of individuals with education duration (r:0.154; p:0.000) but negative association with their age (r:-0.234; p:0.000). Nutrition knowledge scores lower in employed group (p < 0.05) according to employment status and employees have lowest score than other work groups (68.6 ± 15.50) (p < 0.05).

Conclusion

Demographic variation such as age, gender, education duration, marital status and occupation have important effect on nutrition knowledge of individuals. Because of significant differences in nutrition knowledge between groups, nutrition education programmes have to target certain subgroups of community. Therefore, nutrition education may be more efficiently in improving nutrition knowledge and influence on individual behaviour.

Obes Facts. 2018 May 26;11(Suppl 1):145.

T2P85 Assessment of dietary adequacy of adult individuals according to sleep duration

F Nişancı Kılınç 1, B Çakır 1, G Özata Uyar 2, Ç Özenir 1, M Ekici 1, S Eşer 1

Introduction

Short sleep duration and low diet quality are associated with obesity. There are very few studies evaluating the relationship between sleep duration and dietary quality. In this study, we aimed to compare diet quality indices and body mass index(BMI) between short and long sleepers.

Methods

This cross-sectional study was conducted on 2820 adults (20–64 ages) who were chosen among different 25 cities in Turkey based on stratified random sampling method. In the evaluation of the sleep duration, the question ‘how many hours do you sleep last month (may be different from what you spend in bed) was used. Subjects were categorized 3 sleep duration groups (short: < 6 h; normal:6–8 h; long: >8 h). Nutrient adequacy ratio (NAR) scores (carbohydrate, protein, calcium, zinc, iron, vitamin C, riboflavin, niacin, folic acid, B6 and B12) were calculated by using the Dietary Recommended Intake (DRI) levels recommended by age and gender. Mean Adequacy Ratio (MAR) calculates the average for the NAR values for the 11 nutrients for individuals. A score of 80–100% indicates a good diet, a score of 51–80% reflects the need of improving diet quality, and a score ≤50% reflects a poor diet.

Conclusion

According to MAR evaluation, it is necessary to develop diets of both short and long sleep groups. Regulation of sleep duration must be provided and gaining healthy eating habits will contribute to the development of dietary quality. Future research should incorporate objective measures of sleep in a prospective design to determine whether certain sleep durations impact food choices and nutrient intake.

Results

 

Tab. 1.

Distribution of BMI and dietary adequacy according to sleep duration

Parameters <6 hour (n:527) 6–8 hour (n:900) »8 hour (n:1393) Total (n:2820) p
Age (year) 36.6 ± 12.1a 38.5 ± 12.1b, c 39.4 ± 13.1c 38.6 ± 12.6 <0.001*
Gender
Male 248 (%47.1) 491 (%54.6) 630 (%45.2) 1369 (%48.6) <0.001*
Female 279 (%52.9) 409 (%45.4) 763 (%54.8) 1451 (%51.4)
BMI (kg/m2) 25.9 ± 4.9a 26.4 ± 4.9b, c 26.5 ± 4.9c 26.4 ± 4.9 0.044*
NAR (%)
Protein 93.4 ± 13.8a, b 93.6 ± 13.2a 92.1 ± 14.8b 92.8 ± 14.1 0.021*
Carbonhydrate 94.7 ± 13.2 95.5 ± 13.0 95.5 ± 12.4 95.3 ± 12.8 0.457
Calcium 61.1 ± 23.3 61.6 ± 24.2 59.4 ± 23.7 60.4 ± 23.8 0.081
Zinc 83.6 ± 18.9 83.8 ± 21.2 82.4 ± 19.8 83.1 ± 20.2 0.217
Iron 76.3 ± 26.6a 80.1 ± 25.5b 77.2 ± 25.6c 78.0 ± 25.8 0.009*
Vitamin C 69.1 ± 33.2a 74.1 ± 31.2b 72.8 ± 31.7a, b 72.5 ± 31.9 0.016*
B2 85.7 ± 18.5 85.6 ± 18.8 84.4 ± 19.3 85.1 ± 19.0 0.220
B3 94.1 ± 13.0 94.3 ± 12.6 93.2 ± 13.8 93.7 ± 13.3 0.100
Folate 67.7 ± 22.3 69.8 ± 22.1 67.9 ± 21.5 68.5 ± 21.9 0.091
B6 75.4 ± 21.8a, b 76.4 ± 22.0a 74.1 ± 21.9b 75.1 ± 21.9 0.040*
B12 82.7 ± 27.3a, b 83.1 ± 27.3a 80.1 ± 28.9b 81.5 ± 28.1 0.027*
MAR 79.1 ± 13.9a, b 80.2 ± 14.0a 78.6 ± 14.2b 79.2 ± 14.1 0.035*
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a

There are statistical differences between the different letters

b

There are statistical differences between the different letters

c

There are statistical differences between the different letters

*

p < 0.05 The mean age of the individuals is 38.7 ± 12.7 years and a total of 46.8% male 51.4% female.

Subjects who slept short were lower BMI than long sleepers (p = 0.044). NAR of protein, B6 and B12 vitamin and MAR scores of normal sleep group were statistically higher than long sleep group (p < 0.05). Normal sleepers have higher iron adequacy ratio than the other two groups. Individuals with short sleep duration, the adequacy ratio of vitamin C was lower than normal sleepers (p < 0.05).

Obes Facts. 2018 May 26;11(Suppl 1):145.

T2P86 Effect of pre-pregnancy BMI on changes in adipose tissue in pregnancy and delivery outcomes – preliminary results from the CRIBS study

J Šarac 1, M Zajc Petranović 1, D Havaš Auguštin 1, N Novokmet 1, N Fuchs 1, T Carić 1, S Musić Milanović 2, D Karelović 3, S Missoni 4

Introduction

This study evaluated the impact of maternal pre-pregnancy BMI (body mass index) on adipose tissue distribution and weight gain in pregnancy, as well as delivery outcomes, in a cohort of women with term, singleton pregnancies with no history of chronic diseases. All participants are part of the CRoatian Islands’ Birth Cohort Study (CRIBS), an ongoing project investigating risk factors for the development of metabolic syndrome.

Methods

We tested the association of pre-pregnancy BMI values of 171 CRIBS participants with their preperitoneal adipose tissue, biceps and triceps skin fold and waist circumference values in pregnancy, as well as with the delivery mode (vaginal delivery vs. ceasarean section). Pre-pregnancy BMI has been defined in three categories (underweight < 18.5 kg/m2; normal weight 18.5 – 25 kg/m2; overweight and obese ≥25 kg/m2) and all parameters taken during pregnancy were measured once in each trimester (12. – 14., 18. – 22. and 30. – 32. week of gestation).

Results

Trend of increase in all anthropometric parameters followed during pregnancy, from the first to the third trimester, was observed. Furthermore, when pregnant women were divided in nutritional status categories according to their pre-pregnancy BMIs, significant differences in mean values of all the investigated anthropometric parameters between these BMI-defined categories were observed, in all three follow-ups (p≤0.001). Also, a significant association was detected between pre-pregnancy BMIs and delivery mode (143 vaginal deliveries vs. 27 cesarean sections). Women who had a cesarean section had significantly higher mean pre-pregnancy BMI than women who gave birth vaginally (p < 0.05), while the type of delivery was not associated with anthropometric parameters of the newborns (birth weight, birth length or head circumference).

Conclusion

Pre-pregnancy BMI can be a useful predictor for changes in adipose tissue distribution and weight gain during pregnancy and can also help to detect women at risk for perinatal complications and adverse delivery outcomes. Limitation of this study is the relatively small sample size. CRIBS study is an ongoing project and pregnant women are still being recruited. More far-reaching Conclusions will be drawn only after the study is completed.

Obes Facts. 2018 May 26;11(Suppl 1):145–146.

T2P87 Dietary pattern of nurses working night shifts and relation to weight status

L I Arhire 1, O Nita 1, A Gherasim 1, M Beschea-Chiriac 2, G Simion 3, CM Butu 3, L Mihalache 1

Introduction

Currently, 15–20% of the working population of Europe works in shifts. Shift working is associated with increased risk of developing obesity, cardiovascular and metabolic diseases and some types of cancer. These health hazards are in connection with the circadian disalignment, which affect weight and adipose tissue distribution by various and complex mechanisms, including neuro-endocrine signals, hormones, but also through altered behaviour and diet and less exercise. There are a few studies assessing diet of shift workers compared to those who do not work shifts which show that the differences in diet are not in the total energy intake, but in the macro- and micronutrient content and meal schedule, although data is limited and the assessment methods are modest. We aimed to extend current knowledge by assessing diet of shift workers in relation to their night shifts and their wieght status.

Methods

The study population was formed by the nurses working shifts in the Diabetes, Nutrition and Metabolic diseases department in the Sf. Spiridon Clinical Emergency Hospital, meaning 16 female nurses. We assessed their weight, height and waist circuference. We assessed diet by using the 24 hour dietary recall questionnaire: once when the previous 24 hours followed a night shift and once when the previous 24 hours were after 2 nights without shift. We repeated this assessment three times in 6 months. We used the software Nutritrac to transform data collected by questionnaire to quantitative values - calories, macronutrients (carbohydrates, proteins and lipids, including types of lipids), micronutrients (vitamins and minerals). We used statistical analysis to describe and compare diet on the two types of days and evaluate relation to weight status.

Results

The nurses in our study were of 33.7 +/- 5.9 years of age. The average body mass index in the study population was 23.6 +/- 4.8 kg/m2, but the average waist circuference was 79 +/- 6.5 cm. The analysis of the 24 hour dietary recall questionnaires of days which did not follow a night shift showed an average energy intake of 1138 +/- 454 kcal, with the following proportion of macronutrients: 48.9% carbohydrates, 17.1% protein and 34% lipids. The analysis of the 24 hour dietary recall questionnaires of days which followed a night shift showed an average energy intake of 909 +/- 427 kcal, with the following proportion of macronutrients: 47% carbohydrates, 18% protein and 35% lipids. There were no statistical significant differences between these values. A more detailed analysis of data showed significantly lower intake of dietary fiber, polyunsaturated lipids, calcium, magnesium and vitamin D in the days following a night shift. We also observed a high variability in the total number of calories between the two types of days, up to 900 kcal difference. We did not find a statistical significant correlation between energy intake and weight status, but waist circumference was positively correlated with the percentage of lipids consumed.

Conclusion

There are several subtle differences in the diet of nurses working shifts, on the days following a night shift, compared to the days following normal night sleep which need to be researched further in order to better uderstand the mechanisms behind the risk obesity and metabolic diseases of these individuals.

Obes Facts. 2018 May 26;11(Suppl 1):146.

T2P88 Self-reported eating pattern changes and nutrition recommendations in pregnancy

L Meija 1, I Pudule 2, V Cauce 3, A Rurane 4, D Rezeberga 5, L Uspele 6, J Breda 7

Introduction

Evidence increasingly shows that healthy weight and healthy lifestyle, including eating habits play essential role for the short- and long-term effects on outcome of pregnancy. Poor maternal nutrition and excessive gestational weight gain significantly increase risks of complications during pregnancy and birth as well as increase of obesity later in life for the infant. The aim of study was to assess self reported changes in eating patterns and received nutrition recommendations among pregnant women in Latvia.

Methods

A cross-sectional survey of 393 pregnant women, eating habitual food, taking place in maternity outpatient clinics (n = 136) and maternity departments (n = 257) in Latvia during six month period in 2017. Questionnaire included changes in eating patterns during pregnancy and received dietary advises from medical professionals.

Results

The average age: 29 (SD 5) years; education: 55.5% university, 35.6% secondary school, 8.9% elementary school. 67.7% had a normal body mass (BMI: 18.5–24.9 kg / m2), 19.2% were overweight (BMI: 25–29.9 kg / m2), 8.5% obesity (BMI: greater than or equal to 30 kg / m2) and 4.7% underweight (BMI less than 18.5) before pregnancy. There was no correlation between educational level and BMI. 36.6% of all pregnant women were advised to change eating habits during pregnancy; 63.5% of these women were advised to change dietary habits of medical professionals. The main suppliers of nutritional advice were gynaecologists and mid-wives (68.5% and 26.0% of all recommendations of medical professionals, respectively). Perceptions of changes in eating patterns during pregnancy: 47.4% reported healthy eating, 41.7% - unhealthy eating without restrictions in food choices. Changes in portion size during pregnancy: 49.6% reported no changes; 36.1% increase per 10% and 14.2% increase per 30%. Reported changes in food choices: 59.0% increased the intake of fruit and 52.7% increased the intake of vegetables. Higher education correlated with more fish consumption (p = 0.014) and meat (p = 0.009), but not with consumption of fruit and vegetables. Only 22.7% of pregnant women with overweight and obesity before pregnancy received recommendations from medical professionals to reduce weight. The most important recommendation providers were gynaecologists (69.6%) and general practitioners (39.1%). 78.4% of pregnant women were looking for dietary recommendations. The main source of information for nutrition chosen by pregnant women themselves was internet 69.2%, and information from medical professionals from medical professionals received 51.5% of pregnant women.

Conclusion

Although the results showed that about half of the pregnant women changed their diet to more healthy, the results showed heterogeneity and further research was warranted. There is a limited role for medical professionals in advising to improve the quality of the diet, which is extremely important, especially in pregnant women who are overweight and obese.

Obes Facts. 2018 May 26;11(Suppl 1):146–147.

T2P89 Anthropometric measurements among office workers and correlation with their working experience

R Popova 1, L Ivanova 1

Introduction

Office working is associated with low physical activity, bad dietary habits, less sun exposure, higher stress rating. These factors are predisposition for appearance of overweight and obesity.

Methods

To analyze the risk of metabolic disorders among full-time office workers according to their anthropometric measurements and working experience. Using Tanita® Body Analyzer we measured the body composition of 72 office workers (average age 29 years, max-58 years, min- 23 years), 26 men and 46 women. Also we assessed their physical activity level, their stress level and dietary habits using standard questionnaire. We compared two groups – the first group - 38 workers with less than 2 years working experience and the second group – 34 workers with more than 2 years working experience.

Results

The first group shows better results compared to the second group. Most of the employees who worked at the office less than 2 years have normal BMI (79%) and normal fat mass (89,5%), while the employees from the second group are only 35% with normal weight and 29,4% have normal fat mass. The overweight employees with longer working experience are significantly much more (64,7%) compared to those with shorter working experience (15,8%). This is in a correlation with different metabolic disorders which have higher frequency at the group with longer working experience. Analyzing the level of physical activity we didn’t find a significant difference between the 2 groups – 47% vs 52% have lower physical activity. The first group shows higher stress levels than the second group which can be explained by the low experience at work, but they have better dietary habits – they eat rarely semi-processed food, also food which is rich of sugar, fats and salt.

Conclusion

Office workers with long working experience are predisposed to overweight and its consequences much more than those who work less than 2 years because of lower physical activity and bad dietary patterns. The stress level at work does not impact significantly on body composition.

Obes Facts. 2018 May 26;11(Suppl 1):147.

T2P90 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):147.

T2P91 Irrational food beliefs: Validity and reliability study

MB Taylan 1, M Bas 1, Z Cevahir 1

Introduction

Irrational Food Beliefs; nutrition related to inappropriate behavior and cognitive disorders, unrealistic beliefs (irrational) is defined. Individuals being thin and being overweight concerned about their body image, role models/ families/ friends such as interpersonal influences, the impact on the individual ads and behaviors aimed at weight loss. This research, evaluation of individual false beliefs about nutrition and eating behavior in special cases, is made of Irrational Food Beliefs Questionnaire validity and reliability in order to be used in Turkey.

Methods

The study of 208 women participated in college student studying 386 adults with 178 men. Two subscales as the original form of irrational Eating Behavior Survey (rational and irrational) were collected in 57 items. Factor loadings of the substances under the two sub-factors in factor analysis ranged from 0.52 - 0.90. For all participants 0.917, for women 0.930, for men 0.917 were found to be. Scale cross to the validity; Eating Attitudes Scale and Irrational Eating Behavior, Perceived Stress Scale, the Rosenberg Self Valuing Scale has looked at the relationship between Body Image and Coping Strategies Scale.

Results

All participants in; Irrational Behavior between eating and irrational subscales (r: 0.950), and a strong positive relationship between dietary restriction and Eating Attitudes Scale (r: 0.886) were identified. For women Irrational Behavior Eating a strong relationship between negative and irrational subscales (r: −0.961), a strong positive relationship between dietary restriction and Eating Attitudes Scale (r: 0.898) were found. For men between the Irrational Eating Behavior Subscale (r: 0.939), and Eating Attitudes Scale with dietary restrictions (r: 0.890) a strong positive relationship were found between.

Conclusion

Test-retest reliability for a week 386 people with intermediate validity of the re-applied scale reliability coefficients were statistically significant. results show that Turkish version of the IFBQ is a validated questionnaire and reliable research instrument in Turkish population.

Obes Facts. 2018 May 26;11(Suppl 1):147.

T2P92 Picky eating – a risk factor for underweight in Finnish adolescents

H T Viljakainen 1, RA Figueiredo 1, TB Rounge 2, E Weiderpass 3

Introduction

Picky eating is the most common cause of early life feeding problems. The consequences of picky eating on food intake and weight development in populations are not established. This study aims to investigate the association of two aspects of picky eating e.g. pickiness (PE) and food neophobia (FN) on food consumption patterns and weight status in 5700 Finnish preadolescents.

Methods

We utilized the Finnish Health in Teens (Fin-HIT) cohort of 9–12-year-old preadolescents, who were categorized to PE and FN before school age and previously, based on retrospective parental questionnaire. Preadolescents’ food consumption patterns were obtained with a 16-item food frequency questionnaire. Weight was categorized into under-, normal-, and overweight / obesity based on body mass index (BMI) according to IOTF age- and sex-specific cut-offs.

Results

The overall prevalence of PE and FN in the cohort were 34% and 14%, respectively. Compared with non-PE/FN, both PE and FN consumed more frequently unhealthy foods such as biscuits / cookies, ice cream, pizza, hamburger / hot dog, and salty snacks (p < 0.05) and less frequently healthy foods such as cooked vegetables, fresh vegetables/salad, fruit & berries, milk/ sour milk, and dark bread. PE was had higher odds ratio (OR) for underweight 2.0 (95% CI 1.7; 2.3) and lower OR for overweight/obesity 0.7 (95% CI 0.6; 0.8) in a multivariated model adjusting for age of child, number of siblings, age and BMI of guardian. FN increased the likelihood for underweight only (OR 1.4 (95% CI 1.1; 1.7).

Conclusion

Amongst Finnish preadolescents, PE and FN are associated with unhealthy eating patterns and had higher risk for underweight. PE is also associated with overweight/obesity. Management of pick eating in children may be explored as a potential strategy for improving healthy eating and avoiding underweight in preadolescents. Since obesity rebound typically occurs during teenage years, a longer duration of follow-up of the cohort is needed for definitive consequences of PE/FN on health and weigh.

Obes Facts. 2018 May 26;11(Suppl 1):147.

T2P93 Is Eating Attitude Different in Overweight and Non-Overweight Females?

F Ayyıldız 1, H Yıldıran 1, M Gezmen Karadag 1, M S Karacil Ermumcu 1

Introduction

In recent years eating disorders have attracted great interest. Eating disorders prevalence is common especially among female teenage. Eating attitude might change according to body mass index (BMI). Therefore, we aimed to evaluate eating attitude overweight and non-overweight in female teenage.

Methods

This study was conducted among 297 females aged between 17–36 years We used EAT-40, which designed by Garner and Garfinkel, for evaluation of eating attitude. Responses are rated on a 1 (Always) to 6 (Never) spectrum. Total score is the sum of each item. A score greater than 30 is considered to be an indicator anorectic disorder. Body weight and height were taken by researchers. Body mass index was calculated by body weight (kg)/ (height (m))2. Cut off points of BMI was 25 kg/m2.

Results

20.2% of females were anorectic according to EAT-40. 88.3% of anorectic females’ BMI and 84.0% of non-anorectic females’ BMI were less than 25 kg/m2. It was found that 11.7% of anorectic and 16.0 of non-anorectic females’ BMI were higher than 25 kg/m2. BMI value is similar both anorectic and non-anorectic females according to EAT-40 (p > 0.05).

Conclusion

Both eating attitude and BMI is affected by eating habits, body image, psychological factors. So, it may be useful to evaluate these factors together.

Obes Facts. 2018 May 26;11(Suppl 1):147–148.

T2P94 Do Eating Disorders Affect Eating Habits in Adult Males?

B Yılmaz 1, M Gezmen Karadag 1, H Yıldıran 1

Introduction

Eating disorders include severe disturbances in eating behavior such as excessive or unhealthy reduction in food intake or excessive eating. The disorders are also a condition of extreme anxiety, hypersensitivity to body structure or body weight.

Methods

This study was conducted with 375 randomly selected healthy and nutritionally untrained male subjects aged 19–50 years. The EAT-40 test was used to assess eating disorders. Nutritional habits were determined by questionnaire. Their daily dietary energy and nutrient intakes were analyzed with 24-hour dietary recall.

Results

The average age of the individuals is 25.94 ± 6.61 years. The proportion of individuals who detected eating behavior disorder was 3%. 27.3% of the individuals with eating disorders reported that they skip meals, 44,8% of those without eating disorder skip meals. While the daily dietary energy, protein and fat intakes of individuals with eating disorder was higher than that of without eating disorder individuals, the intake of carbohydrate and pulp is lower. Although there are general differences in the intake of energy, macro nutrients and micronutrients, these differences are not statistically significant (p > 0.05).

Conclusion

It has been determined that dietary habits of adult male subjects with eating disorder do not vary greatly. When we look at the literature, we can see that changes in eating habits are more pronounced in female individuals. Further studies are needed to better understanding the eating habits of men with eating disorders.

Obes Facts. 2018 May 26;11(Suppl 1):148.

T2P95 Do Eating Disorders Affect the Waist-Hip Ratio in Adult Males?

M Gezmen Karadag 1, H Yıldıran 1, B Yılmaz 1

Introduction

Eating disorders describe illnesses that are characterized by irregular eating habits and severe distress or concern about body weight or shape. While individuals are concerned about body forms, unhealthy eating habits on the other hand can cause these concerns to move further.

Methods

Three hundred seventy-five male participants were randomly selected. Their ages range from 19 to 50 years. The EAT-40 test was used to assess eating disorders. Anthropometric measurements (body weight, height, waist circumference, and hip circumference) were taken by researchers to be appropriate for measurement techniques.

Results

The average body weight of the individuals was 75,08 ± 11,36 kg, height 177,18 ± 7,63 cm, waist circumference 86,20 ± 9,43 cm and hip circumference 93,82 ± 8,99 cm. Body mass index was calculated as 23,92 ± 3,47 kg / m2 and waist-hip ratio as 0,92 ± 0,09. While 33,3% of the individuals are obese, 16,3% of them are at high risk group with waist-hip ratio. When the waist-hip ratio of the individuals with eating disorders were examined, 9,1% were in the risk group and 16,5% of the individuals without eating behavior disorder were in the risk group.

Conclusion

Eating disorder can affect many factors in the life of individuals. Irregular and inadequate eating habits can change the anthropometric measurements in the long term. Further studies are needed to better understanding the eating habits of men with eating disorders.

Obes Facts. 2018 May 26;11(Suppl 1):148.

T2P96 Is Orthorexia Tendency Affecting their Eating Habits in Males?

H Yıldıran 1, M Gezmen Karadag 1, B Yılmaz 1

Introduction

It is an obsession to consume natural nutrients that interfere with the life of a person, together with being defined as a healthy nutrition obsession. This attachment to the individual's eating habits is not about the amount of food consumed, but about the quality. For this reason, individuals can go through a number of changes in their eating habits in order to find and eat the healthiest food for themselves.

Methods

A total of 375 healthy male subjects aged between 19 and 50 participated in this study. ORTO-15 test was used to determine healthy nutritional obsession. Individual dietary habits were determined by questionnaire. Their daily dietary energy and nutrient intakes were analyzed with 24-hour dietary recall.

Results

The mean age of the individuals is 25.94 ± 6.61 years. 51.7% were found to have orthorectic tendency. When the total number of male subjects were examined, it was reported that 44.3% of those who skipped meals, 49.5% of those with orthorectic tendency skip meals and 50.5% of those with orthorectic tendency did not skip meals. When food consumption of orthotopic individuals is examined, it is seen that the daily dietary energy, protein, fat and carbohydrate intakes are higher than individuals without orthorectic tendency. There is no significant difference in terms of micronutrient intake between male with orthorectic tendency and male without orthorectic tendency.

Conclusion

Healthy eating is characterized by both adequate and balanced nutrition. In this context, while healthy nutrient choices are made, nutritional habits must remain healthy. Orthotopic individuals may skip meals due to the search for healthy food and receive some food items in a smaller amount. However, there is a need for large and longer-term work in order to be able to evaluate the subject better.

Obes Facts. 2018 May 26;11(Suppl 1):148.

T2P97 Does Orthorexia Tendency Affect Waist-Hip Ratio in Males?

M Gezmen Karadag 1, H Yıldıran 1, B Yılmaz 1

Introduction

Orthorexia nervosa (also known as orthorexia) is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. Orthorexia has been also defined as a “pathologic obsession with proper nutrition” including a strict avoidance of food believed to be unhealthy or impure, that can have serious nutritional and medical consequences.

Methods

A total of 375 healthy and nutritionally untrained male subjects aged between 19 and 50 participated in this study. ORTO-15 test was used to determine healthy nutritional obsession. Anthropometric measurements (body weight, height, waist circumference, and hip circumference) were taken by researchers to be appropriate for measurement techniques. The Body Mass Index (BMI) was calculated the body mass divided by the square of the body height (kg/m2).

Results

The mean body weight of individuals were measured as 75,08 ± 11,36 kg, height 177,18 ± 7,63 cm, waist circumference 86,20 ± 9,43 cm and hip circumference 93,82 ± 8,99 cm. According to the classification of BMI, the majority (61.6%) had normal BMI, and 34.1% were overweight and obese. 16.3% of the subjects were in the high risk group according to the waist-hip ratio. 62.4% of individuals with orthorexic tendency were in the low-risk group in waist-hip classification, while 13.9% were in the high-risk group. 66.8% of individuals without orthorexic tendency are low risk group in waist-hip classification.

Conclusion

The search for healthy nutrients by orthotopic individuals may cause psychological and physiological negative effects. Although the orthotopic individuals think that they are feeding healthy, the anthropometric measurements show that the risks are higher than those who do not have orthotopic tendency. However, there is a need for more extensive sampled research on the subject.

Obes Facts. 2018 May 26;11(Suppl 1):148.

T2P98 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):148–149.

T2P99 The Relationship between Eating Attitude and Body Mass Index

N Acar Tek 1, B Deniz Güneş 1, G Akbulut 1, D Agagunduz 2

Introduction

Eating disorders describe illnesses that are characterized by irregular eating habits and severe distress or concern about body weight or shape. Eating behavior disorders appear to be an important variable affecting eating in recent years. In this study, it was aimed to evaluate the eating attitudes of the individuals and the relationship between the eating attitude and body mass index.

Methods

The study was conducted with a total of 400 healthy individuals, 123 boys and 277 women aged 19–30 years. Eating Attitude Test (EAT-26) and the form in which anthropometric measurement information including age, gender, demographic characteristics and height and body weight of the individual were used. Twenty points for EAT-26 were accepted as cut-off points. Those who scored below this value were defined as “normal eating behavior”, 20 points and those who rated it as “abnormal eating behavior”.

Results

The average age of male and female subjects participating in the study was 22.2 ± 1.83 years and 21.3 ± 1.60 years, respectively. The mean body mass index (BMI) of the individuals was 23.2 ± 2.88 kg / m2 and 21.6 ± 2.59 kg / m2 in males and females, respectively. According to BMI classification, 79.7% of males were normal, 15.4% were overweight, 3.2% were obese, 1.6% were underweight and 85.2% of females were normal, 7.2% were underweight, 6.9% were overweight, 0.8% were obese. There was statistically significant difference between the BMI values of the individuals and the sex (p < 0.05). When assessed EAT-26; 16.3% of males, 20.2% of females and 19% of total individuals had eating behavior disorder. Also, 81.6% of the subjects with eating disorder had normal, 11.8% were slightly obese, and 6.6% were weak. There was no statistically significant relationship between eating behavior disorder and BMI (p > 0.05).

Conclusion

In general, it was determined that eating behavior is impaired in one in every 5 individuals. For this reason, the eating attitude of the community should be evaluated and informed about adequate and balanced nutrition.

Obes Facts. 2018 May 26;11(Suppl 1):149.

T2P100 Is healthy eating obsession (Orthorexia Nervosa) more frequent among people exercising regularly?

O Yesildemir 1, N Acar Tek 2

Introduction

It is unclear how sport ande xercise correlate with orthorexia, although it is thought that there is a relationship between sport and symptoms of orthorexia nervosa in people who exercise as a profession orexercise in leisure. For example, debates remain as to whether gym members are a risk group, whether exercise participation is related to orthorexia or whether exercise is a symptom of orthorexia. This study was conducted to determine the prevalence of orthorexia nervosa in exercisers in thegym.

Methods

This study was conducted with 102 males and 104 females aged between 19 and 55 who applied to the dietetic policlinic of Ankara University Olympic Swimming Pool. Participants have been exercising at least twice a week in the fitness/cardio hall and/or the swimming pool and/or the plates hall.The ORTO-15 test was used to propose a diagnostic proceeding and to try verify the prevalence of orthorexia nervosa. Those subjects who were classified below 40 from the ORTO-15 test are accepted to have orthorexia nervosa. The statistical analysis was conducted with SPSS 15.0. Student t test and pearson chi-square test were use for analyses of the data.

Mean score and standard deviation values of the participants from the ORTO-15 test aregiven in Table. While the mean score of the ORTO-15 was found to be 37.1 ± 3.90 in male participants who exercised regularly in the gym, this value was found to be 36.5 ± 4.36 for female individuals. Mean score of the participants the ORTO-15 test is 36.8 ± 4.14, and there is nos tatistical difference between women and men (p > 0.05). A total of 83.3% (85 males) of the males involved in the research scored below 40 and 16.7% (17 males) of the males scored above 40 in the ORTO-15 test. In addition 79.8% (83 females) of females scored below 40 and 20.2% (21 females) of females scored above 40 ORTO-15 test. This difference between men and women was not statistically significant (p > 0.05). In all participants, 81.6% of individuals have orthorexia nervosa.

Conclusion

This study was carried out in order to determine the prevalence of healthy eating obsession in individuals who exercise regularly in different sports branches in gyms. According to the results of the study, healthy eating obsession is high in these individuals. When the orthorexia of these individuals was examined in terms of gender, there was no difference between men and women. Compared to different studies, the high prevalence of orthorexia nervosa in this study shows that this group is a risk group for healthy eating obsession. For this reason, it is necessary to identify the nutrition information and habits of the peoplee xercising regularly and developing appropriate proposals for the situation.

Results

 

Tab. 1.

 Male (n = 102)
 Female (n = 104)
 Total (n = 206)
ORTO-15 total score M SD M SD M SD p
37.1 3.90 36.5 4.36 36.8 4.14 0.342
Cutoff points n % n % n % x2 p
< = 40 85 83.3 83 79.8 168 81.6
>40 17 16.7 21 20.2 38 18.4 0.425 0.514
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Obes Facts. 2018 May 26;11(Suppl 1):149–150.

T2P101 Assessing Nutritional Status and Eating Disorders in Patients with Schizophrenia

M Urhan 1, O Kucukerdonmez 2

Introduction

Eating disorder is one of the important psychiatric disorders occurring as comorbid in patients with schizophrenia. The results obtained in the studies showing the relationship between schizophrenia and eating disorders are inconsistent and limited. The aim of this study is to determine the prevalence of eating disorder in outpatients with schizophrenia and assess their nutritional status.

Methods

A total of 104 outpatients with schizophrenia (62 female, 42 male), who were aged between 20 and 60, were diagnosed with schizophrenia according to the DSM-5 diagnostic criteria, receiving treatment in the Psychiatric Polyclinic of Mental Health and Disorders Hospital (Manisa, Turkey) and 34 healthy individuals (18 female, 16 male) were included in the study. Eating Attitudes Test-26 was used to assess the eating disorders in the participants. Anthropometric measurements were performed for the participants and their 3-day food consumptions were recorded.

Results

This study found that 17.3% of the patients with schizophrenia and 2.9% of the healthy individuals were at risk of eating disorder. Of the patients with schizophrenia who were found to be at risk of eating disorder, 66.7% were female and 33.3% were male. The Eating Attitude Test mean score was found to be 14.1 ± 6.11 in the patients with schizophrenia and this score was 10.3 ± 4.98 in healthy individuals (p = 0.002). This study found that BMI values were found to be 28.5 ± 3.13 kg/m2 and 23.8 ± 3.59 kg/m2 (p = 0.001), dominant hand grip strength to be 25.6 ± 10.22 kg and 26.6 ± 7.8 kg (p = 0.001) in the patients with schizophrenia and the healthy individuals, respectively. The daily energy and nutrient values of patients with schizophrenia according to the Eating Attitude Test are shown in Table 1.

Conclusion

This study found that the risk of eating disorder increased in the patients with schizophrenia. This may cause some psychiatric and physiological health risks inherent in schizophrenia to become more severe. Training programs should be planned to enable these patients to acquire healthy eating habits and increase their physical activity levels. Moreover, additional psychosocial support should be provided for those with eating disorder.

Tab. 1.

The assessment of nutritional status of patients with schizophrenia according to their EAT-26 scores

EAT - 26 ≥ 20 Group (n = 18) x ± SD EAT - 26 < 20 Group (n = 86) x ± SD p
Energy (kcal) 2040.1 ± 744.46 2381.2 ± 872.03 0.126
Carbohydrate (g) 247.3 ± 109.17 298.1 ± 135.8 0.139
Carbohydrate % 49.3 ± 9.13 50.6 ± 8.29 0.560
Fiber (g) 2L9 ± 10.59 27.1 ± 15.98 0.192
Protein (g) 76.6 ± 48.30 82.1 ± 30.34 0.537
Protein (%) 14.8 ± 4.91 14.4 ± 3.91 0.753
Fat (g) 80.2 ± 29.70 91.3 ± 33.16 0.195
Fat % 36.1 ± 6.28 34.95 ± 7.33 0.554
Saturated Fat (g) 23.1 ± 24.6 ± 105 0.573
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Obes Facts. 2018 May 26;11(Suppl 1):150.

T2P102 Evaluation of the relationship among individuals’ energy intake, BMI values and EAT-26 scores

H Yıldıran 1, E Koksal 2, MS Macit 2, G Özata Uyar 2

Introduction

Eating disorders are common mental disorders among adolescent girls and young women. The estimates of lifetime prevalence of anorexia nervosa (AN) among women have been around 0.3–0.9% and the lifetime prevalence of Bulimia Nervosa (BN) among women has been estimated as 0.5–2.9%. Eating attitude test-26 (EAT-26) is a reliable tool to evaluate of disordered eating tendencies. Many studies have been conducted using the EAT-26 to detect early identification of an eating disorder which may provide to earlier treatment thereby reducing morbidity and mortality.

Methods

This study was planned as a cross-sectional study with 306 young female (aged 17–36). Sample characteristics and dietary intake were assessed using a self-administered questionnaire including a 24-h dietary recall. Energy intake was calculated with a computer programme (Nutrition Information System/BeBis). Body Mass Index (BMI) was calculated by dividing the body weight (kg) by the height squared (BMI = weight (kg)/length (m2) . Participants completed EAT-26 for eating disorder tendencies. Scores above 20 evaluate disordered eating. Energy intake was presented in quartiles (lowest to highest as 1 to 4) and one-way ANOVA was conducted for quartiles differences for EAT-26 scores and BMI values.

Results

Disordered eating prevalence of sampling was 23.2% and 74.8% of individuals had normal BMI. Mean values of EAT-26 scores and BMI according to energy intake quartiles were presented in Table 1. Accordingly, EAT-26 scores differ between groups and lowest energy group have higher scores (p < 0.05). BMI values (kg/m2) were not statistically significant between energy groups.

Conclusion

In the present study, disordered eating prevalence was higher (23.2%) than Vlachakis and Vlachaki's results which indicate also a high prevalence in young females (18%) and Louw et al. reported the prevalence as 14%. In this study, the group with the highest EAT-26 scores have lowest energy intake. However, the mean value of this group was below the cutoff point of EAT-26, this result gives information about that young females may show restricted eating behaviors and might indicate a tendency for anorexic-like behavior. EAT-26 is an easy and invasive tool and may help to determine disordered tendencies and take consideration of participants under risk. No association was reported BMI values according to energy intake. This might be the result of physical activity or other energy consumption components of participants. Early detection of possible eating disorders would help to prevent any undesirable changes in BMI.

Fig. 1.

Fig. 1

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Tab. 1.

Mean values of EAT-26 scores and BMI according to energy intake Quartiles

 EAT-26 scores
 BMI values (kg/m2)
Energy intake (kkal) by quartiles N X ± SD X ± SD
Q1 76 19.28 ± 16.2 21.56 ± 3.2
Q2 77 13.57 ± 12.5 21.93 ± 2.7
Q3 77 13.79 ± 12.5 21.99 ± 3.2
Q4 76 12.89 ± 12.1 22.09 ± 2.7
P 0.014* 0.693
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Obes Facts. 2018 May 26;11(Suppl 1):150–151.

T2P103 Association Between Night Eating Syndrome, Sleep Quality and Body Mass Index in Adults

B Çakır 1, F Nişancı Kılınç 1, G Özata Uyar 2, M Ekici 1, Ç Özenir 1, S Eşer 1

Introduction

Night eating syndrome (NES) is thought to be circadian rhythm dysfunction. It is characterized by evening hyperphagia, nocturnal awakings with ingestions, morning anorexia, and insomnia. This study was to asses the relationship of night eating syndrome, sleep quality and body mass index (BMI) in adults.

Methods

This cross-sectional study was conducted on 3361 adults who were chosen among 25 different cities in Turkey based on stratified random sampling method. Participants’ sociodemographic characteristics were questioned, night eating disorder scale and Pittsburg sleep quality index (PSQI) scale were applied and some antropometric measurements were taken (body weight, height, waist circumference, hip circumference and neck circumference). Body mass index was calculated by using weight and height. Statistical analyzes were performed with SPSS 22.0 program.

Results

The mean age of adults was 38.7 ± 12.7 years and a total of participant were 48.6% male, 51.4% female. results showed that the proportion of adults complying with symptoms of NES was 3.9% (n = 134). The mean age of the participant with NES (34.3 ± 11.62 years) was significantly lower than that of non-NES (38.9 ± 12.66 years) (p = 0.025). Participants with NES had higher PSQI score than non-NES (respectively 8.4 ± 2.84, 6.2 ± 2.1; p < 0.001). There were no significant differences between NES and education level, BMI, other anthropometric measurements (p > 0.05).

Conclusion

Sleep quality has an important role in the pathogenesis of night eating syndrome. However, the association between night eating syndrome and BMI has not been clarified. Further research is needed to identify the effect of night hyperfaxia on sleep quality and to understand its effect on BMI.

Tab. 1.

Parametres
 With NES
 Non-NES
 Total
 p
n (%) 134 (4.0) 3227 (96.0) 3361(100.0)
Age (x ± SD) 34.3 ± 11.6 38.9 ± 12.7 38.7 ± 12.7 0.025*
Gender n (%)
Male 74 (44.8) 1559 (48.3) 1633 (48.6) 0.117
Female 60 (55.2) 1668 (51.7) 1728 (51.4)
Education status n(%)
< Less than high school 40 (29.8) 1060 (32.8) 1100 (32.7) 0.536
High school graduate 49 (36.6) 1035 (32.1) 1084 (32.2)
College graduate 45 (33.6) 1417 (35.1) 1177 (35.1)
Smoking status n (%)
Yes 72 (53.7) 1126 (34.9) 1198 (35.6) 0.000*
No 62 (46.3) 2101 (65.1) 2163 (64.4)
BMI classification
Underweight (%) 9 (6.7) 81 (2.5) 90 (2.7) 0.143
Normal (%) 53 (39.6) 1288 (39.9) 1341 (39.9)
Overweight (%) 50 (37.3) 1202 (37.3) 1252 (37.3)
Obese (%) 22 (16.4) 656 (20.3) 678 (20.2)
BMI (kg/m2) 25.8 ± 4.73 26.4 ± 4.94 26.3 ± 4.94 0.752
Waist circumference (cm) 88.5 ± 15.01 88.9 ± 14.47 88.9 ± 14.5 0.969
Hip circumference (cm) 100.6 ± 10.82 102.6 ± 25.34 102.5 ± 24.9 0.708
Neck circumference (cm) 35.9 ± 3.9 36.1 ± 3.8 36.1 ± 3.8 0.540
Waist / hip 0.87 ± 0.09 0.87 ± 0.09 0.87 ± 0.09 0.051
PSQI 8.4 ± 2.84 6.2 ± 2.1 6.3 ± 2.20 0.000*
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BMI: body mass index, PSQI: Pittrsburg Sleep Quality Index,

*

p < 0.05

Obes Facts. 2018 May 26;11(Suppl 1):151.

T2P104 Determining the Feasibility of Nutritional Screening Tests in Hemodialysis Patients

G Taban 1, I Keskin 1, O Kucukerdonmez 2, HF Bayrak 3, S Duman 3

Introduction

Hemodialysis patients are exposed to protein energy malnutrition, which is a major risk and predictive factor of morbidity or mortality. Regarding to the complications of malnutrition in dialysis patients, using an easy and reliable method for evaluating of malnutrition is important in patients with the end-stage renal disease. Inflammation and inflammatory factors have an important role in malnutrition in patients with the end stage renal disease. Based on the Malnutrition Inflammation Score (MIS), this study was designed to determine which of the nutritional screening tests could better detect the risk of malnutrition in hemodialysis patients.

Methods

This descriptive and cross-sectional study was conducted between the dates of June 2017 and August 2017 at two private hemodialysis centers. This study was conducted with 204 hemodialysis patients, being 41.7% female and 58.3% male patient, 18 years of aged over. For data collection; patient information form for hemodialysis patients, anthropometric measurements (height, pre and post dialysis body weight, triceps skin fold thickness, upper middle arm circumference, calf circumference), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index (GNRI), Subjective Global Assessment Scale (SGA), Mini Nutritional Assessment Scale (MNA) were used. Percentile, mean, standard deviation, Independent Samples t test, ANOVA, Tukey and Tamhane test statistics, Mann Whitney U test, Kruskal Wallis H test, Bonferroni correction, Spearman correlation coefficient were used in the analysis of the data. The level of significance was accepted as p < 0.05.

Results

In this study, malnutrition detection rates in hemodialysis patients were found by MIS, GNRI, SGA and MNA, respectively; 70.1%, 14.2%, 36.7%, 57.4%. According to the MIS, 34 patients were severely malnourished and of them 41.2% were female and 58.8% were males. To the 34 patients identified as severe malnourished by MIS, the rates of detection of GNRI, SGA, and MNA; 17.6%, 14.7% and 29.4%, respectively. These rates are very low compared to MIS.

Conclusion

It has been determined that nutritional screening tests (GNRI, SGA, MNA) which are used in this study are not applicable for hemodialysis patients.

Obes Facts. 2018 May 26;11(Suppl 1):151–152.

T2P105 Evulation of Emotional Appetite in Adults with Diabetes

O Kucukerdonmez 1, S Seckiner 2, R Meseri 1, E Koksal 3

Introduction

Although healthy food choices are important in the management of diabetes, making dietary adaptations is often challenging. Emotional Eating is generally conceived as eating in response to negative emotions rather than to feelings of hunger or satiety. It is now recognized that emotions can influence food intake. While some people report eating less when distressed, others report either no change of eating or eating more in the same condition. The Emotional Appetite Questionnaire (EMAQ) comprises ratings of tendency to eat in response to both positive and negative, emotions and situations. This study was planned to evaluate emotional appetite status in adults with diabetes.

Methods

This study was conducted as cross sectional study on diabetic adult participants. Individual demographic variables were questioned with a questionnaire. From anthropometric measurements, body weight, height, waist and hip circumference were taken by the researchers in accordance with the technique. Emotional appetite status was assessed with “Emotional Appetite Questionnaire (EMAQ)”. Statistical analyzes were performed in the SPSS program.

Results

Among participants (n = 393), mean age was 46.23 ± 13.13 years, 34.6% were male 43.8% had primary education or less and 75.8% were married. Most of them (80.7%) were diagnosed with type II DM and mean diabetes age was 10.22 ± 9.06 years. When obesity indices were evaluated, mean BMI was 30.70 ± 7.30 kg/m2, waist circumference 99.47 ± 18.09 cm, Waist Hip Ratio (WHR) 0.93 ± 0.49 and Waist Height Ratio (WHtR) 0.61 ± 0.12. When emotional appetite was evaluated means of positive thoughts were 45.53 ± 9.65 and negative thoughts were 62.03 ± 18.27. Among socio-demographic factors sex (p = 0.243 for positive thoughts and p = 0.502 for negative thoughts) and education status (p = 0.777 for positive thoughts and p = 0.290 for negative thoughts) didn’t affect emotional appetite whereas marital status (being married) increased negative thoughts significantly (p = 0.029) but not positive thoughts (p = 0.672). Being diagnosed with type II DM increased negative thoughts (p = 0.001) significantly but didn’t effect positive thoughts (p = 0.105). Association between obesity indices and emotional appetite was shown in Table 1.

None of the obesity indices were significantly associated with emotional appetite.

Conclusion

As a Conclusion being married and being diagnosed with type II DM increased negative thoughts significantly whereas none of the obesity indices affected emotional appetite significantly.

Tab. 1.

Association of obesity and emotional appetite

Mean ± S Positive thoughts Mean ± S p Negative thoughts Mean ± S p
Normal (< 25 kg/m2) (n = 83) 44.12 ± 10.02 58.65 ± 17.79
BMI (kg/m2) 30.70 ± 7.30 Overweight (≥25 kg/m2) (n = 310) 45.91 ± 9.54 0.133 62.94 ± 18.33 0.058
Normal (M < 102 cm; W < 88 cm) (n = 153) 44.87 ± 8.72 60.42 ± 16.65
WC (cm) 99.47 ± 18.09 Abdominal obesity (M ≥ 102 cm; W ≥ 88 cm) (n = 240) 45.96 ± 10.20 0.260 60.6 ± 19.20 0.162
Normal (M < 0.95; W < 0.88) (n = 175) 44.98 ± 8.81 61.33 ± 16.90
WHR 0.93 ± 0.49 Abdominal obesity (M ≥ 0.95; W ≥ 0.88) (n = 217) 45.91 ± 10.25 0.334 62.70 ± 19.31 0.455
Normal (M < 0.55; W < 0.53) (n = 96) 44.88 ± 9.53 61.06 ± 17.71
WHtR 0.61 ± 0.12 Abdominal obesity (M ≥ 0.55; W ≥ 0.53) (n = 297) 45.74 ± 9.70 0.449 62.35 ± 18.47 0.550
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Obes Facts. 2018 May 26;11(Suppl 1):152.

T2P106 Analysis of relationships between orthorexia features and eating behaviors and body image- related distress in overweight and obese people

N Kołodziejczyk 1, K Czepczor-Bernat 1, A Brytek-Matera 2

Introduction

In the current literature there is little research available which addresses the subject of excessive concentration on healthy eating - Orthorexia Nervosa (ON). Even though the classification of diseases and mental disorders (DSM-5) does not include orthorexia as a separate nosological unit, the fixation on consuming only healthy food can be a serious limitation in the functioning of the individual, and thus it can affect the quality of life.

The aim of the study was to analyze relationships between orthorexia features and eating behavior and body image- related distress in overweight and obese people.

Methods

The research sample comprised 124 participants – 79 female (N = 79) and 45 male (N = 45) aged from 18 to 95 years with overweight and obesity. All participants completed the ORTHO-15 test, the Body Image Avoidance Questionnaire (the BIAQ) and the Three-Factor Eating Questionnaire-R18 (the TFEQ).

Results

Among people who are overweight and obese, the ON symptoms are graded according to the declared satisfaction with the body image and the use of measures to reduce weight. People with a higher intensity of ON features are less likely to be dissatisfied with their body image and the use of activities aimed at reducing body mass is less frequent. In addition, among women, the symptoms of ON correlate negatively with avoiding situations that might raise the concerns about the physical appearance. The intensity of food, weight and physical appearance preoccupation is significantly lower in case of the increase of ON. It was also shown that the symptoms of orthorexia differentiate the use of dysfunctional eating behaviors. Uncontrolled and emotional eating occurs less frequently in case of a larger clinical factor of orthorexia, and the more frequent use of cognitive limitations in eating behaviors is related to a lower occurrence of the emotional component in ON. On the other hand, the preoccupation with the physical appearance strongly correlates with the uncontrolled and emotional eating in the studied group. Furthermore, the declared satisfaction with the body image is a moderator of the relationship between ON and emotional eating, as well as between ON and preoccupation with physical appearance.

Conclusion

Lower intensity of behaviors connected with the preoccupation with healthy eating is associated with reduced body image-related distress and a lower level of cognitive restraint, uncontrolled eating and emotional eating.

Obes Facts. 2018 May 26;11(Suppl 1):152–153.

T2P107 BMI and waist circumference are significant determinants to breast cancer in Korean postmenopausal women

KR Lee 1, IC Hwang 1, MH Seo 2, K Han 3

Introduction

The association between obesity and breast cancer according to menopausal status showed inconsistent results until now. The purpose of this study is to evaluate the association between obesity (BMI, WC) and the incidence of breast cancer according to menopausal status in women using by big data through national insurance health examination data.

Methods

Women aged above 20 years old (N = 11,403,011) for the national health insurance biannual examination in 2009–2015 were included for followed up for 5.5 years. The medical history (hypertension, DM, dyslipidemia), anthropometric, and sociodemographic variables, newly diagnosed incidences of breast cancer were assessed. Using Cox regression, we estimated multivariable hazard ratios (HR) and 95% confidence intervals for breast cancer risk associated with obesity (BMI, waist circumference), considering menopausal status. Compared to women with 18.5 < BMI < 23, those with 23 < BMI to 25 (HR = 1.112, 1.092–1.133), 25 < BMI to 30 (1.122, 1.102–1.143), and BMI > 30 (1.175, 1.133–1.22) were shown to have a higher risk of breast cancer by multivariate adjusted analysis. Women with highest waist circumferences (waist circumference>95cm, HR = 1.432, 1.334–1.538) have higher than others (waist circumference < 70–74, 75–79, 80–84, 85–89 cm, HR = 1.038 (0.976–1.103), 1.125(1.062–1.191), 1.168(1.103–1.236), 1.351(1.266–1.441)) in the incidence of breast cancer in postmenopausal women after adjustment for multivariate.

Results

Hazard ratios of breast cancer incidence are getting higher with increase of BMI and waist circumference in postmenopausal women (>55 years) after controlled for age, smoking, drinking, physical activity, and medical history such as hypertension, diabetes, and dyslipidemia.

Conclusion

BMI, waist circumference are meaningful determinants to breast cancer in Korean postmenopausal women. Nation-wide population based controlled cohort study including hormone replacement therapy; histologic type of breast cancer would be considered in the future.

Fig. 1.

Fig. 1

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Tab. 1.

WC (cm)
 Event
 Duration
 HR
 95% CI
–70 1,528 8994884.77 1
70–74 3,138 17711389.76 1.038 0.976 1.103
75–79 4,979 26512621.3 1.125 1.062 1.191
80–84 5,668 30059889.24 1.168 1.103 1.236
85–89 4J39 20511638.63 1.282 1.209 1.36
90–94 2,385 11446956.33 1.351 1.266 1.441
95- 1,571 7110986.41 1.432 1.334 1.538
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Obes Facts. 2018 May 26;11(Suppl 1):153.

T2P108 Relation between body mass index and bone mineral density/mental health in middle age Japanese subjects

T Takao 1, Y Yamanaka 1, S Fujimoto 1, T Kamada 1

Introduction

The degree of obesity is evaluated by body mass index (BMI) and the standard body weight based on BMI is used for health examinations and treatment. BMI above normal is known as a heightened risk of several diseases. However, a number of evidence inquire whether BMI measurements reveal any general truth about an individual's state of health. Moreover, there is the so-called obesity paradox showing a paradoxical protective effect of obesity in several chronic diseases. A number of studies have identified that higher BMI is associated with higher bone mineral density (BMD). Furthermore, the reference value of BMI is not fully considered for mental health. Some studies have reported that increased BMI is associated with poor mental health, such as depression. Others have reported that being overweight is associated with a lower risk of depression or a reduction in depressive symptoms, known as the “jolly fat” hypothesis. Therefore, the purpose of the present study was to explore the relationship between BMI and bone mineral density and mental health in middle age Japanese subjects.

Methods

We retrospectively studied 4764 subjects (2376 females, 2388 men) aged 48.3 (mean) ± 13.4 (SD) who visited our medical checkup center in 2015. The subjects were classified as underweight (BMI < 18.5), normal weight (18.5 $$ BMI < 25), overweight (25 $$ BMI < 30) and obesity (30 $$ BMI). Various blood examination values for each category were examined. BMD was measured using the Dual Energy X-ray Absorptiometry method. Radial bone, lumbar spine and femoral neck bone density values were expressed in % young adult mean (YAM). Mental health value was examined using WHO-5 questionnaire which was conceptualized as a unidimensional measure that contains five positively worded items. Group comparisons were analyzed by Tukey-Kramer test. Multiple linear regression analysis for BMD and WHO-5 was carried out using age and gender as independent variables.

Results

Waist circumference, systolic blood pressure, diastolic blood pressure, pulse rate, white blood cell count, red blood cell count, hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, cholinesterase, triglyceride, plasma blood glucose, hemoglobinA1c and creatinine levels were significantly higher in the overweight and obese group than those in the normal weight group. BMD of radial bone, lumbar spine and the femoral neck in obesity group was significantly higher compared with underweight group. WHO-5 score was significantly higher in normal weight and overweight group compared with underweight and obesity group. Multiple linear regression analysis showed significant association between BMD and weight category. Moreover, WHO-5 score was positively associated with normal weight and overweight after adjustment by age and gender.

Conclusion

Although reduced weight is the most important in the treatment of lifestyle-related diseases, overweight and/or obesity show better results in terms of bone mineral density and mental health. As ideal weight may be different in each disease, medical professionals should be aware of the suitable BMI depending on circumstances at health examinations and treatment.

Obes Facts. 2018 May 26;11(Suppl 1):153.

T2P110 Gender differences in the association between non-alcoholic fatty liver disease and mortality – A cohort study

Y Hwang 1, H Ahn 2, S Park 3, C Park 4

Introduction

The association between non-alcoholic fatty liver disease (NAFLD) and increased mortality has been reported, yet the results are inconsistent.

Methods

A total of 318,224 Korean subjects (165,131 men and 153,093 women) aged 20–94 years (mean age of 39.3 years) were enrolled from the Kangbuk Samsung Health Study cohort. The presence of NAFLD was ascertained by ultrasonography in the absence of other known liver diseases. Mortality was determined by the nationwide death certificate data from the Korea National Statistical Office.

Results

During a median 5.7-year follow-up period, cumulative overall mortality was 0.51% (1613 deaths)—cancer was the leading cause of death. In men, NAFLD was not associated with increased mortality from any cause, except lower rate of death from cancer (hazard ratio, 0.79; 95% CI, 0.66–0.93; P = 0.005), after adjusting for age, body mass index, smoking status, daily alcohol consumption, and physical activity. In women, NAFLD was independently associated with death from all causes (hazard ratio, 1.79; 95% CI, 1.50–2.14; P < 0.0001), death from cancer (hazard ratio, 1.83; 95% CI, 1.42–2.35; P < 0.0001), death from cardiovascular disease (hazard ratio, 1.63; 95% CI, 1.00–2.66; P = 0.0498), and death from liver disease (hazard ratio, 5.58; 95% CI, 1.79–17.39; P = 0.003). In obese men, NAFLD associated with reduced risk of death from cancer. However, NAFLD was associated with increased risk of death from cardiovascular disease in non-obese men. In obese women, NAFLD did not increase risk of death compared with obesity alone. However, NAFLD was associated with increased overall risk of death and risk of death from cancer in non-obese women.

Conclusion

The association between NAFLD and mortality was different based on sex in Koreans. NAFLD was associated with increased overall mortality and death from cancer, cardiovascular disease, and liver disease in women; however, these associations were not evident in men.

Obes Facts. 2018 May 26;11(Suppl 1):153–154.

T2P111 Time and age trends in sugar intake among German children and adolescents – results from the DONALD study

I Perrar 1, S Roßbach 1, AE Buyken 2, U Alexy 1

Introduction

A high intake of dietary sugar is increasingly discussed to affect health, e.g. to contribute to the development of obesity during childhood and adolescence. However, detailed data on sugar intake of German children and adolescents are lacking. Therefore, the objective of our study was to describe time (1985–2016) and age trends in total, free and added sugar intake among 3–18 year olds.

Methods

Analyses based on 3-day weighed dietary records (n = 10,761) from 1,312 participants (660 boys, 652 girls) of the DONALD (Dortmund Nutritional Anthropometric Longitudinally Designed) study collected between 1985 and 2016. Added sugar [AS] was defined as sugar added to foods during processing or home preparation. AS also including sugar from honey, syrup and fruit juice concentrate. Free sugar [FS] was defined as AS plus sugar from fruit and vegetable juices, juice spritzers and smoothies. Trends in sugar intake (as percentage of energy intake (%E)) were analyzed using polynomial mixed-effects regression models. In the case of a linear trend, the increase or decrease in the respective outcome variable is constant in every year. Quadratic and cubic trends indicate that the magnitude of the trend changes over time or with age. Sex, body weight status and maternal weight and educational status as well as maternal employment were considered as potentially confounding factors.

Results

Both TS (Fig. 1a) and FS (Fig 1b) intake increased slightly between 1985 and 2005 and decreased thereafter (quadratic trend p = 0.0366, cubic trend p < 0.0001 for TS; quadratic trend p = 0.0163, cubic trend p < 0.0001 for FS). AS intake decreased between 1985 and 1995, increased slightly until 2005 and decreased again thereafter (linear, quadratic, cubic trend p < 0.0001) (Fig. 1c). In terms of age trends, older children had lower TS intakes than younger children (linear trend p < 0.0001) (Fig. 1a). Similarly, the oldest children had the lowest FS intake, but differences among the other age groups were negligible (linear, quadratic trend: p < 0.0001) (Fig. 1b). By contrast, the youngest children had the lowest AS intake, with minor differences between the other age groups (linear, quadratic trend p < 0.0001, cubic trend p = 0.0004) (Fig. 1c).

Fig. 1.

Fig. 1

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Conclusion

Overall, sugar intake calculated as TS, AS and FS among German children and adolescents had increased between 1995 and 2005, yet decreased over the last decade. Nevertheless, FS intake still exceeds the daily intake of 10%E recommended by the WHO. Differences in time and age trends between the different sugar definitions – which may reflect the consideration of juices - should be explored in additional analyses.

Obes Facts. 2018 May 26;11(Suppl 1):154.

T2P112 The level of indole-3-carbinol in the diets of overweight students

A Korolev 1, E Denisova 1, E Nikitenko 1, E Kirpichenkova 1, R Fetisov 1

Introduction

The principal aims of the research were to assess the level of intake of the foodstuff that is regarded as a source of indoles (indole-3-carbinol), as well as analyse the frequency of their insertion, compare the quantity of indoles in diets of the students of Medical University.

Methods

The research considered thoroughly food preferences of 193 students, (150 women and 43 men) aged 21 – 27 years old. The study revealed that 28 students, in particular 13 men and 15 women, were overweight. Dietary intake was assessed using 24-hour recall method. It was developed a questionnaire based on the analysis of the main sources of indoles. The questionnaire included the most important sources on the territory of the Russian Federation and anthropometric measurements (height and weight). Food composition database was used to evaluate indole intake.

Results

The average age of students found overweight were 22,7 ± 1,36 years old, average BMI - 29,2 ± 2,7. It was estimated that only 9 of respondents consumed adequate amount of indole-3–carbinol (88,5 ± 38 mcg per day), whereas 5 students consumed indole-3–carbinol below the daily range, 12 students didn’t consume products - sources of indoles. Dietary intake of indoles is often assessed using the consumption of cruciferous vegetables. It should be pointed out that diets of overweight students included sources of indoles like cabbage, napa cabbage, broccoli, cauliflower, ruccola, garden radish, kale and horseradish. The most frequent staple in the diet were cabbage. It included in diets of 81, 2% of respondents. While other cruciferous vegetables included in the diets of only 6–18,7% students. In a comparative analysis of the sources of indoles in the structure of diet according to sex revealed no significant differences in consumption of cruciferous vegetables in men and women.

Conclusion

The results obtained make it possible to conclude that there is a significant deficiency of indoles in the nutrition of students. The research reveals that overweight students do not consume major sources of indoles, which leads to lack of indole-3-carbinol. In students with an adequate amount of indoles in the diet, their intake is determined by the regular consumption of cabbage.

Obes Facts. 2018 May 26;11(Suppl 1):154–155.

T2P113 Geospatial Analysis of Mediterranean Diet Adherence in the U.S.

M Chen 1, T Creger 2, VJ Howard 2, K Fontaine 2

Introduction

Given the growing obesity epidemic in the U.S., identifying and promoting an obesity-modifying dietary approach is urgent. Emerging evidence has suggested the health benefits of Mediterranean diet (MD) against obesity. However, given MD as a relatively new dietary pattern in the U.S., many questions remain unclear. The aim of this study was to investigate the geospatial distribution of MD adherence, and explore predictive factors for MD adherence in the U.S.

Methods

Data from adults aged ≥ 45 years who participated in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study and completed baseline dietary assessment during January 2003 and October 2007 were used for the analysis. The MD adherence score (ranged from 0 to 9, with higher score showing greater adherence) was calculated using the self-administered Block 98 Food Frequency Questionnaire (FFQ). Hot Spot analysis using the Getis-Ord Gi* statistic in ArcGIS 10.4 highlighted the spatial distribution and pattern of MD adherence in these participants. The significance of local clustering was based on a p-value < 0.05. Furthermore, the community characteristics were compared among the identified MD adherence clustering groups (higher MD adherence clusters, lower MD adherence clusters, and non-clustering group) using PROC ANOVA, PROC NPAR1WAY, and PROC FREQ procedures in SAS 9.4 as appropriate. Multiple logistic regression (stepwise) models were developed to explore predictors of high MD adherence (scored 5–9; using median 4 among the participants in analysis as the cutoff).

Results

A total of 20,897 participants from 48 contiguous states and Washington, D.C. were in the analysis. Of the sample, the mean MD score was 4.36 (SD = 1.70), and 46.5% had high MD adherence. Hotspot analysis results showed that higher MD adherence clusters were primarily located in the western and northeastern coastal areas of the U.S. (e.g., Californian, Pennsylvania, New Jersey, New York City, Connecticut, and Massachusetts), whereas lower MD adherence clusters were primarily observed in South and East North Central regions of the U.S. (e.g., Arkansas, Louisiana, Alabama, Georgia, North Carolina, Michigan and northern area of Indiana). Further comparison between the clustering groups showed that higher MD adherence clusters were more likely to be in socioeconomically advantaged, urban neighborhoods with lower percentages of both non-Hispanic white and black residents, whereas lower MD adherence clusters were more likely to appear in socioeconomically disadvantaged, rural, minority neighborhoods with smaller population sizes. Being older, black, not a current smoker, having a college degree and above, and annual household income ≥ $75K, exercising ≥ 4 times/week, and watching TV/video < 4 hrs/day were each associated with higher odds of high MD adherence.

Conclusion

The identification of higher/lower MD adherence clustering and predictors of high MD adherence can guide to target at-risk populations and places in future MD promoting interventions and policies. Future studies may examine local individual and contextual factors to better understand the geospatial cluttering of MD adherence, and help develop tailored MD promoting interventions and policies to combat the obesity crisis in the U.S.

Obes Facts. 2018 May 26;11(Suppl 1):155.

T2P114 The prevalence of desire to lose weight in the adult population in Sweden

A Molarius 1, M Lindén-Boström 2, J Karlsson 3

Introduction

Evidence-based methods to lose weight are important in tackling increasing obesity trends in adult populations. However, attempts to lose weight are often associated with weight gain. In order to design effective preventive weight-control practises, more knowledge is required about the desire to lose weight among the adult population as well as the need for support to lose weight. The aim of this study was to investigate the prevalence of desire to lose weight and the need of support to lose weight in the general population, and whether there are differences by gender, age, BMI and educational level.

Methods

This cross-sectional study is based on 14,126 persons aged 30–69 years who responded to a postal survey questionnaire sent to a random population sample in five counties in Mid-Sweden in 2017. The overall response rate was 43%. BMI was based on self-reported weight and height.

Results

In total, 69% of the women and 59% of the men reported that they wanted to lose weight. There were no differences between age groups, but overweight (79%) and obese (94%) subjects were more prone to report a desire to lose weight than normal weight subjects (35%). The prevalence was higher among those with high and medium educational level compared to those with low educational level. In total, 18% of the subjects who wanted to lose weight, reported that they needed support to do so. This proportion increased with increasing BMI and 44% of the obese women and 25% of the obese men reported that they needed help to lose weight.

Conclusion

The desire to lose weight was very common in the studied age group. Female gender, increasing BMI, and higher educational levels were associated with higher prevalence of desire to lose weight. The widespread willingness and motivation to lose weight and the need for support to do so, especially among overweight and obese subjects, should be taken into consideration when designing preventive weight-control programmes.

Obes Facts. 2018 May 26;11(Suppl 1):155.

T2P115 The association between working hours, sleeping hours and obesity among hospitals physicians

H Hu 1, Y Chou 2

Introduction

Obesity is widely recognized as an epidemic in the Western world. Physicians are an important cadre in health promotion efforts. However, there is only limited understanding of physician's health maintenance behaviors such as obesity and related risk-factors. This study aimed to determine the prevalence of obesity, and explore the influences of working hours and sleeping hours on physician's obesity.

Methods

Our data source were from 2011 and 2015 Physical and Mental Health and Safety Needs in Health Care Full-Time Staff, which were a nationwide survey and conducted by Bureau of Health Promotion. The main dependent variable was body mass index (BMI), and overweight (23.0–24.9 kg/m2), obesity class (25.0–29.9 kg/m2) and obesity class(30.0 kg/m2) were defined based on the WHO-Asia Pacific categories. Multinomial Logistics Regression was used to identify factors associated with physician's obesity. Independent variables include demographics, work characteristics and organizational characteristics.

Results

Male physicians tend to have overweight or obesity than female physicians (OR = 4.94 for overweight; OR = 6.72 for obesity class I; OR = 7.02 for 7.02 for obesity class II). The adjusted regression model points out that when the physicians who work more than 60 hours would have higher risk to have overweight (OR = 1.21 for working hours between 60–88 and OR = 1.15 for working hours > 88 hours) or obesity I (OR = 1.20 for working hours between 60–88 and OR = 1.24 for working hours > 88 hours) or obesity II (OR = 1.14 for working hours between 60–88 and OR = 1.83 for working hours more than 88 hours). Few sleeping hours also may caused physician have overweight or obesity, especially in female physicians. Our result shows that the more sleeping hours that the female physicians have the lower risk to be overweight or obesity (sleeping hours in 6–7 hours group: OR = 0.77 for overweight; 0.97 for obesity class I; and 0.68 for obesity class II. Sleeping hours > 8 hours groups: OR = 0.73 for overweight; 0.68 for obesity class I; and 0.95 for obesity class II).

Conclusion

Nearly half of the hospital physicians were either overweight or obese in Taiwan, especially in Male physician. The finding suggests that having healthy diet, exercise habit, or having favorable work out environment may less effect the physicians’ BMI. Physicians’ working hours per week and sleeping hours may play much important role for Physicians’ BMI.

Obes Facts. 2018 May 26;11(Suppl 1):155–156.

T2P116 How much the prevalence of chronic diseases correlates with overweight? The results of WOBASZ II Survey for adult Polish population aged 20–64 years

A Cicha-Mikołajczyk 1, A Waśkiewicz 1, D Szcześniewska 1, U Stepaniak 2, A Pająk 2, M Kwaśniewska 3, A Tykarski 4, T Zdrojewski 5, K Kozakiewicz 6, W Drygas 1

Introduction

Overweight and obesity contribute to development of many chronic diseases. The purpose of the study was to examine association between prevalence of cardiovascular, musculoskeletal and other diseases and overweight in Polish population aged 20–64 years.

Methods

The self-reported data on prevalence of chosen chronic diseases were obtained in the Multicenter National Population Health Examination Survey WOBASZ II which was conducted in Poland between 2013 and 2014. Body Mass Index was calculated from direct measurements of height and weight. In this paper the crude prevalence ratios of 14 diseases were estimated in groups with normal weight (BMI: 18.50–24.99 kg/m2) and with overweight (BMI> = 25.00 kg/m2) in Polish citizens aged 20–64 years (n = 4627). Additionally group with normal weight was compared with pre-obesity (BMI: 25.00–29.99 kg/m2) and obesity (BMI> = 30.00 kg/m2) groups. Logistic regression was used to estimate the risk of chronic disease prevalence depending on sex, age and overweight as risk factors with reference levels: males, 20–54 years and normal weight. Statistical analyses were performed in SAS 9.2.

Results

The crude prevalence ratios of almost all diseases except abnormal heart rhythm or other arrhythmias and chronic depression were significantly higher in people with overweight than in people with normal weight (Figure 1)

Prevalence of chronic diseases in people aged 20–64 years with normal weight and overweight. For all diseases the prevalence increased with age (p < 0.05). For coronary artery disease, atrial fibrillation, peripheral vascular disease of the lower limbs, cholecystolithias, disorders of thyroid gland, urinary incontinence and all musculoskeletal diseases the adjusted prevalence was higher in people with overweight (Table 1).

Conclusion

Overweight significantly affected the prevalence of many chronic diseases including musculoskeletal diseases, coronary artery disease, cholecystolithiasis, disorders or thyroid gland and urinary incontinence. For all mentioned above diseases the prevalence ratios were increased in people with pre-obesity and obesity, while for myocardial infarction, chronic kidney diseases and chronic depression significantly higher prevalence was observed only in people with obesity.

Conflicts of Interest

AP declared personal fees from AMGEN and Sanofi not related to submitted work. The other authors declared they had no conflict of interest.

Fig. 1.

Fig. 1

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Tab. 1.

Odds ratio of chronic disease prevalence by weight adjusted to sex and age.

Covariates
 OR (+/- 95% CI)
 p
Diseases of the circulatory system
coronary artery disease 2.76 (1.78; 4.27) <0.001
myocardial infarction 1.76 (1.02; 3.03) 0.041
atrial fibrillation 2.16 (1.31; 3.57) 0.003
abnormal heart rhythm, other cardiac arrhythmias 1.05 (0.81; 1.37) 0.717
peripheral vascular disease of the lower limbs 1.92 (1.26; 2.91) 0.002
Diseases of the musculoskeletal system
ostheoarthritis 2.04 (1.64; 2.53) <0.001
lumbosacral spine disease 1.41 (1.22; 1.63) <0.001
cervical/thoracic spine disease 1.33 (1.12; 1.59) 0.001
Other diseases
cholecystolithiasis 2.37 (1.75; 3.19) <0.001
disorders of thyroid gland 1.49 (1.20; 1.84) <0.001
urinary incontinence 2.55 (1.75; 3.73) <0.001
chronic kidney diseases 1.32 (1.01; 1.72) 0.045
sleep disorders 1.18 (0.96; 1.46) 0.122
chronic depression 1.30 (0.94; 1.79) 0.112
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Obes Facts. 2018 May 26;11(Suppl 1):156.

T2P117 Adiposity and Ischaemic Heart Disease in the UK Biobank: A prospective study of 500,000 men and women

D Malden 1, S Lewington 2, J Emberson 2, B Lacey 2, D Bennett 2

Introduction

Excess adiposity is a major cause of ischaemic heart disease (IHD). Body mass index (BMI) is the most widely used population-level adiposity marker. However, it does not directly quantify body fat, nor does it account for differences in body fat distribution. Therefore, BMI may not fully account for adiposity-associated IHD risk. This study aims to compare the IHD risk associated with six anthropometric markers of adiposity.

Methods

BMI, waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio, body fat percentage (from bioimpedance analysis) and trunk fat percentage were measured in 457,936 UK Biobank participants aged 40–69 without known vascular disease at recruitment, 2006–2010. Cox regression was used to estimate overall and sex-specific hazard ratios (HR) for incident IHD per standard deviation (SD) of each adiposity measure. Resurvey measurements in 18,737 participants approximately 5 years after baseline enabled quantification of, and correction for, within-person variability.

Results

All six adiposity markers were positively associated with blood pressure and diabetes prevalence at baseline. 5,239 first-ever IHD events occurred over a mean follow-up period of 6.2 years. In analyses adjusted for age, sex, socio-economic status, smoking and alcohol, usual levels of each adiposity marker were positively and log-linearly associated with IHD risk. Associations were notably stronger for markers of central adiposity, particularly WHR (HR per usual SD: 1.49 [1.42–1.56]) compared with BMI (1.20 [1.17–1.24]). The relevance of usual WHR to IHD was particularly strong among women (1.63 [1.55–1.71]). These associations were partially mediated by blood pressure, pulse rate and diabetes, which together explained at least one-third of the observed excess risk.

Conclusion

Markers of central adiposity or body fat distribution are associated with greater IHD risk compared with BMI, particularly among women, and should be considered when investigating IHD risk in large contemporary populations.

Obes Facts. 2018 May 26;11(Suppl 1):156–157.

T2P118 Beyond energy intake and physical activity: self-reported nightly sleep duration was associated with obesity indices

M Chen 1, D Li 1, H Xue 1, X Lv 1, X Zhang 2, L Quan 1, G Cheng 1

Introduction

Obesity has become a major public health issue that is leading to increased death rates from cardiovascular diseases, cancers, and all-cause mortality. Inadequate sleep duration is prevalent in modern society. Previous studies have shown that nightly sleep duration might be associated with obesity and the associations vary across country and race. We aim to examine whether nightly sleep duration is related to obesity indices among adults in Southwest China.

Methods

A total of 1,276 adults (64.50% women) aged 20–70 years were randomly selected in. Nightly sleep duration was self-reported using a validated questionnaire. Nightly sleep duration was categorized into 5 groups (< 6 hours, 6–7 hours, 7–8 hours [reference], 8–9 hours, ≥9 hours). Participants aged 60 and above were defined as older adults. Anthropometric parameters, including weight, height, waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist/hip ratio (WHR). Multivariate regression analysis was used to estimate the relationship of nightly sleep duration and obesity indices, with adjustment for age, gender, education, marriage, hypertension, energy intake, daytime napping habit, sleep quality and physical activity.

Results

Mean nightly sleep duration was 7.0 hours. For young and middle-aged adults, nightly sleep duration was inversely correlated with BMI (P = 0.0006, β = −0.30) and WHR (P < 0.0001, β = −0.01). After adjustment for confounders, nightly sleep duration was still correlated with BMI (P = 0.0004, β = −0.26) and WHR (p = 0.001, β = −0.01). Nightly sleep duration was not correlated with BMI and WHR among adults which aged 60 years and above (p > 0.05).

Conclusion

Our data suggest that short nightly sleep duration was inversely associated with obesity indices among young and middle-aged adults in Southwest China.

Obes Facts. 2018 May 26;11(Suppl 1):157.

T2P119 Obesity and breast cancer: a case-control study in Iran

B Rashidkhani 1

Introduction

The association between obesity and breast cancer (BC) risk is complex, with results that differ depending on when body size is assessed (e.g., pre- vs. postmenopausal obesity) and when BC is diagnosed (i.e., pre- vs. postmenopausal disease). To provide further information on the issue, the relation between obesity and BC was studied in an Iranian case-control study.

Methods

In the present study, 136 newly diagnosed breast cancer patients and 272 hospitalized controls were recruited using convenience sampling. Weight, height and waist circumference were measured by trained dieticians during face-to-face interview at recruitment to the study. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression.

Results

After adjustment for potential confounders, those in the highest tertile of body mass index (BMI) had 55% higher risk of BC compared with those in the lowest (odds ratio, 1.55; 95% confidence interval, 0.81–2.96). However, being in the highest tertile of waist to hip ratio (WHR) was not associated with BC risk (odds ratio, 1.07; 95% confidence interval, 0.48–2.39; P for trend = 0.85). Subgroup analyses of BMI in relation to BC risk by menopausal status suggested a significant positive association among post-menopausal women (p-trend = 0.05).

Conclusion

Findings of the present study indicate that obesity might be associated with decrease risk of BC especially among post-menopausal women.

Obes Facts. 2018 May 26;11(Suppl 1):157.

T2P120 Metabolically healthy obesity: Myth or reality?

Y De Roeck 1, A Verrijken 2, K Van Dessel 2, C De Block 3, L Van Gaal 4, E Dirinck 3

Introduction

Currently, there is a lack of consensus on defining metabolically healthy obesity (MHO). The first objective of this study was to examine MHO prevalence in an obese population using a range of definitions. Secondly, we examined which anthropometric measurements are better predictors of MHO. Thirdly, we calculated the 10-year cardiovascular (CV) risk of these patients to determine the performance of 1) different MHO-definitions and 2) anthropometric data to best predict 10-year CV risk.

Methods

Adult patients visiting the obesity clinic of the Antwerp University Hospital (Belgium) for a problem of overweight or obesity, were consecutively recruited. Metabolic health status was derived using 7 MHO-definitions: Wildman, Wildman modified, Karelis, Meigs, Meigs-HOMA, Aguilar-Salinas and Alberti. Thirteen anthropometric data were measured using anthropometrics, impedance analysis and CT-scan [body mass index (BMI), abdominal volume index (AVI), waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), weight, height, hip circumference, fat-free mass index (FFMI), fat-mass index (FMI), fat mass percentage (FM%), conicity index (CI) and visceral abdominal tissue (VAT)]. A binary logistic regression was used to find the best predictors of MHO among these data. The 10-year CV risk was calculated in a subset of patients using the Framingham (n = 831) and SCORE (n = 532) tool. ROC-curve analysis was used to determine the optimal discriminators among MHO-definitions and anthropometric measurements in the estimation of a 10-year CV risk of ≥ 5%.

Results

The cohort consisted of 3419 subjects (75,2% female), with a mean age of 43,1 years and a mean BMI of 36,5 kg/m2. Firstly, the prevalence of MHO varied between 13,3 and 74,6%, depending on the used definition, and was higher among women. Meigs, Aguilar and Alberti showed comparable results (resp. 44,3, 40,7 and 43,1%). Secondly, waist, WHR, WHtR, FFMI, VAT, CI and AVI had the best predictive value for MHO: 10–23% of the variability was explained by these individual measurements, depending on the used MHO-definition. Thirdly, among the 7 MHO-definitions, Alberti showed the most discriminatory power to estimate a 10-year CV risk (figure 1). Using the Framingham tool, the area under the curve (AUC) was 0,683 based on the 5% risk. Using SCORE, the AUC was 0,619 based on the 5% risk. Among the anthropometric measures, WHR, CI and VAT showed the most discriminatory power to estimate the 10-year CV risk. Using the Framingham tool, the AUCs were resp. 0,746, 0,734 and 0,753 based on the 5% risk.

Conclusion

The definitions of Meigs, Aguilar and Alberti showed comparable results for MHO-status, with on average 40% of our population defined as MHO. With regards to the anthropometric data, waist, WHR, WHtR, FFMI, VAT, CI and AVI showed the best predictive value for MHO-status. Furthermore, the 3 aforementioned MHO definitions had the most discriminatory power to estimate 10-year CV risk. Among the anthropometric measures, WHR, CI and VAT had the most discriminatory power to estimate 10-year CV risk.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):158.

T2P121 Trends in prevalence of overweight and obesity among adults in Bulgaria

VL Duleva 1, LS Rangelova 1, SP Petrova 1, P Dimitrov 2

Introduction

The last national survey on nutrition and nutritional status of Bulgarian adults was conducted under the National program for prevention of chronic non-communicable diseases 2014–2020. The aim was to evaluate the trends in overweight and obesity prevalence among people aged 19–74.

Methods

A cross-sectional study of a representative sample of 2745 adults was carried out. Overweight and obesity were assessed by Body Mass Index. Trends in the overweight and obesity prevalence among adults were evaluated by comparing the data of the current survey and the data from similar national survey carried out in 1998.

Results

The rate of adults with overweight was between 23.8–40,7%; obesity was 8.9 – 35,3% as it was highest among females aged 60–74 years (35.3%). Compared with the data from 1998, the prevalence of overweight in the defined aged groups of adults (19–29; 30–59; 60–74 years) was in the same range but the prevalence of obesity was increased significantly (obesity in 1998 was in range 1.0–16.0%, obesity in 2014 was in range 7.5-35.3%).

Conclusion

The prevalence of obesity among Bulgarian adults has been increased during the last decade and consumption on energy rich foods significantly contributed to this unfavorable trend.

Obes Facts. 2018 May 26;11(Suppl 1):158.

T2P122 Frequency of obesity in individuals with hypertension and coronary heart disease

SR De Souza 1

Introduction

Cardiovascular disease (CVD) is the main cause of morbidity and mortality in the world, being obesity one of the main risk factors for its development. A recent survey by the Brazilian Ministry of Health has shown that 56.9% of individuals over eighteen years old with excess weight (overweight and obesity) in the country. In this context, although the negative impact of obesity on the genesis and worsening of CVD is known, the current care model for prevention and management of the global epidemic of obesity seems not to be efficient. It is noteworthy that researches on the frequency of obesity in populations with established CVD are scarce. The objective of the present study was to evaluate the frequency of obesity in individuals with hypertension and coronary heart disease attended at a public hospital specialized in cardiology in the state of Rio de Janeiro.

Methods

Cross descriptive study submitted and approved by the Research Ethics Committee where it was carried out. All the individuals who were present in the waiting room for outpatient care with cardiologists were invited to participate, all of whom with hypertension or coronary heart disease, or both. A calendar day was chosen, randomly, for data collection. The acceptance to participate was formalized by signing Free Informed Consent Term. Variables evaluated: age, gender, comorbidities and body mass index (BMI). Descriptive statistical analysis was performed using SPSS version 21.

Results

107 subjects aged between 29 to 83 years were evaluated, with mean age = 61.75 (10.33), adults = 35.5%, women = 45.8%, coronary heart disease = 60.7%, dyslipidemia = 62.5%, diabetes = 20.6%, hypertension = 60.7%, peripheral arterial insufficiency = 8.4%, orovalvar lesion = 5.6%, inter-atrial communication = 1.9%. As for BMI, among adults: eutrophy = 15.8%, overweight = 21.1%, obesity grade 1 = 23.6%, obesity grade 2 = 15.8%, obesity grade 3 = 23.7%; among elderly: thinness = 2.9%, eutrophy = 27.5%, overweight = 69.6%, 14.5% with BMI above 35 and 4.3% above 40. When considering the classification of the sample as a whole, it was observed thinness = 1,9%, eutrophy = 23.4% and excess weight = 74.8%, much higher than 56.9%, observed in the brazilian population.

Conclusion

The findings of the present study showed an even higher percentage of excess weight in individuals with comorbidities than those observed recently in the brazilian population, corroborating the crucial importance of containing obesity in order to obtain better control of the other chronic diseases that, although they are multifactorial, have obesity as perhaps the main risk factor.

Obes Facts. 2018 May 26;11(Suppl 1):158.

T2P123 Association of Serum Vitamin D concentration and Pulmonary Function in obese nonsmokers

SY Lee 1, H Shin 1, J Baek 1, J Kim 1

Introduction

Low blood vitamin D levels have been postulated to be a risk factor for worse lung function in many studies. And there has been an increase in the number of studies which have identified that obesity is associated with vitamin D deficiency over the past decade, and obesity and vitamin D deficiency have both been recognized as major public health issues worldwide. The aim of this study was to investigate the relationship of current vitamin D status (measured by 25-hydroxyvitamin D, 25(OH) D) with lung function in obese population.

Methods

We used cross-sectional data from 2261 participants who had measurements of 25(OH)D and lung function (forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC)) from January 2016 to November 2016 at health promotion center. We include the person who's BMI is 25kg/m2 or more and who has had no respiratory disease. We excluded smoker and ex-smoker who had stopped smoking within 15 years.

Results

After adjustment for sex, age and height FVC and FEV1 showed positive linear relationship with serum 25(OH)D (F-value = 0.843, P = 0.049; F-value = 0.618, P = 0.043). But FVC/FEV1 had no significant relationship with serum 25(OH)D (F-value = 5.253, P = 0.668). We devided participants to three group according to the vitamin D status and there was higher prevalence of vitamin D deficiency than Korean overall prevalence (male 52.9%, female 76% vs male 47.3%, female 64.5%). There was significant difference in FVC and FEV1 between deficiency group and insufficiency group, but there was no difference between insufficiency group and sufficiency group.

Conclusion

There is significant relationship between serum concentration of 25(OH)D, FVC, FEV1 in obese population.

Obes Facts. 2018 May 26;11(Suppl 1):158–159.

T2P124 Body fat distribution and genetic variants are associated with sex differences in serum leptin and adiponectin concentrations

T Christen 1, S Trompet 2, R Noordam 3, JB Van Klinken 3, K Willems Van Dijk 3, HJ Lamb 3, CM Cobbaert 3, M Den Heijer 3, IM Jazet 3, JW Jukema 3, FR Rosendaal 4, R De Mutsert 4

Introduction

Adiponectin and leptin serum concentrations differ between women and men and are influenced by body fat. We investigated to what extent sex differences in body fat distribution, measured with high quality, explained sex differences in adiponectin and leptin concentrations.

Methods

In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, total body fat was assessed by bio-impedance in all participants (n = 6,494), and visceral adipose tissue by magnetic resonance imaging in a subgroup (n = 2,516). Associations of measures of body fat and sex with serum adiponectin and leptin concentrations were examined using linear regression analysis, adjusted for lifestyle and cardiometabolic risk factors. Sex differences were additionally adjusted for the measure of body fat that was most strongly associated with adiponectin or leptin concentrations. Extreme leptin concentrations (>100 μg/L) were observed in 45 women. To find an explanation, we performed a post-hoc target gene study directed at genes that have been shown to be associated with leptin concentrations.

Results

Median adiponectin concentrations were 10.5 mg/L (interquartile range, IQR: 7.7–13.9) in women and 6.1 mg/L (IQR: 4.5–8.2) in men, the mean difference was 4.6 mg/L (95% CI: 4.3, 4.9). Median leptin concentrations were 19.2 μg/L (IQR: 11.5–30.0) in women and 7.1 (IQR: 4.6–11.1) in men, the mean difference was 15.1 μg/L (95% CI: 14.4, 15.8). One standard deviation (SD) visceral adipose tissue (56 cm2) was associated with 0.77-fold lower adiponectin concentrations (95% CI: 0.75, 0.79), while one SD total body fat (9%) was associated with 1.89-fold higher leptin concentrations (95% CI: 1.79, 1.99). After adjustment for visceral adipose tissue, women had 3.8 mg/L (95% CI: 3.3, 4.3) higher adiponectin concentrations than men. After adjustment for total body fat, the difference in leptin concentrations was 0.4 μg/L (95% CI: −1.2, 2.0). One genetic variant (rs4731420) in close proximity to the LEP gene was associated with leptin concentrations >100 μg/L in women.

Conclusion

Higher leptin concentrations in women than in men were completely explained by sex differences in total body fat, while sex differences in visceral adipose tissue only partly explained higher adiponectin concentrations in women than in men. The sex difference in adiponectin concentrations may be due to other factors, such as sex hormones. Furthermore, we found a genetic variant that was associated with extreme leptin concentrations in a small number of women, but not in men.

Obes Facts. 2018 May 26;11(Suppl 1):159.

T2P125 Regional differences of overweight/obesity prevalence in Portugal: educational level and food habits

A Amoroso 1, S Magalhães 1

Introduction

Although Portugal is a small size country, some regional differences in health status can be observed between continental Portugal and its autonomous regions, the archipelagos of Azores and Madeira. In a previous study (Pro. Mo Saúde 2015 – unpublished), overweight/obesity prevalence in the continent was 48.3%, whereas in the archipelagos was 68%. Chi-square showed a statistically significant difference of overweight/obesity prevalence between these two regions (p < 0.001). The purpose of this study was to find behavior differences that might justify these differences.

Methods

Socio-demographic data and self-reported weight and height of 637 adults who participated in Pro. Mo Saúde 2015 were used. Independent sample t-test was used to test which variables affected Body Mass Index in the overall sample. The variables sex, age, educational level, marital status, mothers educational level, mid-morning snack, mid-afternoon snack, cooked vegetables, raw vegetables, fresh fruit, wine and soup are associated with BMI. Chi-square was used to test which of these variables showed regional statistical significant differences.

Results

Q-square results showed that there are no differences between continent and archipelagos regarding sex, age, marital status, raw vegetables, soup and wine consumption. There are statistical significant differences in educational level. In the continent 55.6% has a degree, whereas in the archipelagos is only of 33% (p < 0.001). In the continent, 9.8% has mothers with a degree and in the archipelagos this number reaches 2.3% (p = 0.011). In the continent 51.8% eat a mid-morning snack, whereas in the archipelagos only 31.9% has this habit (p < 0.001). When it comes to mid-afternoon snack, 67.8% in the continent and 59.3% in the archipelagos (p = 0.001). The daily consumption of cooked vegetables is of 36.4% in the continent and 26.4% in the archipelagos (p = 0.040). The daily consumption of fresh fruit is of 67.5% for the continent and 50.6% for the archipelagos (p = 0.002).

Conclusion

Regional differences of overweight/obesity prevalence between continent and archipelagos seems to be justified by educational level (own and mothers) and food habits. It is possible that food choices are connected with educational level. A life-style intervention on food habits on the archipelagos of Azores and Madeira might result in a decrease of this prevalence.

Obes Facts. 2018 May 26;11(Suppl 1):159.

T2P126 Habitual coffee consumption and changes in measures of adiposity: a comprehensive study of longitudinal associations

SC Larsen 1, MK Mikkelsen 1, P Frederiksen 1, B L Heitmann 1

Introduction

A relationship between change in coffee consumption and reduced long-term weight gain has been suggested, but current evidence is inconsistent. Thus, the aim of this study was to examine longitudinal associations between coffee consumption and changes in body mass index (BMI), fat mass index (FMI), fat free mass index (FFMI), body fat % (BF %) and waist circumference (WC).

Methods

The study consisted of up to 2,128 participants from the Danish part of the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) cohort with repeated information on coffee consumption, adiposity measures and covariates during an 11-year period. Linear regression analyses were conducted to assess the associations between baseline coffee consumption and subsequent change in adiposity measures. The same analyses were conducted analyzing associations between change in coffee consumption and concurrent as well as subsequent changes in adiposity measures.

Results

We found no consistent evidence of associations between baseline coffee consumption and subsequent six-year changes in adiposity measures. A statistically significant association between increased coffee consumption over a six-year period and decreased concurrent gain in BMI, FMI, BF %, and WC [-0.05 kg/m2 (95% CI: −0.07, −0.02), - 0.04 kg/m2 (95% CI: −0.06, −0.02), −0.08% (95% CI: −0.13, −0.04), and −0.23 cm (95% CI: −0.34, −0.12), respectively, per 1 cup/day increase in coffee consumption] was found. No association was seen between change in coffee consumption and concurrent change in FFMI. Moreover, an initial change in coffee consumption during the first five-year period was not associated with change in adiposity during the subsequent six-year period.

Conclusion

Increased coffee consumption was associated with a decreased concurrent gain in body weight, fat mass and waist circumference, but the associations were weak. Moreover, a causal relationship could not be established, as we found no evidence of associations between an initial change in coffee consumption and subsequent change in adiposity.

Obes Facts. 2018 May 26;11(Suppl 1):159–160.

T2P127 The national data on obesity prevalence in Serbia

T Pekmezovic 1, D Kisic Tepavcevic 2, D Miljus 3, G Maric 2, S Polovina 4, D Micic 5

Introduction

Despite growing recognition of the problem, the obesity epidemic continues in almost all parts of the world. The most relevant source of information on the distribution of obesity in certain population are prevalence studies carried out in a national representative samples. This study has been performed in Serbia three times until now (in 2000, 2006 and 2013), as a part of the National Health Survey of the Republic of Serbia, organized by the Ministry of Health of the Republic of Serbia.

Methods

The target population in the study performed in 2013 included persons aged 15 and over who were residents of the Republic of Serbia at the time of data collection. A nationally representative random stratified two-stage sample with a known probability of selection of sample units at every stage of sampling was used. All measurements were performed on 13,908 respondents aged 15 years and over.

Results

At the time of testing, using an objective measurement, 40.4% of the sample of the population had normal body weight (body mass index-BMI = 18.5–24.9 kg/m2), 35.1% of participants were overweight (BMI = 25.0–29.9 kg/m2), and 21.2% were obese (BMI more than 30.0 kg/m2), while the average BMI was 26.5 +/– 5.2 kg/m2. Unlike obesity, which was similarly distributed among genders (men 20.1%, women 22.2%), overweight was more common among men (41.4%) than in women (29.1%). The highest proportion of overweight individuals was in the age groups 55–64 (31.8%) and 65–74 (33.0%), and the lowest in the age group 15–24 (4.6%). Based on the waist circumference measurement, abdominal obesity was registered in 67.9% women (waist circumference greater than 80 cm) and 56.6% men (waist size above 94 cm), in the sample. An inverse association was observed between obesity and educational level, and when the distribution of obesity was analyzed in relation to the Legatum Prosperity Index (an indicator of socioeconomic status), the highest prevalence of obesity was reported in people who belong to the first quintile, i.e. the poorest households.

Conclusion

Based on the obtained data, the prevalence of overweight and obesity remains high and quite likely will continue to rise, keeping in mind increasing tendency reported in three surveys conducted so far.

Obes Facts. 2018 May 26;11(Suppl 1):160.

T2P128 Air pollution has a significant impact on intentional efforts to lose weight: A smartphone application based study

SY Rhee 1, M Ustulin 2, JY Kim 3, S Chon 1, J Woo 1

Introduction

Air pollution causes many diseases and deaths. It is important to see how air pollution affects obesity, which is common worldwide. Therefore, we analyzed data from a smartphone application for intentional weight loss, and then we validated them.

Methods

Our analysis was structured in two parts: we analyzed data from a cohort registered to a smartphone application in ten large cities of the world and matched it with the annual pollution values. We validated these results using daily pollution data in US and matching them with user information. BMI variation between final and initial login time was considered as outcome in the first part, and daily BMI in the validation. We analyzed: daily calories intake, daily weight, daily physical activity, geographical coordinates, seasons, age, and gender. Weather Underground API provided daily climatic values. Annual and daily values of PM10 and PM2.5 were extracted. In the first part of the analysis, we used 2608 users and then 995 users located in US.

Results

Air pollution was highest in Seoul and lowest in Detroit. Users decreased BMI by 2.14 kg/m2 in average (95% CI: −2.26, −2.04). From a multilevel model, PM10 (β = 0.04; p = 0.002) and PM2.5 (β = 0.08; p < 0.001) had a significant negative effect on weight loss when collected per year. The results were confirmed with the validation (βAQI*time = 1.5*10–5; p < 0.001) by mixed effects model.

Conclusion

This is the first study that shows how air pollution affects intentional weight loss applied on wider area of the world.

Obes Facts. 2018 May 26;11(Suppl 1):160.

T2P129 Chronotype and energy intake timing in relation to obesity risk: A 7-year follow-up study in adults

M Maukonen 1, N Kanerva 2, T Partonen 3, S Männistö 3

Introduction

Individuals with a later preference for the daily activities (evening types) tend to practice a behavior (e.g. unhealthier diets, physical inactivity) that could put them at higher risk for obesity when compared to those with an earlier preference (morning types). Furthermore, later food intake timing, another behavior more characteristic of evening types than of morning types, has been associated with a higher risk of obesity. However, the long-term weight change in different chronotypes and the role of evening energy intake in the association between chronotype and weight change are not clear. To study this, we first examined the independent associations of chronotype and evening (after 8:00 pm) energy intake with obesity risk (body mass index (BMI) ≥ 30.0 kg/m2) and then we analyzed the interaction between chronotype and evening energy intake on obesity risk.

Methods

Our data included 1097 Finns (aged 25–75 years) who participated in the population-based DIetary, Lifestyle and Genetic Determinants of Obesity and Metabolic syndrome (DILGOM) Study 2007 and in the FinDiet 2007 study. The DILGOM follow-up was conducted in 2014. Chronotype was assessed with a shortened version of Horne and Östberg's Morningness–eveningness Questionnaire. BMI (kg/m2) was calculated from measured and self-reported height and weight values. Evening energy intake was assessed with 48-hour dietary recalls from the FinDiet 2007 study. Logistic regression was used for statistical analyses. The analyses were adjusted for age, sex, education, leisure-time physical activity, smoking, sleep time sufficiency and baseline BMI.

Results

The proportion of individuals whose BMI had increased (≥5%-points) during the 7-years follow-up tended to be higher among evening types than among morning types (33% vs. 20%), though the difference did not reach statistical signifigance. Similarly, in the end of the follow-up, the prevalence of obese individuals tended to be higher among evening types than among morning types (26% vs. 17%). Those in the highest quartile of baseline evening energy intake were almost two times more likely to be obese than those in the lowest quartile of intake after the 7-years (OR 1.92, 95% CI 1.19–3.14, P-trend = 0.046). Furthermore, evening types had a higher baseline evening energy intake than morning types (P < 0.001) but no interaction between chronotype and evening energy intake occurred on obesity risk (P > 0.05).

Conclusion

Our findings indicated that a higher evening energy intake may play a role in obesity regardless of the circadian preference and could pose a risk factor for weight gain.

Obes Facts. 2018 May 26;11(Suppl 1):160–161.

T2P130 High prevalence of vitamin D deficiency among obese adults in a Mediterranean country and its relationship with body composition

A Belancic 1, R Markovic 1, M Mavrinac 1, D Štimac 2, S Klobucar Majanovic 3

Introduction

Obesity has been found to be associated with lower levels of serum 25-hydroxyvitamin D even in sunny regions with Mediterranean climate. The aim of this study was to determine the prevalence of vitamin D deficiency among obese adults in Croatia and its relationship with body composition.

Methods

The study included 127 adults (71.7% female) aged 18–70 years (median age 48 years) consecutively referred to Obesity outpatient clinic at Clinical Hospital Centre Rijeka within a 1-year period. Body composition parameters were assessed by bioelectrical impedance analysis (Model Seca® mBCA 515 Medical Body Composition Analyzer, Hamburg, Germany). The serum levels of 25-hydroxyvitamin D (25(OH)D) were determined with Roche Cobas E601 Immunology Analyzer by ECLIA (Electro-chemiluminescence immunoassay) method. Data were analyzed using MedCalc v12.1.3 (MedCalc Software bvba, Ostend, Belgium) and Microsoft Excel (Microsoft Office).

Results

Mean (± SD) serum 25(OH)D concentration of the study population was 43.35 ± 19.85 nmol/L. Average body composition data were as follows: weight 128.03 ± 32.78 kg, height 169.08 ± 9.16 cm, body mass index (BMI) 44.21 ± 8.81 kg/m2, waist circumference (WC) 127.76 ± 19.53 cm, fat mass (FM) 61.25 ± 18.35 kg, FM% 47.76 ± 5.65%, fat-free mass (FFM) 66.51 ± 17.88 kg, FFM% 52.24 ± 5.65%, muscle mass (MM) 32.83 ± 9.96 kg and visceral adipose tissue (VAT) 7.06 ± 4.77 L. Statistical analysis using Pearson's correlation revealed that serum 25(OH)D concentration was moderately and negatively correlated with BMI (r = −0.33, p = 0.0001), WC (r = −0.27, p = 0.002), FM% (r = −0.23, p = 0.0104) and VAT (r = −0.22, p = 0.0144), while there was a positive correlation with FFM% (r = 0.23, p = 0.0105). Considering the values of serum 25(OH)D concentration, subjects were divided into groups: group 1 - 25(OH)D < 50 nmol/L (n = 89; 70.1%), group 2 - 25(OH)D 50–75 nmol/L (n = 29; 22.8%) and group 3 - 25(OH)D >75 nmol/L (n = 9; 7.1%). According to analysis of variance (ANOVA) there was no statistical significance in FM% within groups (p = 0.193). However, statistical significance was found in WC values (p = 0.003) between group 1 (WC 131.60 ± 19.24 cm) and group 2 (WC 118.93 ± 18.32 cm). Kruskal-Wallis test determined the statistical significance in VAT values (p = 0.0053) between group 1 (VAT 7.79 ± 4.86 L) and group 2 (VAT 5.35 ± 4.40 L). Moreover, it revealed statistical significance in BMI (p = 0.001975) between group 1 (BMI 45.90 ± 9.12 kg/m2) and group 2 (BMI 40.67 ± 7.29 kg/m2) and also between group 1 and group 3 (BMI 38.89 ± 3.24 kg/m2).

Conclusion

The prevalence of vitamin D deficiency among obese adults in Croatia is high. Serum 25(OH)D concentration was negatively correlated with measures of obesity.

Obes Facts. 2018 May 26;11(Suppl 1):161.

T2P131 Association of a Dietary-Based Score with long-term weight gain and risk of overweight and obesity in the SUN Cohort: The Dietary Obesity Score (DOS)

C Gómez-Donoso 1, MA Martínez-González 1, A Gea 1, K Murphy 2, N Parletta 3, M Bes-Rastrollo 1

Introduction

Although preventable, unhealthy BMI and dietary factors have recently been identified as factors causing the greatest burden of disease. Some doubts still exist on the effectiveness of prevailing nutritional messages to prevent weight gain. Thus, we aimed to prospectively examine the association between a Dietary Obesity Score (DOS) based on previous evidence-based results and the incidence of overweight/obesity in the SUN cohort.

Methods

The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates initiated in 1999 with an overall retention rate of 91%. We prospectively assessed 11,645 participants, initially free of overweight or obesity. A validated semi-quantitative 136-item food-frequency questionnaire was administered at baseline and after 10 years of follow-up. Taking into account previous literature, the score positively weighted vegetables, fruit, legumes, yoghurt and nuts; while it negatively weighted red meat, processed meats, animal fat, refined grains, ultra-processed food, fast food and sugar-sweetened beverages. Energy-adjusted tertiles of each item were used to build the DOS, ranging from 1 to 24 points.

Results

After a median follow-up of 9.2 years, 2191 new cases of overweight and obesity were identified. A higher favorable score was significantly associated with 42% lower risk of overweight/obesity (adjusted HR [95% CI] for high adherence to DOS (19–24 points) vs. low adherence (1–6 points) = 0.58 [0.41–0.81]; P for trend < 0.001). Regarded as a continuous variable, the risk of developing overweight/obesity was 7% lower for each 2 additional points in the DOS scale (adjusted HR = 0.93 [0.91–0.96]) after adjusting for potential confounders. When the analyses were updated with repeated assessments of dietary intakes, the results were similar and remained statistically significant (high vs. low adherence: adjusted HR = 0.62 [0.44–0.87]).

Conclusion

The DOS showed an inverse association with long-term risk of overweight/obesity. This simple score exclusively based on dietary components may be applicable in clinical practice as a preventive tool for overweight and obesity. It can also be used as an educational tool to help people improve their dietary habits, increase recognition of dietary risks and raise awareness through self-assessing their susceptibility to weight gain over the long-term according to their current diet.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):161.

T2P132 An assessment of the association between obesity and selected biochemical parameters and blood pressure in men from Greater Poland

J Olechnowicz 1, J Suliburska 1, K Skrypnik 1, D Skrypnik 2, P Bogdański 2

Introduction

Obesity is associated with a range of metabolic disorders such as hyperglycemia, hypercholesterolemia and elevated blood pressure. Biochemical markers of these disorders are factors of cardiovascular risk. What is more, obesity leads to subclinical inflammation, obesity-related glomerulopathy and liver disfunction. These states significantly increase patients cumulative cardiometabolic risk. The aim of this study was to assess the correlation between obesity and selected biochemical parameters of cardiometabolic risk and blood pressure in obese men from Greater Poland.

Methods

119 male subjects from Greater Poland aged 20–71 were enrolled. 62 subjects were obese and 57 had normal body mass. Anthropometric parameters and blood pressure were measured and body mass index (BMI) was calculated. Blood samples were collected in the morning after 10-hour fast and nightlong rest. The statistical analysis was performed with Statistica ver. 12.

Results

It was found that systolic (SBP) and diastolic (DBP) blood pressure were significantly higher in obese than in normal weight men (SBP: 142.05 ± 17.35 vs 131.33 ± 24.34 mmHg; DBP: 84.93 ± 12.67 vs 80.59 ± 10.41mmHg). Moreover, in obese subjects significantly higher levels of alanine aminotransferase (ALAT) (40.33 ± 21.24 vs 31,20 ± 20.12 U/L) and triglycerides (TG) (204.31 ± 189.82 vs 124.09 ± 88.99 mg/dL) and lower levels of high density lipoprotein (HDL) (51.23 ± 9.44 vs 64.28 ± 15.50 mg/dL) in serum compared to men with normal body mass were registered. Serum concentrations of glucose (G), creatinine (Creat), uric acid (UA), C-reactive protein (CRP), aspartate aminotransferase (AS-PAT), total cholesterol (TCh) and low density lipoprotein (LDL) were not significantly different between the groups. Moreover, positive correlation between BMI and SBP (R = 0.20), DBP (R = 0.17), UA (R = 0.36), ALAT (R = 0.27) and TG (R = 0.29) and negative correlation between BMI and HDL (R = −0.36) were observed in whole population. In obese men positive correlation was found only between BMI and UA (R = 0.32). However, in normal-weight men no significant correlations between BMI and other analyzed parameters were observed.

Conclusion

In conclusion, obesity is associated with high values of metabolic and cardiovascular risk factors in male population of Greater Poland and appears to be a good marker of cumulative cardiometabolic risk in this population.

Obes Facts. 2018 May 26;11(Suppl 1):162.

T2P133 The Association Between Nutrient Adequacy and Body Mass Index in Young Female Adults

G Özata Uyar 1, E Koksal 2, H Yıldıran 3, MS Macit 2

Introduction

Dietary quality has been reported to be a good predictor of body weight as well as health promotion. In this study, it was aimed to evaluate the correlation of nutrient adequacy with body mass index (BMI) in young female adults.

Methods:

This cross-sectional study was conducted on 876 (18–35 years old) voluntary young female adults. Dietary intake of individuals was taken by using 24-hour recall method. Mean adequacy ratio (MAR) scores were used for dietary adequacy assessment. Nutrient adequacy ratio (NAR) scores were calculated by using the Dietary Recommended Intake (DRI) levels recommended by age and gender. Mean Adequacy Ratio (MAR) calculates the average for the Nutrient Adequacy Ratio values for this 9 nutrients (protein, calcium, magnesium, zinc, iron, vitamin C, folate, B12 and fiber) for a certain individuals. A score of 80–100 indicates a good diet, a score of 51–80 reflects the need of improving diet quality, and a score < 51 reflects a poor diet.

Results

The mean age of the individuals is 20.8 ± 1.7 years. According to BMI classification, 78.0% normal and 11.1% overweight was found. The mean MAR score of individuals was 70.6 ± 17.4. When the mean adequacy ratio was evaluated, it was found 15.5% had poor diet, 50.2% the need of improving diet quality, and 34.2% was sufficient. There was a positive correlation between BMI and protein, magnesium, iron, folat and fiber of NAR and MAR (p < 0.05).

Conclusion

The relationship between diet quality and BMI was found in this study. According to the MAR evaluation, the fact that a few individuals have inadequate nutrient intake can be attributed to the greater presence of BMI in normal individuals. There are also a large number of individuals for whom the quality of the diet should be improved. For this reason, providing nutrition education to individuals can play a key role in increasing the quality of the diet.

Tab. 1.

Correlation Between Nutrient Adequacy and Body Mass Index

Variables r P
Age (year) 0.044 0.195
NAR Protein 0.072 0.032*
NAR Calcium 0.056 0.096
NAR Magnezyum 0.080 0.017*
NAR Iron 0.076 0.025*
NAR Zinc 0.055 0.101
NAR B12 0.022 0.515
NAR Folate 0.096 0.000*
NAR Vitamin C 0.038 0.256
NAR Fiber 0.072 0.032*
MAR 0.083 0.014*
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Obes Facts. 2018 May 26;11(Suppl 1):162.

T2P135 A novel adiposity index as an integrated predictor of cardiometabolic disease morbidity and mortality

NH Kim 1, HS Kim 2, SG Kim 1

Introduction

A variety of anthropometric indices including body mass index (BMI) and waist circumference (WC) are widely used as indicators of obesity. Their clinical value, however, has been limited by inconsistent association with morbidity and mortality. We herein propose a new anthropometric index, weight-adjusted-waist index (WWI), to assess central obesity by standardizing waist circumference for weight.

Methods

WWI, calculated as waist circumference (cm) divided by the square root of weight (kg) (cm/, was measured from 465,981 subjects in the Korean National Health Insurance Service cohort (2008–2013). Cox regression analysis was used to compare WWI with BMI, WC, waist-to-height ratio (WHR), and a body shape index (ABSI) in predicting cardiometabolic morbidity and mortality risk. The predictive performances were evaluated by −2log likelihood (-2logL), Akaike Information Criterion (AIC), Schwarz Bayesian criterion (SBC), and Harrell's C-statistics (C).

Results

For incident hypertension, type 2 diabetes, and cardiovascular disease (CVD), BMI had the strongest predictive power, followed by WWI and WC. However, WWI showed the best predictive performance for CVD mortality (the lowest value of −2logL, AIC and SBC, as well as the highest C statistic of 0.887). Also, a linear positive association between adiposity indices and cardiovascular and all-cause mortality was only shown in WWI and ABSI, not BMI, WC and WHR which showed inverse J-shaped patterns. In the test of joint effects of each index, WWI combined with BMI was the strongest in the prediction of incident cardiometabolic diseases, cardiovascular and all-cause mortality.

Conclusion

WWI is an index of central obesity that predict both incident cardiometabolic disease morbidity and mortality with excellence in predictive power and linear positive association with both morbidity and mortality.

Obes Facts. 2018 May 26;11(Suppl 1):162–163.

T2P136 Major dietary patterns and central obesity among Iranian women: a case-control study

B Rashidkhani 1

Introduction

Given the high prevalence of central obesity in Iran, identification of the link between central obesity and diet is essential.

Methods

In this cross-sectional study of 300 women aged 20–50 years, usual dietary intakes were assessed by using a valid food frequency questionnaire. Weight, height and waist circumstances (WC) were measured with standard Methods. Central obesity was defined as WC> = 95 cm. Factor analysis was used for identifying major dietary patterns.

Results

We identified 2 major dietary patterns: “Healthy” and “Unhealthy” dietary patterns. Individuals in the highest tertile of the Unhealthy dietary pattern score were more likely to be centrally obese (OR = 2.41% CI: 1.18–4.94). After adjusting for confounders, the associations remained significant (P-trend < 0.05). We could not detect any significant association between Healthy dietary pattern and central obesity.

Conclusion

Unhealthy dietary pattern of Tehrani women has a significant association with central obesity.

Obes Facts. 2018 May 26;11(Suppl 1):163.

T2P137 Association between diabetes, hypertension, physical activity, and body mass index among older adults

AR Barbosa 1, V Meneghini 1, AP Coutinho 1, E D’Orsi 1

Introduction

We examined the association between diabetes, hypertension, physical activity, and body mass index (BMI) in community dwelling older adults.

Methods

This cross-sectional study analyzed data of a population- and household-based survey carried out with 1,702 subjects aged 60 or more (probability sample), residents in Florianopolis, southern Brazil. The body mass index (dependent variable) was calculated from manually measured stature and weight values. The diabetes and hypertension were identified by self-report. The IPAQ (International Physical Activity Questionnaire) verified the practice of physical activity (sufficiently active, ≥150 minutes per week; insufficiently active, < 150 minutes per week). Simple and multiple linear regression and 95% confidence intervals (95%CI) verified the association between independent variables and BMI (sex-stratified). We considered three regression models for association: Model 1) adjusted by age, schooling, marital status and living arrangements; Model 2) adjusted by model 1, smoking, waist circumference, use of medications, and cognitive status; Model 3) adjusted by model 1, model 2, physical activity, and 14 chronic diseases, including diabetes and hypertension to eliminate the possible confounding effect of comorbidities. Among the adjustment variables, age and BMI were entered in the models as continuous variables and the others were entered as categorical variables.

Results

The mean female age (n = 1088) was 70.7 ± 8.0 years and the mean male age (614) was 70.2 ± 7.8 years. The mean BMI values were higher in men (30.0 ± 6.4 kg/m2) than in women (27.2 ± 6.4 kg/m2); p < 0.001. In the simple analysis, diabetes, hypertension, and physical active were associated with higher BMI in women. When the adjustment variables were added to the model 2 only physical activity remained associated with BMI. In men, the results of the simple analysis showed that hypertension and physical activity were associated with higher BMI. At the final model, in both sexes, only physical activity remained associated with BMI (Table 1).

Conclusion

Our findings show significant independent and positive association between insufficiently physically active and the prevalence of higher BMI. This reinforces the importance of physical activity to health outcomes.

Tab. 1.

Linear regression analysis (simple and multiple) for diabetes, hypertension, physical activity and body mass index

Simple analysis Model 1 Model 2 Model 3
β (95%-IC) p β (95%-IC) p β (95%-IC) p β (95%-IC) p
Women
Diabetes 1.66 (0.29–3.03) 0.018 1.64 (0.26; 3.02) 0.021 –0.89 (–1.88–0.10) 0.076 –0.94 (–1.95–0.06) 0.065
Hypertension 2.07 (1.16–2.99) ≤0.001 2.15 (1.28; 3.01) ≤0.001 0.34 (–0.37–1.04) 0.342 0.41 (–0.30–1.12) 0.254
Insufficiently active 1.34 (0.39–2.30) 0.006 1.30 (0.38; 2.22) 0.006 1.09 (0.24–1.94) 0.012 1.11 (0.24–1.98) 0.013
Men
Diabetes 1.15 (–0.38; 2.67) 0.138 1.48 (–0.09; 3.05) 0.064 0.28 (–0.85–1.42) 0.618 0.43 (–0.81–1.67) 0.489
Hypertension 2.61 (0.27–4.95) 0.029 2.58 (0.31; 4.84) 0.024 0.42 (–0.64–1.47) 0.437 0.21 (–0.90–1.32) 0.712
Insufficiently active 1.36 (0.12–2.60) 0.033 1.80 (0.61; 2.99) 0.004 1.45 (0.74–2.15) ≤0.001 1.23 (0.52–1.94) ≤0.001
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Obes Facts. 2018 May 26;11(Suppl 1):163.

T2P138 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):163.

T2P139 The risk of myocardial infarction and ischemic stroke according to waist circumference in Korean adults: A Nationwide Population-Based Cohort Study

SJ Yoo 1, K Han 2, HS Kwon 1, W Lee 3, M Kang 4

Introduction

Visceral obesity is a significant risk factor for cardiovascular disease (CVD). There was no large-scale data to show the relation of waist circumference (WC) to CVD in Korea. We studied the relationship between baseline WC and incident myocardial infarction (MI) and ischemic stroke (IS) using a nationwide population-based cohort.

Methods

Our study included 21,749,261 Koreans over the age of 20 who conducted Korean National Health Screening between 2009 and 2012, and occurrence of MI or IS were observed by the end of 2015. We classified study groups according to WC and body mass index (BMI) levels, and perform multivariable adjusted analysis to compare the risk.

Results

127,289 and 181,637 subjects were newly diagnosed with MI and IS. The incidence rates and hazard ratio of MI and IS were increased linearly as the WC level increased, regardless of further adjusting BMI or not. When the WC was divided into wider categories, the lowest risk of MI was found in the WC of 70–74.9cm in male and 60–64.9cm in female, and in the WC of 65–69.9cm and < 60cm each of IS. According to the BMI level, a U-shaped curve was obtained in the MI group with the BMI 18.5–22.9kg/m2 as the lowest point, and the IS group showed a linear increase pattern. After comparing the likelihood ratio between BMI and WC, WC showed better CVD predictions.

Conclusion

WC had a significant linear relationship with the risk of MI and IS. The risk began to increase from lower WC than expected. These raise the importance of earlier intervention for visceral obesity to reduce CVD events, mirrored in this short-term follow up study.

Obes Facts. 2018 May 26;11(Suppl 1):163.

T2P140 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):163.

T2P141 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):163–164.

T2P142 Consumption of ultraprocessed foods and its association with obesity in individuals with hypertension and coronary artery disease

S R De Souza 1, L S Da Costa 1

Introduction

Obesity is an important risk factor for cardiovascular disease (CVD), the main cause of mortality in the world. Ultraprocessed foods (UPF) have high energy density, high glycemic load, are poor in dietary fibers, micronutrients and phytochemicals; contain chemical additives, such as stabilizers and flavorings. Its chemical composition seems to alter the endogenous mechanisms of satiety, promoting increased consumption and, consequently, triggering obesity, hypertension, diabetes, dyslipidemia. The objective of the present study was to evaluate the consumption of UPF and their association with obesity in individuals with hypertension and coronary artery disease treated at a public hospital specialized in cardiology in the state of Rio de Janeiro.

Methods

Cross descriptive study submitted and approved by the Research Ethics Committee where it was carried out. Individuals who were present in the waiting room for outpatient care with cardiologists were invited to participate, all of whom with hypertension, coronary artery disease, or both. A calendar day was chosen, randomly, for data collection. The acceptance to participate was formalized by signing the Terms of Consent. Variables evaluated: age, gender, comorbidities and body mass index (BMI). The consumption of UPF was evaluated by closed response questionnaire about consumption in the previous day. A list of sweet and salted UPF was presented to each participant, who answered affirmatively or negatively. Statistical analysis was performed using SPSS v.21, considering statistically significant p < 0.05.

Results

107 subjects aged between 29 to 83 years were evaluated, with mean age = 61.7(10.3), adults = 35.5%, women = 45.8%, coronary artery disease = 60.7%, dyslipidemia = 62.5%, diabetes = 20.6%, hypertension = 60.7%, peripheral arterial insufficiency = 8.4%, orovalvar lesion = 5.6%, inter-atrial communication = 1.9%. BMI among adults: eutrophy = 15.8%, overweight = 21.1%, obesity grade 1 = 23.6%, obesity grade 2 = 15.8%, obesity grade 3 = 23.7%; among elderly: thinness = 2.9%, eutrophy = 27.5%, overweight = 9.6%, 14.5% with BMI above 35 and 4.3% above 40. When considering the classification of all the sample: thinness = 1,9%, eutrophy = 23.4% and excess weight (overweight and obesity) = 74.8%. 57 subjects confirmed consumption of at least one UPF in the previous day and 50 denied. The BMI of those who confirmed and denied consumption of UPF was, respectively, 33.4(6.39) versus 29.7(5.56), with p = 0.002.

Conclusion

The findings of the present study evidenced the important association between the consumption of UPF and obesity, especially in a sample already with established CVD, corroborating the importance of intensifying public health policies to clarify regarding the negative impact brought by consumption of UPF to human health.

Obes Facts. 2018 May 26;11(Suppl 1):164.

T2P143 Association between cardio-metabolic risk factors and body mass index, waist circumferences and body fat in a Zanzibari cross-sectional study

A Hebestreit 1, MA Nyangasa 1, C Buck 1, S Kelm 2, MA Sheikh 3, K Brackmann 1

Introduction

We aimed at assessing the prevalence of obesity indices (body mass index (BMI), waist circumference (WC), body fat percent (BF%)) and cardio-metabolic risk factors in a random population of Zanzibar, Tanzania. We further investigated the association between obesity indices and cardio-metabolic risk factors.

Methods

In 2013 information on socio-economic status, measured anthropometry and venous blood were collected during a cross-sectional survey on Zanzibar, Tanzania. In total, 470 Zanzibaris aged 5–95 years were included in this analysis. Associations between obesity indices and cardio-metabolic risk factors were investigated using multilevel logistic regression analyses.

Results

We observed high proportion of individuals with high BMI (26.4%), high WC (24.9%) and high BF% (31.1%). The proportion of individuals with hypertension was 24.5%, low HDL-C (29.4%), high HDL-C (21.3%) and high HbA1c (19.1%). Proportions of obesity and hypertension increased with age, and were most prevalent among participants above 45 years. Dyslipedemia and diabetes markers varied with age, low-HDL-C was most prevalent among participants ≥18 to < 45 years old, while high LDL-C was more prevalent above 45 years. Multilevel logistic regression analyses revealed association between BMI, WC and BF%, with hypertension (OR = 2.41 (1.33, 4.47); OR = 3.68 (1.81, 7.52); OR = 2.51 (1.40, 4.51), respectively). High WC or high BF% was associated with higher chances of high levels of LDL-C (OR = 2.52 (1.24, 5.13), OR = 1.91 (1.02, 3.58), respectively). In addition, BMI and WC were associated with levels of HbA1c (OR = 2.08 (1.15, 3.79), OR = 3.01 (1.51, 6.03), respectively). Considering obesity indices within one regression model, only high WC was associated with higher chances for hypertension (OR = 2.62 (1.14, 6.06)) and for high levels of HbA1c (OR = 2.62 (1.12, 6.15)).

Conclusion

High BMI, WC and BF% were strongly associated with hypertension in this Zanzibari population, individuals with high WC were twice more likely to be hypertensive. Overweight/obesity and cardio-metabolic risk factors were highly prevalent in the present study population which calls for early and effective screening strategies for this population.

Obes Facts. 2018 May 26;11(Suppl 1):164.

T2P144 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):164–165.

T2P145 Severity of nonalcoholic fatty liver disease is associated with subclinical cerebro-cardiovascular atherosclerosis risk in Korean

DH Jung 1, MJ Kim 2

Introduction

No studies have reported the relationship between nonalcoholic fatty liver disease (NAFLD) and concurrent cerebral artery and coronary artery atherosclerosis simultaneously. We aimed at determining whether NAFLD, as assessed by ultrasound, is associated with subclinical cerebro-cardio vascular atherosclerosis (CCVA) by multidetector-row computed tomography (MDCT), and high resolution - magnetic resonance angiography (HR-MRA).

Methods

A total of 1799 men, aged 20 or older, who underwent a routine health examination, were enrolled at the health promotion center of Gangnam Severance Hospital in Seoul, Korea between January 2007 and July 2010. we evaluated the relationship between NAFLD and coronary artery atherosclerosis, as assessed by multidetector-row computed tomography (MDCT), a noninvasive method that can detect coronary plaque with high accuracy and examine the anatomy of coronary arteries to predict the severity of coronary artery disease. We also investigated the relationship between NAFLD and cerebral artery atherosclerosis, as assessed by high-resolution magnetic resonance imaging (HR-MRI) and magnetic resonance angiography (MRA). In addition, we evaluated the relationship between NAFLD severity, as assessed by ultrasonography, and subclinical cerebro-cardiovascular atherosclerosis (CCVA) in Korean men.

Results

A total of 1,652 men participated in the study (normal, n = 835; mild-to-moderate NAFLD, n = 512; severe NAFLD, n = 305). The risk of subclinical CCVA was positively associated with age (odds ratio [OR] 1.068; 1.054–1.081, p < 0.001), body mass index (OR 1.120; 1.08 0–1.162, p < 0.001), hepatic enzyme levels (OR 1.012; 1.001–1.023, p = 0.027; OR 1.006; 1.001–1.012, p = 0.036), fasting glucose (OR 1.021; 1.015–1.027, p < 0.001), triglycerides (OR 1.002; 1.000–1.003, p = 0.016), hypertension (OR 2.836; 2.268–3.546, p < 0.001), and diabetes (OR 2.911; 2.137–3.964, p < 0.001). Also, high-density lipoprotein cholesterol was inversely associated with subclinical CCVA (OR 0.974; 0.965–0.982, p < 0.001). Compared with normal controls, the OR for subclinical CCVA after full adjustment was 1.46 in the mild-to-moderate NAFLD group (95% confidence interval [CI]: 1.10 to 1.93) and 2.04 in the severe NAFLD group (95% CI: 1.44 to 2.89).

Conclusion

Our data show that nonalcoholic fatty liver disease is common among Korean men ≥ 20 years old, and nonalcoholic fatty liver disease severity on ultrasonography is associated with subclinical cerebro-cardio vascular atherosclerosis, as assessed by multidetector-row computed tomography, and high resolution - magnetic resonance angiography.

Obes Facts. 2018 May 26;11(Suppl 1):165.

T2P146 Association between exercise and body composition the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV, 2009)

YA Kim 1

Introduction

Although, the favorable role of exercise in abdominal obesity and bone health, epidemiological data are still lacking. We analyzed the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV, 2009) to identify the association between exercise and body composition.

Methods

A total of 10, 533 Korean were screened. Cases with insufficient data for exercise and pregnancy were excluded. The amount and duration of exercise were assessed from a questionnaire. Exercise tertiles were stratified by the amount of moderate to severe exercise; none (n = 3641), < = three times (n = 2748), > four times (n = 2552). Body composition including body fat percentage and bone mineral density (BMD) at the lumbar and hip was measured by dual-energy X-ray absorptiometry. fasting blood samples collected during the survey were also analyzed for laboratory data which were related to metabolic syndrome.

Results

After adjusting for traditional confounders, exercise tertiles was significant positively associated with BMD at femur neck and total femur, while no association was shown at lumbar spine. Interestingly, there was a strong negative correlation between abdominal obesity and exercise, while a weak association was shown with body fat percentage. Factors relating metabolic syndrome; blood pressure, fasting glucose and triglyceride were lower in moderate to severe exercise group with higher value of insulin compared with no exercise group. On the other hands, the value of LDL cholesterol showed little difference among exercise tertiles.

Conclusion

Exercise tertile showed positive associations with femur BMD and lesser weight circumference, while LDL cholesterol or lumbar spine BMD showed little association. A detailed analysis of exercise effects might be contribute to the development of precision medicine in the future.

Obes Facts. 2018 May 26;11(Suppl 1):165.

T2P147 Impact of wrist and ambient temperature on cold-induced brown adipose tissue and muscle glucose uptake in adults

B Martinez-Tellez 1, H Xu 1, Y Garcia-Rivero 2, G Sanchez-Deglado 1, F Acosta 1, JM Alcantara 3, MA Contreras-Gomez 1, JM Pascual-Gamarra 3, A Ramirez-Navarro 2, JR Ruiz 3

Introduction

Brown adipose tissue (BAT) is considered an attractive target in therapies against obesity. Cold is one of the main activators of BAT, and it has been shown that BAT glucose uptake measured by 18-Fluoro-deoxyglucose in combination with a positron emission tomography-computed tomography (18-F-FDG PET/CT) scan is higher in winter than in summer. Cold-intervention studies suggest that BAT and SM glucose uptake increases after the cold exposure, yet whether skeletal muscle glucose uptake is influenced by cold or seasonality is unknown. We studied the association of wrist and ambient temperature with cold-induced BAT and SM 18F-FDG uptake in adults.

Methods

A total of 74 young adults (21.9 ± 2.3 years; 25.2 ± 4.8 Kg/m2; 65.7% women) participated in the study. Participants wore 2 iButtons during 7 days before performing the 18F-FDG PET/CT scan. One iButton was attached to the ventral part of the non-dominant wrist and the other was placed in the wrist as to measure the participant's personal environmental temperature (Personal-ET). We excluded the non-wear periods and computed the average of the whole periods. Moreover, we quantified the total amount of hours per day in every single range of temperature where participants were exposed. We performed a 2h personalized cooling protocol before the PET/CT scan. PET/CT images were analyzed by FIJI software following the latest recommendations to quantify BAT and skeletal muscle. All iButtons were analyzed by the Temperatus® software.

Results

We found that wrist temperature and Personal-ET were negatively and significant associated with BAT volume and BAT activity (all P ≤ 0.012). Personal-ET was also significant and negatively associated with SM activity (β = –0.025; R2 = 0.122; P = 0.002) whereas wrist temperature was not (P = 0.401). We also observed that the time exposed at 16 to 20°C was significantly and positively associated with BAT-related outcomes (all P ≤ 0.05) but not with skeletal muscle (all P ≥ 0.072). Moreover, time exposed at 12–15°C was positively correlated with skeletal muscle activity (all P ≤ 0.05) but not with BAT-related outcomes (all P ≥ 0.185).

Conclusion

Here we show for the first time that wrist temperature and Personal-ET is associated with BAT and SM glucose uptake in adults. Furthermore, it seems that BAT is activated under certain temperature ranges (16–20°C), but that below a certain temperature threshold (< 16°C), BAT capacity to thermoregulate might be limited and skeletal muscle plays a major role.

Obes Facts. 2018 May 26;11(Suppl 1):165.

T2P148 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):165–166.

T2P149 Pilot study: Innovative workshops to foster family meals – a method to modify dietary behaviour of all family members?

M Hatz 1, J Leitgeb 2, N Möstl 1, A Auer 1, E Fattinger 1, E Pail 1

Introduction

The Austrian Childhood Obesity Surveillance Initiative (COSI) data shows a prevalence of overweight and obesity of approximately 20–30% in 8–9 year-old Austrian children (1). About 60% of children who were overweight before adolescence have an increased risk of staying overweight or obese (2). Due to increasing rates of full-time employment of parents, children and adolescents are being provided with more meals in community catering and enjoying food within the family setting moves into the background (3). However, positive framing conditions of family meals are crucial for the development of healthy eating habits and the involvement of the entire family in the prevention of overweight and obesity is indicated (4). Unhealthy (dietary) behaviours, as well as the risk of overweight and obesity can be reduced.

Methods

A pilot project in a community setting was designed with the aim of raising the awareness of family members of the significance of shared involvement in family nutrition. Therefore, a cooking workshop series with the title “4 seasons - sustainable and regional kitchen for all ages” in the period 02/17–11/17 was organized. It took place as part of the initiative “FamilienKomm! Pass” of two Styrian municipalities g and in cooperation with the FH JOANNEUM University of Applied Sciences and the College of Agriculture and Food Schloss Stein. The pilot project was implemented by dietitian J. Leitgeb and award-winning chef F. Bauernhofer. For achieving a sustainable learning outcome, the didactic principles included the involvement of all senses as well as age-appropriate learning-Methods. A questionnaire with a 5-point Likert scale was used to gather data about the satisfaction of the participants with the workshops. Data were presented by means of descriptive statistics.

Results

A total of 40 persons participated in the cooking workshop series. The gender distribution was as following: 29 women (85%) and 5 men (15%) as well as 3 girls (50%) and 3 boys (50%). The age range (n = 38) was from 2.5 to 68 years (adults: n = 32, M ± SD = 41,50 ± 11,19; children: n = 6, M ± SD = 10,25 ± 3,87). The evaluation of the satisfaction of the participants regarding the fulfilment of their expectations resulted in an average of 1,16 for the adults (n = 32, M ± SD = 1,16 ± 0,21) and 1,72 for the children (n = 4, M ± SD = 1,72 ± 0,89). The following points were taken into account: clarity of content, quality of knowledge and skills transfer, opportunity for active individual participation, the general atmosphere and location as well as duration and scope of the cooking workshops. It can be said that the satisfaction of the participants is very high and can be rated with “very good”.

Conclusion

The cooking workshop series represents an innovative method to convey the significance of shared family meals which can be easily

Fig. 1.

Fig. 1

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Tab. 1.

Time schedule and contents of the workshop series

Workshop 1 February 16th 2017 „Right inside!” – actively involve children in nutrition matters
Workshop 2 May 18th 2017 „Healthy food starts at the (super)market” – grocery shopping for the whole family
Workshop 3 June 22nd 2017 „Kids in the kitchen” – cooking together with the whole family
Workshop 4 November 16th 2017 „Dinner is served” – family meal: it tastes better together!
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Obes Facts. 2018 May 26;11(Suppl 1):166.

T2P150 Healthy aging and intestinal microbiota

T Koçak 1, N Acar Tek 2

Introduction

Aging; is defined as the deterioration that occurs in physiological functions with the progress of age. The intestinal system consists of a complex structure of approximately 1013-1014 microorganisms. Human intestinal microbiota has an important role in various metabolic, nutritional, physiological and immunological systems. Deterioration in physiological functions with aging causes a decrease in microbial diversity, DNA damage, stress response and protection of the immune system in the intsetinal system. Aging also affects the gastrointestinal tract, negatively affecting the hormones that control food intake, thus reducing food intake. N Due to dietary differences, low-fat and high fiber content polysaccharides from vegetable origin have led to high Firmicutes type colonization, while animal fats containing high fat and low fiber content have led to low Firmicutes type microorganism colonization in intestinal microbiota. Aging is an effect on nutrient consumption, while nutrient consumption affects on aging. For this reason, the consumption of nutrients, which are the most important components of microbiota, which contains probiotic bacteria (probiotics) or nutrients (prebiotics) will enable the beneficial microorganisms to survive / multiply in microbiota and consumption of high nutrients in the pulp content to provide short chain fatty acid synthesis has become increasingly important in recent years. This review was conducted to investigate the interaction between intestinal microbiota and healthy aging and to understand the relationship of microbiota to nutrition and its effects on metabolism.

Methods

Literature review

Results

The microbiota that started to change with birth continues to change until the age of adulthood and continues to change with the effect of aging,

Conclusion

Aging is defined as the impairment of physiological functions with age progression. Aging is a period of increased sensitivity to diseases. In the aging process, the bacterial composition and metabolic functions change in the intestine. Probiotics, prebiotics and synbiotics exhibit the potential to alleviate gastrointestinal problems in older people by modulating microbial activity and immune status. Probiotics are short chain (oligosaccharides) carbohydrates with health-promoting effects in the intestine. Prebiotics regulate the composition and balance in both the lumenal and mucosal surfaces as a suitable living space for bifidobacteria and lactobacilli in microbiota. Prebiotics also ffermentation short-chain fatty acids in the colon to provide energy for the intestines and other body tissues. As a result healthy microflora is resistant to intestinal infections and shows immunomodulatory effect. Briefly, pro-prebiotics and synbiotics alleviate the defects caused by age and environmental effects in the organism and play an important role in increasing the optimum quality of life. Considering the elderly's aging, difficulties in chewing and other digestive problems, we think that the supplementation of pre-probiotic and sinbiotics is important for the health of the intestinal microbiota by the qualified professionals besides the adequate and balanced nutrition for the optimum development of the intestinal microbiota

Obes Facts. 2018 May 26;11(Suppl 1):166–167.

T2P151 The effect of curcumın and white bean extract on biochemical and anthropometric parameters in women with polycystic ovary syndrome

SA Asan 1, M Bas 1

Introduction

This study was planned to investigate the effects of personal diet therapy with curcumin or white bean extract (Phaseoleus vulgaris) on anthropometric measurements and some biochemical parameters in patients with polycystic ovary syndrome (PCOS).

Methods

During 8 weeks period, the study was conducted on 45 diagnosed volunteer PCOS patients, the first group (n = 15) was treated with the combination of curcumin extract and weight loss diet, the second group (n = 15) was treated with the combination of white bean extract and weight loss diet, the third group (n = 15) was treated only weight loss diet.

Results

According to the evaluation of weight loss target (2–5% of the body weight) in all groups are similar (there were 4% in the 1st group, 2% in the 2nd group and 3% in the 3rd group weight reduction that have no differences statistically). After 8 weeks all groups have significant decreases in BMI, waist and hip circumferences and body fat mass (p < 0.05). 1st group has decreases in glucose, fasting insülin, HOMA-IR and CRP; 2nd group has significant reduction in fasting insülin, TG and increase in LH, testesterone, SHGB levels; 3rd group has reduction in LH and increase in SHBG, DHEAS levels (p < 0.05). At the beginning, groups which have no difference between anthropometric measurements, have significant reduction in waist/hip ratio after 8 weeks. 3rd group has the highest reduction ratio with 18%. After 8 week the body analyze of groups were not different. The biochemical analyzes between groups at 8th week, there were significant difference in LH, SHBG, TG, CRP, fasting insulin an HO-MA-IR (p < 0.05). Between groups, 1st group has the most decrease in CRP; 2nd group has the most decrease in fasting insulin, TG and HOMA; 3rd group has the most increase in SHBG and LH.

Conclusion

This results are positive effects for PCOS treatment but increases in LH of 2nd group and in CRP of 3rd group does not mean positive. This method of this study is the fist one in PCOS so longer studies should be investigated for the benefit of treatment.

Obes Facts. 2018 May 26;11(Suppl 1):167.

T2P152 High prepregnancy BMI and low dietary intake of fibre relate to higher circulating VLDL lipids in pregnant women

K Laitinen 1, N Houttu 2, K Mokkala 2

Introduction

Pregnant woman faces a range of physiological metabolic changes to meet the needs for foetal growth and development. However, maternal overweight and obesity status as well as consumption of unhealthy diet may induce metabolic disturbances, including aberrant glucose metabolism and subsequent gestational diabetes, during pregnancy. The aim was to investigate the relation of dietary intake and BMI with circulating lipid measures in pregnant women. Also the differences between overweight and obese women were evaluated.

Methods

Women were studied for dietary intake of nutrients and circulating lipid metabolites in early pregnancy (mean 13 weeks). Of the women 52 were overweight and 47 obese. Dietary intakes of nutrients were calculated from 3-day food diaries. Circulating serum lipid metabolites were analyzed by NMR metabolomics. The correlations were tested by Spearman rank correlation analyses and differences between overweight and obese women by t-test and Mann-Whitney U test. The analyses were adjusted for multiple comparisons using Benjamini-Hochberg procedure for false discovery rate controlling. The P-values < 0.05 and adjusted P-values < 0.12 were considered significant.

Results

The dietary intake of fibre (mean (SD) intake 20 (6) g/d; 19 (6) in overweight and 20 (7) in obese women, NS between the groups) correlated with several serum lipid metabolites (103/213). Primarily, negative correlations were detected between fibre intake and many lipid measures in VLDL particles. Prepregnancy BMI correlated with 65 of 213 lipid metabolites, mainly those related to VLDL particles and fatty acids. In the evaluation of lipid profiles between overweight and obese pregnant women, 84 of the 213 lipid metabolites differed between the two groups, the majority (59/84) being higher in obese women. Specifically, concentrations of several VLDL particles and lipid measures in many VLDL subclasses were higher in obese than overweight pregnant women. In contrast, lipids in certain HDL subclasses and proportions of omega-6 fatty acid, 18:2 linoleic acid and polyunsaturated fatty acids of total fatty acids were lower in obese compared to overweight pregnant women.

Conclusion

Dietary intake of fibre and prepregnancy BMI, as well as overweight and obesity status of pregnant women related to circulating lipid profile. Higher lipid measures in several VLDL subclasses were related to lower intake of fibre, higher BMI and obesity. These finding may contribute to adverse clinical manifestations in pregnancy and may thus be utilized in advancing healthy dietary and lifestyle habits in pregnant women.

Obes Facts. 2018 May 26;11(Suppl 1):167.

T2P153 Degree of obesity in pregnant women is related to metabolic and inflammatory profiles

N Houttu 1, K Mokkala 1, K Laitinen 1

Introduction

In non-pregnant individuals obesity has been related to altered metabolic and inflammatory profiles that could contribute to clinical manifestations. Particularly branched chain amino acids and low-grade inflammation have been associated with obesity and insulin resistance. Whether this is the case in pregnant women is poorly known. Thus, our objective was to investigate whether serum amino acid and inflammatory profiles differ between overweight and obese pregnant women. Secondly, we studied the interrelations among amino acids and inflammatory and metabolic risk markers.

Methods

Overweight (n = 52) and obese (n = 47) women were studied in early pregnancy (a mean of 13.2 ± 2.5 weeks of gestation). Nine circulating serum amino acids and a marker of low-grade inflammation, Glycoprotein acetylation, GlycA, were analyzed by NMR metabolomics and another marker of low-grade inflammation, high sensitivity C-reactive protein, hsCRP, was quantified by immunoassay. The metabolic risk markers evaluated were: prepregnancy body mass index calculated from weight obtained from the maternal welfare clinic records and height measured by a wall stadiometer, glucose concentration measured by an enzymatic method utilizing hexokinase, insulin concentration using an immunoelectrochemiluminometric assay and insulin resistance with homeostatic model assessment-method, HOMA2-IR. The Mann-Whitney U test, adjusted for multiple comparisons using Benjamini-Hochberg procedure for false discovery rate controlling, was used to compare differences between overweight and obese pregnant women. A principal component analysis was conducted to study the interrelations among amino acids, inflammatory and metabolic risk markers. The P-values < 0.05 and adjusted P-values < 0.12 were considered significant.

Results

Three branched chain amino acids, isoleucine (median (IQR) 0.05 (0.04–0.06) vs 0.04 (0.04–0.05) mmol/l, adjusted P = 0.024), leucine (0.07 (0.06–0.08) vs 0.06 (0.06–0.07) mmol/l, adjusted P = 0.026), valine (0.2 (0.1–0.2) vs 0.1 (0.1–0.2) mmol/l, adjusted P = 0.10) and one aromatic amino acid, phenylalanine, (0.08 (0.08–0.09) vs 0.08 (0.07–0.08) mmol/l, adjusted P = 0.050), were higher in obese compared to overweight pregnant women. Also, the markers of low-grade inflammation, hsCRP (median (IQR) 6.1 (4.0–10.0) vs 4.0 (1.8–6.9) mg/l, P = 0.0015) and GlycA (mean ± SD 1.57 ± 0.19 vs 1.45 ± 0.11 mmol/l, P < 0.001), were higher in obese compared to overweight pregnant women. In evaluation of the interrelations of the markers, GlycA was found to cluster closely with isoleucine, leucine, phenylalanine, HOMA2-IR and insulin.

Conclusion

The serum branched chain and aromatic amino acids as well as inflammatory markers were higher in obese compared to overweight pregnant women, and furthermore were associated with insulin resistance. These results provide new knowledge about the impact of degree of obesity on amino acid and inflammatory profiles which may be of significance considering the risk for clinical manifestations mediated by obesity.

Obes Facts. 2018 May 26;11(Suppl 1):167–168.

T2P154 Women's Perceptions of Gestational Weight Gain Guidelines and Factors Associated with Meeting Recommendations

L Halili 1, R Deonandan 2, KB Adamo 1

Introduction

Obesity is disproportionately affecting women of child-bearing age. A healthy pregnancy is critical for short and long-term maternal and fetal wellbeing. Excessive gestational weight gain (GWG) poses a risk in pregnancy by increasing the odds of postpartum weight retention and subsequent obesity. Fetal exposure to maternal obesity and excessive GWG increases the likelihood of babies born large for gestational age, downstream chronic disease, and obesity in childhood. Our goal was to examine the perceived attainability of the 2009 Institute of Medicine (IOM) GWG guidelines and whether women's perceptions influence adherence to the guidelines.

Methods

Cross-sectional data was gathered from pregnant and postpartum women who responded to a unique, validated electronic questionnaire. Consenting women completed the Electronic Maternal (EMat) Health Survey through RedCap, a secure online forum. Data from currently pregnant (n = 179) and postpartum women (n = 860) were used to compute whether women were on track to meeting or had met GWG guidelines. Multiple logistic regression analyses were performed using IBM SPPS v. 24.

Results

Select questions were chosen for analysis and are summarized in Table 1. Age, ethnicity, education, income, marital and employment status, living conditions, alcohol intake and smoking status were considered as covariates. Table 1 Logistic Regression Analyses for Factors (Perceptions and Barriers) Associated with Meeting IOM GWG Guidelines

Conclusion

Women who reported being always confident were associated with a greater likelihood of guideline-concordant weight gain whereas those who were sometimes confident were significantly less likely to meet guidelines. Pregnant respondents who reported no barriers to healthy weight gain were more likely to be on track to guideline-concordant weight gain. Self-perception and locus of control may be important factors to consider in assisting practitioners when suggesting interventions associated with healthy weight gain during pregnancy. Further analysis will be conducted as data collection from EMat is ongoing. Perceived barriers of lifestyle behaviours (diet and physical activity patterns) will also be explored in detail.

Tab. 1.

Variables
 P-value
 OR
 95%
 CI for OR
Lower Upper
POSTPARTUM
PERCEPTIONS
Did you feel confident about being able to stay within the weight gain limits?
Always 0.021 1.763 1.088 2.855
Most of the time 0.000 3.570 2.019 6.312
Never 0.000 3.014 1.756 5.174
Rarely 0.119 0.393 0.121 1.273
Sometimes 0.044 0.411 0.173 0.977
Do/Did you worry that you may gain too much weight?
Always 0.999 – – –
Frequently 0.004 0.439 0.250 0.769
Never 0.124 0.706 0.452 1.101
Occasionally 0.448 1.182 0.768 1.820
Sometimes 0.435 1.175 0.784 1.763
BARRIERS
What do you believe are the barriers to gaining within a targeted weight?
Lack of guidance from health care professional 0.045 1.526 1.010 2.305
Weight gain during pregnancy is beyond control of the mother 0.009 0.522 0.321 0.850
PREGNANT
PERCEPTIONS
Do/Did you worry that you may gain too much weight? All P > 0.05 – – –
BARRIERS
What do you believe are the barriers to gaining within a targeted weight?
I don’t believe there are any barriers to gaining a healthy amount of weight 0.030 5.354 1.181 24.281
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Note. Statistically significant associations are bolded.

Obes Facts. 2018 May 26;11(Suppl 1):168.

T2P155 Subjective conception about weight in type 2 diabetes patients with obesity

K Liesionytė 1, R Pauliukienė 2, E Danytė 2, R Žalinkevičius 2

Introduction

Incorrect understanding by patients about their weight does not allow to identify the problems on time, increases the prevalence of obesity and limits the use of preventive opportunities. The aim of this study was to evaluate obese type 2 diabetic persons’ subjective assessment of their own weight and its impact on the life; identify the main reasons for weight loss, the most common weight loss Methods, the need for assistance.

Methods

During the period of 2016 - 2017 104 adult patients with type 2 diabetes (T2DM) and obesity (BMI ≥30 kg/m2) were surveyed by the method of anonymous questionnaire. The patients were divided into two groups: group I patients with BMI from 30 to 34,9 kg/m2 and group II - BMI ≥35 kg/m2. A questionnaire on weight estimation and reduction possibilities was completed and the expectations of the patients were considered. Statistical analysis was performed using Microsoft Excel and SPSS 20.0 programs.

Results

Almost all respondents (I gr. 43 (95.56%), II gr. 59 (100%), p = 0.102) agree that obesity is harmful to health and would like to reduce body weight (I gr. 41 (91.11%), II gr. 57 (96.61%), p = 0.233). Not all participants agreed to be overweight (I gr. agree 31 (68.89%), II gr. 53 (89.83%), p = 0.007). One third of participants (14 (31.11%)) in I gr. do not consider themselves obese. A total of one fifth of the participants (19 (18.27%)) has never tried to lose weight (I gr. 11 (57.90%), II gr. 8 (42.10%), p = 0.122). Those who had tried to reduce weight before, most of them (50 (58.82%)) regained the same weight, mostly noticed in II gr. participants, p = 0.009. The main common interferences in weight reduction - lack of will (I gr. 26 (48.15%), II gr. 28 (51.85%), p = 0.297). 91.76% of the participants (I gr. 30 (38.46%), II gr. 48 (61.54%), p = 0.087) reduce weight for seeking better health, 67.06% (I gr. 22 (38.60%), II gr. 35 (61.40%), p = 0.290) do it by changing their diet. 2.75 times more often in II gr. vs I gr. participant's doctors say they are obese, 3.12 times more often say friends and relatives, their social life has a 4.69 times higher probability of being restricted. 44 patients (42.31%) received help from doctors (I gr. 18 (40.91%), II gr. 26 (59.09%), p = 0.677), remaining respondents received help from relatives and family members (p > 0.05). 36 (34.62%) patients noted that they did not receive help in reducing body weight (18 patients (50.00%) in each weight group).

Conclusion

Not all obese people consider themselves obese. More obese patients are more likely to understand their weight problems, try to reduce body weight, change their diets most often and have a greater likelihood of restricted social life.

Obes Facts. 2018 May 26;11(Suppl 1):168–169.

T2P156 Determination of knowledge levels on functional foods of university students

B Senol 1, Z Saat 2, T Yılmaz 3, E Karaca 3

Introduction

The importance of functional foods in the world is increasing. The aim of this study is to determine the level of know ledge about functional foods of university students in health science sand the other faculties.

Methods

This study was made betweenJanuary and March 2017, on 300 students who were studying at someuniversities in Istanbul, Turkey. 206 female and 94 male students between 18–27 years of age were included in the study.One hundred and thirty-two students participating in the study were studying in one of the faculties of health sciences and the other 168 students were studying in other departments. The level of knowledge about demographic information, nutrition habits and functional foods of the students participating in the survey was determined by a questionnaire survey conducted by the researchers. The data obtained in the study were analyze dusing SPSS (Statistical Package for Social Sciences) for Windows 22.0 program.

Results

In the study therewere 206 female and 94 male students. Participant's age of the study varies between 18–27 years old. There was a significant relationship between knowing of the term functional food and gender (X2 = 9,773; p = 0,001 < 0.05). 25 of the male responses (26.6%) were yes, 69 (73.4%) were no; 94 (45.6%) of the women's responses were yes, and 112 (54.4%) were no. There was a significant relationship between low-calorie foods and faculty(X2 = 12,951; p = 0,002 < 0.05). 40 students of the health sciences response (%30.3) as yes low calorie foods were functional food, 55 of them response (41.7%) as not sure, 37 of them response (28.0%) as no; 69 of the other department students response (41.1%) as yes, 79 of them response (%47,0) as not sure, 20 of them response (%11,9) as no. There was a significant relationship between the faculty and the question ‘I do not believe that it is useful’(X2 = 10,233; p = 0,037 < 0.05). One-w ayanalysis of variance (ANOVA) was used to determine whether there was a statistically significant difference between the groups in terms of serum cholesterol-lowering and cardio-vascular risk scores of the students participating in the study. results of the ANOVA the difference between group averages was statistically significant(F = 3,339; p = 0,020 < 0.05). A complementary post-hoc analysis was conducted to determine the sources of the differences.

Conclusion

There was not significant relationship between low calorie foods, low sodium foods, gluten-free foods, sports foods, diabetic foods, enriched foods, probiotic and prebiotic containing foods, anti-aging foods, foods used for reducing pre or post menstrual symptoms, containing herbal additives foods such as echinacea, gingko, gingeng, foods incrased of omega 3 and omega 9 fatty acids content and faculty. There was no significant relationship between foods with increased dietary fiber content, immune systemstreng then foods and faculty.

Obes Facts. 2018 May 26;11(Suppl 1):169.

T2P157 The level of anxiety in women seeking professional support in reduction of excessive weight

M Bąk-Sosnowska 1

Introduction

Anxiety is a chronic, nasty state of a relatively constant intensity that it caused by an individual's internal experience, the existence of which is often unaware. The factor triggering anxiety is a socially unacceptable appearance. It is excess weight in the Western culture that can be the source of prejudice and discrimination. The aim of the study was to assess the level of anxiety in women with excess body weight seeking the professional support.

Methods

We examined 135 adult women that came for the first time to the Obesity Counseling Clinic. Their mean age was 46, 85 ± 14,92 years, mean BMI 38,35 ± 7,33 kg/m2. The majority of them had an average or high level of education and was professionally active. We used Catell's self-assessment test, which examines the level of anxiety by means of five personality factors: self-assessment, neuroticism, suspiciousness, depression, emotional tension.

Results

We stated that the general level of anxiety, as well as the level of: neuroticism, suspiciousness, depression and emotional tension were higher than in the general population. The level of self-assessment stayed within normal range. We observed positive correlation between BMI and the levels of: general anxiety (p < 0,05) and neuroticism (p < 0,05). The positive correlation was also noticed between the age and: depression (p < 0,01) and emotional tension (p < 0,01) of participants, whereas the negative one between age and suspiciousness (p < 0,05).

Conclusion

We concluded that the level of anxiety in women with excess body weight seeking professional support is elevated. The level of anxiety in this group of patients is connected with their BMI and age.

Obes Facts. 2018 May 26;11(Suppl 1):169.

T2P158 Assessment of the frequency and severity of depression and anxiety among candidates for bariatric surgery: Results of a University Hospital in Brazil

AM Neder 1, J E Poletto 2, EC Cândido 2, L BDS Jaroslavski 1, L Nascimento 2, DAO Modena 2, L Baltieri 1, RC Gobato 2, FDM Chaim 1, FHM Chaim 2, E Cazzo 2, É A Chaim 2

Introduction

There is an obesity epidemics worldwide over recent years. It leads to high costs for the health providing systems, since obesity is difficult to control and leads to high morbidity rates. Our service has a multidisciplinary team of physicians, nurses, psychologists, nutritionists and physiotherapists, essential in the pre- and post-operative care of individuals who undergo bariatric surgery (BS). Anxiety and depression are common diseases among the bariatric population; it is important to identify their occurrence and treat them appropriately prior to the surgery, since they may significantly influence the treatment outcomes. This study aims to evaluate the levels of depression and anxiety among the patients with morbid obesity who are candidates for bariatric surgery and to characterize their emotional state.

Methods

This is a cross-sectional study which assessed the occurrence of depression and anxiety by means of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires, respectively; the answers allow to obtain scores, which were used to quantify the intensity of these diseases, relating them to age, sex, BMI and length of stay in the preoperative program.

Results

Overall, 80 patients (64 females) were enrolled in this study. The lowest, moderate, and severe depression scores were respectively: 66.2%, 20.8% and 13%; for anxiety, the scores were respectively: 56.8%, 16.8% and 12.7%; most of them being female, with no relation to BMI and length of stay in the preoperative program.

Conclusion

Anxiety and depression are diseases that should be well evaluated in the preoperative period of candidates for bariatric surgery, since they are common and some individuals present worrying scores. The presence of a psychologist in the multidisciplinary team is mandatory for bariatric surgery services, to identify and indicate the appropriate treatment for these individuals.

Obes Facts. 2018 May 26;11(Suppl 1):169–170.

T2P159 Translation, adaptation and validation of the Leeds Food Preference Questionnaire for Brazilian population

J P Carvalho-Ferreira 1, G Finlayson 2, G Caldas 1, D Bandoni 3, VV Rosso 4

Introduction

In an obesogenic food environment, the hedonic system is a powerful determinant of food intake and exploring the psychological components of food reward (liking and wanting for food) is key to understand food preferences linked to overeating and weight gain. The aim of the present study was to translate, adapt and validate the Leeds Food Preference Questionnaire (LFPQ) for the Brazilian population. LFPQ is a computer-based platform which uses a ready-to-eat food pictures database to evaluate Explicit Liking (EL), Explicit Wanting (EW) and Implicit Wanting (IW) for four food categories according to taste and fat characteristics (high fat savoury and sweet; low fat savoury and sweet).

Methods

The LFPQ was translated by one of the authors, a certified translator and a bilingual researcher with expertise in the field. The three versions were compared to create the final one (LFPQ-BR), which was piloted before the experiment. A food picture database was created and validated by an online questionnaire to evaluate cultural suitability and perception about the nutritional characteristic of each food. To verify the validation of the task, an experiment was conducted to evaluate food preference in fasted and fed states. Participants (N = 48, 21 male and 27 female) had 32.8 (1.5) years in average and mean body mass index (BMI) 26.6 (0.1) kg/m2, ranged from 16.46 kg/m2 to 54.28 kg/m2. They arrived at the laboratory with a 4 hour fasted, anthropometric measures were taken and a fixed test meal (600 kcal) was provided. Food preferences (using the LFPQ-BR) were accessed before and after the meal.

Results

There was a main effect of condition with a greater EL [F (1,47) = 86.28, p < 0.001] and EW [F (1,47) = 87.52, p < 0.001] for foods on fasted compared to fed state. It was also observed a main effect of taste, with greater EL [F (1,47) = 28.07, p < 0.001], EW [F (1,47) = 21.64, p < 0.001] and IW [F (1,47) = 46.34, p < 0.001] for sweet foods. Condition and taste presented interaction for the three components of food preference, with EL [F (1,47) = 121.84, p < 0.001], EW [F (1,47) = 112.47; p < 0.001] and IW [F (1,47) = 265.71 p < 0.001] for sweet foods being higher on the fed compared to fasted state. Finally, there was a three way interaction between condition, taste and fat: EL [F (1,47) = 14.92, p < 0.001] and EW [F (1,47) = 6.73, p < 0.05] for high and low fat savoury decreased in the fed compared to the fasted state. The three way interaction for EL was the same for savoury food and, additionally, IW for high fat and low fat sweet were higher on the fed compared to fasted state [F (1,47) = 36.2, p < 0.001]. In addition, correlation analysis showed a positive association between BMI and IW fat appeal bias (r = 0.329, p = 0.023) on the fasted state.

Conclusion

All together, these results are consistent with previous studies which evaluates psychological components of food reward. Therefore, the present version of the LFPQ is suggested to be a valid and sensitive method for analysis of liking and wanting for food in Brazil.

Obes Facts. 2018 May 26;11(Suppl 1):170.

T2P160 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):170.

T2P161 Health locus of control (HLC) and visceral obesity in adults

W Gruszka 1, P Kocelak 1, J Chudek 2, M Olszanecka-Glinianowicz 3

Introduction

Our previous study revealed that obese subjects have external health locus of control (HLC) with impact of other more often than normal-weight and overweight. However, the association between visceral obesity and HLC has not been studied yet. Therefore, the aim of the study was to assess the association between visceral obesity and HLC.

Methods

744 adults (452 women and 292 men; age 35.9 ± 12.4 years), including 326 normal weight, 221 overweight and 176 obese subjects, were enrolled. Waist circumference was measured and visceral obesity was diagnosed according to the International Diabetes Federation criteria. HLC was assessed based on Multidimensional Health Locus of Control Scale (MHLCS) adapted by Juczynski.

Results

Subjects with visceral obesity had significantly higher level of external HLC with impact of other (p < 0.001) and with impact of chance (p < 0.01) than subjects without visceral obesity. In addition, both women and men with visceral obesity had significantly higher level of external HLC with impact of other than subjects without visceral obesity (respectively p < 0.01 and p < 0.01). However, only in women with visceral obesity higher level of external HLC with impact of chance was observed than in subjects without visceral obesity (p < 0.01).

Conclusion

Visceral obesity in women is associated with higher frequency of external HLC with impact of other and impact of chance. While visceral obesity in men is associated with higher frequency of external HLC with impact of other.

Obes Facts. 2018 May 26;11(Suppl 1):170.

T2P162 What is the role of psychoanalysis in the treatment of severely obese patients at a cardiology hospital in Rio de Janeiro?

J QDA Serpa 1, L Oliveira 1

Introduction

In the last few years Brazil has ceased to be marked by malnutrition and now has obesity as one of its public health problems. According to the Ministry of Health (2017), nowadays one in two Brazilian adults is overweight and about 20% of the country's population is considered obese. We also know that obesity is one of the risk factors for cardiovascular disease, which is the main cause of death in Brazil. Within this context, in a cardiology hospital, we found obese patients who are already heart patients in need of losing weight so that they can undergo cardiac surgery safely. We noticed that all medical institutions are highly characterized by protocols, prescriptions and prognostics. There is something, however, that falls outside of the scope of the medical system and puts an end to the good progress of the treatment. Severely obese patients regain weight after undergoing bariatric surgery, making progress and then sliding backwards at a rather peculiar pace. We have a serious problem here as these patients are at great risk. The urgent need for cardiac surgery seems to have no effect, though. A cry for help from the nutrition service arrives at the psychology service: “how can we improve treatment compliance?”. So, we welcomed this demand as an invite, and we partnered with them in creating an unprecedented treatment facility in the institution. The present study aims to verify the role of psychoanalytic listening in the translation of a line of care for the obesity and present the report of such an interdisciplinary experience.

Methods

It is important to note that our work was submitted to and approved by the institution's ethics committee. Through the analysis of the data already collected at that interdisciplinary experience and the bibliographical review of specific literature on the subject, we have achieved some Results.

Results

The patients do not lack information on the topic, they are all very well informed. One of them tells us that he knows exactly what fatty foods can get through his gastric ring and eats them, another seems to find amusing the fact by which she is known among her peers: although she is aware of the importance of the habit, she does not drink water. The reasons for their actions are as many as the number of patients heard. We see clearly the symptom is not something that affects the patient from the outside, it is rather a product of their actions, especially choices related to their physical condition. When we collect speeches such as those, in which the patient's position comes out crystal clear, and we can intervene, we can hopefully make them question themselves about their actions, and that may induce a subjective change, crucial to a new way to see the treatment.

Conclusion

The results suggest that many patients work under a logic of victimization, which is reinforced by the fact they are treated as objects by the most diverse branches of the health institution. A psychoanalytic listening device performs a different role in that, as it does not offer the patient one answer to what makes them suffer, and, by refusing to give them a closed answer, it may give real space to their singularity. As we make the patient speak about what affects them, we give them the opportunity to take responsibility and ownership of what determines them, which creates a new destiny for the treatment and for them.

Obes Facts. 2018 May 26;11(Suppl 1):171.

T2P163 Interdisciplinary action report on obese individuals with hypertension and coronary heart disease

J QDA Serpa 1, L Oliveira 1, SR De Souza 2

Introduction

Obesity is a major risk factor for cardiovascular disease (CVD). In Brazil, this is a major public health problem, affecting more than 50% of adult individuals. Although sedentary and inadequate food intake are the main responsible for its development, psychosocial factors contribute to its genesis and aggravation. Obstacles placed by the psychism are impeditive to good adherence to the treatment and barrier to lifestyle changes, evidencing the importance of the joint action of the health professionals involved, as well as the inclusion of the patient in the problematization of the weight loss process. The objectives of this study were to create a psychoanalytic and nutritional orientation and listening group composed of ten obese individuals with CVD attended at a public hospital specialized in cardiology in the state of Rio de Janeiro and to identify their difficulties in the process of definitive weight loss, without weight regain.

Methods

Cross descriptive study submitted and approved by the Research Ethics Committee where it was developed. The individuals formalized their acceptance in participating by signing a Term of Informed Consent. Variables evaluated: gender, age, body mass index (BMI) and comorbidities. The listening group was led by a nutritionist and a psychologist. Participants sat in chairs arranged in circular position and were invited to introduce themselves and expose their troubles and difficulties in the tackling of obesity.

Results

Six men and three women attended, with mean age = 59 (6.63), BMI = 41.1 (3.82), of which 5 had coronary heart disease and all with hypertension. Among men, 2 post-bariatric surgery, postoperative period of more than 10 years, without success in weight loss, with BMI 41.01 and 44.69. The list of difficulties presented was as plural as the number of patients listened to, being scored successive losses, ambivalence of feelings, negative influence of family and friends regarding food choices, difficulty in controlling for compulsive eating, anxiety, feeling of pleasure and consumption of certain processed foods.

Conclusion

The findings showed that the current model of care based on prescriptions (diets, medications and bariatric surgery) is not enough to contain the obesity epidemic. When the individual has the opportunity to talk about what affects him in a listening device, he is able to take responsibility and take ownership of what determines him, having the chance to participate in creating a new path to treatment and to himself, suggesting that integral approach of the individual, which contemplates and gives place to the psyche, is fundamental.

Obes Facts. 2018 May 26;11(Suppl 1):171.

T2P164 Food craving, impulsivity, and symptoms of binge eating disorder in obese patients

K Sonnabend 1, A Pokrajac-Bulian 1, S Klobucar Majanovic 2, M Kukic 1

Introduction

About 10% of obese individuals who take part in obesity treatment suffer from Binge Eating Disorder (BED). Craving for food is positively associated with BED and is considered to be a maintenance factor of obesity, as well as impulsivity trait which predisposes an individual to reduced control and planning capability. Therefore, the relationship of these variables should be investigated in more detail in order to improve obesity treatments. The present study aims to examine the contribution of food craving, body mass index and impulsivity in explaining the symptoms of BED in obese patients. Based on previous research findings, a model of the relationship among these variables was proposed and investigated. In that model food craving is defined as a mediator between body mass index/impulsivity and symptoms of BED.

Methods

The research was conducted on a clinical sample of obese patients from the Outpatient clinic for diabetes, endocrinology and metabolic diseases in the Clinical Hospital Centre Rijeka. A total of 71 patients (70.4% women) were enrolled in the study. The average age of participants was 45.20 years (SD = 11.13; ranged from 26 to 71 years), and the average body mass index was 41.97 kg/m2 (SD = 8.85; ranged from 29 to 71 kg/m2). Participants completed the Food Cravings Questionnaire - Trait (Cepeda-Benito, Gleaves, Williams, & Erath, 2000), the UPPS Impulsive Behavior Scale (Whiteside & Lynam, 2001), and the Binge Scale Questionnaire (Hawkins & Clement, 1980).

Results

The results showed that 6.25% of subjects have a complete clinical presentation of BED. Furthermore, 41.7% of them have a binge-eating tendency. The results of regression analysis showed that food craving and sensation seeking (component of impulsivity) were significant positive predictors of the symptoms of BED. Food craving had mediating effect on the link between impulsivity and symptoms of BED. The results of regression analyses showed that a higher degree of impulsivity increased the food craving, which in turn had a direct effect on the development of the symptoms of BED.

Conclusion

The results of this study suggest that special attention should be paid to the identification of those obese patients with increased impulsivity and those who experience high levels of food craving. It is important to teach those obese people how to recognize factors that may make losing body weight difficult, and how to cope with those factors.

Obes Facts. 2018 May 26;11(Suppl 1):171–172.

T2P165 Depressive symptoms, eating patterns, shame and guilt due to body and body weight in obese patients

A Hajsok 1, S Klobucar Majanovic 2, A Pokrajac-Bulian 1, M Kukic 1

Introduction

Obesity is affecting a large number of world populations and its proportions reach epidemic levels. Depression is a disease that is often associated with obesity. Obesity as well as depression are major public health problems, presenting a risk of developing other diseases and increasing mortality rates. Research suggests that obese people are more likely to feel shame and guilt due to their body and weight. The aims of this study were: 1) to examine the presence of depressive symptoms in obese patients; 2) to examine the contribution of eating patterns and shame and guilt due to body weight in explaining depressive symptoms in obese patients.

Methods

The research was conducted on a clinical sample of obese patients from the Outpatient clinic for diabetes, endocrinology and metabolic diseases in the Clinical Hospital Centre Rijeka. A total of 71 patients (50 women and 21 men) were enrolled in the study. The average age of participants was 45.20 years (SD = 11.13; ranged from 26 to 71 years), and the average body mass index was 41.97 kg/m2 (SD = 8.85; ranged from 29 to 71 kg/m2). Participants completed the Weight and Body Related Shame and Guilt Scale (WEB-SG; Conradt et al., 2007), the Three-Factor Eating Questionnaire R-18 (TFEQ R-18; Karlsson, Persson, Sjoèstroèm, & Sullivan, 2000), and the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977).

Results

In the present study, 49.3% of subjects showed significantly elevated levels of depressive symptoms. Sex differences in shame, guilt, eating patterns and depressive symptoms were not obtained in this sample of obese patients. Emotional and uncontrollable eating were positively associated with symptoms of depression, and cognitive restraint as eating pattern was negatively associated with depressive symptoms in obese patients. Cognitive restraint pattern of eating and shame due to body and body weight were significant predictors of depressive symptoms in obese patients.

Conclusion

Negative emotions such as shame and certain patterns of eating are associated with more depressive symptoms in obese people. These results suggest that it is important that the experts working with obese patients consider the emotions experienced by obese people as well as their eating patterns. Educating patients about their emotions and eating patterns should be an integral part of weight loss and weight maintenance programs, especially in depressed patients.

Obes Facts. 2018 May 26;11(Suppl 1):172.

T2P166 Confirmatory Factor Analysis of the Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale in a sample of women participating in a community-based weight management programme

C Duarte 1, RJ Stubbs 1, P Gilbert 2, C Stalker 2, F Catarino 2, J Basran 2, G Horgan 3, L Morris 4

Introduction

The Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale (WFFSCRS) is based on the original 3-factor Forms of Self-Criticising/Attacking and Self-Reassuring Scale (Gilbert et al., 2004). The WFFSCRS comprises 22 items and assesses two forms of self-criticism when people face weight-related problems: the Inadequate Self form which involves a sense of personal inadequacy, and the Hated Self form, which assesses a sense of self-hatred and desires to hurt or persecute the self. The scale also measures the ability to self-reassure – Reassured Self. The current study examined the factorial structure of the WFFSCRS in 724 overweight/ obese women participating in a community-based weight management programme (CBWMP).

Methods

The scale was examined through a Confirmatory Factor Analysis and scrutiny of its construct and convergent validity. Participants’ mean (SD) age was 44.89 (SD = 11.30) years, and BMI was 32.81 (SD = 6.40).

Results

The three-factor model proposed for the original scale fitted the data for the weight-focused version well (chi-square2(204) = 699.63, p < .001; chi-square2/df = 3.43; TLI = .93; CFI = .94; RMSEA = .06, p = .003, SRMR = .05). The items’ standardized regression weights for the Inadequate Self subscale ranged from .45 to .77, for the Hated Self sub-scale ranged from .47 to .79, and for the Reassured Self subscale ranged from .41 to .80. The WFFSCRS revealed high Composite Reliability for the Inadequate self subscale (.93), for the Hated Self subscale (.87) and for the Reassured Self subscale (.90). The WFFSCRS was positively associated with concurrent measures of body shame, eating-related difficulties, symptoms of anxiety, depression and stress, and with body mass index (Table 1).

Conclusion

The WFFSCRS is a valid measure to assess self-criticism and self-reassurance in overweight and obese participants of a CBWMP.

Conflicts of Interest

R James Stubbs is a consultant to Slimming World through University of Leeds Consulting (Trading as Consulting Leeds).

Funding

This study was funded by a grant in aid of research from Slimming World UK, to the University of Derby.

Tab. 1. to T2P166.

Correlation coefficients (two-tailed Pearson r) between the WFFSCRS and concurrent variables

 1
 2
 3
 4
 5
 6
 7
 8
 9
 10
 11
1 Inadequate self 1
2 Reassured self -0..53** 1
3 Hated self 0.71** –0.60** 1
4 BISS 0.64** –0.53** 0.67** 1
5 Disinhibition 0.37** –0.29** 0.34** 0.43** 1
6 Susceptibility to hunger 0.30** –0.22** 0.28** 0.37** 0.61** 1
7 Restraint –0.13** 0.24** –0.16** –0.13** –0.33** –0.28** 1
8 Binge Eating 0.55** –0.45** 0.58** 0.60** 0.68** 0.57** –0.28** 1
9 Depression 0.60** –0.52** 0.69** 0.59** 0.35** 0.30** –0.18** 0.54** 1
10 Anxiety 0.48** –0.31** 0.52** 0.50** 0.22** 0.23** –0.07 0.42** 0.71** 1
11 Stress 0.57** –0.41** 0.56** 0.52** 0.27** 0.24** –0.05 0.44** 0.76** 0.73** 1
12 BMI 0.23** –0.19** 0.34** 0.40** 0.19** 0.20** –0.25** 0.34** 0.28** 0.28** 0.17** 1
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Obes Facts. 2018 May 26;11(Suppl 1):172–173.

T2P167 Weight status, household environments, and diet-related behaviors among parent-adolescent dyads in a United States survey

L Nebeling 1, L Dwyer 2, A Oh 1, E Hennessy 3

Introduction

Despite increasing rates of obesity, large studies assessing obesity-related behaviors and correlates among dyads are uncommon. However, these studies can identify whether dyad members are correlated on obesity-related variables and provide a way to examine family and household dynamics in conjunction with other variables that predict health behaviors. This analysis uses data from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study, a survey of a national United States sample of parent-adolescent dyads, to examine parent-adolescent associations in diet-related behaviors and perceptions of the home environment, and the role of dyads’ weight status and socioeconomic factors in predicting these variables.

Methods

Dyads (n = 1,109) were grouped by weight status: both healthy weight (31%), both overweight/obese (24%), adolescent healthy weight; parent overweight/obese (40%), and parent healthy weight; adolescent overweight/obese (6%). We examined parent-adolescent correlations in eating behaviors (frequency of eating “junk food,” sugary food, and fast/convenience food) and reports of the home environment (home availability of foods and beverages; types of evening meals eaten at home; importance of family meals), as well as mean levels of these variables, across dyad weight status. In multiple regressions, we examined whether dyads’ weight status, parent education, and parent weekly work hours predicted behaviors and home environments.

Results

With one exception, parents and adolescents from the same family were moderately to strongly correlated with each other on reports of behavior and home environment variables, across weight status groups (rs ≥ 0.33, ps ≤ 0.009). Fruit/vegetable (FV) availability in the home and home-cooked meals were most frequent when both dyad members were at a healthy weight (ps < 0.01). When regressing behavioral and environmental variables on weight status and socioeconomic factors, dyad weight status was a significant predictor of some outcomes, including home FV availability which was lower when the parent was overweight, as compared to when both dyad members were a healthy weight (Bs ≤ –0.14, ps < 0.05). However, parents’ working more than 40 hours per week (but not dyads’ weight status) predicted greater consumption of delivery meals at home (Bs ≥ 0.14, ps < 0.05) and fewer home cooked meals (Bs ≤ –0.46, ps < 0.05).

Conclusion

The parent-adolescent dyad should be considered when studying and intervening upon healthier eating behaviors and environments. Consistent parent-adolescent correlations suggest that one dyad member's behavior and perceptions may provide insights into behaviors and perceptions within the family, regardless of the weight status of multiple household members. While dyads’ weight status was associated with some home environment variables, other potential points of intervention (e.g., home cooked meals and delivery meals) were predicted by parent work schedule. Further work can identify the different intervention approaches that are effective within families to promote specific target outcomes in families with adolescent children.

Obes Facts. 2018 May 26;11(Suppl 1):173.

T2P168 Garment size, choice of colour, and BMI

C K Nikolaou 1, S Gilmour 1, ME Lean 2

Introduction

Choices of size and colour of clothing depend on many personal factors, among which perceived or actual fatness may contribute. We explored relationships between body weight/BMI and the size and colours of garments purchased online, as potential early indicators of a need for weight-management or weight-gain prevention.

Methods

Data on clothing size and colour chosen by customers using a global online retail service were collected from the e-commerce platform for dresses and skirts for women, and pants for men, during a two-month period (Oct–Dec 2017). Customers provide information on body-weight and height, size and garment colour on their feedback forms. These are available in public domain. Country from which the order was made were grouped by the World Bank classification of average income (Low-Income(LI) < $1,005, Lower-Middle Income(LMI) = $1,006-$3,955, Upper-Middle income(UMI) = $3,956-$12,235, and High-Income(HI)>$12,236). Descriptive statistics and linear regression were performed with SPSS 25 (IBM, SPPS, Chicago).

Results

Complete data were available for a total of 34,378 customers, 27,083 women (8,119 skirts and 18,964 dresses) and 7,295 men, from 119 countries and from a total of 36 clothing brands. Garment size labels ranged from XS-6XL for women and one size available for some of the brands. There were two different sizing formats for men's garments; one from XXS–5XL and one from 26–44 ‘inch-waist’. Mean BMI(SD) of women customers was; for those purchasing dresses = 22.8(4.6)kg/m2, for those purchasing skirts = 21.9(3.9)kg/m2 and for men customers purchasing pants = 25.3(4.4)kg/m2. Percentage of overweight/obese customers (BMI >25 kg/m2) was; for dresses 22.8%, for skirts 15.2%, and for pants 49.0%. Origin countries of purchasers were: for dresses: HI:50.3%, LI:0.08%, LMI:6.4% and UMI:43.2%; for skirts: HI:39.2%, LI:0.06%, LMI:5.3%, UMI:55.4%; for pants: HI:42.2%, LI:0.1%, LMI:6.0%, UMI:51.7%. Garment size was closely related to BMI (p < 0.001) and waist circumference. Choice of colour was a significant predictor of purchaser's BMI, and that association remained (p < 0.001, r2 = 0.32) after adjustment for the country of origin. Women with higher BMI were more likely to buy black/blue/dark colours and floral dresses (β = 0.488, p < 0.001), and multicolour and dot-patterned skirts (β = 1.059, p < 0.001). Men with higher BMI chose to buy black or white pants (β = 0.9, p = 0.001).

Conclusion

Clothing size is a good indicator of BMI and waist circumference. Darker and multicolour garments are preferred by women with larger BMIs while black garments are preferred by men with larger BMIs. Online clothing purchasing choices could be used to target non-judgemental messages about weight-management and weight-gain prevention.

Obes Facts. 2018 May 26;11(Suppl 1):173.

T2P169 The relationship between central obesity and erosive esophagitis in a non-obese Taiwanese population

C Li 1, C Chou 1, P Chih 1, Y Yang 2, J Wu 1, F Lu 1, C Chang 1

Introduction

There has been an increasing prevalence of erosive esophagitis (EE) in Asia, which might lead to development of Barrett's esophagus and esophageal adenocarcinoma. In the general population, obesity and central obesity as potentially modifiable risk factors have been known to promote EE besides male gender, hiatus hernia, alcohol consumption, and smoking. However, there were no studies targeting on non-obese subjects. Thus, the aim of this study was to investigate the association between central obesity and EE in a non-obese population.

Methods

Totally, 11931 subjects underwent upper gastroenteroscopy from July 1997 to October 2007. A total of 5826 non-obese subjects were included for final analysis after excluding the subjects with esophageal or gastric cancer, current medication of gastrointestinal disease, heart disease, arrhythmia, asthma and arthritis. Central obesity was defined by a waist circumference (WC) greater than 90 cm in male and 80 cm in female. Overweight was defined as BMI of 24–26.9 kg/m2. The Los Angeles classification was adopted to determine the presence of EE.

Results

A total of 1096 (18.8%) subjects had EE. Compared with subjects without EE, those with EE were likely to be male, and had higher BMI, WC, blood pressure, fasting plasma glucose, uric acid, creatinine, triglyceride, and higher prevalence of hiatal hernia, central obesity, overweight, hypertriglyceridemia, current tea drinking, smoking, and alcohol drinking. Multivariate regression analyses revealed the significantly associated factors of EE were central obesity, hypertriglyceridemia, hiatal hernia, and current alcohol drinking. After substituting central obesity with overweight as an independent variable, overweight remained a significantly positive association with EE.

Conclusion

Even in the non-obese population, central obesity and overweight still increase the risk of reflux esophagitis, although obesity has been considered as a well-established risk factor of reflux esophagitis.

Obes Facts. 2018 May 26;11(Suppl 1):173–174.

T2P170 The impact of obesity on risk of pregnancy complications and perinatal outcomes in women of reproductive age

K L Kim 1, S Yoo 2

Introduction

Obesity at reproductive age is associated with detrimental obstetric outcomes and numerous obstetric complications. We aimed to assess the relationship between prepregnancy BMI and pregnancy maternal complications using the Korean National Health Insurance System (NHIS) cohort.

Methods

We performed a population-based retrospective cohort study using NHIS cohort from 2005 to 2015. From NHIS cohort, we identified all deliveries (n = 844,663) from January 1st, 2006 to December 31st, 2015. For prepregnancy anthropometric measurements, NHIS health check-up data of all delivery experienced mothers (from 645 days before childbirth to 280 days before childbirth) were collected. For maternal adverse outcome data, the diagnoses of maternal complications based on International Classification of Disease 10th revision that were made during the periods of 300 days prior each deliveries were researched.

The incident rates (IRs) and 95% confidence intervals (CIs) for eclampsia/preeclampsia, threatened abortion, cesarean section, premature rupture of membrane (PROM), multiple birth, high risk mother and polycystic ovary syndrome (PCOS) by five BMI categories (under 18.5, 18.5–23, 23–25, 25–30, over 30 kg/m2) were calculated. The IRs were calculated also in two age groups; same or under 30 years old group and over 30 years old group.

Results

The IR of eclampsia/preeclampsia was higher in the prepregnancy obese (BMI over 30 kg/m2) group than prepregnancy normal BMI (18.5–23.0 kg/m2) group (IR and 95% CI, normal 0.49% [0.46, 0.50], obese 2.37% [1.99, 2.58]). This relationship is same for cesarean section (normal 3.28% [3.69, 3.79], obese 5.5% [4.97, 5.86]), PROM (normal 3.58% [3.53, 3.63], obese 4.41% [4.03, 4.84]), multiple birth (normal 1.42% [1.44, 1.5], obese 1.72% [1.8, 2.37]), high risk mother (normal 7.59% [8.43, 8.58], obese 9.13% [12.04, 13.34]) and PCOS (normal 0.22% [0.21, 0.23], obese 0.62% [0.59, 0.93]). The relationships between prepregnancy BMI and those maternal complications were identical in both of young and old age group. However, IRs of threatened abortion were not significantly different between prepregnancy normal and obese women (normal 13.52% [13.43, 13.61], obese 14.15% [13.49, 14.85]).

Conclusion

Compared women with normal prepregnancy BMI, women with prepregnancy obesity had a higher incidence of eclampsia and preeclampsia, cesarean section, PROM, multiple birth and PCOS in Korea.

Obes Facts. 2018 May 26;11(Suppl 1):174.

T2P171 The metabolic syndrome in pre- and post-menopausal woman

G Akbulut 1, N Acar Tek 1, G Özata Uyar 2, B Deniz Güneş 1

Introduction

The aims of this study were the estimation and comparison of cardiometabolic risk factors and the prevalence of Metabolic Syndrome (MetS) among pre-menopausal (pre-M) and post-menopausal (post-M) women.

Methods

This study was conducted on total of 664 (pre-M: 378, post-M: 286) women, aged between 30–64 years. Body weight, waist circumference (WC) were taken from all participants, body mass index (BMI) and waist hip ratio (WHR) were calculated, and lipid profiles were investigated.

Results

The mean ages of pre-M women and post-M women were found 42.1 ± 4.50 and 56.2 ± 4.19 years, respectively (p < 0.001). Mean WC, WHR, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) levels were significantly higher in post-M women as compared to pre-M women (p < 0.001). The mean fasting plasma glucose (FPG), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and total cholesterol/high density lipoprotein cholesterol (TC/HDL-C) were significantly lower in pre-M women (p < 0.05) and TC was significantly higher in post-M women (p < 0.001). There was found a significant increase of prevalence of the MetS among the post-menopausal women in both IDF and NCEP ATPIII criterias.

Conclusion

Menopause is an important risk factor for metabolic syndrome. MetS was more prevalent among postmenopausal women than among premenopausal women by both criterias.

Obes Facts. 2018 May 26;11(Suppl 1):174.

T2P172 Mediating Effects of Inflammation on Obesity- and Age-Related Psychomotor Slowing

L J Balter 1, S Aldred 2, JE Raymond 2, S Higgs 2, JA Bosch 3

Introduction

It has been argued that obesity may accelerate cognitive aging, and immune-system activation (inflammation) has been proposed as underlying mechanism. Using a 4-group design, the present study investigated obesity and ageing in relation to attention and psychomotor speed. Further, we tested to what extent these associations, if any, were mediated by inflammation.

Methods

Ninety participants (61% male) were enrolled; 41 were classified as lean (mean BMI = 22.4) and 48 as obese (mean BMI = 33.1). Divided evenly over these weight-groups, 42 were young (mean age = 26; 21–35 years) and 48 were older adults (mean age = 71; 63–80 years). The Attention Network Test (ANT) was used to determine psychomotor speed and three distinguishable attention processes, i.e., alerting, orienting and conflicting. Blood was collected to assess the inflammatory marker IL-6.

Results

Inflammation was linked to reduced psychomotor speed (r = .429, p < .001). Further, both increased age and obesity were independently associated with psychomotor speed (r = .688 and r = .318, respectively; p < .001), as well as higher inflammation (r = .320 and r = .638, respectively; p < .01). Mediation analysis showed that inflammation mediated obesity-related psychomotor slowing (p < .001), but not aging-related psychomotor slowing. Adjusting for psychomotor speed, the data provided no evidence that obesity or inflammation specifically impaired attention.

Conclusion

The present observations showed slower task-responses in obese individuals, consistent with an aging-like effect. Moreover, shown for the first time, inflammation mediated obesity-related psychomotor slowing. Further research may test if aging-like effects associate with obesity and inflammation and generalize to other aspects of cognitive functioning.

Obes Facts. 2018 May 26;11(Suppl 1):174.

T2P173 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):174–175.

T2P174 Drinking to cope: A qualitative analysis of alcohol problems following weight loss surgery

D L Reaves 1, JM Dickson 2, JCG Halford 1, CA Hardman 1

Introduction

Bariatric surgery is an effective weight loss tool for individuals with excess weight and/or co-morbid health conditions. However, an under-communicated side effect of bariatric surgery may include an increased risk for alcohol problems. While some demographic susceptibilities have been identified using cohort data, few studies have employed a qualitative approach to examine other possible contributors to alcohol problems following surgery and potential psychological mechanisms. Therefore, the current study aimed to generate insight informed by patients who experienced problematic alcohol use following bariatric surgery, and explore comparisons within non-problem drinking bariatric patients.

Methods

Patients from a bariatric surgery support group in the United Kingdom (women, n = 9; men, n = 5) completed semi-structured interviews using questions relating to alcohol use, relationship to food, support and surgical experiences. Thematic analysis was conducted to provide insight into the factors which influence drinking behaviors following bariatric surgery, and motivations for drinking or limiting alcohol.

Results

Five core themes were identified across? both problem and non-problem drinking patients: 1) Drinking Behavior (Drinking to Cope, Disinhibited Drinking, Social and Maintaining Control), 2) Self Image, 3) Impact of Restriction on Eating Behavior, 4) Support Needs and 5) Surgical Preparedness. A sixth core theme (‘Resilience’) was identified specifically amongst non-problem drinkers. Divergent experiences, cognitions and behaviors were observed between the patient groups across the five shared themes.. Features defining ‘Resilience’ were captured and expanded upon as a unique quality in non-problem drinking patients.

Conclusion

This study is the first to qualitatively assess themes relating to the development of problematic alcohol use after bariatric surgery while additionally using a comparison non-problem drinking group. Findings reveal key psychosocial contributors to the development of problematic alcohol use amongst bariatric patients, which may be helpful for informing prevention and treatment. Importantly, including a comparison group highlights where experiences or cognitions diverge across the surgical experience. This study has clinical implications for researchers and hospital services seeking to improve patient care outcomes, and to better understand factors underpinning the ‘addiction transference’ phenomena in this population.

Obes Facts. 2018 May 26;11(Suppl 1):175.

T2P175 How can obesity patients be more involved in their illness?

J Vinglid 1

Introduction

How can obesity patients be more involved in their illness? How can we encourage the profession and research to meet the target group to enable development in the treatment and care of obesity patients? How can we spread facts and knowledge about obesity? Riksförbundet HOBS is a national non-profit organisation. Which since 1995 work and follow patients that are obese or live with obese children or adults and other relatives. HOBS has also followed the development of obesity care and research within the healthcare system. Based upon the patients needs and the professions wishes to reach patients as well as the researchers need to reach the target group.

Methods

HOBS has together with Yellowbits, a development company, produced a social learning platform, along with it an app which enables patients, professions and research the ability to meet, react and interact. HOBS social learning platform enables patients to increase their knowledge about obesity. The ability to interact in the social welfare zones. The possibility to break isolation and create more awareness and involvement in their own treatment. The profession, through the platform, enables the possibility to reach patients and society, with facts, education and spread knowledge about obesity. Our social learning platform also opens up for the meeting between research and recipients of the Results, the profession and the patients. Through our HOBS zones can a researcher reach patient groups directly, and spread their research Results. Knowledge and facts enables us to break down the stigmatisation patients experience from healthcare, but also from society as a whole.

Results

Why exactly this learning platform? This social platform has been developed based on patient needs. Vi have for over 20 years questioned, discussed, followed target groups live, and on social media, the needs of the patients. What is constantly emerging is the need for support, knowledge and information. Most of all a platform where the profession gains a better insight and about how patients experience the care they receive, their involvement in society and how it is to live with obesity.

Conclusion

Through this social learning platform, we get one step closer to the patient being involved in his disease with the right conditions, knowledge and support

Obes Facts. 2018 May 26;11(Suppl 1):175.

T2P176 The body mass index cut off to impair obesity-related Quality of Life in obese Korean adults

E Sung 1, J Nam 1, Y Heo 2, J Kang 3, DJ Park 4, J Kwon 5

Introduction

Health-related quality of life (HRQOL) among obese individuals is associated with degree of obesity, age, sex. Obesity related QOL is lower among groups who seek treatment in order to lose weight. The objective of the current study was to investigate the cut point of BMI to aggravate obesity-related quality of life in Korean overweight/obese individuals by age and sex.

Methods

Study subjects are 200 obese patients BMI more than 30 who participate clinical trial. Weight-related QOL is measured by The impact of weight on quality of life (IWQOL-Lite), a self-administered instrument that assesses quality of life in obesity. It is composed of 31 items and five domains (physical function, self-esteem, sexual life, public distress, and work). Age, sex, smoking, alcohol, physical activity, and medical history collected by self-administered questionnaire.

Results

The results will come out the end of January, 2018.

Conclusion

The results will come out the end of January, 2018.

Conflicts of Interest

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea

Obes Facts. 2018 May 26;11(Suppl 1):175.

T2P177 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):175–176.

T2P178 Problems with falling asleep depending on the assessed level of physical activity in children

P Metelska 1, M Brzezinski 2, A Gac 3

Introduction

Sleep is an essencial part of life. It's affecting the health of every human beeing, especially children. A developing person needs a high quality resting time to grow up properly. During sleep, hormones are released and the necessary cellular processes follow.

In the literature the relationship between sleep deprivation and increased appetite for high-sugar and high-fat products has been described, which consequently may lead to a higher incidence of excess body weight in the population. The sleep quality might be disturbed by various factors, i.e. poor nutrition or low physical activity, which are also the main causes of obesity. The medical literature describes examples of correlation between increased body weight and sleep disorders such as sleep apnea. People with a higher BMI are also sleeping longer but their quality of sleep is assessed as lower.

Methods

In this paper we analyzed the relation between the quality of falling asleep of a child and level of physical activity assessed by their parents. 24.517 children age 6–14 were included into this study during 6 year period of screening part of programme 6–10–14 for health. We asked their parents, using a dedicated questionnaire, following questions: “How many hours a day child spends in front of the TV/computer?” and: “How many hours per week child spends on physical activity (excluding physical activity lessons at school)?” Responses indicating less than one hour in front of TV / computer and a minimum 5 hours of physical activity per week were considered as correct behaviour.

Results

Parents of 91% of children with correct physical activity level and 86% with low level (incorrect) declared their children never or almost never had a problem with falling asleep (detailed results are presented in Table 1) The problems with falling asleep occur significantly more often in children with a low level of physical activity (p < 0,001)

Conclusion

The Conclusions obtained as a result of the analysis prove the thesis presented in analogical papers. The sleeping disorders might by correlated with decreased physical activity in children. Other factors that may influence the occurrence of falling asleep are currently being assessed. It is necessary to further assess the factors affecting the occurrence of problems with falling asleep. The impact of body mass and cardiorespiratory fitness level are currently analyzed.

Tab. 1.

The incidence of problems with falling asleep
 Level of physical activity
corrent
 incorrect
n
 %
 n
 %
Never 753 53,79 9875 42,72
Very rarely 526 37,57 10143 43,88
Once a month 36 2,57 803 3,47
Once-twice a week 47 3,36 1305 5,65
3–4 times a week 27 1,93 633 2,74
More than 5 times a week 11 0,79 358 1,55
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Obes Facts. 2018 May 26;11(Suppl 1):176.

T2P179 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):176.

T2P180 Impact of a pregnancy physical activity intervention on gestational weight gain

A Silva 1, B Pereira 1, S Souza 2, I Peixoto 1, C Moreira 3, C Guerra 4, C Ferreira 4, L Lopes 3, R Santos 3, R Rosário 5

Introduction

Healthy pregnancy includes a healthy gestational weight gain. It is known that excessive weight gain is associated with adverse maternal and neonatal outcomes. There is scarce evidence on effective interventions during pregnancy to prevent excessive weight gain. This study aimed to analyze the impact of a physical activity intervention program during pregnancy on gestational weight gain.

Methods

265 pregnant women participated on this nonrandomized trial, 154 (58,1%) were included in the control group and 111 (41,9%) in the intervention group. Data collection were taken at baseline (beginning of the program), and after the intervention (between the 1st and 3rd day after delivery), and included anthropometry data, sociodemographic profile, dietary intake and a physical activity questionnaire. Weight was measured by health professional and recorded in the pregnant book. The intervention program included women (from 12 weeks of gestation until the end of pregnancy) included 3 days a week classes of physical exercise, one of which developed in the aquatic environment. Classes last for 45/50 minutes and consisted of: a warm up (7/8 minutes), a fundamental part (30 minutes) and cool down (10 minutes). The exercises performed were of moderate / vigorous intensity, and included aerobic workout, strength, coordination and flexibility. The control group received the standard care that is usually provided by health professionals to pregnant women.

Results

After the intervention, the gestational weight gain (difference between the end and the beginning of pregnancy) was higher in the control group than in the intervention group [mean (SD) of 14.28 (5.50) kg and 12.79 (3.40) kg respectively]. After adjusting for confounders, such as age, socioeconomic status, pre-pregnancy weight, baseline energy intake, physical activity, gestational age at delivery, and regular exercise before pregnancy, weight gain was significantly lower in the intervention group when compared to the controllers (p < 0.001).

Conclusion

This physical activity intervention program was effective in preventing excessive weight gain and may contribute to inform other programs and policies aiming at improving lifestyles during pregnancy.

Obes Facts. 2018 May 26;11(Suppl 1):176.

T2P181 Physical activity and blood pressure over the life course: LifeLines cohort study

O Byambasukh 1, E Corpeleijn 2

Introduction

Previous studies showed that physical activity (PA) is associated with reduced blood pressure, but it is not clear whether all domains of daily-life physical activity are associated with blood pressure, or how this association depends on age and weight status.

Methods

In the population-based LifeLines Cohort (N = 125,402, 40.5% males, 44 ± 12 years of age), moderate-to-vigorous physical activity (MVPA) was assessed by the SQUASH, a self-reported questionnaire in different domains (commuting = CPA, leisure-time = LTPA, occupational = OPA and total = TPA). Systolic (SBP) and diastolic (DBP) blood pressures were assessed using three measurements after 10 minutes rest in supine position. Hypertension was defined as SBP > = 140 mmHg or/and DBP > = 90 mmHg or/and self-report or/and use of antihypertensive medication. Exclusion criteria were previously diagnosed cardiovascular disease and renal failure. All analyses were adjusted for age, gender, education level, smoking status and alcohol consumption.

Results

Adjusted means of total and domain-specific daily-life MVPA were significantly lower in hypertensive people. TPA, CPA and LTPA were inversely associated with blood pressure (Figures 1A and 1B). Higher LTPA and TPA were associated with lower DBP in a graded fashion (Figure 1B). Beta coefficients (95%CI) were −0.68 (-0.83;-0.47), −1.08 (-1.29;-0.86) and finally −1.97 (-2.20;-1.75) mmHg for the low, middle and highest tertile of LTPA, respectively, and −1.17 (-1.46;-0.87), −1.64 (-1.93;-1.34) and finally −2.14 (-2.43;-1.85) for the lowest, middle and highest tertile of TPA, respectively. All tertiles of TPA, CPA and LTPA were associated with a lower risk for having hypertension, but not in dose-dependent manner. Compared to “No MVPA” of each domain, the ORs (95% CI) for highest tertiles of TPA, CPA and LTPA were 0.74 (0.69;0.81), 0.84 (0.79;0.89) 0.77 (0.73;0.82) respectively. There is no significant association between OPA and blood pressure or the risk for having hypertension. Further adjustment for BMI attenuated the associations with 30–50%, but LTPA, CPA and TPA remained significantly associated with blood pressure and risk of hypertension. According to age, only the association between LTPA and SBP was age-dependent: beta coefficients (95%CI) for highest tertiles of LTPA were −1.05 (-1.61;-0.48) in adults < 35 years and −2.88 (-4.78;-0.97) in adults>65 years.

Conclusion

Commuting and leisure-time MVPA are significantly associated with reduced blood pressure and lower risk for having hypertension to a similar degree over all ages except for a slightly stronger association between LTPA and SBP with older ages.

Figure 1.

Figure 1

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Association between domain-specific moderate-to-vigorous physical activity and blood pressure.

Obes Facts. 2018 May 26;11(Suppl 1):177.

T2P182 The role of mindfulness in physical activity: A systematic review

J Schneider 1, P Lattimore 1, P Malinowski 1, P Watson 2

Introduction

Despite public health campaigns to increase physical activity (PA), a majority of the population is inactive. PA interventions show modest changes in PA and limited long-term benefits. Mindfulness-based training (MBT) practices are receiving attention in lifestyle interventions. This review evaluates evidence for the potential of MBT approaches for PA.

Methods

A systematic search was conducted for papers published up to 1 December 2017 using Google Scholar, MEDLINE (PubMed), PsycINFO, PsycNET, PsycARTICLES, and Ovid. Inclusion criteria: 1) cross-sectional studies that measured dispositional mindfulness 2) interventions that contained mindfulness meditation training or related skills; 3) mindfulness-based interventions that included PA education; 4) measured any frequency, type, duration, or intensity of PA; 5) included quantitative outcomes; and 6) published in English.

Results

A total of n = 33 papers were included. Evidence from cross-sectional studies (n = 16) indicated a positive relationship between mindfulness and PA-related cognitions, e.g., self-efficacy and self-regulation, but results were mixed for PA behaviour. Three studies found that the mindfulness-PA relationship was mediated by stress, satisfaction with PA, and state mindfulness. Two studies found that mindfulness moderated the relationship between PA cognitions and PA. Evidence from MBT interventions (n = 17) showed a positive effect on PA in over half of the studies. However, interventions varied in duration, session length, group size, delivery, and content, and many had no follow-up data. MBT interventions were more likely to be successful if they contained PA-specific components.

Conclusion

results indicate that mindfulness relates to PA cognitions and behaviour, but the body of research shows a need for more methodologically rigorous studies to establish the role of mindfulness in PA. Longitudinal and experimental designs with follow-up are needed to identify mechanisms involved in the mindfulness-PA relationship.

Obes Facts. 2018 May 26;11(Suppl 1):177.

T2P184 Exploratory study on walking behavior related with weight maintenance

M Kruseman 1, A Paraschiv-Ionescu 2, I Carrard 1

Introduction

Physical activity (PA) is a major component of weight loss maintenance in the context of overweight and obesity, but adherence often withers over time. Walking is a simple way to increase PA, and a better understanding of its subtle structure could provide useful information to individualize advice. The aim of this exploratory study was to analyze the characteristics of walking episodes among Weight loss maintainers (WLM), Regainers and stable-weight Controls.

Methods

The subjects were a subgroup of a study on WLM. Five WLM (20 ± 7.8% weight loss and 7 ± 4.4 years maintenance), two Regainers (initial 26 ± 2% weight loss, 1 ± 0 year maintenance and ≥90% weight regain) and 10 lifetime stable-weight Controls (± 5 kg) wore a PA-assessment device (Actigraph) for at least 5 consecutive days. Weight and height were measured in underwear on a calibrated scale. Weight history was assessed by interview and ascertained by photographs. The raw data of the Actigraphs were processed to extract the durations (endurance) and cadence (performance) of walking episodes (WE). Data are provided as mean ± SD.

Results

On average, the total time spent walking and the most usual cadence of daily WE were similar across groups (Table 1). However, the distribution of the duration of WE varied widely, as did the walking endurance and performance (Table 1). At least half of each group's subjects, 3 WLM (60%), 1 Regainer (50%) and 7 Controls (70%) did not reach 30 minutes in their longest single continuous WE. Walking represented, on average, between 5 and 7% of monitored time, but plotting the detailed parameters of walking activity revealed individual or group differences (Figure 1).

Conclusion

The comprehensive, multidimensional assessment of daily walking behavior provides information on individual variability that could help health professionals tailoring personalized advice in the context of WLM. Specifically, the numerous short WE suggest personal preferences or capabilities that should be taken into account.

Fig. 1.

Fig. 1

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Objective walking behavior parameters in a sample of subjects (n = 17) ranked by BMI and weight history (blue = Controls, green = WLM, red = Regainers)

Tab. 1.

Characteristics of walking behavior in a sample grouped by weight history (N = 17)

Total walking (% monitored time) 7.2 ± 2.5 5.4 ± 1.3 7.1 ± 2.4
Usual cadence (steps/min) 106 ± 15 98 ± 3 103 ± 18
Number of WE
5 to < 10 min 15 ± 11 13 ± 6 7 ± 3
10 to < 15 min 4 ± 3 3 ± 0 2 ± 2
Endurance & performance
Longest WE (min) 21 ± 22 24 ± 5 40 ± 35
Endurance & performance
Maximal cadence (steps/min) 129 ± 11 122 ± 2 125 ± 3
Endurance & performance
Number WE of ≥30 seconds and >100 steps/min 46 ± 52 63 ± 74 40 ± 50
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Obes Facts. 2018 May 26;11(Suppl 1):177.

T2P185 Occupational physical activity may increase the risk of metabolic syndrome: Results from Korea National Health and Nutrition Examination Survey (KNHANES)

H Kwon 1, B Cho 1, J Park 1

Introduction

Physical activity in general lowers blood pressure and lipid, prevents diabetes, coronary heart and stroke, and reduces all-cause mortality. But occupational physical activity (OPA) is associated with higher risk for long-term sickness, accelerated progression of atherosclerosis, and all-cause mortality. We aimed to show the association of OPA and metabolic syndrome (MetS)

Methods

A cross-sectional study was performed using data collected from the KNHAENS VI. The study outcome was Mets defined by modified NCEP-ATP III guideline. OPA was categorized into 3 groups (inactive, light, and active). Logistic regression analysis was performed to examine the association between OPA and MetS

Results

Among 2,181 eligible study population, 412 has MetS. Compared to inactive subjects, male with high level OPA are more likely to have MetS (adjusted OR 1.73; 95% CI, 1.06–2.78). But in female, no significant association between OPA and MetS was detected (adjusted OR 0.62; 95% CI, 0.28–1.39)

Conclusion

The study results showed that higher OPA could be linked to higher risk of MetS in Korean men. This finding should be confirmed with a large prospective study.

Obes Facts. 2018 May 26;11(Suppl 1):178.

T2P186 Prolonged daily fast facilitates transient loss of body fat and improvement in insulin sensitivity

AS Bashraheel 1, A Mohammed 1, S Alsowidi 1, M Aljaber 1, K Alsaadi 1, W Samsam 1, S Voss 1, C Georgakopoulos 1, M Alsayrafi 1, V Ali 1

Introduction

Periods of prolonged daily fasting and robust feeding-fasting patterns may improve circulating levels of both glucose and inuslin. Therefore, this study tested the hypothesis that restricting food intake for greater than 12h in a 24h cycle, without calorie restriction, reduces relative hypergylcaemia and hyperinsulinemia, independent of changes in body weight.

Methods

All participants were Arab males (n = 10). The study consisted of three phases: Phase 1 normal eating pattern: 2 visits; phase 2: 3 visits (1 per week) during 30 days of fasting for greater than 12 hours per day (Ramadan); and phase 3: 1 visit one month after phase 2, when normal patterns of eating had been resumed. On each study day subjects attended twice, once in the morning (between 08:30 and 10 AM) and once in the afternoon (between 2:00 to 4:30 PM). All subjects maintained a daily exercise programme throughout all three phases. The study was approved by the National Research Ethics Committee. Height and weight (kg) were recorded, as well as body composition by electrical bio-impedance. Blood pressure and heart rate were measured. Blood samples were drawn for determination of glucose, insulin, lipids and indices of liver fuction.

Results

There was significant reduction in body weight, fat mass and BMI during the 2nd and 3rd weeks of prolonged daily fasting. However, this was not sustained in the period immediately following the fasting month, as all weight loss was regained. There were no significant changes in muscle mass, body water or blood pressure. Of note is that all participants were relatively hyperinsulinaemic in the periods prior to and after the cessation of daily prolonged fasting. However, during the fasting period insulin levels were significantly reduced (see Figure). triglycerides. NO changes were seen for all other measured variables. All subjects remaind euglycaemic.

Conclusion

This study shows that prolonged periods of fasting during the day, even without reducing overall daily calorie intake, favours loss of body fat, while preserving muscle mass. This was accompanied by significant improvement in systemic hyperinsulinaemia and indices of liver function.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):178–179.

T2P187 The relationship of sitting time and physical activity with the risk of metabolic syndrome in adults

E Suliga 1, E Ciesla 2, D Koziel 3, D Rebak 3, S Gluszek 3

Introduction

In recent years, in metabolic syndrome prophylaxis, special attention is paid not only to the role of physical activity but also to sedentary behaviors. By a majority of researchers, they are treated as two independent types of behavior which can have different determinants, and which can affect our health independently. The aim of this study was to find relationship between sitting time and physical activity, and the risk of metabolic syndrome and its components.

Methods

Altogether, the data from 10367 participants aged between 37–66 were used in the study (7479 overweight and obese). The studies included anthropometric measurements, blood pressure measurements and analyses of collected fasting-blood samples. The definition of metabolic syndrome devised by the IDF Joint Interim Statement criteria, using an ethnic-specific cut-point for waist circumference as the central obesity criterion was adopted. An extensive interview was carried out in order to collect information about the subjects’ lifestyle during the last year. International Physical Activity Questionnaire (long form) was used to assess physical activity and sitting time. To assess the relationship between physical activity, sitting time and the risk of metabolic syndrome and its components, a logistic regression analysis was applied. Analyses were conducted with stratification according to BMI.

Results

In the model adjusted for covariates, in both analyzed BMI groups, longer sitting time was only related to the risk of abdominal obesity (p trend = 0.013 in the group with normal BMI; p trend = 0.017 in overweight and obese). In participants declaring low physical activity, the risk of metabolic syndrome (p trend < 0.000 in the group with normal BMI; p trend < 0.000 in overweight and obese) and an abnormal triglycerides concentration (p trend = 0.033 in the group with normal BMI; p trend = 0.025 in overweight and obese) was higher compared to those declaring high physical activity. In the group with overweight and obesity, low physical activity was connected with a higher risk of abdominal obesity (p trend = 0.001), increased glucose concentration (p trend < 0.001) and elevated blood pressure (p trend = 0.037). In participants with a normal BMI, analogical associations did not occur.

Conclusion

Our data suggest that physical activity has a preventive effect against metabolic syndrome and its components. A longer sitting time was associated only with an increased risk of abdominal obesity. In participants with overweight and obesity, low physical activity was considerably more strongly connected with the risk of abnormal metabolic syndrome components, compared to those with normal BMI.

Obes Facts. 2018 May 26;11(Suppl 1):179.

T2P188 An exercise-induced decrease in fat mass in overweight women is partially compensated by an increase in appetite, but not by a decrease in non-exercise physical activity

A Myers 1

Introduction

Exercise-induced weight loss is often less than expected and highly variable between individuals. This implies some degree of compensation in response to the energy deficit generated by the exercise regime. Given that energy intake (EI) and non-exercise physical activity (NEPA) are major determinants of body weight, compensation in either, or both, of these could undermine the exercise-induced energy deficit and compromise weight loss. The aim of this study was to examine changes in body composition, appetite, NEPA and sedentary behaviour (SB) in response to a 12-week supervised and monitored aerobic exercise intervention in overweight and obese women.

Methods

Twenty-four women aged 33.1 years (SD = 11.7) with a body mass index (BMI) of 27.9 kg/m2 (SD = 2.7) completed 12-weeks of supervised exercise (500 kcal, 5 times per week). Body weight, waist circumference (WC), body composition, resting metabolic rate (RMR), total daily energy intake (EI), subjective appetite sensations and postprandial peptides (insulin, acylated ghrelin, peptide YY and glucagon-like peptide 1) were measured at baseline (weeks 0) and post-intervention (week 12). Free-living physical activity (PA) and SB were measured at baseline, week 1 and 10 of the exercise intervention, and at post-intervention. The study procedures and all study materials were reviewed and approved by the National Research Ethics Service Committee Yorkshire & the Humber.

Results

There was a significant reduction in body mass (M = 0.83 kg, SD = 1.85), BMI (M = 0.30 kg/m2, SD = 0.66), WC (M = 3.62 cm, SD = 3.85), fat mass (FM; M = 1.50 kg, SD = 2.18) and a significant increase in fat-free-mass (FFM; M = 0.67 kg, SD = 0.98). There was an increase in total [P = .028], ad libitum [P = .030] and snack box EI [P = .048]. This was accompanied by an increase in hunger [P = .016] and a decrease in fullness [P = .040] throughout the day at the end of the exercise intervention compared with baseline. The peptides did not explain the exercise-induced increase in appetite. There was no evidence for a compensatory reduction in NEPA [P = .99] and there was a decrease in SB as a result of increased structured exercise [P = .03].

Conclusion

Twelve weeks of supervised aerobic exercise resulted in significant weight (FM) loss. The effect of exercise was partially compensated by an increase in EI that was accompanied by an increase in hunger and a decrease in fullness throughout the day. There was no evidence for a compensatory reduction in NEPA and the structured exercise displaced some SB. Dietary intervention, as an adjunct to exercise, is required to offset the exercise-induced increase in EI and result in a greater reduction in body mass.

Obes Facts. 2018 May 26;11(Suppl 1):179.

T2P189 Association of physical activity and sedentary behaviour with visceral adipose tissue accumulation in participants from the PREDIMED-PLUS trial

A Galmés 1, J Konieczna 1, A Colom 2, I Abete 3, N Babio 4, Z Vázquez 5, M Fiol 2, J Salas-Salvadó 4, E Toledo 5, JA Martínez 3, D Romaguera 2

Introduction

Visceral adipose tissue (VAT) is a strong predictor of cardiometabolic health, while physical activity (PA) may have a positive influence on VAT accumulation and other aspects of body composition related to health. The aim of this study was to assess the cross-sectional association between baseline levels of physical activity and sedentary behaviour with VAT accumulation in a sample of older individuals with overweight/obesity and metabolic syndrome.

Methods

The present investigation is a cross-sectional analysis on baseline data within the frame of the PREDIMED-PLUS study in a sample of 969 men aged 55–75 and women aged 60–75 with ≥3 components of the metabolic syndrome, and BMI ≥27 - ≤40 Kg/m2. Levels of leisure-time PA (total, light, and moderate-vigorous, in METs.min/day) and sedentary behaviour (h/d) were evaluated using validated questionnaires. The chair test was used to estimate the muscle strength. VAT accumulation was assessed with DXA-CoreScan. Multivariable adjusted linear regression models were used to assess the association between our exposures and outcome.

Results

Mean (SD) total leisure-time PA was 462 (413) and 314 (260) METs. min/day in men and women respectively; Mean (SD) h/d of sedentary behavior was 2.83 (1.46) and 3.40 (1.70) and mean (SD) repeats in the chair test were 14.2 (4.7) and 12.6 (4.7) in men and women respectively. Men had a mean (SD) of 2697 (829) g of VAT and women 1751 (577) g. Total leisure-time PA (p-value 0.001), moderate-vigorous PA (p-value < 0.001) (but not light PA), and chair test repeats (p-value 0.001) were associated with lower VAT accumulation. On the other hand, h/d of sedentary behaviour was associated with greater VAT (p-value 0.001).

Conclusion

In older subjects with overweigh/obesity and metabolic syndrome, levels of PA (total and moderate-to-vigorous) and muscle strength were associated inversely, and sedentary behaviour positively with VAT accumulation. Time spent on light PA did not influence VAT depot.

Obes Facts. 2018 May 26;11(Suppl 1):179–180.

T2P190 Influence of endurance and endurance-strength training on inflammation state in women with abdominal obesity

D Skrypnik 1, M Szulińska 1, J Karolkiewicz 2, E Mądry 3, D Pupek-Musialik 4, J Walkowiak 5, P Bogdański 1

Introduction

Interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP) are markers of sub-clinical inflammation elevated in obesity. CRP is an independent predictor of cardiovascular diseases (CVD). The American Heart Association (AHA) recommends the use of CRP for detailed stratification of cardiovascular risk. Studies have shown that also IL-6 and TNFα are risk factors of CVD. Increased expression of the soluble receptor 2 of TNFα (sTNF R2) in adipose tissue in patients with obesity is also observed. The reduction of morbidity and mortality in patients with CVD after physical training is proven. The mechanism of this positive effect of exercise is not well understood. One of suggested mechanisms is the impact of exercise on pro-inflammatory mediators. The aim of this study was to compare the influence of 3 month endurance training and 3 month endurance-strength training on inflammatory markers in women with abdominal obesity.

Methods

38 women with body mass index ≥ 30 kg/m2 and waist circumference > 80 cm were randomized into groups A or B. Both groups underwent three-months long training comparable in exercise volume, with training session lasting 60 minutes. Group A performed endurance training on cycle ergometers. Group B underwent endurance-strength training with endurance component performed on cycle ergometers and strength component performed with the use of a neck barbell and a gymnastic ball. The total caloric, minerals and nutrients consumption were comparable between the groups and constant. At baseline and at completion anthropometric measurements were performed and blood samples were collected. Serum TNFα, sTNF R2, IL-6, IL-1 and CRP levels were measured with a double-antibody sandwich enzyme-linked immunosorbent one-step process assay.

Results

A decrease in serum CRP and sTNF R2 concentrations was observed in group B. In group A serum CRP and sTNF R2 concentrations tended to decrease, buy with no statistical significance. Neither endurance nor endurance-strength exercise led to changes in serum concentrations of IL-1, IL-6 and TNFα. There were no significant differences in serum concentrations of inflammatory markers between groups A and B before and after the training. In group B there were negative correlations between Δ (change of parameter after 3-month training) CRP serum concentration and Δ hip circumference, Δ CRP serum concentration and Δ total body lean mass, Δ CRP serum concentration and Δ total body fat-free mass, Δ sTNF R2 serum concentration and Δ resting heart rate.

Conclusion

Three-month endurance-strength training, unlike three-month endurance training alone, exerts a favourable effect on inflammatory state in women with abdominal obesity.

Obes Facts. 2018 May 26;11(Suppl 1):180.

T2P191 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):180.

T2P192 Fitness measured using a simple Step Test is associated with body fat levels in 5-year-old children: Findings from the ROLO Kids Study

A A Geraghty 1, EC O’Brien 1, MK Horan 1, E Larkin 2, J Donnelly 2, FM McAuliffe 2

Introduction

Fitness in children has declined worldwide alongside the high levels of childhood obesity. Cardiovascular fitness is important for good health and low levels have been linked with metabolic risk factors and adverse body composition in adults. However research on fitness in young children and how this is related to body composition is limited, along with a lack of simple methods of estimating fitness in 5-year-old children.

Methods

Analysis was carried out on 272 5-year-old children from the ROLO Kids study. Using a 25cm step, the children stepped up and down as many times as possible for 3 minutes. A pedometer was worn to record number of steps. Participants had their heart rate measured before the test, after the 3 minutes and monitored until it returned to resting. Heart rate recovery time was calculated. Child anthropometry including height, weight, circumferences and skinfold thickness were collected. T-tests and linear regression models were used.

Results

Males had a significantly quicker heart rate recovery after completing the step test than females (113 seconds vs.129 seconds, P < 0.05). Participants with a slower recovery time (>105 seconds) had higher sum of skinfolds compared to participants with a quicker recovery time (37.9cm vs. 35.0cm, P = 0.03). Heart rate recovery remained positively associated with skinfold measurements after controlling for confounders, including child sex, age, step number and effort rating.

Conclusion

Child adiposity was positively associated with heart rate recovery, a proxy for cardiovascular fitness, using the ROLO Kids Step Test. This novel test could be used as a measure of fitness in 5-year-old children, suitable in both research and clinical settings. Replication and validation of these findings is required to provide a valid method of tracking children's fitness and health.

Obes Facts. 2018 May 26;11(Suppl 1):180–181.

T2P193 Overweight is related to level of physical activity, but not with sedentary behavior in adolescent girls

N Leite 1, LMS Brito 1, FJ Menezes-Júnior 1, IC Jesus 1, PRP Corazza 2, MC Tadiotto 2, DA Michel 2, AM Sulzbach 3, KSM Purim 3, LV Tureck 4, L Furtado-Alle 2, J Mota 5

Introduction

Sedentary behavior (SB) and reduction in moderate-to-vigorous physical activity (MVPA) are health problems associated with increase of overweight (OW) in adolescent population. The therapeutic for obesity and comorbidities include nutritional guidance, to increase MVPA and reduction of SB. The objective of this study was to evaluate the frequency of OW in female adolescents, relating the anthropometric measures to time spent in SB and level of physical activity (LPA).

Methods

484 girls from a public educational institution in the South of Brazil, were selected randomly, and divided according to age into three groups: G1 (n = 48, 10–11 years) G2 (n = 384, 12 to 15 years) and G3 (n = 52, 16 to 18 years). Anthropometric measures of weight and height were evaluated. The z-score body mass index (BMI-z) was calculated. The sample was classified as adequate weight (≤ 1 standard deviation) or overweight (> 1 standard deviation). The time spend in SB was evaluated by means of the Adolescents Sedentary Activity Questionnaire and the MVPA by a questionnaire on energy expenditure. The time in SB was classified as low SB (< 2h / day) or high SB (> 2h / day), subdivided weekly (days of the week or weekend). The LPA was calculated from the daily quotient between energy expenditure and the basal metabolic rate of the adolescent during physical activity, classified as mild (mPA) (< 1.56) and MVPA (>1.64). For the analysis of the data, we used ANOVA to identify differences between the groups, chi-square for the differences in proportions, as well as the multiple linear regression model to evaluate the relationship between the BMI-z, SB and LPA, with significance of p < 0.05.

Results

The frequency of OW was similar between the groups, 30.1% (10.4% obesity) in G1, 19.3% (5.2% obesity) in G2 and 11.5% (1.9% obesity) in G3. The frequency of MVPA was lower in G1 (20.8%, p < 0.05) than G2 (35.6%) and G3 (40.4%). LPA average was lower in G1 than G2 (p < 0.001) and G3 (p < 0.001). The proportions of SB were similar during the week to G1 (56.3%), G2 (46.9%) and G3 (51.9%) and on weekends between G1 (70.8%), G2 (71.4%) and G3 (69.2%). The groups were similar to BMI-z and the time of SB at weekends. However, the G1 presented higher time values in SB on weekdays than G2 (p = 0.002). In addition, girls with MVPA were oldest (p = 0.003) and showed higher BMI-z than girls with mPA (p < 0.001). The regression model showed direct and moderate correlation between the BMI-z and the LPA (r = 0.53; p < 0.001), but not with the time spent in SB in adolescent girls.

Conclusion

Our study showed that MVPA was associated with higher age and BMI-z in adolescent girls, but the groups presented similar proportion of SB. Probably, overweight girls are performing physical activities as therapy for weight reduction.

Obes Facts. 2018 May 26;11(Suppl 1):181.

T2P194 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):181.

T2P195 The effect of frequency and duration of exercise on body composition and anthropometric measurements

O Yesildemir 1, N Acar Tek 2

Introduction

Body composition and anthropometric measurement values, especially body weight and BMI, are associated with decreased physical activity rather than increased energy intake. Regular exercise improves body composition by providing weight loss, increasing muscle mass and reducing body fat mass. In this study, the relationship between exercise duration and frequency with body composition and anthropometric measurements was investigated.

Methods

This study was conducted with 206 volunteers (102 males, 104 females) aged 19–55 years. Participants have been exercising at least twice a week in the fitness/cardio hall and/or the swimming pool and/or the plates hall. The data were collected using face-to face interview method via questionnaire form. The duration and frequency of exercise were recorded in the questionnaire form. Individua lanthropometric measurements were taken and body composition was measured by BIA. The statistical analysis was conducted with SPSS 15.0 using correlation analysis.

p < 0.05 p < 0.01 The comporison of duration and frequency with anthropometric measurement and body composition are shownTable. There is a positive correlation between exercise frequency and height, total body water and fat free mass (p < 0.01). Similarly, there is a positive correlation between exercise duration and height, total body water and fat free mass (p < 0.01). On the contrary, there was a negative correlation between body fat percentage and both frequency and duration of exercise (p < 0,05). There was a positive correlation between duration of exercise and body weight (p < 0.05).

Conclusion

In this study, as the duration and frequency of exercise increase, body fat percentage decrease and fat free mass increase. Inaddition, as the duration of exercise increases, body weight also increases. This condition can be related to the increase in fat free mass as the duration of exercise increases. In order to reduce the risk of disease and maintain a healthy life, exercise should be continued for a certain duration and frequency. For this reason, a moderate intensity exercise of 150 minutes per week (30 minutes per day) is considered sufficient for adults to achieve the desired body composition values.

Results

 

Tab. 1.

 Male (n = 102)
 Female (n = 104)
 Total (n = 206)
Frequency
 Duration
 Frequency
 Duration
 Frequency
 Duration
r
 r
 r
 r
 r
 r
Height (cm) 0.157 0.179 –0.121 –0.150 0.217** 0.227**
Body weight (kg) –0.043 0.017 0.020 –0.018 0.127 0.152*
Body mass index (kg/m2) –0.101 –0.046 0.077 0.048 0.040 0.057
Body fat percentage (%) –0.110 –0.127 0.130 0.072 –0.169* –0.208*
Fat mass (kg) –0.081 –0.076 0.084 0.028 –0.078 –0.125
Total body water (kg) 0.000 0.098 –0.085 –0.090 0.220** 0.269**
Fat free mass (kg) 0.001 0.100 –0.080 –0.084 0.222** 0.271**
Waist circumference (cm) –0.078 0.011 0.000 –0.045 0.094 0.120
Hip circumference (cm) –0.71 0.027 0.093 0.080 0.034 0.078
Waist/hip ratio 0.002 0.002 –0.122 –0.162 0.127 0.122
Waist/height ratio –0.135 –0.055 0.024 0.000 0.016 0.041
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Obes Facts. 2018 May 26;11(Suppl 1):181.

T2P196 Evaluation of Activities of Daily Living and Abdominal Obesity in Healthy Individuals

B Deniz Güneş 1, N Acar Tek 1, G Akbulut 1

Introduction

In addition to adequate and balanced nutrition in maintaining body composition, there is a need for a lifestyle that is maintained with regular exercise habits. Abdominal obesity is an indication of visceral fat. Even if the body weight is normal, abdominal obesity is accepted as a risk factor for many diseases. This study was conducted to evaluate abdominal obesity in individuals with normal body mass index and correlate them with activities of daily living.

Methods

A total of 334 individuals (98 male, 236 female) aged between 18 and 29 years participated in the research. A questionnaire was applied to question the demographic characteristics, physical activity status of the individuals and anthropometric measurements such as body weight, height, waist, hip, neck circumference were taken. Waist/hip ratios and waist/height ratios, a marker of abdominal obesity, were calculated. Waist circumference >102 cm in males, >88 cm in females, waist/hip ratio in males >0.90, females >0.85 and waist/height ratio ≥0.5 indicated the presence of abdominal obesity.

Results

The BMI classification of the individuals participating in the study was in the normal range and the average age of the individuals was 21.6 ± 1.73 years. The proportion of participants with regular physical activity was 14.7%. When daily activities were questioned, it was determined that they spent most of their time watching TV-sitting-reading (610.0 ± 207.10 min), sleeping (473.9 ± 69.00 min) and standing office work (374.9 ± 225.37 min). Individuals had abdominal obesity at 2.1% according to waist circumference, 17.4% according to waist/hip ratio and 11.1% according to waist/height ratio. Positive correlation was found between sitting time and waist circumference, waist/hip ratio, waist/height ratio (r = 0.175, p < 0.01; r = 0.144, p < 0.01; r = 0.234, p < 0.01, respectively). A negative correlation was determined between the standing office work time and waist/height ratio (r = −0.130, p < 0.05). There was no statistically significant difference between abdominal obesity and regular activities (p > 0.05).

Conclusion

The prevalence of abdominal obesity was high in individuals with normal BMI. It should be emphasized that this is a situation that should be taken into consideration for underweight and normal individuals. For this reason, abdominal obesity should be assessed to prevent cardiovascular risks, metabolic syndrome and other related chronic diseases in non-obese people.

Obes Facts. 2018 May 26;11(Suppl 1):181–182.

T2P197 Profile of Physical Activity and the Risk of Obesity in Medical Students

GM Magalhães 1, CP Tavares 1, FT Queiroz 1, JB Rocha 1, MM Banharo 1, CS Moreira 1, M Marins 1, VM Morgado 1, SR De Souza 2, LS Da Costa 1

Introduction

According to the Word Health Organization, performing physical activity (PA) results in less chance of coronary heart disease development, hypertension, diabetes, obesity, heart attack, colon and breast cancer and depression, in addition to promote quality of life (QOL) improvement. Some studies show that students perceptions about QOL during your college experience are essentially related to the levels of academic support. Thus, it is considered that the level of subject PA is crucial in promoting health and QOL in medical students and have important role to disseminate information in society, that could modify the community culture and habits where they are inserted.

Methods

This subset study is a part of an observation study with cross-sectional delineation, with data collected through the application of an anonymous questionnaire. The collection of these data was the basis of an instrument for assessing the QOL of the medical students of this College. For descriptive purposes, we analyze gender, age, BMI (Body Mass Index), year, place and frequency of PA, type of exercise performed and time spent per week with PA. The objective of this study is to identify the profile of PA on medical students of a private College in Rio de Janeiro, Brazil.

Results

Of the 490 students with an average age 21.7 years (16–42 years), 64 .1% female, 75.1% practiced PA prior to entered the medical college, but 38.4% decreased the frequency after initiated the college, 22.2% perform regular PA three times a week, 44.5% practice anaerobic and aerobic PA and 28.6% are sedentary. Among the male participants, 83% vs.70.7% female, practiced PA before starting the Medicine course (p = 0.003), both with reduced frequency after admission in college (38.1% vs.38.5%, respectively, p = NS). The combined aerobic and anaerobic activities predominates in both genders. Comparing the data obtained between the first and second years (Group A), with the fifth and sixth years students (Group B), statistically significant relative sedentary (A 34.5% vs. 23.3% B) and reduction PA after admission in college (A 33% vs. 56.7% B).

Conclusion

Physical inactivity may be considered a primary and independent risk factor for the development of obesity. Thus, it is important to implement strategies that stimulate physical activity, especially in young people, since the prevalence of obesity in this age group has increased exponentially. Special attention should be paid to medical students who present risk factors for disease development, particularly physical inactivity. Studies confirm that the teaching model full-time activities imposed in medicine schools reduces the time required to adapt personal habits and maintain a good QOL.

Obes Facts. 2018 May 26;11(Suppl 1):182.

T2P198 Determination of reference values for the 6-min walk test for obese patients

I Nobre 1, J Nazare 2, C Fantin 1, C Leandro 3, E Disse 2

Introduction

The 6-Min Walking Test (6MWT) is widely performed to measure functional capacity of individuals in various conditions including obesity, which is associated with reduced mobility and capacity. However, the applicability of reference values obtained from healthy normal-weight population for the obese population is discussed. The study aimed at developing a cross-validated sex-specific reference equation for the 6MWT in obese adults.

Methods

793 obese patients (BMI ≥ 30kg/m2) hospitalized for initiation of obesity care management were included. Anthropometric measures and 6MWT were evaluated. Patients were divided into two groups: a group used to develop the equation (n = 552) and a cross-validation group (n = 241). The proposed equations were compared to 11 other equations from the literature, specific to healthy or obese adults from different countries.

Results

The distance walked in 6MWT was inversely proportional to BMI values. 2 equations were developed for women and men respectively: Ob-6MWTWomen = 18.584 – (3.758*ageyear – (2.212*weightkg) + (4.18*heightcm); Ob-6MWTMen = 57.459 – (3.291*ageyear) – (1.655*weightk) + (4.509*heightcm). These equations explained 39.4% and 45.4% of the total variance for men and women respectively (p < 0.001). Predictive Precision (PP) and Mean Absolute Percent Error (MAPE) were evaluated in the total sample, by sex and by BMI category. Ob-6MWT equation was the most accurate with a PP of 47.3% for the total population, but also for men and women separately, compared to other equations. For BMI, Ob-6MWT equation was the most accurate for women in all BMI categories, and was the second most accurate equation for men. All the others 11 equations overestimated the values measured in the 6MWT, while Ob-6MWT equations had 30% overestimated and 22% underestimated data. In both men and women, MAPE was lower with Ob-6MWT equations.

Conclusion

We propose 6MWT equations specifically developed to assess functional ability to exercise in obese men and women, regardless of their BMI category. Considering that the equations reported in the literature have a lower overall predictive capacity for 6MWT, the development of specific equations appears more accurate and relevant to evaluate the exercise capacity of obese individuals.

Tab. 1.

Validation set
 Mean
SD
 Predictive precision
 Under prediction
 Over prediction
 MAPE
 P value
n = 241 m m % % % %
Measured 6MWT 426.1 +/– 112.6
Ob-6MWT 440.1 +/– 67.4 47.3 22.4 30.3 5.2 0.25
Masmoudi 2009 486.4 +/– 70.6 41.1 5.8 53.1 6.0 0.001
Alameri 2009 473.9 +/– 28.0 39.0 0.0 61.0 6.6 0.001
Enright 1998 497.3 +/– 94.8 33.2 7.9 58.9 6.2 0.001
Capodaglio 2012 534.1 +/– 48.6 29.9 0.0 70.1 7.4 0.001
Iwana2009 555.6 +/– 39.4 23.7 0.0 76.3 8.2 0.001
Ben Saad 2009 550.4 +/– 104.5 21.2 1.7 77.2 7.6 0.001
Osses2010 551.4 +/– 59.3 17.0 0.0 83.0 7.9 0.001
Chetta 2006 567.3 +/– 53.4 14.5 0.0 85.5 8.5 0.001
Troosters 1999 617.6 +/– 98.3 4.1 0.0 95.9 9.6 0.001
Camarri 2006 654.3 +/– 52.7 0.0 0.0 100.0 10.8 0.001
Gibbons 2001 677.8 +/– 56.0 0.0 0.0 100.0 11.3 0.001
Open in a new tab
Obes Facts. 2018 May 26;11(Suppl 1):182–183.

T2P199 Anthropometric indicators of general and abdominal fat and dementia in older women from southern Brazil

AR Barbosa 1, V D’ Meneghini 1, E Orsi 1, S C Confortin 1

Introduction

The relation of general and abdominal fat to dementia is controversial. The present study investigate the association of anthropometric indicators of general and abdominal fat with dementia in older women from southern Brazil.

Methods

This cross-sectional study analyzed data from the second wave (2013/14) of a population- and household-based survey. Dementia was defined according to the combination of low score for the Mini-Mental State Examination and moderate/severe dependence in the activities of daily living. The independent variables were categorized as tertiles: body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and conicity index. The associations were explored using logistic regression (crude and adjusted), expressed in terms of odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 778 older women (mean age, 74.9 ± 7.3 years) were interviewed, and the estimation of the prevalence of dementia was 17.5%. After adjustments (sex, age, income level, smoking, alcohol consumption, physical activity and geriatric depression scale) all indicators were associated with dementia. The outcome was more than twice as high among those with anthropometric indicators in the upper tertile compared to those in the lowest tertile (table 1).

Conclusion

The results of this study suggest that older women with higher values of BMI, WC, WHtR and conicity index are more likely to present with dementia. The results highlight the importance of these anthropometric indicators of general and abdominal fat in the assessment to prevent dementia.

Tab. 1.

Crude and adjusted analyzes of the association between anthropometric indicators of general and abdominal fat and dementia in older women

 OR (95% CI)
 p
 OR (95% CI)
 p
Body mass index (kg/m2) 0.068 0.011
<25.7 1.00 1.00
25.7 to 29.5 0.82 (0.38–1.77) 1.17 (0.53–2.58)
>29.5 1.76 (0.90–3.45) 2.46 (1.20–5.07)
Wait circumference (cm) 0.008 0.006
<89.0 1.00 1.00
89.1 to 99.9 0.87 (0.47–1.59) 1.19 (0.56–2.52)
> 99.9 2.01 (1.25–3.24) 2.25 (1.28–3.96)
Waist-to-height ratio 0.001 <0.001
<0.57 1.00 1.00
0.57 to 0.63 0.87 (0.38–1.96) 1.12 (0.45–2.78)
>0.63 2.93 (1.64–5.22) 3.00 (1.51–5.94)
Conicity index <0.001 0.005
<1.28 1.00 1.00
1.28 to 1.36 1.79 (1.08–2.96) 1.51 (0.82–2.76)
>1.36 2.88 (1.71–4.48) 2.45 (L34–4.50)
Open in a new tab
Obes Facts. 2018 May 26;11(Suppl 1):183.

T2P200 Review of food based dietary guidelines for infants and young children and subsequent evaluation of processed cereal based food and baby food currently in the market

E Grammatikaki 1, J Wollgast 1, S Caldeira 1

Introduction

Introducing children to healthy and diverse foods at an early age helps to establish taste preferences and good eating habits later in life. Processed cereal based food (PCBF) and baby food are designed to satisfy the nutritional requirements of healthy infants and young children, and are intended for use by infants while they are being weaned and by young children as a supplement to their diet and/or for their progressive adaptation to ordinary food. However the current EU compositional requirements for such products date back to 1990 and therefore need to be updated.

Methods

We compiled existing food based dietary guidelines (FBDGs) and recommendations in the context of infant and young child feeding (from 4/6 months to 3 years old). An EU survey complemented the review. We also extracted information from a commercial database on the composition of PCBF and baby food currently on the market.

Results

In general, FBDGs recommended the Introduction of weaning foods not earlier than at the beginning of the 5th month and no later than at the beginning of the 7th month. Most of the FBDGs emphasised the importance of consuming a varied diet, opting for low fat, low sugar and low salt products. Many of the countries had specific recommendations regarding the consumption of fruit juices. In addition, the FBDGs indicated some foods that should be consumed in moderation or not at all to avoid allergies and/or excessive or insufficient intakes of some nutrients or other substances. Nutrition information regarding energy, protein, carbohydrates, sugars, fat, saturated fat, sodium and dietary fibre was extracted for a total of over 4500 PCBF and baby food products. An in-depth evaluation was done based on the core recommendations that came out of the FBDGs review.

Conclusion

We reviewed the national FBDGs and based on the core recommendations, we evaluated the PCBF and baby food products currently in the market. Our results will inform the revision of the EU compositional requirements for PCBF and baby food that is currently underway.

Obes Facts. 2018 May 26;11(Suppl 1):183.

T2P201 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):183.

T2P202 Applying information technology to develop an integrated mobile cloud computing in diabetic patients

C Lu 1

Introduction

Mobile cloud computing (MCC) is an integration of cloud computing into the mobile environment which brings new types of services and facilities for mobile users. The study aimed to design a MCC to integrate personal information and offer diabetic patients a route for self-managed health by App.

Methods

There was three parts of MCC: cloud service, network service and users. First, the cloud service was coordinated by physicians and operated by case managers. The content included data access, security and privacy, data exchange with data bank, cloud message which send message from case managers to patients and receive message from patients to case managers. Second, network service mainly consisted of delivering information, lab data, vaccination records, and appointment from the original data center. Third, the users got information from App (IOS and/or Android system).

Results

The established MCC integrates personal medical record of diabetes, past vaccination record, and personal habits such as smoking and drinking. Except information integrating, the MCC reminds personal medical appointment, vaccination schedule and regular self-manged health such as checking blood pressure, fasting blood sugar, body weight, etc. Twitter system was applied to remind patient for regular check. Furthermore, the MCC sets a platform for announcement of educational and medical news, experiencing sharing and questions about diet, exercise, diabetic complications, etc. In our study, we used secure sockets layer (SSL) for safety control.

Conclusion

MCC, a combination of cloud computing and mobile web, is notable for the easy access, storage service in cloud and is challenged for the safety and privacy of personal information. Applying MCC in type 2 diabetes could improve personal health by providing a route to easily capture relevant personal information of their diabetes control. Our apps integrates multiple functions including personal habits, preventive medicine, immunization history, cancer screening, and etc. In the future, our team will try to facilitate the usage of the multifunctional MCC in the diabetic patients who joined diabetes share-care network in the outpatients department.

Obes Facts. 2018 May 26;11(Suppl 1):183.

T2P203 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):183–184.

T2P204 The framing of obesity in local government policy across England

J Nobles 1, K Pickering 2, J Saunders 1, M Butler 1, C Weir 1, D Radley 1, P Sahota 2, P Gately 1

Introduction

Obesity is a product of many complex, multi-faceted, and systemic factors. The recent publication of the Childhood Obesity Plan by the UK government reflects a move towards recognising complex adaptive systems as important, however much of the previous national discourse and policy framed individuals with obesity as responsible for the causation of, and solution to, their weight. Framing often determines the prescribed solution and the UK government have historically positioned themselves as facilitators; helping individuals to help themselves in making healthier choices. As of 2013, much of the responsibility for preventing and treating obesity in England was transferred to local government organisations (Local Authorities [LAs]). Whilst the national government framing of obesity is known, the LA position remains somewhat unknown.

Methods

The approach taken by four LAs in England between 2008 and 2016 was investigated through an analysis of publicly available LA documentation, including: Director of Public Health Annual Reports, Health and Wellbeing Strategies, Joint Strategic Needs Assessments, Sustainable Community Plans, and Obesity/Healthy Weight Strategies. A collective of 46 documents were analysed using an adapted framework of Jenkin et al., (2011). This framework systematically appraises four framing devices, namely: the position on obesity; the causal roots of obesity; the solutions to obesity; and, the core values towards obesity.

Results

LAs predominantly framed obesity as a matter of individual responsibility; an issue which is caused by unhealthy lifestyle behaviours, and exacerbated by the obesogenic environment. Seldom was individual biology, individual psychology, food production, and the physical activity environment mentioned as pertinent causal factors. As a result, the prescribed solutions focused on enhancing public knowledge on how to make an informed, healthy choice (e.g., through social marketing campaigns, physical activity promotion, breastfeeding support groups, weight management services). Some action sought to modify the environment (e.g., fast food outlet restriction, school playground redesign, cycle infrastructure), however these were infrequent. National policy was heavily cited in the LA documentation, and the local approaches heavily mirrored the approach advocated by national government.

Conclusion

The role of the LA was to help people, help themselves, to make healthier choices and the preponderance of action thus aimed at individual-level behaviour change (prevention and treatment). However, the extent to which the local approach – and the framing of obesity – was driven by the ideological positioning of the LA is unclear; the tones of earlier national policy were present in LA documentation. LAs subtly acknowledged the complex aetiology of obesity, but if the framing of obesity was to truly account for this complexity, a whole systems response may start to be implemented.

Obes Facts. 2018 May 26;11(Suppl 1):184.

T2P205 Future trends in social inequalities in overweight and obesity in England, Scotland and Wales

L Keaver 1, L Webber 2, C Pérez-Ferrer 3

Introduction

It is well documented that obesity prevalence is increasing in all countries worldwide, generating a serious health burden in populations. Previous studies, have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in England, Scotland and Wales.

Methods

BMI data for England, Scotland and Wales from the Health Survey for England (2004–2014), Scottish Health Survey (2008–2014) and the Welsh Health Survey (2004–2014) respectively. A nonlinear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035

Results

Routine and manual jobs are projected to have the highest prevalence of obesity in 2035 and also experience the highest increases in obesity prevalence to 2035. The social inequalities gap between those in managerial roles and those in routine & manual roles is projected to widen in both countries (England and Wales) with the exception of English females where it is projected to reduce. In terms of educational impacts on overweight prevalence, the gap between those with less than tertiary education and those with tertiary education is reducing in England and Wales and increasing in Scotland. The social inequalities gap in obesity is projected to decrease in all countries with the exception of Welsh females where it is projected to increase.

Conclusion

It is important that future interventions and action in this area are accessible to all and are designed to impact all sectors in society to further reduce these inequalities.

Obes Facts. 2018 May 26;11(Suppl 1):184.

T2P206 Impact of Education on Lifestyle Interventions to Reduce Gestational Weight Gain – Individual participant data meta-analysis from the International Weight Management in Pregnancy (i-WIP) collaboration

EC O’Brien 1, R Segurado 2, G Alberdi 3, AA Geraghty 3, FM McAuliffe 3; I-Wip (International Weight Management In Pregnancy) Collaborative Group

Introduction

Pregnancy outcomes, including gestational weight gain (GWG), are negatively influenced by low socioeconomic status. Lifestyle interventions aim to manage GWG, but few stratify analyses by socioeconomic status. We aimed to identify if socioeconomic status is a prognostic factor for GWG, and to determine the differential effects of lifestyle interventions (diet-alone, exercise-alone or mixed approach) on GWG, according to socioeconomic status.

Methods

Data from the International Weight Management in Pregnancy (i-WIP) Network were used, including 21 RCTs and 5,183 participants. The PRISMA-IPD Statement guidelines and pre-specified protocol were followed. The outcome GWG was analysed as: (a) inadequate, adequate, and excess per the Institute of Medicine (2009) guidelines, and (b) as kg/week. Maternal educational attainment was used as a proxy for socioeconomic status and women were categorised as having higher education (at least some tertiary education) or lower education (secondary education or less). IPD meta-analyses were performed using one-step generalised linear mixed models.

Results

Women of lower educational attainment had increased risk of excessive (OR: 1.182) and inadequate (OR: 1.284) GWG. Among women with lower education, diet-alone interventions reduced risk of excessive and inadequate GWG (OR: 0.515; 0.504, respectively), and reduced kg/week gain (B = −0.055). Mixed interventions reduced risk of excessive GWG for women with lower education (OR: 0.735). Among women with high education, diet-alone interventions reduced risk of excessive GWG (OR: 0.609), and mixed interventions reduced kg/week gain (B = −0.053). Exercise-alone interventions did not impact GWG in the total cohort, nor stratified by education.

Conclusion

Pregnant women with lower education are at an increased risk of excessive and inadequate GWG, highlighting the need for targeted intervention in this vulnerable population. Diet-alone interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial. Women with higher education also benefited from diet-alone interventions. Exercise-alone interventions did not impact GWG. Healthcare professionals should consider tailored nutrition based interventions as part of baseline maternity care packages, for all women.

Obes Facts. 2018 May 26;11(Suppl 1):185.

T2P207 Interprofessional Collaborations Leading to Seating Solutions for Persons with Obesity

M Forhan 1, R Lederer 2

Introduction

Persons living with obesity face many challenges in their everyday lives interacting with objects in the built environment. A considerable problem is finding a suitable place to sit. Most of the chairs that inhabit domestic, work and public spaces are designed with little or no consideration for this user group. The objectives of this project were to design various seating solutions that meets the needs of persons living with obesity.

Methods

A team of instructors from industrial design and occupational therapy offered a course to students enrolled in an industrial design program. The purpose of this course was to design a seating solution for persons with obesity. Students spent time in the classroom learning about obesity. Then students spent time interviewing persons living with obesity (clients) to gather information to inform their design. Each student prepared design models and presented them to their clients for feedback.

Results

Several diverse seating options were designed and rendered in small-scale models that aim to provide bariatric sensitive and appropriate solutions for use in the community, home and work setting.

Conclusion

An inter-professional course in industrial design was effective in producing a range of viable design solutions aimed to foster opportunities for accessible and aesthetic seating for persons living with obesity.

Obes Facts. 2018 May 26;11(Suppl 1):185.

T2P208 Impact of obesity and anthropometric parameters on the qualities of life and sleep: A pilot study

J E Poletto 1, DV Tezoto-Rizzo 2, L Baltieri 2, EC Cândido 2, LBDS Jaroslavski 2, AM Neder 2, RC Gobato 1, DAO Modena 1, E Cazzo 1, É A Chaim 1

Introduction

Obesity is a disease characterized by the accumulation of abnormal or excessive fat that causes health damage that may lead to impairment of both qualities of life (QoL) and sleep (SQ). The aim of this study was to evaluate the QoL and SQ of obese patients, grades II and III, attended at the Bariatric Surgery Outpatient Service of the State University of Campinas.

Methods

This is a cross-sectional study involving 30 female subjects. The anthropometric variables analyzed were: weight, body mass index (BMI), mean abdominal circumference (ABC) and percentage of fat (%F). The QoL was assessed by the questionnaire World Health Organization Quality of Life Assessment Bref (WHOQOL BREF), with two general issues and 24 facets divided into four domains: Physical, Psychological, Social Relations and Environment. For the SQ assessment, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the Berlin questionnaire to identify Obstructive Sleep Apnea Syndrome. The data were transcribed to the SPSS program (Statistical Package for Social Science) v.13.0. The Shapiro-Wilk test was used to verify the normality of the data and the Spearman Correlation test to verify the correlations between the variables.

Results

The weight presented significant negative correlations with the general QoL (R = −0.541; p = 0.002) and with the domains “Physical” (R = −0.421; p = 0.021), “Psychological” (R = −0.399; p = 0.029) and “Social relations” (R = −0.416; p = 0.022). The BMI showed significant negative correlations with the general QoL (R = −0.423; p = 0.020) and with the domains “Psychological” (R = −0.432; p = 0.017), “Social relations” (R = −0.512; p = 0.004) and “Environment” (R = −0.447; p = 0.013). ABC presented a significant negative correlation with the general QoL (R = −0.460; p = 0.011). And the %F showed significant negative correlations with general QoL (R = −0.491; p = 0.006) and with all domains of QoL, “Physical” (R = −0.375; p = 0.041), “Psychological” (R = −0.398, p = 0.030), “Social relations” (R = −0.444, p = 0.014) and “Environment” (R = −0.396, p = 0.030). Anthropometric measurements have not presented significant correlations with SQ.

Conclusion

Obesity and anthropometric parameters presented a significantly negative impact on QoL. They are associated with physical and mental health impairment, make social and sports activities more difficult, lead to dependency and cause deficit in functional capacity. Although the statistical analysis of the SQ has not presented a significant correlation with the anthropometric variables, the patients’ reports, during the completion of the questionnaire, revealed the difficulty they present in sleeping and the presence of sleep deprivation in their daily routine.

Conflicts of Interest

PhD Scholarship – CAPES

Obes Facts. 2018 May 26;11(Suppl 1):185.

T2P209 Influence of weight loss on levels of adipokines and asthma control among asthmatic individuals with obesity: One-year follow-up

L Baltieri 1, E Cazzo 2, RDP Vieira 3, J E Poletto 2, LC Martins 2, É A Chaim 2

Introduction

Asthma is a chronic inflammatory disease of the airways and is associated with hyperresponsiveness leading to episodes of wheezing, dyspnea, chest tightness and coughing. The obese individual is more likely to develop asthma in comparison to eutrophic, but the exact mechanism is still uncertain and several hypotheses have been raised, such as the inflammatory hypothesis, related to the release of inflammatory mediators secreted by adipose tissue.

Objective: To evaluate the prevalence of asthma in obese patients (grade II and III), and longitudinally evaluate the effects of weight loss in these patients submitted to bariatric surgery, regarding symptomatology, local and systemic inflammatory process.

Methods

The study evaluated patients undergoing bariatric surgery (gastric bypass) with diagnosis of asthma, except smokers. The patients were evaluated at the time of entry into the group (T1), just before bariatric surgery (after initial weight loss - T2), after six months of surgery (T3), and after 12 months of surgery (T4). The following were measured: anthropometric data, dosage of systemic inflammatory markers by means of blood collection, local inflammatory markers dosing by induced sputum collection, and symptomatology by the ACT questionnaire (Asthma Control Questionnaire).

Results

The prevalence of asthma in the study was 4.57% in a sample of 4,791 obese subjects. Twenty-one patients participated in the study. In relation to the analysis of the pulmonary inflammatory profile, there was an increase in adiponectin in T3 (p-value = 0.0345), reduction of IL-6 (p-value = 0.0002), IL-8 (p-value = 0.0001), TNF-α (p-value = 0.0036) and PCR (p-value = 0.0010). In relation to systemic inflammation, there was a reduction of TNF-α (p-value < 0.0001) and of CRP (p-value = 0.0417). There was also improvement in asthma control.

Conclusion

There was a prevalence of asthma of 4.57% in the study population and there was improvement in the symptomatology of asthma after weight loss, as well as in the systemic and local inflammatory profile.

Conflicts of Interest

São Paulo Research Foundation (FAPESP), process number 2014/06293-2

Obes Facts. 2018 May 26;11(Suppl 1):186.

T2P210 Correlation of vitamin D status with obesity among young male workers

R Meseri 1, O Kucukerdonmez 1, RN Akder 1, E Canbay 2, E Sozmen 2

Introduction

Obesity is ever increasing in all age groups and some studies found that insufficient vitamin D status was associated with obesity. The objective of this study was to evaluate the correlation between Vitamin D statuses and obesity among young male adults working in a factory.

Methods

In this cross-sectional study, the study sample was the male factory workers (n = 650). All the volunteers were included in the study and no sample was selected (n = 123). Obesity status was the dependent variable whereas socio-demographic variables, working characteristics, health history and serum vitamin D status. Obesity was determined via 1. Percent Body Fat (PBF), 2. Body Mass Index (BMI), 3. Waist Height Ratio (WHtR). The ones who had PBF ≥ 25% or BMI ≥30 kg/m2 or WHtR ≥ 0.5 were considered obese. A venous blood sample was taken after 12 hours of fasting to determine serum vitamin D status and was analyzed via Ultra performance liquid chromatography - tandem mass spectrometer (UP-LC-MS/MS). Serum Vitamin D status was evaluated as ≤10 ng/ml severely deficient, 11–20 ng/ml deficient, 21–29 ng/ml insufficient and >30 ng/ml sufficient. Data was collected at the working place three consecutive weeks in order to catch all the volunteers working in different shifts. Data was analyzed in SPSS 15.0 via independent samples t test and chi-square tests. For correlation analysis, Pearson correlation coefficient was used and p < 0.05 was deemed significant. The study was approved by an independent ethics committee and a written informed consent was obtained from every participant.

Results

Mean age (n = 123) was 34.34 ± 6.20 and most of the participants (65.0%) had at least 12 years of education. One third (32.5%) stated that they had a diagnosed disease whereas three quarters (74.6%) defined their health status as well or very well. Among participants, 56.9% were overweight and 17.1% were obese according to BMI, 78.0% according to WHtR and 28.5% according to PBF. Mean serum vitamin D was 18.11 ± 7.99 and 70.7% had serum vitamin D ≤20 ng/ml. Obesity was moderately but significantly correlated with metabolic blood parameters. As obesity increased, LDL-C and total cholesterol increased, HDL-C decreased. When liver tests were evaluated, ALT had a significant moderate positive correlation with obesity as well as uric acid. Serum vitamin D status was not significantly correlated with any of the obesity indices (Table 1).

Conclusion

As a Conclusion, obesity and insufficient serum vitamin D status was prevalent among young adult male workers. Obesity was correlated with some blood parameters but not serum vitamin D status. Shift workers must be monitored for daily sun exposure and serum vitamin D status.

Tab. 1.

Correlation between metabolic blood parameters and obesity

 WHtR
 PBF
 BMI
LDL-C 0,277 0,372 0,238
HDL-C –0,319 –0,242 –0,348
Total-C 0,305 0,304 0,238
Triglyceride 0,204(*) 0,111 0,150
FBG† 0,248 0,089 0,151
HbA’c 0,193(*) 0,054 0,100
insulin 0,290 0,240 0,294
HOMA-IR 0,217(*) 0,153 0,212(*)
AST 0,135 0,038 0,088
ALT 0,431 0,416 0,432
Uric Acid 0,392 0,438 0,417
25OHD3 –0,169 –0,109 –0,144
Open in a new tab
†

Fasting Blood Glucose

*

p < 0.05; Bold indicates p < 0.001

Obes Facts. 2018 May 26;11(Suppl 1):186–187.

T2P211 Effects of physical-educative interventional program on body composition of rural elderly women

P J Ruiz-Montero 1, A Castillo-Rodríguez 2, JC Fernández-García 3

Introduction

The ageing affects to living organisms and produces a continuous degenerative change in most physiological functions of people, specifically in body composition. Body composition changes are considered as direct cause of chronic diseases in elderly people1. The aim of the present study is to compare the differences of body composition characteristics according to physical activity levels and population of different geographical locations between active and inactive rural elderly women.

Methods

The total sample of participants included in the present study was composed of a population consisting of 208 female active participants (AP) (68.7 ± 5.2) and inactive participants (IP) (69.1 ± 6.2) elderly attending a physical-educative interventional program through Pilates-Aerobic exercises and healthy sessions, all of them from Málaga province (Spain). The inclusion criteria were i) not to be diagnosed with an acute or terminal illness, ii) not have functional mobility limited. We measured weight (Kg), FM (Kg and %), SMM (Kg), FFM (Kg) and body mass index (BMI) by bioelectrical impedance analysis with a Tanita SC 330s. Waist circumference (cm) was measured with the participant standing at the middle point between the ribs and ileac crest (Harpenden anthropometric tape, Holtain Ltd., Crymych, UK). Height (cm) was measured using a stadiometer (Seca 22, Hamburg, Germany). According to population of geographical locations (village and town) who participated, the sample of participants was classified in three groups under 10.000 residents. The collected data processing included the use of adequate statistical methods for calculating central and dispersion parameters: arithmetic mean and typical deviation. To determine the significance of differences of body composition characteristics, body composition characteristics were assessed by two-ways ANOVA (physical activity and population). T-test for related samples were applied after significant ANOVA Results. Data were analysed using the SPSS statistical program (SPSS for Windows 21.0, Inc., Chicago, Illinois, USA).

Results

Waist circumference and fat mass in IP that live in towns of < 2.000 of population are the lowest (p < 0.05). In addition, in AP, weight, waist circumference and fat mass is the lowest too in towns of < 2.000 of population (p < 0.05). Furthermore, skeletal muscle mass is highest in these towns, both AP and IP, although these differences are not significant (p > 0.05).

Conclusion

Elderly participants have different physiological and body composition characteristics by a level of physical activity and the population location. Active female participants who live in small areas and a number of inhabitants is limited, show the best physiological state to cope with aging.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):187.

T2P212 A low-grade inflammation genetic score may contribute to identify subjects at a higher risk of metabolic inflammation

S Galmés 1, M Cifre 1, A Palou 2, P Oliver 2, F Serra 2

Introduction

Isolated human peripheral blood mononuclear cells (PBMC) have been used to assess lipid metabolism and to test associated responses to n-3 long chain polyunsaturated fatty acids (LCPUFA) (NU-TRI-BLOOD study; Mol Nutr Food Res 61, 4, 2017), which is impaired in Overweight/Obese individuals (Ow/Ob)). However, analysis of gene expression showed a high level of inter-individual variation, which could suggest that differences in genetic background would also be relevant. Therefore, the aim of the present study has been to further characterize the presence of genetic variants in the same set of subjects and to assess their potential influence on inflammatory status.

Methods

Data from the subjects recruited in NUTRI-BLOOD study were collected; plasma C-reactive protein (CRP) and IL-6 and TNFα from PBMC media were determined. An overall response in the expression of pro-inflammatory genes (ΔEPG) was calculated taking into account the expression of IL-6, TNFα and CRP in PBMC under n-3 LCPUFA treatment (EPA and DHA) in comparison with the respective non-treated control cells. In addition, from a saliva sample, a genetic score for low-grade inflammation associated with obesity (LGI-Ob) was defined and calculated from a selection of six genetic variants associated with: rs1800629 (TNFα), rs9939609 (FTO), rs1260326 (GCKR), rs1800795 (IL6), rs5082 (ApoA2) and (rs4880) SOD2. Student's test, correlation and linear regression analysis were performed with SPSS for Windows (SPSS, Chicago, IL, USA).

Results

Rare allele carriers (A) of rs1800629 (TNFα) presented lower secretion of TNFα in media under the different conditions (control, DHA and EPA treatments) than GG carriers. The same but attenuated pattern was observed concerning IL-6 media secretion in A carriers. Interestingly, rare allele carriers showed higher anti-inflammatory potential reflected on ΔEPG in PBMC in response to DHA or EPA treatment. Furthermore, a significant and positive correlation was found between plasma CRP and the LGI-Ob score among subjects. When BMI was taken into account, the correlation remained significant in Ow/Ob, but not in normoweight subjects.

Conclusion

The in vitro system based on PBMC is an efficient tool to assess the effects of specific nutrients according to the genotype of the individual from which they derive. The study underlined the role that may play certain genetic variants modulating the anti-inflammatory effect derived from the exposure to EPA or DHA. Despite the low number of individuals (N = 18), our results suggest that the knowledge of the genetic profile, as the LGI-Ob score defined, together with the plasma inflammatory biomarker CRP may contribute to define more precise strategies for the prevention and treatment of individuals at risk of high inflammatory status associated with obesity.

Obes Facts. 2018 May 26;11(Suppl 1):187–188.

T3P1 Cross-sectional and longitudinal association between weight status and motor skills in adolescents

C Drenowatz 1, K Greier 2

Introduction

Despite considerable efforts, the prevalence of overweight and obesity in youth remains high. The limited success of various intervention efforts also reflects the limited understanding of key contributors to weight gain. Poor motor skills have been associated with increased body weight but there remains limited information on the longitudinal association of these health parameters. The present study, therefore, examines the prospective association between motor skills and body weight in 10–14-year-old Austrian students.

Methods

A total of 213 secondary school students (57% male) were followed over a 4-year period with annual measurements. Body weight and height were measured according to standard procedures and motor skills were assessed via the DMT6–18. Additionally, club sports participation, media consumption and migration status were assessed via questionnaire.

Results

In addition to the inverse cross-sectional association between body weight and motor skills excess body weight was associated with impaired development of motor abilities. Further, weight loss was associated with enhanced motor development and allowed previously overweight students to catch up with their normal weight peers regarding their motor skills. Students with high motor skills at baseline also displayed significantly higher odds of maintaining a healthy body weight or change from being considered overweight/obese to normal weight during the observation period (Figure 1). These results were independent of club sports participation. Figure 1: Odds ratios (OR) for maintaining a normal body weight or loosing weight by tertiles of motor skills at baseline [Reference value is lowest tertile]

Conclusion

results of the present study indicate a bi-directional, synergistic association between body weight and motor skills. Facilitating the development of motor skills in children and adolescents, therefore, may be a viable intervention strategy targeting weight management by facilitating physical activity in youth.

Fig. 1.

Fig. 1

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p < 0.05; ** p < 0.01 *

Obes Facts. 2018 May 26;11(Suppl 1):188.

T3P2 Causal Relationships between Adiposity and Asthma in Children: Bi-directional Mendelian Randomization Analysis

YC Chen 1, H Fan 2, Y Huang 3, S Huang 4, T Liou 5, Y Lee 6

Introduction

Obesity and asthma are common chronic diseases in children and have been reported to be mutually causative. We investigated the causality and direction of the relationship between adiposity and asthma using genetic markers as instrumental variables (IVs) in bi-directional Mendelian Randomization (MR) analysis.

Methods

We used data from the Taiwan Children Health Study with 24 body mass index (BMI)-single-nucleotide polymorphisms (SNPs, combined into a weighted allelic score) and 16 asthma-SNPs (combined into two weighted allelic scores, separately for asthma inflammatory and anti-oxidative genes) to yield genetic IVs for adiposity and asthma, respectively. 2525 children aged 11–12 years with available data on adiposity, genotyping, and asthma were included. We used the two-stage least squares (2SLS) method to estimate the causal direction between adiposity and asthma.

Results

The weighted allele score for BMI was strongly associated with adiposity (p < 0.001) and active asthma (p = 0.03). The two-stage least square regression risk ratio (RR) for the effect of BMI on asthma was 1.04 (95% confidence interval: 1.00–1.07, p = 0.03). Although the weighted asthma genetic scores were significantly associated with asthma (p < 0.01), no association was seen for genetically instrumented asthma with BMI using MR. Central obesity was the most accurate predictor of asthma. This causal effect was significant for non-atopic asthma compared with atopic asthma and was significantly stronger in boys than in girls. Causal effect estimates were similar while omitting FTO locus from the genetic score. Sensitivity analysis for MR revealed no directional genetic pleiotropy effects. The causal effect RRs of BMI on asthma were 1.04, 1.08, and 1.03 for inverse-variance-weighted, MR-Egger regression (slope), and weighted median Methods, respectively, all in accordance with the MR estimates.

Conclusion

On the basis of a bi-directional MR approach, our study demonstrated that high adiposity leads to asthma, whereas the effects of asthma on adiposity accumulation are likely to be small.

Tab. 1.

Summary of coefficients used for reciprocal Mendelian Randomization analysis

 Genetic score with intermediate trait
Genetic score with outcomes
Two-stage IV analysis (asthma or z-BMI)
Instrumental variables (IV) Coefficient (95% CI) p-value Coefficient (95% CI) p-value Coefficient (95% CI) p-value
BMI genetic score (24 SNPs) 2.70 (2.21, 3.18) <0.001 0.10 (0.01, 0.18) 0.03 0.04 (0.003, 0.07) 0.03
FTO gene (1 SNP) 2.00 (–2.81, 6.80) 0.42 –0.45 (–1.31, 0.40) 0.30 –0.18 (–0.71, 0.34) 0.49
non-FTO genes (23 SNPs) 2.64 (2.16, 3.11) <0.001 0.10 (0.01, 0.18) 0.03 0.04 (0.004, 0.07) 0.03
Asthma genetic score (16 SNPs) 0.09 (0.02, 0.16) <0.01 0.14 (–0.30, 0.58) 0.55 1.50 (–3.46, 6.46) 0.55
inflammatory genes (8 SNPs) 0.05 (0.00, 0.11) 0.05 –0.05 (–0.39, 0.30) 0.79 –0.89 (–7.62, 5.84) 0.80
anti-oxidative genes (8 SNPs) 0.04 (–0.01, 0.08) 0.08 0.18 (–0.10, 0.45) 0.21 4.61 (–4.14, 13.33) 0.21
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Obes Facts. 2018 May 26;11(Suppl 1):188.

T3P3 Body composition as predictor of telomere length in the transition from child to adolescent

C Van Aart 1, N Michels 1, I Sioen 1, D Martens 2, T Nawrot 2, S De Henauw 1

Introduction

Telomeres are seen as marker for ageing, as accelerated shortening is involved in the development of age-related diseases, including cardiovascular disease. Overweight and obesity might influence telomere shortening even in children, as there is evidence that early-life-obesity is an indicator of healthy ageing in later life. Therefore, this study investigated the role of body composition on telomere length in the transition from childhood to (early) adolescence.

Methods

Healthy Flemish children (N = 142) were followed-up between 2008–2015 (aged 2.7–8.1 years old at baseline, 53.4% boys). Body mass index (BMI; 4.1% overweight), waist circumference, body fat percentage and inflammatory parameter C-reactive protein (CRP) were obtained using standardized protocols. Average relative telomere lengths were measured in blood samples using a quantitative real-time PCR method and were ranked from high to low. Cross-sectional and longitudinal age and sex adjusted linear regression models addressed the association between body composition and telomere length ranking.

Results

Telomere length was shorter with increasing age (p = 0.01). In cross-sectional analysis, body composition was not associated with telomere length but higher CRP was associated with shorter telomeres (p = 0.04). Longitudinal analyses showed borderline negative relations with increasing BMI, waist circumference and CRP.

Conclusion

This study over a 7-year period shows that childhood body composition might already affect telomere length. Inflammation could be the underlying reason towards this effect, as higher CRP was associated with shorter telomeres.

Obes Facts. 2018 May 26;11(Suppl 1):189.

T3P5 Musculoskeletal Pain in Obese Children and Adolescents at a Specialized Pediatric Obesity Clinic

L M Bjurvald 1, G Morinder 2, A Janson 2

Introduction

Obesity in children and adolescents is a major public health problem. Physical activity is a core element in obesity treatment, as a way to increase energy expenditure but also to reduce the risk for co-morbidities. Among children and adolescents with insufficient level of physical activity, pain could be a potential barrier to increase or maintain participation in physical activity. The aim of this study was to describe the prevalence of pain related to physical activity among obese children and adolescents admitted to a specialized referral pediatric obesity clinic in Sweden.

Methods

Cross-sectional study of children and adolescents entering a treatment program at the National Childhood Obesity Centre, Stockholm, Sweden during 2016. On the first visit to a physiotherapist the participants were asked if they experienced any pain during physical activity, and if so, the location of the pain. The participants (n = 70, corresponding to 89% of all eligible patients, 34 girls, 3–16 years, mean 11,9 years) were all classified as obese according to IOTF at referral.

Results

Of all 70 children and adolescents n = 33 (47%) reported pain during physical activity. The most common location of pain was lower extremities, followed by neck and back. The frequency of children reporting pain increased with age: 3–8 years n = 2 (6%), 9–12 years n = 13 (39%) and 13–16 years n = 18 (55%). Mean age among the individuals reporting pain was 12,3 years, and mean age for the ones reporting no pain was 11,5 years. Slightly more boys than girls reported pain (n = 18, 55% and n = 15, 45%).

Conclusion

This study shows that almost half of the children and adolescents admitted to a specialized pediatric obesity clinic reported pain during physical activity. In our sample boys reported slightly more pain than girls, and the mean age for those reporting pain was 0,8 year higher compared to those not reporting pain. The result highlights the importance of screening for pain related to physical activity among children and adolescents undergoing obesity treatment, and find suitable forms of exercise and encourage coping strategies to promote physical activity also in children who experience pain.

Obes Facts. 2018 May 26;11(Suppl 1):189.

T3P6 Capture rate of childhood obesity on well child visits using ICD code-based diagnosis in comparison to chart review measured BMI

HF Lantigua 1, D Ovadia 2, N Rubio 1, M Yafi 1

Introduction

To investigate the capture rate of obesity in children during a well child visits using ICD code-based diagnosis of obesity relative to the gold standard measured BMI taken during same visit.

Methods

We performed a chart review on longitudinal collected data looking for anthropometric measures (i.e. measured BMI) and ICD-code based diagnosis assessed during a well child visit. Information was collected during the 2014 year. We included all children that visited the clinic for the proposed well child/ health maintenance visit. A total of 1469 clinic visits were analyzed. Body mass index (BMI) was calculated from measured height and weight. “Obesity” was defined as BMI >or = 95th percentile by using Sex –specific Centers for Disease Control and Prevention 2000 growth charts.

Results

A total of 315 cases had BMI >or = 95th percentile (21.4%), of these 84 cases (26.67%) had an associated diagnostic code of obesity. Doing age group stratification, obesity was 18% among 2- to 5-year-olds, 21% of 6- to 11-year-olds and 24% of 12- to 19-year-olds. Respectively for each group, 19%, 34% and 25% has the associated diagnostic code.

Conclusion

Capture rate of obesity have similar distribution among the 3 age groups in our study population. The majority of cases (73%) with BMI in the obesity range have not been documented as obese, although this capture rate appears to be better compared to other publications. The Obesity rate is comparable to those numbers from the CDC, 21.9% vs 21.4% in our review, except for 2–5 age group that the CDC report was 7.5% vs 18% in our review. This review demonstrates that the use of ICD codes tend to underestimate the actual obesity prevalence. Improved screening can lead to earlier intervention. A suggested change in the office electronic medical records, might be incorporating an automated alert that prompts the providers when BMI in obese or overweight range.

Obes Facts. 2018 May 26;11(Suppl 1):189–190.

T3P7 Overweight patterns and Esophageal Adenocarcinoma Risk in Men: Linkage of Copenhagen Schools Health Records Register and Danish Conscription Database

B W Jensen 1, J Petrick 2, TIA Sørensen 3, MB Cook 2, JL Baker 3

Introduction

Over the last two decades, esophageal adenocarcinoma (EA) has been among the most rapidly increasing cancer types in Denmark and other Western countries. Additionally, this tumor has a 5-year survival rate of ~26%. Elevated body mass index (BMI, kg/m2) in adulthood is a risk factor for EA. While the underlying causal mechanisms of the BMI–EA association are unclear, leading hypotheses include the ideas that high levels of adiposity may promote gastroesophageal reflux and/or metabolic sequelae, possibly already through adiposity and weight changes during early life. As more than a fifth of the European population is considered obese (BMI ≥ 30) and one in three European children are classified as overweight or obese, it is vital to understand when obesity interventions may be successfully implemented to reduce the risk of this lethal cancer type. We therefore investigated the timing of obesity and weight gains in relation to EA.

Methods

We assessed the association of change in overweight status between childhood (7–13 years) and early adulthood (17–26 years) in relation to EA risk in men, using a linkage between the Copenhagen Schools Health Records Register and Danish Conscription Database. This study included measured weights and heights on 64,695 males born 1939–1959. Follow-up was conducted via linkage with the Danish Cancer Registry through December 31, 2014 to identify cases of EA (N = 146, mean follow-up: 24 years). The boys and young men were categorized as normal weight or overweight according to the recommended BMI cut-offs from the International Obesity Task Force (< 18 years) and the World Health Organisation (≥18 years). Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression with age as the underlying time metric, stratified by year of birth and adjusted for educational level and age at the conscription examination.

Results

Compared to men with normal weight, men with overweight at ages 7, 13, or early adulthood showed 2–3 times increased risk of EA. Compared to men without overweight at age 7 and early adulthood, exceeding a BMI of 25 kg/m2 at early adult ages was associated with an 83% increased risk of EA (HR = 1.83, 95%CI: 1.06–3.14). However, men with persistent overweight (i.e., overweight at age 7 and early adulthood) had 4-times the increased risk of EA (HR = 4.29, 95% CI: 1.99–9.21). results were similar examining changes in overweight between age 13 and early adulthood.

Conclusion

Overweight in childhood and early adulthood was associated with an increased risk of EA, with the highest risk noted for men with persistent overweight. This underscores the need for obesity interventions to be focused on early-life and maintenance of a healthy weight throughout the life course.

Obes Facts. 2018 May 26;11(Suppl 1):190.

T3P8 Correlation between pre-pubertal IGF-II and pubertal fat distribution: findings from the Avon Longitudinal Study of Parents and Children (ALSPAC)

M N Alfares 1, SD Leary 2, C Perks 1, JM Holly 3, JP Hamilton-Shield 4

Introduction

Recent reports have suggested a role for IGF-II in body fat regulation and metabolism. IGF-II has also been strongly linked to obesity in genetic studies. The genetic polymorphisms in IGF-II expression were also reflected in IGF-II circulatory levels; higher levels of IGF-II were associated with decreased body weight and less susceptibility to future weight gain in adults. However, limited studies have investigated IGF-II's role in children, and whether IGF-II levels may be an indicative marker for body weight and tissue compartment distribution in adolescents.

Methods

Data of 631 children were used for analysis; the participants were collected as part of the Avon Longitudinal Study of Parents and Children, Bristol, UK. IGF-II levels were determined using direct enzyme-linked immunosorbent assay (ELISA; Diagnostic Systems Laboratories, Inc., Sinsheim, Germany), and were measured from cord blood and at 61 months of age. Fat mass for (total, trunk, arms, legs, android and gynoid) and lean mass was measured by dual-energy X-ray absorptiometry at 15 and 17 years of age. Body mass index (BMI) was calculated as weight (kg) divided by height squared (m). Regression coefficient comparison between the outcome measures was performed using z-scores for fat mass compartments and lean mass. Data analysis was conducted using IBM SPSS statistics version 23 software.

Results

Cord blood IGF-II showed strong evidence of an inverse association with total body fat (β -.014;P = 0.017) and trunk fat mass (β-.016;P = 0.011) measured at 17 years of age. These correlations were found when adjustment of sex and age confounders was used; however, the associations were attenuated when further confounders were adjusted. There was no evidence of an association between IGF-II and lean mass at puberty.

Conclusion

Early life IGF-II levels have been associated negatively with body fat, particularly trunk fat mass measured by DXA at puberty. However, there is no evidence of an association with lean body mass.

Obes Facts. 2018 May 26;11(Suppl 1):190.

T3P9 Adiposity and Blood Pressure in Australian Toddlers from the Get-Up! Study

E Sousa-Sá 1, Z Zhang 1, J R Pereira 2, S LC Veldman 1, A D Okely 1, R Santos 1

Introduction

As high blood pressure (BP) during childhood is a risk factor for later cardiovascular disease and is strongly associated with overweight, there is a need to better understand the early development of BP and its relationship with overweight. We aimed to assess the association between levels of adiposity and BP, in toddlers, accounting for physical activity levels.

Methods

This study comprised 265 toddlers (129 girls), aged 19.6 ± 4.2 months from the GET-UP! Study, NSW, Australia. BP was obtained with a digital vital signs monitor following standardized protocols. Z-scores by age and sex were computed for systolic and diastolic BP and waist circumference. Participants were classified as non-overweight and overweight according to the World Health Organization criteria for body mass index. For waist circumference, participants with a z-score ≥1 standard deviation were considered overweight. Physical activity was assessed during child-care hours, with activPAL accelerometers. ANCOVA was conducted to test differences in BP between non-overweight and overweight children, with adjustments for socio-economic status, physical activity (minutes of stepping per hour of monitor wear time), sex and age.

Results

Overweight children showed higher values of systolic and diastolic BP z-scores than non-overweight children. However, these were not significant after adjusting for potential confounders (p > 0.05 for all adjusted models).

Conclusion

Our findings suggest that excess of adiposity may not be detrimental for BP levels at a very young age. However, establishing healthy lifestyles early in life, including physical activity, seem important to maintain healthy BP levels.

Obes Facts. 2018 May 26;11(Suppl 1):190.

T3P10 Long-term outcomes after bariatric surgery in individuals with early-onset obesity in the Swedish Obese Subjects (SOS) study

J Andersson-Assarsson 1, FM Kristensson 1, C Maglio 1, M Peltonen 2, LM Carlsson 1

Introduction

To date, bariatric surgery is the only effective treatment for substantial and long term weight loss in individuals with obesity. It has positive effects not only obesity but also on obesity comorbidities such as cancer, cardiovascular disease, and diabetes. Although it is effective in the general obese population, there are subgroups where the outcome after surgery is less favorable. One such potential subgroup is individuals who developed obesity at an early age - an indication of a stronger hereditary component. Early-onset obesity often persists into adulthood and is associated with higher rates of morbidity and mortality. To our knowledge, few studies have evaluated the effects of bariatric surgery in individuals with early-onset obesity. Our aim in this study was therefore to compare the long-term effects of bariatric surgery on weight loss, comorbidities (i.e. cancer, cardiovascular disease and diabetes) and metabolic risk factors in patients with early-onset obesity and in those who became obese as adults.

Methods

The SOS study is an ongoing, nonrandomized, prospective study of 4047 participants; 2010 who underwent bariatric surgery and 2037 matched controls. The surgery group underwent gastric bypass (GBP, 13.2%), banding (18.7%), or vertical banded gastroplasty (VBG, 68.1%). The control group received the customary obesity treatment at their primary health care centers. Here, we used self-reported weight at 20 years of age to calculate BMI and classify individuals as normal weight (n = 1594), overweight (n = 1465), or obese (n = 967). Individuals that had a BMI 3 30 kg/m2 at 20 years of age were considered to have early-onset obesity. Median follow-up was 19 years.

Results

There was a small difference in long-term weight change after bariatric surgery between individuals with early-onset obesity compared to those that developed obesity as adults (-20.0 +/- 1.2 kg and −22.9 +/-1.65 kg, respectively, p < 0.01). There were no differences in incidence of comorbidities or changes in metabolic risk factors, between the two groups. In the control group, weight change was also very similar between individuals with early-onset obesity compared to those that developed obesity as adults (+1.38 +/-1.19 kg and −0.05 +/-1.64 kg, respectively, p = 0.17), and no differences were seen in incidence of comorbidities or metabolic risk factors.

Conclusion

In our study, individuals with early-onset obesity achieved similar long-term weight loss, and beneficial effects on obesity comorbidities, after bariatric surgery as those that developed obesity as adults. Our results indicate that bariatric surgery is a treatment option in individuals with early-onset obesity.

Obes Facts. 2018 May 26;11(Suppl 1):191.

T3P11 Parental feeding practices and social vulnerabilities in relation to subsequent BMI trajectories of European children – the IDEFICS/I. Family cohort

L Arvidsson 1, M Monica Hunsberger 1, A Siani 2, A Szommer 3, A Solea 4, C Börnhorst 5, G Williams 6, I Pigeot 7, I Isabel Iguacel Azorín 8, LH Bogl 5, LA Moreno 9, M Leu Agelii 10, N Michels 11, T Veidebaum 12, V Pala 13, W Ahrens 14, L Lissner 15

Introduction

Parents have potential to support children's healthy eating habits and weight development. However, there is a need for prospective studies to establish the association between parental feeding practices (PFPs) and children's weight development, and to explore the effect of socioeconomic factors on this relationship. Our study aims to investigate baseline PFPs and children's body mass index (BMI) trajectory in a large cohort of European children while considering the moderating effect of social vulnerabilities on this association.

Methods

5,542 children from the IDEFICS/I.Family cohort were included. Height and weight were measured during the IDEFICS study (2007/08 or 2009/10) and reevaluated in I. Family (2013/2014). BMI trajectory was calculated based on age- and sex-specific BMI z-scores. Parents reported on PFPs using the ‘Preschooler Feeding Questionnaire’. Multilevel linear regression was used to determine how much of the variation in BMI z-score could be explained by these PFPs. Multilevel logistic regression models were estimated to investigate children's BMI trajectory as functions of PFPs while considering important confounders such as baseline BMI z-score and parental BMI. Regression analyses were performed separately among children with normal weight at baseline and children with overweight at baseline. Finally, the analyses were stratified by social vulnerability assessed by low education, low income, minimal social network, non-traditional family, migrant status, and unemployment.

Results

Twenty-two percent of the variation in BMI z-score was explained by the PFPs reported at baseline. Among children with normal weight at baseline the PFPs: “stop child from eating too much” and “consider putting child on a diet to avoid overweight” were associated with higher odds of the child experiencing major weight gain. These associations were stable across social vulnerability groups and could not be explained by baseline BMI z-score, sedentary time, parental BMI or concern about the child's weight. Among children with overweight at baseline no significant association were identified between PFPs and the odds of experiencing major weight loss.

Conclusion

Parental feeding practices regarding food restriction and putting the child on a diet are not helpful in promoting a healthy weight development among European children independent of social vulnerability group. It is important that future studies investigate the underlying reason for using these parental feeding practices, how they are manifested, and how parents can be empowered to support a healthy weight trajectory of their child.

Obes Facts. 2018 May 26;11(Suppl 1):191.

T3P12 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):191–192.

T3P13 Consumption of Sugar-Sweetened Beverages impairs the LDL Subclass profile – Data from a double-blind randomized controlled trial

B Geidl 1, M Hochuli 1, GA Spinas 1, P A Gerber 1

Introduction

The consumption of Sugar-Sweetened Beverages (SSB) is associated with adverse effects on various metabolic parameters, suggesting a causal relationship between SSB consumption and components of the metabolic syndrome as overweight, insulin resistance or altered lipid metabolism. However, only few controlled intervention studies have investigated changes in lipid metabolism so far. A Low-density-lipoprotein profile with a predominance of small, dense LDL particles is associated with an increased cardiovascular risk and is typically seen in patients with obesity and features of the metabolic syndrome. Earlier data from a short (3 weeks) crossover trial from our institution suggests adverse effects of SSB (and in particular fructose sweetened beverages) on LDL particle subclasses.

Methods

Lipid profiles were analyzed in a sub-study of a double-blind, randomized controlled trial in healthy young men who were randomized to an 8-week intervention with beverages sweetened with either glucose, fructose or sucrose (80g per day) or to a control group. Blood was drawn in the fasted state after the intervention and analysis of LDL size and subclasses was performed using nondenaturing polyacrylamide gradient gel electrophoresis of plasma.

Results

94 subjects (23 to 24 per group) were included in the study (all male, age 22.7 years, weight 72.0kg, BMI 22.0kg/m2). The consumption of sugar-sweetened beverages for 8 weeks induced a significant increase in the proportion of small, dense LDL particles by 7.0% from baseline (p < 0.05). In the control group, no changes in LDL particle size distribution was observed. When assessing the three groups of subjects exposed to SSB with different sugars separately, we observed a statistically significant increase in small dense LDL particles in subjects exposed to SSB sweetened with fructose containing sugars (fructose or sucrose) (p < 0.05), compared to subjects not exposed to fructose (control subjects or subjects consuming SSB sweetened with glucose). The trend towards an increase in small LDL particles was most pronounced in the group exposed to fructose only containing SSB.

Conclusion

The consumption of Sugar-Sweetened Beverages in moderate amounts (comparable to the consumption of SSB in everyday life) results in adverse LDL subclass profile changes, promoting an increase in small, dense LDL particles and a decrease in large, buoyant LDL particles. In particular, the consumption of fructose containing beverages (free fructose or sucrose), but not of beverages containing glucose alone, induced such changes.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):536.

T3P14 Nutrient composition of food and drink available in hospital vending machines; cause for concern

FE Lithander 1, A James 1, L Birch 1, J P Hamilton-Shield 1

Introduction

The National Health Service (NHS) in England has committed to making healthy foods available to hospital staff and visitors. Indeed, the National Institute for Health and Care Excellence (NICE) Quality Standard 94 entitled ‘Obesity in children and young people: prevention and lifestyle weight management programmes’ refers to the need for healthy food and drink in hospital vending machines. The aim of this study was to analyse the nutrient composition of food and drink available in hospital vending machines and to assess their healthfulness.

Methods

The study was conducted in two hospitals in England and data were collected by one individual in July 2016. The UK Department of Health Nutrient Profiling Model (NPM) was used to classify food and drink as ‘less healthy’ or ‘healthy’. Points were allocated based on the nutrient content per 100g of food or 100ml of drink with respect to energy; saturated fat; total sugar; sodium; fruit, vegetable and nut content; fibre, and protein. ‘Less healthy’ foods scored ≥ 4 points and ‘less healthy’ drinks scored ≥ 1 point.

Results

Forty foods and 15 drinks were available in 18 vending machines. Only 10% of foods and 50% of drinks were classed as ‘healthy’ using the NPM (Table 1). In addition, 4 of the 5 food categories had a mean total sugar content of >22.5g per 100g and as such were classified as high-sugar foods.

Conclusion

There were limited healthy foods or drinks for sale in the hospital vending machines. Given that the availability and accessibility of unhealthy foods has been previously identified as a risk factor for overeating, hospitals should take the lead in supplying food and drink that reflects evidence based nutrition.

Tab. 1.

Mean nutrient composition per 100g of food or 100ml of drink and mean (sd) Nutrient Profile Model (NPM) Score

 Energy
 SFA
 Sugar
 Na
 FVN
 Fibre
 Protein
 NPM score
(kJ)
 (g)
 (g)
 (mg)
 (%)
 (g)
 (g)
Crisps, n = 10 2094 3 3 589 0 4 6 10 (4)
Chocolate, n = 19 2115 15 53 121 2 2 6 26 (1)
Sweets, n = 2 1695 1 93 42 0 0 0 16 (1)
Biscuits, n = 4 2011 9 24 483 1 3 8 20 (7)
Dried fruit and/or nuts, n = 5 1819 9 28 22 63 4 8 6 (13)
Drinks, n = 15 95 0 5 6 8 0 0 1 (2)
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SFA = saturated fat; Na = sodium; FVN = fruit, vegetable, nuts

Obes Facts. 2018 May 26;11(Suppl 1):192–193.

T3P15 Primary prevention of fat and weight gain among obesity susceptible normal weight preschool children. Results from the “Healthy Start” randomized controlled intervention

N J Olsen 1, L Ängquist 2, P Frederiksen 1, EL Mortensen 3, BL Heitmann 1

Introduction

The vast majority of childhood weight gain and obesity prevention interventions included a mix of both normal weight and overweight children, e.g. in school settings. Only about 1/4 of these previous interventions were effective in reducing weight gain, and studies have proposed, that the positive effect of these interventions were restricted to those already overweight, or to those children who were at high-risk for obesity, rather than to the normal weight children. The objective of the Healthy Start primary prevention RCT was to examine if excessive weight and fat gain can be prevented among normal weight, but obesity susceptible children aged 2–6 years.

Methods

Children were identified from public registries and considered at high risk for future obesity if they either had a high birth weight, maternal pre-pregnancy obesity, or maternal low educational level. Subsequently, all children were randomized into the intervention group, or the control group. Trained project staff took anthropometric measurements at baseline and follow-up. All overweight children were excluded from subsequent analysis (n = 92), while all normal weight children were included (n = 543). The intervention aimed to deliver improvement in diet and activity habits, optimization of sleep quantity and quality and reduction of stress in the family. Average intervention period was 1.3 years, and drop-out rate was 49%. Per protocol and intention-to-treat (ITT) analyses were conducted, adjusting for gender and age.

Results

Intention-to-treat analyses showed a lower gain in %-fat mass (β = −1.96 (95% CI −3.69;-0.23, p = 0.03)) and a higher gain in fat free mass (β = 0.35 (95% CI 0.01;0.69, p = 0.05)) in the intervention group compared to the control group, but non-significant differences in BMI z-score gains (p = 0.29).

Conclusion

This primary weight gain prevention intervention among young normal weight children at high risk of future obesity suggested improved development in growth and body composition after the 15 months intervention.

Obes Facts. 2018 May 26;11(Suppl 1):193.

T3P16 Habitual intake of breakfast in relation to overweight status among Viennese preadolescents

M Luger 1, M Schmid 2, M Schätzer 3, E Winzer 1, P Rust 2

Introduction

Dietary habits indubitably play a role in the development of child overweight including obesity (OW/OB). Studies have shown a positive association between breakfast skipping and OW/OB. The aim of this study was to examine the reported habitual intake of breakfast as well as food and beverages in a cohort of preadolescents in secondary schools in Vienna. Furthermore, the study analyses these habits and socioeconomic factors in relation to OW/OB in preadolescents.

Methods

This cross-sectional study builds on data collected in 2017 from 13 selected schools in ten urban school districts in Vienna. Measured anthropometric and child questionnaire data including habitual intake of breakfast, food and beverages, and socioeconomic status (migration background, family affluence scale) were collected. A total of 652 Viennese preadolescents (54% boys) between the 5th and 8th grade were included.

Results

The pupils were 12.7 (1.3) years old and 42% were regular (daily) and 30% inconsistent breakfast eaters (≤5 times/ week) whereas 28% were breakfast skippers. The prevalence of OW/OB was 29%. Regarding BMI and habitual breakfast intake, there were significant differences in the BMI of 21.3 (3.8) kg/m2 among breakfast skippers, inconsistent breakfast eaters of 21.5 (4.4) kg/m2, and regular breakfast eaters with the lowest BMI of 20.9 (4.5) kg/m2 (p = 0.049). Figure 1 presents the BMI within the self-reported reasons for not having breakfast. The odds of being OW/OB was higher among those who usually (≥3 times/ week) drink fruit juice for breakfast (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.01–2.34; p = 0.040) and those who eat pastries as a typical breakfast (OR 2.5, 95% CI 1.15–5.28; p = 0.021), but it was lower in those who usually drinking water (OR 0.6, 95% CI 0.40–0.82; p = 0.002), adjusted for socioeconomic status. Furthermore, the odds of breakfast skipping was higher among preadolescents with parenteral migration background (OR 1.7, 95% CI 1.16–2.57; p = 0.008) but not with lower socioeconomic status (adjusted for age and sex).

Conclusion

Breakfast skippers and inconsistent breakfast eaters showed a higher BMI and particularly in those who skipped breakfast out of habit and who wanted to stay slim or lose weight. Drinking fruit juice for breakfast and eating pastries showed a higher odds of being OW/OB, whereas drinking water for breakfast demonstrated lower odds. Interventional studies are needed to determine the causal relationships.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):193–194.

T3P17 The Dutch leptin receptor deficiency cohort: extensive phenotyping

O Abawi 1, L Kleinendorst 2, MM Van Haelst 2, EC Houdijk 3, SE Hannema 4, HJ Van Der Kamp 5, B Van Der Zwaag 6, EF Van Rossum 7, EL Van Den Akker 1

Introduction

Leptin receptor deficiency is a rare genetic disease associated with early-onset morbid obesity, hyperphagia and hypopituitarism (hypogonadotropic hypogonadism (HH), growth hormone deficiency (GHD) and/or hypothyroidism (HT)). It is caused by homozygous or compound heterozygous mutations in the LEPR gene. LepR-signaling is needed for proper functioning of the leptin-melanocortin pathway, which controls energy expenditure and food intake. No causal pharmacological treatment exists yet. The tertiary pediatric obesity clinic CGG of the Erasmus MC Sophia Children's Hospital (Rotterdam, The Netherlands) is a national expertise center for pediatric obesity to which patients with suspected genetic or syndromic obesity are referred nationwide. This study aims to describe the clinical characteristics of all 6 known Dutch children with leptin receptor deficiency.

Methods

Six children and adolescents (aged 2–19 years) were diagnosed with a leptin receptor deficiency and referred to the Sophia Children's Hospital. An extensive diagnostic workup was performed, including age of onset, anthropometrics (SD scores based on Dutch reference growth charts), laboratory, dietary and physiotherapeutic assessment, eating behavior and resting energy expenditure (REE) measurement by indirect calorimetry (Quark RMR).

Results

All 6 patients are extremely obese (average BMI at screening of 33.5kg/m2 (BMI SDS +5.28)) and all became overweight before the age of two. Five of the six patients are hyperphagic. Clinical characteristics and LEPR mutations are presented in the figure.

Conclusion

Here we present the characteristics of all known Dutch pediatric patients with leptin receptor deficiency. Diagnosis of the disease made adequate treatment of disease-specific comorbidities possible. However, the severity of obesity in this cohort demonstrates the dire need of a future treatment aimed at restoring the defective LepR-signaling pathway.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):194.

T3P19 A critical review of the role of milk and dairy products in the development of obesity in children and adolescents

A Dougkas 1, S Barr 2, S Reddy 3, CD Summerbell 4

Introduction

Existing reviews suggest that milk and dairy products do not play a role in the development of obesity in childhood, but they do make an important contribution to children's nutrient intake. It is thus curious that public health advice on the consumption of milk and dairy products for children is often perceived as unclear. This review aimed to provide an overview of the totality of the best available evidence taken from cross sectional studies, prospective longitudinal studies, and intervention studies, which have reported on the associations between milk and dairy intake, and body fatness, in children.

Methods

The literature for English-language articles published from January 1990 up to June 2017 was reviewed by searching the following three databases: ISI Web of Knowledge/Web of Science (Thomson Reuters, UK), PubMed (US National Library of Medicine National Institutes of Health) and Google Scholar (Google, UK). Search terms included “dairy”, “milk”, “calcium”, “obesity”, “adiposity”, “body weight”, “children”, “adolescent”, “girls”, “boys” and combinations of these. Our search identified 43 cross sectional studies, 32 longitudinal cohort studies, 20 randomised controlled trials.

Results

On balance, we found that milk and dairy products are consistently found to be not associated, or inversely associated, with body fatness in children. Also, on balance, we found no evidence to suggest that the relationship varied by type of milk or dairy product, or age of the children, although there was a dearth of evidence for young children. Only nine of the 95 studies found a positive association between any one component of milk and dairy products and body fatness. This review also aimed to review the plausible mechanisms underlying the effect of milk and dairy products on body-weight regulation, and found that there is no underlying mechanistic rationale to support the hypothesis that milk and dairy products promote excess weight gain, or increase appetite.

Conclusion

In conclusion, there is no foundation for any concern to limit the consumption of milk and dairy products for children on the grounds that they may promote obesity. Furthermore, the existing evidence shows that there is no underlying mechanistic rationale to support the hypothesis that milk and dairy products promote excess weight gain, or increase appetite. Further research is needed to better understand the role of different milks and different dairy products in childhood obesity. The new and emerging range of products (including plant based alternatives) being used as dairy milk substitutes have yet to be evaluated in scientific studies.

Conflicts of Interest

A funding contribution was provided by The Dairy Council (http://www.milk.co.uk/)

Obes Facts. 2018 May 26;11(Suppl 1):194–195.

T3P20 Maternal fat and fatty acid intake during lactation and the development of childhood overweight

T Westerholm 1, S Ahonen 2, M Åkerlund 1, R Veijola 3, J Ilonen 4, J Toppari 5, M Knip 6, SM Virtanen 1, S Lehtinen-Jacks 1

Introduction

Childhood obesity is a growing concern. Early childhood is one of the critical periods for the growth of fat tissue. The diet of the mother affects the composition of breastmilk, which contains a high amount of fat and has an impact on the diet of the infant. Our aim was to study the association between maternal intake of fat and fatty acids during lactation and childhood overweight (obesity inclusive) at the age of 5 years in a cohort study design. This relationship has been studied in few intervention studies that mainly focused on n-6- and n-3-polyunsaturated fatty acids (PUFA).

Methods

We used data from a prospective Finnish Type 1 Diabetes Prediction and Prevention birth cohort Study (DIPP Study, n = 6068). We included mother-child-pairs with information about the mother's dietary intake during lactation and the child's growth at the age of 5 years (n = 1863). Food Frequency Questionnaires (FFQ) were given to lactating mothers at the 3-month study visit of the child and the 181 items of the FFQs covered maternal dietary intake during the preceding month. Intakes of total fatty acids and individual saturated, monounsaturated and polyunsaturated fatty acids were calculated by using the Finnish Food Composition Database (Fineli). Intake ratios of n-6:n-3 PUFAs were calculated. BMI (kg/m2) was calculated by using weight and height measured at the study visits. We defined childhood overweight (obesity inclusive) according to the IOTF BMI criteria. We categorized the dietary variables into quartiles and combined the two middle quartiles to a reference category. We used logistic regression models to study the association of the maternal fatty acid intake and offspring overweight, separately for girls and boys. We adjusted the models for maternal BMI, glucose intolerance diet, education and smoking during pregnancy, birth weight and gestational age of the offspring, and for duration of breastfeeding and amount of breastmilk.

Results

Of the boys 12%, and of the girls 18%, were overweight. Low maternal dietary n-6:n-3 PUFA ratio, i.e. a high intake of n-3 PUFA related to the intake of n-6 PUFA, increased the risk of childhood overweight for girls (OR 1.84, 95% CI 1.15–2.95), as compared to the two middle quartiles. We did not find a similar association in boys. Other maternal dietary intake variables of fat, fatty acids or fatty acid ratios were not associated with overweight in either sex.

Conclusion

Low maternal dietary ratio of n-6:n-3 PUFA may be associated with childhood overweight in girls.

Obes Facts. 2018 May 26;11(Suppl 1):195.

T3P21a The potential cost-effectiveness and equity impacts of restricting television advertising of unhealthy food and beverages to Australian children

V Brown 1, J Ananthapavan 1, L Veerman 2, G Sacks 3, A Lal 1, A Peeters 3, K Backholer 3, M Moodie 1

Introduction

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Whilst limited broadcasting restrictions currently exist, Australian children are exposed to high levels of HFSS advertising. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising before 9:30pm in Australia, and to examine how health benefits and healthcare cost-savings differ by SEP.

Methods

Meta-analysis informed the estimate of effect among children aged five to 15 years. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by measure of area-level SEP, using Socioeconomic Indexes for Areas (SEIFA) quintiles 1 (most disadvantaged) and 5 (least disadvantaged). A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. results were presented on a cost-effectiveness plane, using the commonly accepted Australian benchmark of AUD50,000 per health adjusted life year (HALY) to determine cost-effectiveness. Given the relative uncertainty of effect, threshold analysis was undertaken to establish the minimum effect size required to achieve cost-effectiveness.

Results

An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M-AUD7M), resulting in modelled reductions in energy intake (mean 115kJ/day) and BMI (mean 0.352kg/m2) at the population level (Table 1).

Conclusion

This study indicates the significant potential of legislation restricting TV advertising of HFSS food and beverages to Australian children as a cost-effective intervention, with greatest benefits for the most socioeconomically disadvantaged. Furthermore, results from our threshold analysis demonstrates the very small population level effect size required for the intervention to be considered cost-effective.

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Tab. 1.

Cost-effectiveness Results of restricting HFSS TV advertising

Results
 Children (5–15 years)
 Children Q1 (most disadvantaged)
 Children Q5 (least disadvantaged)
Mean modelled kJ effect per day, children aged five to 15 years –115kJ/day –*kJ/day –97kJ/day
Mean modelled BMI effect, children aged five to 15 years –0.352kg/m2 –0.395kg/m2 –0.299kg/m2
Mean BMI effect maintained in adulthood –0.345kg/m2 –0.313kg/m2 –0.282kg/m2
Total HALYs saved over lifetime 88,396 (95% UI 54,559–123,199) 17,512 (95% UI 10,372–25,155) 11,321 (95% UI 6,812–15,679)
Total healthcare cost-savings over lifetime AUD783.8M (95% UI AUD375.6M-1.2B) AUD127.5M (95% UI AUD59.8M-198.1M) AUD92.1M (95% UI AUD45.4M-137.5M)
Total intervention costs AUD5.9M (95% UI AUD5.8M-7M) AUD1.2M# (95% UI AUD1.1M-1.3M) AUD1.2M# (95% UI AUD1.1M-1.3M)
Total net cost-savings AUD777.9M (95% UI AUD369.8–1.2B) AUD126.3M (95% UI AUD58.7M-196.9M) AUD90.9M (95% UI AUD44.3M-136.3M)
Net cost per HALY saved (ICER) Dominant* Dominant* Dominant*
Probability of dominance 100% 100% 100%
Probability of cost-effectiveness 100% 100% 100%
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Table notes:

#

Assumed attribution of one-fifth of total intervention cost to each quintile.

*

Dominant interventions result in health gains and cost-savings.

Quintile results won’t add up to the population totals because they are based on the quintile-specific data and populations. 95% UI = 95% uncertainty interval based on 2,000 simulations. AUD = Australian dollars. BMI = body mass index. HALYs = Health adjusted life years. ICER = Incremental cost-effectiveness ratio. kJ = kilojoule. 1 kilocalorie is equal to 4.184 kilojoules. M = million. Q = SEIFA IRSD quintile. The intervention is likely to be dominant (i.e. cost-saving and health promoting), resulting in 88,396 HALYs saved (95% UI 54,559–123,199) and total cost-savings of AUD777.9M (95% UI AUD369.8M-AUD1.2B) at the population level over the lifetime (Figure 1) (Table 1). Importantly, the intervention may reduce health inequities, resulting in 1.5 times more HALYs and 1.4 times higher total cost-savings in children living in the most disadvantaged areas (Q1) compared to the least disadvantaged areas (Q5) (Figure 1) (Table 1). All modelled scenarios and sensitivity analyses resulted in dominance. Threshold analysis demonstrated that the effect size (expressed as the relationship between ‘minutes of exposure to TV ads for HFSS food’ and ‘energy intake’) could be reduced by more than two orders of magnitude (from a lower range estimate of 15.5 kcal per minute exposed, to < 0.1 kcal per minute exposed) for the intervention to remain cost-effective.

Obes Facts. 2018 May 26;11(Suppl 1):196.

T3P21b The long-term impact of high levels of α-MSH in energy balance among obese adolescents

ACP Kravchychyn 1, RMDS Campos 2, F C Corgosinho 3, DCL Masquio 4, SEDCF Vicente 1, YAM Ferreira 1, PL Da Silva 3, ADP Ganen 5, LM Oyama 1, L Tock 1, MT De Mello 6, S Tufik 7, AR Dâmaso 1

Introduction

In obese adolescents occur deregulation of orexigenic and anorexigenic pathways. Alpha-melanocyte-stimulating hormone (α-MSH) is a key catabolic mediator of energy homeostasis and important anorexigenic neuropeptide in the control of energy balance and thermogenesis. However, it was not well explored if α-MSH can modulate long-term weight loss therapy responses as dependent manner according to its concentration. We hypothesis is that high α-MSH concentration at baseline promotes better modulation of anorexigenic/orexigenic pathways in obese adolescents.

Methods

110 post-pubertal obese adolescents (BMI>95th percentile), were submitted to 1 year of interdisciplinary therapy (clinical, nutritional, psychological, physical exercise and physiotherapy support). Body composition by pletismography and plasma levels of α-MSH, NPY, MCH, AgRP were measured before and after therapy. For the analyses the volunteers were grouped by α-MSH, according baseline values: Low (< 0.75ng/ml), Medium (≤0.76 to ≥1.57ng/ml) and High (>1.57ng/ml) concentration. Significance was set as p < 0.05.

Results

The treatment promoted a significant improvement in body adiposity and free fat mass for all groups. In highlight, only in the high α-MSH group it was observed a significant increase in the α-MSH/NPY ratio and decrease in the MCH concentration, compared to medium and low groups. Additionally, in the high α-MSH concentration group it was observed negative correlations between anorexigenic delta ratio of α-MSH/NPY with orexigenic ratio NPY/AgRP(r = −0,84), NPY(r = −0,58) and MCH levels(r = −0,43) confirmed in linear regression.

Conclusion

The high α-MSH concentration promotes better modulation of anorexigenic/orexigenic pathways in obese adolescents follow long-term weight loss therapy and this is important in the clinical practice.

Acknowledgement

CAPES; CNPq 300654/2013–8 and 409943/2016–9; FAPESP 2011/50414–0 and 2017/073702–1.

Obes Facts. 2018 May 26;11(Suppl 1):196.

T3P22 Expression of cues by infants during complementary feeding – an observational study of infant clarity of cues and maternal sensitivity

R Byrne 1, AK Ventura 2, E Jansen 3, A Morawska 4, L Daniels 5

Introduction

Understanding how infants regulate their appetite – and how care-givers support or interfere with this – are key factors in understanding the aetiology of paediatric obesity. In particular, care-giver meal-time practices that are not responsive to a child's cues, may teach children to eat for reasons other than hunger, facilitating overeating and overweight. The aims of this study were to observe infant cues and maternal sensitivity during a typical meal time in a naturalistic setting, and determine whether child clarity of cues was related to maternal sensitivity to cues, maternal concern about infant overeating/undereating, child temperament or weight-for age z-score (WAZ).

Methods

This is an analysis of 33 mother-child dyads from the Australian NOURISH trial who participated in an observational sub-study (Morawska et al, 2014). A baseline assessment occurred when infants were 4–7 months of age, at which time mothers completed a self-administered questionnaire including the Short Temperament Scale for Infants (AIFS, 2003) and concern about overeating/overweight and under eating/underweight subscales of the Infant Feeding Questionnaire (Baughcum, 2001). Anthropometry was measured by trained research staff, and WAZ derived using WHO Standards (WHO, 2008). For participants in the sub-study, a typical feeding interaction was videotaped at their home. All children were consuming solids, hence it was an observation of complementary feeding. Videos were coded using the NCAST feeding scale and scores derived for child clarity of cues and maternal sensitivity to cues.

Results

Mean age of infants at the observation was 7.6 months (sd = 1.4); n = 13 male. Mean age of mothers was 30 years (sd = 5.8)and half had a university education. Child clarity of cues (mean score = 13.0, sd = 1.3; range = 11–15) was not correlated with maternal sensitivity to cues (mean score = 11.4, sd = 2.2; range = 7–15), r = 0.30, p = 0.09; concern about overeating/overweight, r = 0.02, p = 0.89; concern about undereating/underweight, r = -.01, p = 0.97; child temperament r = 0.36, p = 0.11; or WAZ, r = 0.02, p = 0.89.

Conclusion

Observed child clarity of cues was not related to maternal sensitivity to cues, self-reported concern about weight, child temperament, or measured WAZ during a mealtime observation in a naturalistic setting. Investigation of these relationships in a larger sample size is recommended.

Obes Facts. 2018 May 26;11(Suppl 1):197.

T3P23 Evaluation of food interest and preference among school children by a subjective picture choice method using touch-screen tablets with a web-based data collection system

S Kimura 1, R Fukuoka 2, S Kanayama 3, Y Endo 4, K Minamimae 4, K Hanaki 4

Introduction

Food interest and preference as major factors of eating behavior have a close link with development of obesity. However, there is not an appropriate method to evaluate them in childhood. That seems because children cannot understand questions for evaluation usually employed in adults. Here we have devised a computer program based on a subjective picture choice method, which is easy to understand for children, as an evaluation tool to detect food interest and preference in childhood. In this study, data among school children were collected by using the program running on touch-screen tablets with a web-based data collection system, and compared on their sex or body physique.

Methods

In total, 798 school children aged 6–12 years (383 boys, 415 girls) were enrolled in the study. To evaluate food interest, subjects were instructed to choose any 10 of 36 pictures on a panel on the screen depicting 10 different foods and 26 objects normally exist around children. The number of food chosen was set for food interest score (point). The test was performed no later than 30 minutes after meal. For food preference, they were instructed to choose any 10 of 36 pictures on the other panel depicting 36 different foods reported to be their favorites, which were staple foods, main greens, second greens, fruits, cakes, taste drinks and fast foods. Based on the ingredients of the 10 foods chosen, energy density (kcal/100g of food), fat energy ratio (%), saturated fatty acid score (point) and healthy Japanese food score (point) were calculated. This test was performed between meals to avoid postprandial satiety effect. Body mass index (BMI) was calculated by height and weight reported. Subjects were classified as the overweight group (overweight + obesity) according to the IOTF standard with a modification for Japanese population.

Results

1) Food interest: The score was significantly higher in boys than girls (3.6 ± 2.2 vs.1.8 ± 1.8, p < 0.001), higher in children aged 10–12 years than those aged 7–9 years (2.8 ± 2.2, 2.5 ± 2.1, p < 0.05), and higher in the overweight group than the rest (3.3 ± 2.5, 2.6 ± 2.2, p < 0.05). 2) Food preference: Energy density, fat energy ratio, saturated fatty acid score, and Japanese food score were significantly higher in boys than girls (220.8 ± 49.4 vs. 213.8 ± 47.5, 43.2 ± 7.3 vs. 39.6 ± 7.0, 4.1 ± 1.6 vs. 3.4 ± 1.6, 1.5 ± 1.1 vs. 1.3 ± 1.1, p < 0.05). In the overweight group, energy density was lower than the rest (203.5 ± 46.6 vs. 218.4 ± 46.9; p < 0.05). 3) Correlation between the variables: Positive correlations were found between food interest and a preference for energy-dense foods (energy density (ρ = 0.19, p < 0.05), fat energy ratio (ρ = 0.30, p < 0.001), saturated fatty acid score (ρ = 0.29, p < 0.001).

Conclusion

Food interest and preference expressed by the children themselves showed a definite sexual dimorphism as well as a positive correlation with each other, although there still remain unresolved questions why the preference for energy-dense foods was found in boys and not in overweight children. The subjective picture choice method combined well with a web-based, touch-screen tablet assuring spontaneity of children could be one of the practical tools to evaluate childhood eating behavior.

Obes Facts. 2018 May 26;11(Suppl 1):197.

T3P24 Children's body composition and inflammatory markers as predictor of retinal microvascular geometry

C Van Aart 1, N Michels 1, I Sioen 1, T Nawrot 2, S De Henauw 1

Introduction

Childhood obesity is associated with retinal arteriolar narrowing and venular widening, markers of cardiovascular ageing. The relation with the microvascular geometry, such as bifurcation angles, is however unknown. Therefore, this study investigated the association between body composition and inflammatory markers with the retinal microvascular geometry in healthy children.

Methods

We recruited 197 Flemish children, aged 9–16 years old (54.8% boys). Body mass index (BMI), waist circumference, fat mass index and inflammatory markers (CRP; IL-1beta; IL-2; IL-4; IL-6; IL-8; IL-12p70; IL-13; TNFalpha; IFNgamma; Serum amyloid A; ICAM-1; VCAM-1) were obtained using standardized (laboratory) protocols. Microvascular geometry (bifurcation angles and bifurcation optimality deviations) were calculated with Iflexis software from retinal photographs. Univariate and multivariate (adjusting for age, sex and mean arterial pressure) associations were explored with microvascular geometry as outcome.

Results

BMI was positively associated with higher arteriolar optimality deviation (p = 0.01). No associations were seen with waist circumference and fat mass index. Inflammatory marker TNFalpha was correlated with venular branching angle (p = 0.04), however this disappeared after adjustment. Borderline associations were seen between TNFalpha and arteriolar optimality deviation, VCAM-1 and arteriolar bifurcation angle, CRP and venular bifurcation angle and serum amyloid A and venular optimality deviation. Associations with BMI disappeared after additional adjustment for inflammatory parameters.

Conclusion

This study shows that increased childhood BMI might negatively affect optimum conditions for distribution of blood across bifurcations in the arterioles. These microvascular changes could be driven by inflammation induced endothelial dysfunction.

Obes Facts. 2018 May 26;11(Suppl 1):197–198.

T3P25 Using neuroimaging to investigate the impact of Mandolean® training in young people with obesity: A pilot randomised controlled trial

E C Hinton 1, L Birch 2, J Barton 3, JM Holly 4, KM Biernacka 4, SD Leary 1, A Wilson 5, OS Byrom 1, JP Hamilton-Shield 1

Introduction

Slowing eating rate using the Mandolean® previously helped obese adolescents to self-select smaller portion sizes with no reduction in satiety, and enhanced ghrelin suppression. The objective of this pilot, randomised trial was to investigate the neural response to food cues following Mandolean® training using functional Magnetic Resonance Imaging (fMRI), and measures of ghrelin, PYY, glucose and self-reported appetite.

Methods

Twenty-four obese adolescents (11–18 years; BMI ≥ 95th centile) were randomised (but stratified by age and gender) to receive six-months of standard care in an obesity clinic, or standard care plus short-term Mandolean® training. Two fMRI sessions were conducted: at baseline and post-intervention. These sessions were structured as an oral glucose tolerance test, with food cue-reactivity fMRI, cannulation for blood samples, and appetite ratings taken at baseline, 30 (no fMRI), 60 and 90 minutes post-glucose. As this was a pilot trial, a conservative approach to the statistical analysis of the behavioural data used Cliff's delta as a non-parametric measure of effect size between groups. fMRI data was analysed using non-parametric permutation analysis (RANDOMISE, FSL).

Results

Following Mandolean® training: (i) relatively less activation was seen in brain regions associated with food cue reactivity after glucose consumption compared to standard care group (Figure 1); (ii) 22% reduction in self-selected portion size was found with no reduction in post-meal satiety. However, usage of the Mandolean® by the young people involved was variable and considerably less than planned at the outset (on average, 28 meals with the Mandolean® over six-months). Figure 1: Clusters of reduced activation in the Mandolean®+ group compared to the standard care group for the contrast between 60 minutes post-glucose and baseline in the Post-intervention session. (a) Temporal Occipital Fusiform Cortex (TOFC) t = 3.88, x = 32, y = −42, z = −22, cluster size = 16 voxels); (b) Percentage signal change in the TOFC; (c) Putamen t = 4.29, x = 24, y = 24, z = −4, cluster size = 4 voxels; (d) Percentage signal change in the putamen.

Conclusion

This pilot trial provides preliminary evidence that Mandolean® training may be associated with changes in how food cues in the environment are processed, and supports previous studies that showed a reduction in portion size with no reduction in satiety. In this regard, the study supports targeting eating behaviour in weight-management interventions in young people. However, given the variable usage of the Mandolean® during the trial, further work is required to design more user-friendly interventions to aid a reduction in eating speed.

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Obes Facts. 2018 May 26;11(Suppl 1):198.

T3P26 Dietary normalization one month before gestation in diet-induced obese rats programs a greater thermogenic capacity in female offspring

P Castillo 1, H Castro 2, J Sánchez 3, A Palou 3, C Picó 3

Introduction

Maternal obesity during pregnancy has adverse consequences on health in their offspring. Therefore, its prevention is one of the challenges on health research. The general recommendations are to reduce body weight before pregnancy; however, it is necessary to determine the conditions of how and when lose the excess of weight around the perigestational period to prevent negative effects. This study aims to analyze the effects of diet normalization one month before pregnancy in rat dams made obese by cafeteria diet feeding on body weight and thermogenic capacity of brown adipose tissue (BAT) in the offspring.

Methods

We studied a group of Wistar rats at the age of 6 months, whose mothers were fed a cafeteria diet from days 10 to 100 of age and then a standard diet for one month, before pregnancy (postcafeteria dams). The offspring of control and postcafeteria dams were a fed standard diet from weaning until 4 months of age and then a standard diet or a western diet until 6 months. Protein levels of uncoupling protein 1 (UCP1), the molecular basis of thermogenesis, and tyrosine hydroxylase (TYROH), a marker of sympathetic activity, were determined in BAT by western blot.

Results

The male and female offspring of postcafeteria dams presented lower body weight than controls, both under standard and western diet conditions. In females, this was associated to higher UCP1 and TYROH protein levels in BAT, particularly when exposed to western diet.

Conclusion

These results suggest a phenomenon of metabolic programming associated to the elimination of the obesogenic diet before gestation in offspring, which confers a protective effect in terms of weight gain in adulthood, even under an obesogenic environment. In the case of females, this seems to be attributable, at least in part, to an increase in the thermogenic capacity and sympathetic activity of BAT.

Obes Facts. 2018 May 26;11(Suppl 1):198.

T3P27 Incidence of obesity in asthmatic children

R Varekova 1, I Klimesova 1

Introduction

Recently, many studies have found that current lifestyle with lack of physical activity and immoderate food intake leads to unsatisfactory body composition from the youngest age. In asthmatic children, this is further worsened by chronic inflammation and long-term intake of corticoids which results in reduction of physical activities due to the fear of onset of acute asthma

Methods

122children with astma were enrolled in the study (63 boys and 59 girls, x = 12.4 y.old, SD ± 3.29). Bioimpedance method (In Body 720) was used to assess the body composition and the percentile charts by age categories (Vignerová, 2001) were used to evaluate the main anthropocentric parameters (body weight and height) and BMI.

Results

The most numerous 49% was the group above the standard - this group can be divided into 14% increased weight (robust) boys, 6% overweight boys and 29% clearly obese. Likewise, as in the boys, the most numerous group 47%were the girls above the standard -of whom 17%had increased weight (robust), 15% was overweight and 15% was clearly obese (90 < percentile). Evaluation of individual body components by InBody 720 device confirmed previous findings. The figures of muscle component points to low activity lifestyle, with only 52% of the boys and 54% of the girls being within the standard.35% of the boys and 39% of the girls were below the standard.

Conclusion

The results indicateprevalence of overweight and obesity in asthmatic children and an unhealthy ratio of individual body components from the youngest age – too high percentage of body fat and weak percentage of muscles component. That is why it would be desirable to increase physical activity and make changes in dietary routines.

Obes Facts. 2018 May 26;11(Suppl 1):199.

T3P28 Illustrating the pivotal role of obesity as a driver of diabetes

A Moses 1, N Lund 2, BB Jensen 3, D Napier 4

Introduction

The prevalence of diabetes and its persistent increase constitutes one of today's major health challenges. 425 million people live with diabetes globally, making diabetes responsible for 12% of global health care expenditures1. However, many cases can be prevented or at least delayed1. Type 2 diabetes (T2D) is influenced by various factors and long delays between these initiating factors and their effects. The rise is primarily driven by population growth and ageing, physical inactivity, unhealthy diet, rising overweight and obesity2. The most significant modifiable driver is excess body weight3. Today, 650 million people globally have obesity4. Cities Changing Diabetes was established in 2014 to improve the understanding of factors driving the rise of diabetes in urban settings. The programme is a partnership consisting of University College London, Steno Diabetes Center Copenhagen, Novo Nordisk, as well as a broad range of local partners. One aim of the program was to model how future diabetes prevalence will be impacted if the current obesity level is extrapolated linearly. Furthermore, the model provides insights into how much the current obesity level must be reduced to stabilise the diabetes prevalence.

Methods

Population data for all countries in the world were obtained from the Non-communicable Disease Risk Factor Collaboration5. For each country, population was divided into age groups. From 2000–2014, the population in each age group was divided into BMI categories. For each country and age group, share of people in each BMI class was projected. Diabetes risk for each age and BMI group was applied6,4 allowing estimations of diabetes prevalence for each country each year. The prevalence for each country was calibrated to match International Diabetes Federation's regional estimates thereby taking into account differences in way of life, nutrition and genetic disposition for diabetes.

Results

The global diabetes prevalence will reach 11.7% by 2045 and 13.3% in 2100 if current global obesity rate increases linearly. In contrast, stabilising the global diabetes prevalence at 10.0% by 2045 will require global obesity rate to be decreased by 25% by 2045 compared to 2017. The methodology was validated by external experts in obesity and diabetes.

Conclusion

The global prevalence of obesity and diabetes is projected to increase dramatically unless prevention of obesity is significantly intensified. Developing effective global programs to reduce obesity offer the best opportunity to slow or stabilize the unsustainable prevalence of diabetes.

Conflicts of Interest

I am an employee and a stock/shareholder of Novo Nordisk.

References

Obes Facts. 2018 May 26;11(Suppl 1):199.

T3P29 Association of circulating growth arrest-specific 6 protein with adiposity and metabolic syndrome in obese children and adolescents

P Matusik 1, O Zajdel-Cwynar 1, M Olszanecka-Glinianowicz 2, E Malecka-Tendera 1

Introduction

Growth arrest-specific 6 (Gas6) is a vitamin K-dependent protein produced by several types of cells including adypocytes and regulates their homeostasis. Previous studies indicate that Gas6 signaling may be involved in the pathogenesis of obesity and its complications, including systemic inflammation and insulin resistance. However, little is known about the clinical significance of the Gas6 system in childhood obesity. The aim of the study was to determine the potential association of circulating Gas6 with anthropometrical and metabolic status of obese children and adolescents.

Methods

In 74 obese children and adolescents (33 boys and 41 girls) in the mean age of 13.92 ± 3.14 years growth arrest-specific 6 (Gas6), glucose and insulin fasting and in oral glucose tolerance test (OGTT), HOMA-IR index and lipid profile were determined. Anthropometric parameters expressed as BMI Z-score, WHR, W/HtR and body composition was evaluated by bioelectrical impedance analysis (BIA) such as fat mass (FAT), fat-free mass (FMM), and total body water (TBW). Gas6 level was then correlated to the all anthropometrical and metabolic parameters. Patients were divided into two groups: with and without metabolic syndrome (MS), which were then compared for Gas6 level. The association for the Gas6 level and specific MS criteria was also assessed.

Results

Gas6 was significantly higher in MS patients (20.87 ng/ml vs. 13.64 ng/ml; p < 0.05). There was also significant positive relationship with number of MS criteria reached, and Gas6 level based on the ANOVA test (p < 0.05). Gas6 was also significantly higher in patients with abnormal triglycerides and HDL cholesterol levels (p < 0.01 and p < 0.05 respectively). Gas6 correlated significantly (positive) with BMI Z-score and FAT% (p < 0.05). There were also a negative significant correlations with FFM% and TBW% (p < 0.05). No significant associations were found with glucose and insulin metabolism parameters.

Conclusion

Circulating Gas6 levels are significantly associated with body composition (especially adiposity level) and are also related to the risk of metabolic syndrome development in obese pediatric population. The potential role of Gas6 signaling in the pathogenesis of childhood obesity and its complications requires futher investigation.

Obes Facts. 2018 May 26;11(Suppl 1):199–200.

T3P31 Impulsivity and its clinical associations in children with overweight and obesity versus normal-weight

C Hübner 1, C Sebert 1, C Kösling 1, A Hilbert 1, R Schmidt 1

Introduction

First evidence indicated greater general and food-specific impulsivity in children with overweight versus normal-weight. However, little is known about the presence of neurophysiological indicators of impulsivity and the association between self-reported and experimentally assessed measures of impulsivity in children. The present study aimed at the multimodal assessment of impulsivity in children depending on their weight status. Further, clinical correlates of impulsivity were determined.

Methods

In N = 34 children aged 8 to 13 years (n = 12 children with overweight and obesity; n = 22 children with normal-weight), the Balloon Analogue Risk Task-Youth (BART-Y) and the Approach Avoidance Task (AAT) were applied for the assessment of general and food-related impulsivity, respectively. Further, well-established self-report questionnaires and interviews were used for the assessment of children's impulsivity as well as their general and eating disorder psychopathology via self- and parent-report.

Results

In a preliminary analysis, only data of the BART-Y were analyzed. Children with overweight and obesity showed marginally less risk taking behavior in the BART-Y and reported greater general as well as eating disorder psychopathology compared to children with normal-weight. Within children with overweight and obesity, significant associations were found between greater risk taking behavior and different clinical features, e.g., greater self-reported impulsivity, while no associations were found in children with normal-weight. The association between self-reported and experimentally assessed impulsivity was non-significant.

Conclusion

results of this pilot study indicate impulsivity to be differentially related to clinical features in children with overweight and obesity versus normal-weight. Associations with children's food-related impulsivity assessed via the AAT as well as with their neurophysiological profile are currently examined. Altogether, future research is needed in order to provide data about predictive validity of self-reported as well as experimentally assessed general and food-related impulsivity for weight development.

Obes Facts. 2018 May 26;11(Suppl 1):200.

T3P32 Catalase activity is related with inflammatory status in overweight and obese children

M D Mesa 1, J Olza 1, AI Ruperez 1, R Vázquez-Cobela 2, LA Moreno 3, R Leis 2, G Bueno 3, A Gil 1, C Aguilera 1

Introduction

Catalase (CAT) erythrocyte activity has been found to be lower in normal-weight children, and it is correlated with obesity and insulin resistance biomarkers. The aim of the present work was to evaluate the relationship between CAT activity, metabolic risk factors and inflammation in overweight and obese children compared with normal-weight.

Methods

Four hundred eighty eight children (mean age 10.4 ± 0.1 years) were enrolled in this study: 237 boys (166 overweight and obese and 71 normal-weight) and 251 girls (187 overweight and obese and 64 normal-weight). Erythrocytic antioxidant CAT activity, weight, body mass index (BMI), waist circumference (WC), blood pressure (BP), glucose, insulin, homeostasis model assessment for insulin resistance (HOMA), the lipid profile, as well as plasma inflammatory biomarkers were determined. T-test for independent samples was used to compare overweight and obese with normal weight children. A lineal regression adjusted by age was performed to establish the relation between CAT activity and metabolic and inflammatory biomarkers: BMIz score, WC, systolic and diastolic BP and blood glucose, HDL-cholesterol, resistin, leptin, monocyte chemotactic protein-1 (MCP1) and tumor necrosis factor-α (TNFα).

Results

In girls, CAT activity, diastolic BP, plasma insulin, triacylglycerols, leptin, MCP1, TNFα and the HOMA index were higher in overweight and obese compared with normal-weight, while HDL, adiponectin, resistin and MPO were lower. In boys, plasma insulin, triacylglycerols, leptin and the HOMA index were higher in overweight and obese compared with the controls, while HDL, adiponectin and resistin were higher in the normal-weight children. After adjusting by age, CAT activity correlates independently with waist circumference (WC) (β = 0.200, p = 0.003) and resistin (β = −0.141, p = 0.032) in girls, predicting the 9.3% of the CAT activity variation (r2 = 0.093). On the other hand, in boys CAT activity correlates with WC (β = 0.175, p = 0.008), glucose (β = −0.-0.161, p = 0.012), resistin (β = −0.161, p = 0.017) and TNFα (β = 0.163, p = 0.012), predicting the 15% of the CAT activity variation (r2 = 0.151).

Conclusion

CAT activity is related with some inflammatory biomarkers in children.

Conflict of Interest

None Disclosed

Funding

This study was funded by the Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (I+D+I), Instituto de Salud Carlos III-Fondo de Investigación Sanitaria [PI11/02042, FEDER] and Redes temáticas de investigación cooperativa RETIC [Red SAMID RD16/0022/0003].

Obes Facts. 2018 May 26;11(Suppl 1):200.

T3P33 Milk Intake and Serum Insulin Levels in Obese Children and Adolescents

M Yafi 1, S Hashmi 2, S Nandiola 2, M Eissa 2

Introduction

Milk consumption has shown reduction of the risk of metabolic syndrome (MS) in adults. However, data on milk consumption and its association with clinical parameters, including insulin levels, in obese children are not well studied.

Methods

The aim of this study is to assess daily milk intake and its association with fasting serum insulin levels in obese children and adolescents who are seen in a pediatric weight management clinic. We conducted a retrospective chart review of 353 patients aged 3 through 18 years with BMI > 95%ile seen between December 2008 to December 2010 in our pediatric weight management Clinic. Among these, initial visit data on fasting serum insulin was present in medical records of 171 patients. Additional information was obtained on daily milk intake in cups, milk types, fasting blood glucose, and other clinically relevant measurements for each patient during their initial visit. Milk intake was categorized into less than a cup a day, 1 to less than 2 cups a day and 2 or more cups a day. Kruskal-Wallis test (with post-hoc Dunn's test) was used to compare continuous variables across the milk intake categories. Categorical variables were compared using Fisher exact tests. Fasting Insulin levels were categorized (< = 19 and >19 uiu/ml) and logistic reaction models were assessed. Statistical significance was assumed at a Type I error rate of 5%.

Results

Participants were 54% male, 74% Hispanic, with mean age of 11.3 years (SD 3.1 years). Only 13% (23/171) of the patients reported their average daily milk intake to be at the recommended three cups or more. Females reported less milk intake compared to males (p = 0.026) whereas there was no difference in milk consumption by ethnicity. 44% of patients who reported milk intake of < 1 cup/day had fasting insulin levels < = 19 uiu/ml in comparison to 72% of patients who reported 2+ cups/day (p = 0.057). Patients who drank < 1 cup/day had higher levels of fasting insulin (median = 23, IQR:13–38) compared to those drinking 1- < 2 cups/day (median = 15, IQR:8–29, p = 0.028) or 2+ cups/day (median:13, IQR:7–22, p = 0.004). There was no association between milk intake and glucose levels. Logistic regression models (adjusted for patients’ race/ethnicity, gender, glucose levels and the type of milk based on fat content) demonstrated a lower fasting insulin levels among those drinking 2+ cups/day (OR: 0.19, 95% CI: 0.06–0.64).

Conclusion

The majority of children with obesity consume less than the RDA of milk. Increased daily milk intake is associated with lower levels of fasting insulin in these obese children suggesting better glycemic control among those with higher milk intake. Milk intake maybe encouraged in children, especially, those with obesity who are at risk for insulin resistance and poor glycemic control.

Obes Facts. 2018 May 26;11(Suppl 1):200–201.

T3P34 Does the impact of a plant-based diet during pregnancy on birthweight differ by ethnicity? A dietary pattern analysis from a prospective Canadian birth cohort Alliance

M A Zulyniak 1, RJ De Souza 2, M Shaikh 3, D Desai 4, D Lefebvre 4, M Gupta 4, J Wilson 5, G Wahi 2, P Subbarao 6, AB Becker 7, P Mandhane 8, SE Turvey 9, J Beyene 2, S Atkinson 10, K Morisson 10, S McDonald 2, KK Teo 4, M Sears 4, SS Anand 4

Introduction

Birthweight is an indicator of newborn health and a strong predictor of health outcomes in later life, including cardiovascular disease, diabetes, and obesity. The significant variation in dietary intake during pregnancy between ethnic groups living in high-income countries provides an ideal opportunity to investigate the influence of maternal diet on birthweight. We aimed to investigate the impact of maternal dietary patterns on birthweight in four multi-ethnic birth cohorts based in Canada (The NutriGen Alliance).

Methods

We analyzed 3,997 full-term mother-infant pairs of diverse ethnic groups. Multivariable regression was used to test the association between 3 principal component analysis (PCA)-derived diet patterns — plant-based, Western, health-conscious — and birthweight. The foods comprising significant diet patterns were then investigated to identify key food items contributing to this association.

Results

No associations were identified between the Western and health-conscious diet patterns and birthweight; however, the plant-based dietary pattern was inversely associated with birthweight (β = −67.6g per 1-unit increase; P < 0.001) and an interaction with non-white ethnicity and birthweight was present. Ethnically stratified analyses demonstrated that among white Europeans, maternal consumption of a plant-based diet associated with lower birthweight (β = −65.9g per 1-unit increase; P < 0.001), increased risk of small for gestational age (SGA; OR = 1.46; 95%CI:1.08–1.54;P = 0.005), and reduced risk of large for gestational age (LGA;OR = 0.71; 95%CI:0.53–0.95;P = 0.02). Among South Asians, maternal consumption of a plant-based diet associated with a higher birthweight (β = +40.5g per 1-unit increase; P = 0.01), partially driven by cooked vegetable consumption.

Conclusion

Maternal consumption of a plant-based diet during pregnancy is associated with birthweight. Among white Europeans, a plant-based diet is associated with lower birthweight, reduced odds of an infant born LGA, and increased odds of SGA, whereas among South Asians living in Canada, a plant-based diet is associated with increased birthweight.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):201–202.

T3P35 Breakfast Skipping and overweight/obesity among European adolescents, a cross-sectional analysis of the HELENA dataset: a DEDIPAC study

F Riordan 1, N Barrett 2, N Michels 3, L Frost Andersen 4, P Vant Veer 5, LA Moreno 6, K Widhalm 7, Y Manios 8, F Gottrand 9, AM Santaliestra-Pasías 6, J R Ruiz 10, L Censi 11, S De Henauw 3, M Kersting 12, J M Harrington 1

Introduction

Breakfast is frequently skipped, particularly among adolescents. Existing research examining the relationship between breakfast skipping and overweight/obesity is predominantly based on cross-sectional data from single country studies; this relationship has not been explored among adolescents across Europe. Our objectives were to examine the demographic factors associated with breakfast skipping, determine the prevalence of skipping among European adolescents, examine differences in macronutrient and food intakes between skippers and non-skippers, and determine whether skipping is associated with overweight/obesity.

Methods

Cross-sectional data from the Healthy Lifestyle in Europe by Nutrition in Adolescence study (n = 3528) conducted in ten European cities: Athens (Greece), Dortmund (Germany), Ghent (Belgium), Herkalion (Greece), Lille (France), Pecs (Hungary), Rome (Italy), Vienna (Austria), Stockholm (Sweden) and Zaragoza (Spain) were used. Analysis was carried out using a sub-sample of adolescents (n = 1894) aged 12.5–17.49 years with data on breakfast skipping and two days of 24-Hour Diet Recall data. Using responses from the Food Choices and Preferences Questionnaire adolescents were classified as skippers or non-skippers. All analyses were stratified by sex. Differences in the intake of macronutrients, both overall and when breakfast was excluded, and key foods were compared between skippers and non-skippers using the Wilcoxen Rank-Sum test. Multivariate logistic regression adjusted for demographic (region, age, maternal education, FAS, and family structure) and lifestyle (physical activity and diet quality) factors was used to examine the relationship between breakfast skipping and overweight/obesity.

Results

Overall, 44% of females were skippers compared to 36% of males. Across the eight countries the proportion of breakfast skippers ranged from 52.7% (Greece and Austria) to 21.5% (Spain). Among male skippers, there were a higher proportion younger adolescents (≥15 years) and from the Central or Southern regions of Europe compared to non-skippers (p < 0.001). Among females, there were a greater proportion of skippers with low Family Affluence score and from the Central or Southern region of Europe, and with mothers of lower education level compared to non-skippers (p < 0.001). Among both male and female skippers estimated mean fibre intake and median fruit intake was significantly lower compared to non-skippers. Male skippers were significantly more likely than non-skippers to be overweight/obese [AOR, 2.34, 95% CI, 1.40–3.90] but this association was not observed among females [AOR, 0.89, 95% CI 0.59–1.34].

Conclusion

Different patterns of daily macronutrient intake were observed among adolescents who skip and do not skip breakfast. Male breakfast skippers had an increased likelihood of being overweight/obese compared to non-skippers. These results may present an opportunity to identify and target adolescents who may be at risk of a poorer nutritional profile or being overweight/obese. Gender may play a key part in breakfast skipping behaviours. Interventions to target breakfast skipping may need to account for potentially different motivations for the behaviour among male and female adolescents.

Obes Facts. 2018 May 26;11(Suppl 1):202.

T3P36 Portion size in parents’ eyes: a mixed methods systematic review of parental portioning practices for their children

L Kairey 1, K Matvienko-Sikar 1, C Kelly 2, MC McKinley 3, EM O’Connor 4, PM Kearney 1, JV Woodside 3, JM Harrington 1

Introduction

Portion sizes consumed by children have increased in recent decades and are positively associated with children's energy intake and weight status. Children, like adults, are susceptible to portion size effects, consuming more in response to being served larger portion sizes. Given children are reliant on parents for the provision of the majority of their food, this review focused on ‘parental portioning practices’ and factors influencing these practices.

Methods

Electronic databases PubMed, EMBASE, SCOPUS, PsycINFO and CINAHL Plus were searched using terms including ‘portion size’, ‘meal’, ‘snack’, ‘beverage’, ‘parent’, ‘child’, ‘knowledge’, ‘perceptions’, ‘practices’. Two independent reviewers screened 355 records, then assessed 65 full-text articles against eligibility criteria: quantitative or qualitative studies of parental portioning practices or determinants of these practices in parent(s) with ≥1 child aged 2–12 years residing in highly developed countries.

Results

Narrative synthesis of quantitative studies (n = 11), indicate that parents consider their child's portion sizes appropriate and place rather greater importance on the quality of their diet. Parents serve larger portion sizes to children perceived as hungry and those with a higher body mass. At meals where parents serve themselves more food, they also serve their children more. Further, parents are more willing to reduce family portion sizes if their child is overweight or obese, although portion sizes are less important to parents than physical activity for family weight control. Thematic synthesis of qualitative studies (n = 13), indicates that ‘parental portioning practices’ are broadly defined as decisions parents make regarding the amounts (portion sizes) of foods and beverages to serve, while objective measures of these practices remain to be defined. Portion sizes served by parents are ultimately influenced by their need for a fed (or full) and healthy child (of a healthy weight). Parents also serve the portion sizes that they have learned to be ‘enough’ for their child. Parents perceive the portion sizes children need as highly individual (i.e. what is appropriate for one child would be too much/little for another) and, needing to increase with child age and developmental periods (i.e. growth spurts). A child's weight provides an indication to parents of their child's health and hence, parents use different portioning practices for children viewed as too thin (i.e. encouraging more food even in absence of hunger) to those viewed as carrying excess weight (i.e. restricting portion sizes and/or third helpings where felt necessary to avoid health problems). Some parents allow their child to decide their portion sizes or include them in negotiations. Knowledge of appropriate portion sizes for children and adults is limited and parents are unaware of existing guidance, but also differ in their opinion as to a need for such guidance.

Conclusion

Greater public awareness of the impacts of serving larger portion sizes to children is critical. Clear information for families on appropriate portion sizes for both children and adults is needed. Future interventions should address the reported determinants of parental serving of larger portion sizes to children.

Obes Facts. 2018 May 26;11(Suppl 1):202–203.

T3P37 Development of an attractive bread for school children meeting health claim regulations

M Wallner 1, S Berner 1, W Gunzer 1, M Peterseil 1, A Kronberger 1, J Martin 1, S Schantl 1, M Konrad 1, S Maunz 1, B Wrank 1, M Derler 1, E Pail 1, B Fuchs-Neuhold 1

Introduction

Customised sensory properties focusing on taste and product attractiveness might help children and their parents make healthier food choices (van Kleef et al., 2014). In children increased fiber consumption is related to a healthier eating style (Ruottinen et al., 2010) and better health outcomes (Choumenkovitch et al., 2013), the opposite is true for high salt consumption (Grimes et al., 2013; Lava et al., 2015). Therefore, a sensorily attractive whole-grain bread, was developed based on health claim reulations for salt and fiber and further specific product requirements (attractive shape, size and color) and was evaluated by children.

Methods

38 children, aged 6–10 years, tested different types of the bread which differed in shape, color, symmetry and taste. Data were generated via eye-tracking (Tobii® X2–60 Eye-Tracker), preference and acceptance testing.

Results

The liking of the star-shaped was significantly higher (1.5 ± 0.92) in contrast to the square-shaped bread pictures (2.0 ± 1.09, p < 0.05). The yellow colored versions of the bread were chosen less often (18.4%) compared to usual brown bread (81.6%, p < 0.000), what was also shown by eye-tracking (p < 0.05, Fig. 1). Although, 44.7% preferred white bread and 53% don’t eat whole-grain bread regularly, the acceptance of the star-shaped bread was high: 76.3% rated the bread good or very good in terms of taste (p < 0.000).

Conclusion

The modified color using turmeric was not accepted by children, indicating natural brown bread colors are preferred in the testing group. We further conclude that the tested children like an attractive child-oriented bread-style, which could help children making a healthier food choice.

Fig. 1.

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Results of eye-tracking and preference testing (n = 38) Choices made by children (spots on AOIs) and heatmap (indicated by darker, red spots with more fixations, and lighter greener spots with less fixations) Description of AOIs (Areas of interest): AOI A: star-shaped, brown AOI B: star-shaped, yellow AOI C: square-shaped, yellow AOI D: square-shaped, brown AOI E: asymmetric star-shape, brown AOI F: asymmetric star-shape, yellow AOI G: symmetric star-shape, yellow AOI H: symmetric star-shape, brown Gazing behavior parameters median (95% Confidence interval): FD: fixation duration in seconds FC: fixation counts Relevant AOIs are linked and number of choices N = (%) and gazing behavior parameters FD, FC for shape, color or symmetry are presented. Data analyzed with binomial distribution (preference testing) or paired Wilcoxon test (eye-tracking), significant differences considered p < 0.05 are marked * or for Trend < 0.15

Obes Facts. 2018 May 26;11(Suppl 1):203.

T3P38 Average Diet Quality Scores of Inactive Adolescents Was Not Altered by an 8-Week Aerobic Exercise Program

C Pouliot 1, A Biagé 1, I Giroux 2, D Prud’Homme 1

Introduction

Exercise is known to have many health benefits. Studies suggest it may lead to a decrease in energy intake of adolescents, thus playing a role in obesity prevention and management. This may be in part due to changes in macronutrient intake, which was especially observed in adolescents with excess body weight. However, studies remain unclear as to how adolescents modify their diet following the initiation of an exercise program. This study examined the effect of both exercise and weight status on diet quality of previously inactive adolescents.

Methods

A total of twenty-six adolescents, 17 with normal weight (BMI: 20.4 ± 1.9kg/m2) and 9 with excess body weight (BMI: 29.0 ± 3.6 kg/m2), participated in an 8-week moderate intensity aerobic exercise program on cycle ergometers. Two 24-hour dietary recalls were completed in pre-intervention and four in post-intervention. Dietary assessments were conducted by dietitians and trained nutrition interns using the Multiple Pass Method and food models. Data were analyzed with ESHA Food Processor software. The Healthy Eating Index adapted to Canadians (HEI-C) was used to assess diet quality of participants. Daily scores were averaged for pre- and post-intervention conditions. Scores were categorized as “good quality diet” (>80%), “diet needing improvement” (50–80%) or “poor quality diet” (< 50%). A mixed-method ANOVA was conducted to compare pre- and post-intervention HEI-C scores between adolescents with normal and excess body weight. Friedman's test was also used for data that did not meet normality assumptions.

Results

Average HEI-C scores of adolescents was 59.62 ± 12.24% at baseline, which qualifies as “diet needing improvement”. There was no significant difference in baseline scores based on weight status or sex. Our analyses also revealed no significant interaction or independent effect of exercise or weight status on HEI-C scores of adolescents (p > 0.05). When analyzing each components of the HEI-C, scores were not statistically different between pre- and post-intervention conditions (p > 0.05). However, we observed individual variation in diet quality scores in response to the exercise program (Figure 1). Twenty-seven percent of participants changed diet quality categories following the exercise program. Five of those participants made improvements to their diet (“poor quality diet” to “diet needing improvement”) while the other two decreased their adherence to Canadian Food Guide recommendations (“diet needing improvement” to “poor quality diet”).

Conclusion

Participation in the 8-week exercise program did not significantly influence the total HEI-C scores of adolescents or any of its components. Our results highlight the need to provide nutrition education to adolescents initiating an exercise program. Future studies should aim for a larger sample size and examine the effect of exercise on other dietary assessment parameters.

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Obes Facts. 2018 May 26;11(Suppl 1):203.

T3P39 A new way to prevent obesity for kids aged between 8–10 years

T Knopf 1

Introduction

Prevalence of overweight and obesity has reached alarming rates in European Union and numbers are still rising. Moreover overweight children have a high risk to become overweight adults with a high risk for type 2 diabetes, cardiovascular, orthopedi and other diseases. Aim of the Eddy Young Study is to raise awareness and to prevent children to get overweight individuals.

Methods

160 primary school children aged between 8–10 years have been tested. The group is devided into a contoll group (n = 88) and a intervention group (n = 72). The children of the intervention group received 8h nutrition (healthy food, cooking, etc.) and 16h sport (endurance and strength) lessons. Furthermore they had the opportunity to use a special tailored App (Cally App). The german motorik test with 8 different sport tasks and a questionnaire about nutrition knowledge and behavior has been used. Data were computed by SPSS Statistic.

Results

from the german motoric test are showing that intervention group approaches to controll group. Furthermore children from the intervention group could reduce body fat while muscle mass increases. In addition there has been a positive change in nutrition lifestyle. For example: children from the intervetion group consumed less fast food.

Conclusion

The results are showing that a combination of nutrition and sport intervention is successful to reduce body fat and increase muscle mass. The intervention has to be done by expert staff. Besides it is important to integrate the childrens environment (school, parents, etc). Furthermore it is fundamental to raise awareness of a healthy nutrition and increase physical activity already in early age. Obesity prevention is possible if all indicators falls together into place.

Obes Facts. 2018 May 26;11(Suppl 1):203–204.

T3P40 Dietary pattern is associated with overweight/obesity among school-aged children in Southwest China

D Li 1, M Chen 1, H Xue 1, Y Liang 1, G Tian 1, Y Gong 2, G Cheng 1

Introduction

The association of dietary pattern with obesity risk has been investigated widely in Western countries. However, data from Chinese children and adolescents are limited. The aim of this study was to identify dietary patterns among school-aged children in Southwest China and to explore its association with overweight/obesity.

Methods

A total of 1010 children aged 7–12 years were recruited in Southwest China with cluster random sampling. Data on socio-demographic, dietary and lifestyle factors were collected through face-to-face interview. Dietary intake was assessed using a 47-item food frequency questionnaire (FFQ). Height and weight were measured to calculate body mass index (BMI) and BMI z Score. Principal components analysis (PCA) was used to identify dietary patterns. To examine the association between dietary patterns and overweight/obesity, multivariate logistic regression analysis was performed

Results

Three major dietary patterns were identified among children aged 7–12 years in Southwest China: the western dietary pattern, the traditional dietary pattern, the vegetable/fruit dietary pattern. The Western pattern was characterized by high consumption of beverages, ice-cream, fast food and desserts. The traditional pattern reflected high intakes of soybeans, potatoes, whole grains. The vegetable/fruit dietary pattern was characterized by high intakes of fruits and vegetables. After adjusting related confounders, a higher traditional dietary pattern score was associated with a lower risk of overweight and obesity (p = 0.04). The western dietary pattern and the vegetable/fruit dietary pattern were not related with overweight and obesity of children.

Conclusion

Three main dietary patterns were identified among school-aged children in Chengdu. Dietary patterns were associated with overweight and obesity of children.

Obes Facts. 2018 May 26;11(Suppl 1):204.

T3P41 Validation Of A Turkish Version Of The Food Choice Questionnaire On Adolescents

Z Cevahir 1, M Bas 1, E Evcil 1, M Eygi 1, I M Durasi 1

Introduction

Understanding nutrition choice motivation is necessary to plan public nutrition policies aimed at promoting health and well-being, and to inform food product innovation and food marketing. With the increase of the globalizing market and its economy it is important to understand the variation of the food selection motivation of different countries and its cultures. Food Choice Questionnaire (FCQ) has been developed by Steptoe and Pollard (1995) and tested in the United Kingdom for to evaluate the food choice motivation. The original design for FCQ aimed to evaluate the 36 items in 9 different dimensional reasons behind the food choice questionnaire. This study is aiming to show the validation of the “food choice questionnaire” on adolescents in Turkey.

Methods

A total of 829 people, 409 males and 420 females between the ages of 14–17 years, participated in the study voluntarily in Istanbul, Turkey. The questionnaire included socio-demographic characteristics and “Food Choice Questionnaire”. The FCQ comprised of 36 items. In the questionnaire, every item started with “What's important to me about the food I eat on a typical day”. Every item in the questionnaire has been scored from 4 points; 1 = not important, 2 = less important, 3 = mid-grade important, 4 = very important. For to evaluate the validity of the Turkish version of Food Choice Questionnaire (FCQ) on Adolescents; item-total correlation, internal consistency (Cronbach alfa) and test-retest correlation has been used.

Results

The participants’ mean age was 15.80.8 years of female and 15.5 ± 0.9 years of male. The average BMI of the male participants was 22.2 ± 3.5 kg/m2, and the average BMI of the female participants was 21.2 ± 3.6 kg/m2 (%41.9 of female participants were underweight and %44.4 normal,%8.8 overweight, %2.9 were obese; %27.6 of male participants were underweight, %53.8 normal,%16.4 overweight and %2.2 obese). The construct validity of the food choice questionnaire was tested by CFA. Standardized factor loadings of every materials between of 0.41–0.89 (>40). Statistics obtained from CFA to evaluate the model fit were as follows: x2/df = 4.88 < 5, CFI = 0.976 ≥ 0.95, and RMSEA = 0.068 > 0.06. The CFA result indicated acceptable fit for the Turkish version of the FCQ. Cronbach's alpha values of the FCQ's 0.91 and test retest reliability was tested 0.97. According to these results the Turkish FCQ of the survey were determined to be in acceptable alignment. Cronbach's Alpha values for the overall questionnaire it was 0.91. Test-retest reliability was tested with ICC and the ICC values 0.97.

Conclusion

results show that Turkish version of the FCQ is a validated questionnaire and reliable research instrument in Turkish adolescent population.

Obes Facts. 2018 May 26;11(Suppl 1):204.

T3P42 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):204.

T3P43 Assessment of maternal nutrition during pregnancy and [early] lactation period in Austria: Comparison of a Food-Frequency Questionnaire with a 24-hour Recall

W Gunzer 1, M Peterseil 1, R Pilz 2, E Pail 1, B Fuchs-Neuhold 1

Introduction

Maternal diet during pregnancy and lactation has a significant impact on health outcomes for mother and child. Evidence suggest the protective effect of prenatal micronutrient status regarding fetal growth and mortality prevention. Furthermore, dietary habits reflect macronutrient supply and help to understand the development of overweight or obesity and subsequently associated diseases in mother and child. Nutritional recommendations for pregnant and lactating women are already stated in Austria. However, there is a need to assess reliable nutritional intake data for this specific population. The food frequency questionnaire (FFQ) as a reliable but low-cost tool to explore food consumption and nutrient status, have been the most commonly used approach to assess maternal diet in pregnancy. Therefore, as part of an ongoing prospective observational pilot study at the Laboratory for Sensory and Health (HPL), the aim of the present work was to evaluate our newly developed FFQ for the use in pre- and postnatal period against a 24h dietary recall.

Methods

A random sample of 54 healthy pregnant women (Mage = 32.00, SDage = 4.01) were investigated twice from January to October 2014. The main inclusion criteria were age of 18 to 50 years, pregnancy less than 28 weeks, unobtrusive oral glucose tolerance test, non-smoking and BMI ≥18,5 kg/m2 to ≤30 kg/m2. Women suffering from chronic health conditions, conditions influencing maternal feeding behaviour or sensory perception as well as prematurity and drug usage were excluded. Development and validation of the health pregnancy lactation-specific FFQ. The HPL-FFQ was designed to assess the food intake retrospective over the last 3 months of Austrian women during pregnancy and lactation. The development of the FFQ aimed to keep participants time burden low while providing acceptable accuracy of food intake amount and frequency at the same time. At first, available FFQs especially used in scientific studies with pregnant women were screened and checked for feasibility in the current pilot study by nutrition experts. Secondly, relevant food groups and specific items for the use in the FFQ have been selected and pre-tested for cultural consistency. For validation, the reference method of a 24-hours dietary recall was used. The 24-hours recall method is a recommended comparison method because it does not require subject literacy (if the investigator do the recall) and produce high levels of specificity.

Results

Pearson's Correlation coefficient was used to determine the correlation between the two different dietary assessment Methods. Agreement between the two dietary methods was assessed using the Bland-Altman method. As shown in Table 1, moderate correlations were found between the reported intake using the HPL-FFQ and the 24-hour recall (r = .21 to r = .44; p = .039 to p < .001). The limits of agreement for the Bland-Altman plot were between −80.38 and 75.25g reported from food (Fig. 1).

Conclusion

High compliance by participants and the moderate associations which have been shown in 30 nutritions indicate, that the newly developed HPL-FFQ might be a feasible practical tool to assess nutritional intake of women during the late pre- and early postnatal stage who might be at risk of inadequate dietary habits.

Obes Facts. 2018 May 26;11(Suppl 1):205.

T3P44 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):205.

T3P45 Beverage consumption among toddlers in Poland – results of the PITNUTS 2016 study

H Weker 1, M Więch 1, E Brudnicka 1, M Barańska 2, M Strucińska 1, W Klemarczyk 1, H Dyląg 1, G Rowicka 1

Introduction

Early childhood is a critical period for shaping appropriate dietary habits, including correct choices of food and beverages, such as water and juices. The aim of the study was to analyse beverage consumption among children aged 13–36 months in Poland compared to the current recommendations.

Methods

The study of beverage consumption among children aged 13–36 months was conducted on a nationwide representative sample (n = 612) using a questionnaire survey and 3-day dietary records.

Results

Milk and water were the main beverages consumed by children aged 1–3 years. From among the analysed children, 43%consumed formula milk, 46% cow's milk, 69.1% mineral and/or spring water, 23.5% water with fruit syrup, 31.2% sweetened teas and 35.1% juices. Children in the second year of life consumed mainly formula milk, while those in the third year of life drank only cow's milk. In 78.3% of children milk consumption was lower than recommended. The average daily consumption of water amounted to 376.6 ± 268.5 ml. Juice consumption differed significantly between children from the group with appropriate body mass and those at risk of overweight and obesity.

Conclusion

Formula milk prevails among all milk beverages consumed by childrenin the second year of life, and cow's milk among older children (third year of life), which may have an impact on the nutritional value of their diets. The share of such beverages as water, juices and other beverages in the diets of toddlers was incompliant with recommendations, thus the need to promote the principles of appropriate consumption of beverages, including good quality water.

Obes Facts. 2018 May 26;11(Suppl 1):205.

T3P46 Association between hair cortisol concentration and dietary intake among normal weight preschool children predisposed to overweight and obesity

S C Larsen 1, JF Rohde 1, NJ Olsen 1, MN Händel 1, M Stougaard 1, J Fahrenkrug 2, BL Heitmann 1

Introduction

There is a lack of evidence on how chronically elevated cortisol, as measured by hair cortisol concentration (HCC), is associated with dietary intake among children. Moreover, it is unknown whether there is an association between parental HCC and dietary intake among their children. Thus, the aim of this study was to examine associations between HCC and dietary intake among children, and to explore the association between parental HCC and dietary intake among their children.

Methods

We conducted a cross-sectional study based on 296 children predisposed to overweight and obesity who participated in the Healthy Start study. Linear regression analyses, with adjustment for potential confounders, were conducted to assess the association between HCC and total energy intake, macronutrients, fruit and vegetables, added sugar, sugar-sweetened beverages (SSB), and a diet quality index (DQI) developed for children.

Results

Among the children, we found that higher HCC was associated with a lower consumption of dietary fat (β: −0.7 g/day [95% CI: −1.3, −0.0] per 100 pg/mg HCC). We found no statistically significant association between HCC and intake of total energy, protein, carbohydrate, fruit and vegetables, added sugar, SSB or DQI. Likewise, we found no association between parental HCC and intake of total energy, added sugar, selected food groups or DQI among their children. However, stratified analyses showed that paternal HCC was associated with a borderline significant lower total energy intake and significantly lower protein intake, however only among daughters (adjusted β: −42 kcal/day [95% CI: −85, 0] and −2.6 g/day [95% CI: −4.4, −0.8] per 100 pg/mg HCC, respectively).

Conclusion

Overall, our study suggests that HCC is, at the most, weakly associated with dietary intake among children. However, there was some evidence that a high HCC among children may be related to a low fat consumption, and that a high paternal HCC may be related to a low intake of energy and protein among their daughters but not among their sons.

Obes Facts. 2018 May 26;11(Suppl 1):205–206.

T3P47 Relationship between protein intake daily and isometric muscle strength in Spanish adolescent according to the overweight level

A Castillo-Rodríguez 1, JC Fernández-García 2, PJ Ruiz-Montero 1

Introduction

Weight and body mass are correlated with greater muscle strength1 and this muscle strength is associated positively to the protein intake daily2. However, adolescents, who have taken several years a lifestyle through unbalanced diets, are overweight. It results in not beneficial aspects for the future health in adulthood. Consequently, the first aim of this study was to know the relationship between protein intake daily and hand-leg isometric strength in adolescent, and the second aim was to evaluate the differences of these variables according to the gender and overweight status.

Methods

This cross-sectional study was performed at middle schools from the South of Spain with a convenience sample of two hundred and thirty-one healthy adolescents with mean age of 15.2 ± 1.7 year-olds (117 boys and 114 girls). Protein intake daily was registered by food frequency questionnaire, isometric muscle strength was measured with a handheld dynamometer, and the overweight was categorised by Body Mass Index level3, so 58.5% of adolescents are overweight (OA), and 41.5% are non-overweight (NOA), so 35.4% of the boys and 47.7% of the girls were NOA (50.0 ± 5.7 kg; 162.3 ± 8.7 cm; 46.5 ± 5.3 kg; 154.5 ± 6.1 cm) and 64.3% of the boys and 52.3% of the girls were OA (73.0 ± 12.0 kg; 172.5 ± 5.9 cm; 65.4 ± 6.4 kg; 162.4 ± 5.9 cm).

Results

There is a low relationship between protein intake and dominance hand strength (R2 = 11%; P < .05; η2p = .35; Figure 1), and moderate relationships between dominance hand strength and weight and body mass index (R2 = 39%; P < .01; η2p = .55; and R2 = 14%; P < .01; η2p = .37, respectively). NOA have higher protein intake than OA (2.91 vs. 1.97 mg/kg/day; P < .01), although, OA have higher handgrip (33.8 kg) and leg strength (82.9 kg) than NOA (25.7 and 71.2 kg, respectively, P < .01; table 1), possible due to that NOA have 79% of skeletal muscle mass versus OA with 72% of mean caused by sedentary lifestyle.

Conclusion

Although OA eat less daily protein, they have greater strength in the hand and leg test. This is due to their greater body mass and weight than NOA. A lower protein intake is recommended in NOA to avoid this lifestyle not recommended and a weight gain in the future.

Fig. 1.

Fig. 1

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Relationship between protein intake and strength dominance hand.

Tab. 1.

T-test of the strength and intake variables according to the overweight level
NOA (N = 96)
 OA (N = 135)
 P
 η2p
Dominance Hand Strength (kg) 25.71 ± 6.3 33.80 ± 8.8 0.00 0.45
Non-dominance Hand Strength (kg) 24.46 ± 6.3 32.56 ± 7.8 0.00 0.49
Leg Strength (kg) 71.24 ± 34.5 82.91 ± 32.7 0.01 0.17
Carbohydrates daily (mg/kg) 8.70 ± 4.6 5.69 ± 2.7 0.00 0.38
Proteins daily (mg/kg) 2.91 ± 1.7 1.97 ± 0.9 0.00 0.33
Fats daily (mg/kg) 3.58 ± 2.0 2.32 ± 11 0.00 0.36
Energy intake (cal) 3660.3 ± 1583 3455.1 ± 1481 0.32 0.06
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References

  • 1.Wind AE, Takken T, Helders PJM, et al. Is grip strength a predictor for total muscle strength in healthy children, adolescents, and young adults? Eur J Pediatr. 2010;169:281. doi: 10.1007/s00431-009-1010-4. [DOI] [PubMed] [Google Scholar]
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Obes Facts. 2018 May 26;11(Suppl 1):206.

T3P48 Does the Role of Food in the Self Management of Pain in Teens with Juvenile Arthritis Vary Based on Gender or Ethnicity?

K A Lewis 1, A Mabry 2, L Nielson 3

Introduction

The complex emotional interplay between chronic pain and familial and cultural norms about food could lead to the development of disordered eating or obesity in adolescents with persistent inflammatory disease. As a crucial first step, our interdisciplinary team explored meanings assigned to food and pain, how these meanings are affected by multiple levels of communication (i.e., relational, cultural, mass media), and the unique ways in which teens with Juvenile Arthritis (JA) communicate about this topic. JA is a collection of joint diseases with symptom onset prior to age 16 and is the most common rheumatologic disease in children, accounting for over $285 mil annual USD. Joint pain is the most common symptom, which leads to stiffness, loss of fine motor skills, immobility, and fatigue, and requires daily self-management. Chronic pain may limit mobility and can contribute to a sedentary lifestyle, while chronic use of immunosuppressant medications increases appetite and leads to weight gain. The negative physical and psychological consequences (i.e. low self-esteem, bullying) may present a challenge for teens at a developmental stage in which the pressure to maintain a particular body image is communicated at all levels, from peers to mass media, and is more likely to be internalized, resulting in unhealthy behaviors or distorted self-image.

Methods

The cross-sectional, inductive qualitative analysis was guided by the social-ecological model. Diverse focus groups of N = 46 teens aged 13–17 were recruited from a clinic in Austin, TX using a two (Hispanic ethnicity, white) by two (male or female) array. An experienced moderator led the Discussion using a semi-structured interview guide. The recorded transcripts were systematically analyzed following an established protocol from previous literature.

Results

The sample from three focus groups was 56% female, 33% Hispanic ethnicity, and 22% overweight or obese (BMI percentile >85). All participants described the multiple levels of interplay between food and pain: individual, familial, community, and societal. Communication at multiple levels (relational, cultural, and mass-media) was a source of influence in all groups for varying reasons. Food choices centered on individual, familial, and peer preferences and beliefs about how the food would make them feel. Hispanic males and females were more likely to mention a spiritual component; consume different foods; and minimize symptoms in order to avoid distressing family members. Peer relationships and societal influences (school, commercials, social media) both positively and negatively affected food choices and pain.

Conclusion

Findings from this study indicate similarities and differences based on gender and ethnicity in a sample of adolescents with JA when they communicate about food and pain. These findings have implications for clinical practice to address the dietary needs of this population in a developmentally appropriate, gender-specific, and culturally sensitive way. The communication influence at multiple levels (relational, cultural, and mass-media) is a novel consideration in designing interventions and policy recommendations to promote the best outcomes among adolescents with JA. Futher research is warranted to confirm these findings.

Obes Facts. 2018 May 26;11(Suppl 1):206–207.

T3P49 Having home-made dinner in Hong Kong secondary school students: prevalence and correlates

SY Ho 1, HY Mok 1, TH Lam 1

Introduction

Home meals are more nutritious while eating out is linked to obesity. However, few studies have investigated the patterns of having home-made dinner in Chinese populations. We studied its prevalence and correlates in Hong Kong adolescents.

Methods

In the Hong Kong Student Obesity Surveillance (HKSOS) project, 34678 students (mean age 14.6 ± 2.0, 44.8% boys) from 42 secondary schools completed a questionnaire. Data included the number of days having home-made dinner in a typical week, family structure, perceived family affluence, parental marital relationships, parental occupation and living with domestic helpers. Weight status was based on self-reported weight and height. Welch's t-test and multiple regression were conducted to identify correlates of the frequency of having home-made dinner.

Results

Most (89.0%) students reported having home-made dinners, including 29.9% for 1–4 days and 59.0% for 5–7 days. The mean frequency was 4.50 (SD 2.52) days per week. In bivariate analyses, having more frequent home dinner was significantly associated with girls (4.83 days/week vs boys 4.09), intact families (4.57 vs non-intact 4.13), lower perceived family affluence (poor 4.57, medium 4.48, rich 4.33), older age (18+ vs 14–17 vs ≤13: 4.73 vs 4.53 vs 4.39), better parental marital relationships (good 4.56, fair 4.49, poor 4.19), mothers being housewives (4.73 vs 4.49 for unemployed and 4.40 for employed) and lower weight status (underweight 4.82, normal 4.73, overweight 4.39, obese 4.04). Living with domestic helpers was non-significantly associated with lower frequency of having home-made dinners (4.40 vs 4.51 days/week). In multivariate analyses, having more days of home-made dinner was significantly associated with girls [0.65 days/week (95% CI 0.48, 0.81)]; intact families [0.34 (0.20, 0.48)]; poor perceived family affluence [0.23 (0.10, 0.37)] (vs rich); older age [0.27 (0.11, 0.43) for age 18+, 0.20 (0.13, 0.27) for age 14–17] (vs age ≤13); better parental marital relationships [0.37 (0.22, 0.51) for good, 0.25 (0.07, 0.42) for fair] (vs poor); mothers being housewives [0.31 (0.22, 0.40)] (vs employed). Overweight students had 0.21 (0.08, 0.35) fewer days of home-made dinners (vs normal weight).

Conclusion

Home-made dinner was common in Hong Kong secondary school students with a mean frequency of 4.50 days per week. More frequent home-made dinner was independently associated with being girls, intact families, poor perceived family affluence, older age, better parental marital relationships, mothers being housewives, and normal weight status.

Funding

University Research Committee, Strategic Research Theme on Public Health, University of Hong Kong

Obes Facts. 2018 May 26;11(Suppl 1):207.

T3P50 The Association of Obesity with Pancreatitis in Children

C Pillai 1, M Yafi 1, N Rubio 1, O Rodziyevska 2, S Hashmi 3, M Eissa 3

Introduction

The incidence of both acute pancreatitis and obesity has been rising over the last twenty years. This is especially troublesome as studies in adults and children have shown that obesity is a risk factor in the severity of acute pancreatitis with obese patients having longer length of stays and worse mortality. Some studies suggest further that obesity is itself in an independent risk factor for gallstone pancreatitis in children. Our data looking at trends over the last eleven years further supports this. It suggests that the increased incidence of acute pancreatitis is linked with increasing incidence of obesity via an increase in gallstone pancreatitis.

Methods

Retrospective chart review of children aged 18 and below who were admitted with proven laboratory and radiology diagnosis of pancreatitis to a tertiary children hospital in an 11 year period.

Results

One hundred fifty-seven cases with acute pancreatitis were identified. The demographics distribution showed that 54% of the patents were females, 37% were African-Americans and 31% were Hispanics. Twenty one percent of the patents were obese while 17.8% were overweight and 52.2% had documented hyperlipidemia at admission with elevated LDL Cholesterol and or Triglyceride levels. Out of all cases of pancreatitis, the percentage of gallstone pancreatitis has increased from 15% in the 2002–2003 to 50% in the 2011–2012 period. Fifty three percent of children with gallstone pancreatitis were obese.

Conclusion

The increased prevalence of obesity in children has increased many obesity- related pathologies. The increased rate of pancreatitis in children in general and the specifically gallstone induced pancreatitis can be attributed to the increased rate of pediatric obesity. Obesity management with dietary counseling, lifestyle modification as well as hyperlipidemia monitoring and therapy should be an essential standard to prevent pancreatitis.

Obes Facts. 2018 May 26;11(Suppl 1):207.

T3P51 The evaluation of Body Mass Index (BMI) in girls with Turner Syndrome

S Lugo 1, M Rivera-Davila 1, D Rodriguez-Buritica 1, H Nothrup 1, M Yafi 1

Introduction

Turner Syndrome (TS) is the only monosomy compatible with life affecting 1 per every 2000- 3000 live-born girls with a prominent clinical finding of short stature. This short stature, along with weight gain, may affect body mass index (BMI) calculations which is an indicator for childhood overweight and obesity. The obesity rate in pediatrics has increased globally, with an increased risk for its associated complications such as metabolic syndrome, type 2 diabetes, cardiovascular disease, hypertension, and dyslipidemia. TS patents may already have an inherently increased risk for hypertension and diabetes. Overweight and obesity may increase this risk further

Methods

We obtained the latest measurements for height, weight, and body mass percentile from a TS cohort at our pediatric endocrinology clinic. Inclusion criteria was confirmation of karyotype positive for TS (including mosaic) and age between 9 and 18 years. We compared this data with body mass percentile rates in the average published childhood population.

Results

Of the 74 subjects that fit inclusion criteria, we applied the body mass percentile definition of the Center for Disease Control (CDC). A total of 40 subjects (54.1%) were within the normal body mass index for age. Twenty-five subjects (33.8%) were in the overweight range and 8 subjects (10.8%) were in the obesity category.

Conclusion

Overweight rates have tripled in the pediatric population of the United States and are currently at 16% for the female population. Obesity rates in the pediatric female population of the United States are 17.1%. When comparing to our small TS group to the average childhood population, overweight category was higher, but obesity category was lower. Monitoring weight, height and BMI in girls with TS is of a great importance since short stature may play a major role in increasing BMI. TS-specific BMI can be also utilized as well as other methods of assessing obesity since calculation of TS- BMI is impacted by short stature.

Obes Facts. 2018 May 26;11(Suppl 1):207.

T3P52 Lifestyle behaviours as predictors of future weight status in school-aged children: do they play a role? – The Childhood Obesity Surveillance Initiative in the Republic of Ireland

S Bel-Serrat 1, MM Heinen 1, J Mehegan 1, CM Murrin 1, C C Kelleher 1

Introduction

Longitudinal research on the predictors of obesity in school-aged children is still equivocal and scarce, especially in European populations. Our study aims to prospectively investigate lifestyle predictors of overweight and obesity in a large sample of Irish schoolchildren.

Methods

A cohort of 1,268 Irish children (53.5% girls), aged 6–10 years at baseline, participating in the Childhood Obesity Surveillance Initiative were included. Mean follow-up period was 3 years. Height, weight and waist circumference (WC) were objectively measured. Overweight and obesity were defined with the International Obesity Task Force (IOTF) and the World Health Organisation (WHO) 2007 cut-offs. A parentally reported questionnaire was applied to collect information on the following lifestyle variables: birthweight, breastfeeding, breakfast consumption, dietary intake, physical activity, screen time and sleep habits. Predictors of overweight and obesity at follow-up were investigated by multivariable logistic regression analyses adjusting for schools’ socioeconomic level.

Results

Baseline weight status emerged as the strongest predictor of subsequent overweight or obesity (IOTF:OR = 13.5,95%CI = 7.9–23.1; WHO:OR = 13.9,95%CI = 8.9–21.8). Children with greater WC at baseline (IOTF:OR = 1.23,95%CI = 1.17–1.30; WHO:OR = 1.21,95%CI = 1.15–1.27) were more likely to be overweight or obese at follow-up. Children with no savoury snacks intake (OR = 0.29;95%CI = 0.12–0.74) or with occasional intake (IOTF:OR = 0.50;95%CI = 0.26–0.94) at baseline were less likely to be overweight or obese at follow-up than those with daily intakes. Although not significant (p = 0.061), the same tendency was observed among non-consumers of savoury snacks with the WHO cut-offs. Children who attended sports/dancing clubs 3 days/week (IOTF: OR = 0.45, 95%CI = 0.25–0.82; WHO: OR = 0.46, 95%CI = 0.28–0.76) or 4–6 days/week (IOTF: not significant, but a trend (p = 0.081); WHO: OR = 0.38, 95%CI = 0.21–0.70) were at lower odds of being overweight or obese at follow-up. No significant associations were observed with other lifestyle factors.

Conclusion

Initial weight status was the main predictor of subsequent overweight and obesity in schoolchildren, followed by WC. Lifestyle factors including savoury snacks intake and physical activity were also significantly associated with future overweight or obesity. These behaviours may deserve more attention in excess body weight prevention strategies aiming at school-aged children. However, lifestyle behaviours examined in this study appeared to have little effect when baseline weight status and WC were taken into account. Research on the factors linked to weight gain at early ages should be a priority to identify potential intervention areas for the development of effective strategies.

Obes Facts. 2018 May 26;11(Suppl 1):208.

T3P53 Birth weight as a risk factor for obesity among young adult

T AA Alnoor 1, HS Humeda 2, L Kaddam 1

Introduction

Epidemiological evidences suggest a strong relation between birth weight and some diseases in adult life (hypertension, diabetes, cardiovascular diseases (CVD)). It is thought that an adverse intrauterine environment provokes adaptive response to ensure fetal survival which if persist into adulthood may cause metabolic and CVD disease. The Aim of this study is to assess birth weight role in the development obesity, hypertension and metabolic syndrome in young adults; aiming to avail information to build the natural history of weight gain during early adulthood.

Methods

This descriptive cross-sectional study conducted in Al-Neelain-public University; done as part of a larger study that examined the prevalence of obesity among medical, 50 students who have birth weight data were involved in this study. Data were collected by Questionnaire, blood pressure, anthropometric measurements and blood sample. Data were analyzed using SPSS(version 23).

Results

In this study metabolic syndrome risk factors were highly prevalent 21.2%; for obesity and overweight, 46% for hypertension HTN pre hypertension. There was gender base difference in mean blood pressure BP where The means for both systolic and diastolic BP was higher in male; with high statistical significance for mean systolic BP (significance test = 0.039), and the relationship between blood pressure classification and gender was statistically significant p value = 0.048, with higher prevalence of pre hypertension among male. Higher mean values for obesity measure was seen among Large for gestational age LGA and extreme low birth weight individuals. Low birth weight individual have higher mean value for systolic and diastolic BP compared to appropriate birth weight individual, no relation between birth weight and serumuric acid level was found. Birth weight show high statistical significance in relation to two factors: exercise (P value = 0.014) and uncontrolled eating habit (P value = 0.005) with higher prevalence among LGA individuals

Conclusion

This study shows alarming high prevalence of overweight/obesity as well as pre-hypertension/ HTN among young adult. The study also revealed “:lkU shape relationship between birth weight and obesity, it is recommended that larger cohort study held to examine this theory where feasible.

Obes Facts. 2018 May 26;11(Suppl 1):208.

T3P54 Overweight and obesity in school children in Tapachula, Chiapas, Mexico. “ALI Program”

M Villalobos Martínez 1, F Villalobos Martínez 1, V Arija Val 1

Introduction

. Childhood obesity is a worldwide health epidemic affecting both developed and developing countries. Mexico ranks second to the United States in rates of Childhood obesity. The adverse effects of obesity among children on health status are not fully reversible, including cardiovascular, respiratory, and health-related quality of life. In developing countries, we lack information on the extent of the problem and the risk factors involved.

Methods

. The aim of the study was to determine the prevalence rates of overweight and obesity among school children in the urban area of Tapachula, Chiapas, Mexico. A cross-sectional study in a representative sample (n = 275) schoolchildren aged 6 to 11 years was conducted. Data collected included anthropometric measurements (weight and height) and blood pressure. Biochemical parameters: total cholesterol, triglycerides and glucose (capillary blood samples). Physical activity was assessed with a valid questionary. Body mass index (BMI) was calculated using the weight (kg)/height (m2). Overweight and obesity were detected using the Word Health Organization cutoffs according to body mass index (BMI).

Results

. 54% of the sample were women. Mean age was 7.99 years old (± 1.66). The prevalence of overweight was higher in girls (23.5%) compared to boys (11.6%) (p < 0.05) but obesity was higher in boys (33.9%) compared to girls (14.1%)(p < 0.05). Higher sistolic blood pressure were observed in obese children compared to overweight children (98,6 mmHg vs 87,9 mmHg; p < 0.05). Biochemical parameters were higher in obesity children compared to overweight children: total colesterol (144.19 mg/dL vs 139.86 mg/dL), triglycerides (94.86 mg/dL vs 91.71 mg/dL), glucose (94.70 mg/dL vs 86.67 mg/dL) (p < 0.05). On the other hand, insufficient physical activity in 76.7% (< 3 times/week) of children was observed and it was associated with the increased in the BMI in multivariate model adjusted by potential counfunders. Children spend 2.66 hr/day (± 1,03) watching TV.

Conclusion

. A high prevalence of overweight and obesity was observed among school children 6 to 11 years old in Tapachula, Chiapas, Mexico. results of this study underscore the importance of overweight and obesity in children as a public health problem in Mexico, and the need to develop preventive interventions.

Obes Facts. 2018 May 26;11(Suppl 1):208–209.

T3P55 Fathers – the forgotten parent: Comparison of early feeding practices in mother-father dyads and indirect impact of the efficacious NOURISH maternal intervention on fathers’ feeding practices

L Daniels 1, K Mallan 1, E Jansen 1, J Nicholson 2, A Magarey 3

Introduction

Early child feeding practices are associated with child obesity risk. Fathers have an important role in early feeding but are largely absent from interventions that aim to prevent or treat obesity in early childhood. (1) Little is known about fathers’ early feeding practices, how they compare to maternal practices and potential responsiveness to intervention. This pilot secondary analysis aims to compare feeding practices within mother-father dyads and explores whether an intervention for first-time mothers that was associated with positive effects on maternal feeding practices (2) resulted in any indirect effects on fathers’ feeding practices.

Methods

The NOURISH RCT (2) evaluated an early feeding intervention for first-time mothers delivered via 2 modules of 6 group sessions over 12 weeks, commencing at child ages 4 and 14 months. The intervention group was provided with written summaries of key intervention messages and encouraged to discuss these with their partner. Mothers self-reported their feeding practices at child age 2 years via widely-used validated scales (1 = low to 5 = high). About 9 months later fathers were invited (via mail request to mothers) to complete a similar questionnaire. Mean scale scores were compared using independent samples t-tests.

Results

Complete data were available from 70 parent dyads (21% response rate; control n = 37, intervention n = 33) at mean child age = 33 months, SD = 5; 58% girls. Overall, mothers’ (n = 70) perceived responsibility for feeding was higher (4.2 vs 2.4), yet fathers scored higher on concern about the child becoming overweight (2.2 vs 1.3), restriction (3.6 vs 2.9) and pressure (2.6 vs 2.1). All P < 0.001. Fathers whose partners were in the intervention group used less pressure (mean difference 0.46 p = 0.045) and were more willing to let the child decide how much to eat (-0.51 P = 0.032) than those with partners in the control group.

Conclusion

Fathers appeared to feel less responsible for feeding but were more concerned about child weight and used more non-responsive feeding practices. These sub-optimal paternal feeding practices have the potential to attenuate the impact of maternal-focused interventions. This preliminary evidence for disparities in parent feeding practices and for a modest impact of a ‘light touch’ indirect intervention on paternal practices speak to the importance of including fathers in early feeding interventions. The poor response rate to proxy recruitment via mothers suggests more effective direct strategies are required. Overall these results suggest potential benefits in directly targeting fathers for early feeding interventions that aim to prevent child obesity. 1. Morgan et al. Pediatrics 2017;139(2):e20162635 2. Daniels et al. Pediatrics 2013;576(1):e109; 2015;136(1):e40

Obes Facts. 2018 May 26;11(Suppl 1):209.

T3P56 Characterization of a Portuguese sample of children and adolescents: overweight/obesity and it's determinants

A Amoroso 1, S Magalhães 1

Introduction

The WHO estimates that 10% of children between the age of 5 and 17 is overweight or obese. The aim of this study was to characterize parents and children's behavior, considered to be health determinants, since mother's pregnancy.

Methods

The parents filled a questionnaire concerning sociodemographic information of the family, data about their own height and weight at birth and in the present, about pregnancy, and data about their children, namely, own height and weight at birth and in present, physical activity, leisure activity, eating and sleeping habits. Descriptive statistic of main results is presented.

Results

The total of participating children reached 551, ranging from 4 to 18 years old, and 52.5% were males. Almost 20% was overweight or obese at birth and 23.5% (23.5% for boys and 22.9% for girls) are overweight or obese in the present. Almost 46% never or almost never rides a bike, but 60.6% practices sport once or twice a week. Walking for at least 20 consecutive minutes, once or twice a week is performed by 29.4%. More than half (60.4%) spends less than 2 hours a day in activities that do not imply physical effort (e.g. television, videogames) in week days, whereas in weekends, almost half (49.8%) spends from 2 up to 4 hours in such activities. When it comes to food habits, 73.2% eat soup in a daily basis and 80.8% eat fruit also every day. Fast food is consumed once or twice a month by 67% and sweets are consumed once or twice a week by 51.8%. Almost half (47.2%) goes to bed between 9 a 10 pm, on week nights and 65.1% wakes up between 7 and 8 am. At birth, 24.7% of the mothers and 38% of the fathers were overweight or obese, whereas at the present, 34.9% of the mothers and 68.2% of the fathers are overweight or obese. The large majority of women (90.9%) did not smoke and did not consume alcohol (85.7%) during pregnancy. Mother's age at child birth ranges between 19 and 53 years old.

Conclusion

Overweight and obesity at birth seemed to improve from parents to their children, although missing data especially from father's height and weight at birth might have biased these Results. Sex differences in overweight and obesity is only observed in parents, where fathers have almost twice the percentage than mothers. Sleeping and food habits seem age appropriate, whereas there is space for improvement in physical activities.

Obes Facts. 2018 May 26;11(Suppl 1):209.

T3P57 The maternal intake of a cafeteria diet during lactation promotes the infiltration of macrophages in the liver of the male descendants in the adulthood

CA Pomar 1, J Sánchez 1, A Palou 1

Introduction

Maternal unhealthy diet during lactation induces lasting metabolic alterations in the offspring. The aim of the present study was to investigate in rats the effects of the maternal intake of a cafeteria diet during lactation in the metabolic responses of male and female offspring in the adulthood when exposed to an obesogenic diet.

Methods

Offspring of control dams (O-C) and offspring of cafeteria fed dams during lactation (O-CAF) were fed with standard diet (SD) until 4 months, and then half of the animals of each group were fed with a Western diet (WD) until 6 months of age. Food intake and body weight were recorded. Circulating parameters and hepatic lipid content were measured in adulthood under SD and WD-fed conditions. Gene expression in liver was also measured.

Results

Under WD-fed conditions, both male and female O-C and O-CAF rats presented higher body weight gain, hyperleptinemia, greater NEFA, TG levels and hepatic lipid content in WD conditions compared with SD counterparts. Notably, males (but not females) displayed higher HOMA-IR under WD condition, which was more marked in O-CAF compared to O-C animals. Gene expression analysis revealed that, under a WD, O-CAF animals displayed greater expression levels of hepatic fatty acid oxidation related genes (Ppara and Cpt1a) compared with O-C rats. Also, O-CAF males but not females showed greater expression levels of Lepr and of genes related to macrophage infiltration (Cd68 and Ccr2) in liver compared with O-C.

Conclusion

The metabolic effects of a maternal inadequate nutrition during lactation includes changes in the descendants, which under an adult exposure to obesogenic diet, predisposes males, but not females, to metabolic alterations and greater hepatic macrophage infiltration.

Obes Facts. 2018 May 26;11(Suppl 1):209–210.

T3P58 Association between proportion of milk feeds delivered via bottle at age 4 months and weight at 14 months – the Australian NOURISH trial

R Byrne 1, E Jansen 1, M KT Yeo 1, L Daniels 1

Introduction

Several mechanisms have been proposed for the relationship between weight gain in infancy and obesity risk. While the link with formula intake and attendant higher protein intake is now well documented, it has been proposed that method of milk delivery may also contribute. While breastfeeding an infant largely has control over the amount of milk consumed, while when bottle feeding, either formula or expressed breastmilk, the care-giver can exert more control. Bottle-feeding practices that are not responsive to a child's cues of hunger and satiety, may result in overfeeding excess weight gain. The aim of this analysis was to examine the relationship between proportion of milk feeds delivered via bottle (breastmilk, formula or mixed feeding) at age 4 months and weight-for age z-score (WAZ) at 14 months.

Methods

This is a secondary analysis of longitudinal data from mother-child dyads participating in the Australian NOURISH trial. Baseline assessment occurred when infants were approximately 4 months of age, at which time mothers reported three days of child dietary intake. For those infants who were exclusively milk-fed (breastmilk, formula or mixed feeding) over the three days, the average proportion of number of feeds delivered via a bottle per day was calculated; ranging from 0% for the exclusively breastfed infant fed directly from the breast, to 100% for the infant fed only via bottle. Anthropometry were measured by trained research staff at baseline and at a second assessment at child age 14 months, then child WAZ (WHO Standards, 2008) and maternal BMI were derived. Multiple regression was used to determine the relationship between WAZ at 14 months and proportion of feeds delivered via bottle at 4 months of age adjusting for WAZ at baseline, protein intake, maternal BMI and age at child's birth, and NOURISH trial allocation.

Results

Three days of dietary intake at 4 months and anthropometric data at 4 and 14 months was available for 284 infants (48% male). Mean proportion of feeds delivered via bottle per day at 4 months of age was 26% (sd = 39, range 0–100). The regression model explained 41% variance in WAZ at 14 months (adj R2 = 0.41, SE = 0.66). WAZ at 14 months was associated with proportion of feeds delivered via bottle at 4 months of age (ß = 0.12, p = 0.01) adjusting for WAZ at 4 months (ß = 0.62, p < 0.001), protein intake, g/kg bodyweight per day (ß = 0.13, p = 0.02), maternal BMI (ß = 0.12, p = 0.01), maternal age (ß = -.05, p = 0.25) and NOURISH allocation (ß = -.08, p = 0.10).

Conclusion

These results add to the growing body of evidence that how an infant is fed - bottle feeding versus directly fed from the breast - may contribute to higher relative weight. Providing mothers with support to bottle feed in a way that is responsive to an infant's hunger and satiety cues is a potential strategy for obesity prevention that requires further investigation.

Obes Facts. 2018 May 26;11(Suppl 1):210.

T3P59 Dietary control one month before gestation in diet-induced obese dams programs a better food intake control in male offspring

H Castro 1, A Solomando 1, C Picó 2, A Palou 2, J Sánchez 2

Introduction

Maternal obesity and/or maternal overfeeding during gestation are associated with a greater propensity for obesity and other metabolic diseases in the offspring. Interestingly, we have recently described that dietary normalization one month before gestation in diet-induce obese dams can prevent detrimental effects on the offspring. This study aims to analyse whether the protective effect of maternal dietary normalization before gestation is due to changes in the expression of metabolic key-genes that regulate food intake and thermogenic capacity of the offspring at early age.

Methods

We studied pups at early age whose mothers where fed a cafeteria diet from days 10 to 100 of age and then a standard diet for one month, before pregnancy (postcafeteria dams). The offspring of control and postcafeteria dams were sacrificed on postnatal day 26 (PN26) under fasting or ad libitum feeding conditions. Hypothalamic expression of genes related to food intake control (Npy and Pomc) was analysed by RT-qPCR. Protein levels of uncoupling protein 1 (UCP1) and tyrosine hydroxylase (TYROH) were determined by western blot in brown adipose tissue (BAT).

Results

On PN26 male, but not female, offspring of postcafeteria dams displayed lower body weight and lower food intake than controls. The offspring of postcafeteria dams presented lower hypothalamic mRNA levels of Npy and Pomc than control animals under fed and fasting conditions, in the case of males, and only under fed conditions in the case of females. In addition, the offspring of postcafeteria dams displayed lower UCP1 levels in BAT in comparison with their controls, which seems to be attributable to the lower intake that show these animals. Protein levels of TYROH in BAT were not altered, suggesting no deterioration of BAT sympathetic innervation.

Conclusion

At early age, the offspring of postcafeteria dams presented a lower expression of the orexigenic Npy that may account for the lower food intake observed in these animals, especially in males. Thus, there is an early programming in food intake control systems in offspring of postcafeteria dams, which could be attributed to maternal dietary normalization one month before pregnancy, and may account for the protective effects against overweight observed in these animals.

Obes Facts. 2018 May 26;11(Suppl 1):210.

T3P60 The role of endocrine disrupting compounds effects in endocrine network diseases

M Radács 1, Z Molnár 1, K Sepp 2, A László 3, P Hausinger 4, L Rácz 1, Z Valkusz 5, Z Balla 6, M Gálfi 7

Introduction

The living organisms are dynamic, opened and complex systems, which can regularly exchange feedbacks with their environment. This regulation mechanism is maintained by the homeostasis, wherein universal units are the components of psycho-neuroendocrine-immune system, in primates. The body weight and the metabolism are controlled by the hypothalamo-hypophyseal system. The endocrine disrupting compounds (EDC), which originate in the man-made environment can cause disturbance in the homeostatic system and can provoke different diseases, e. g. in human obesity, depression, immune deficiency, etc. Our aim was to investigate the effects of EDC, namely phenylurea herbicides (PUH) (Phenuron: PU; Monuron: MU; Diuron: DU) on neuro-endocrine and cellular immune function.

Methods

In our experiment, the Wistar rat (♂, bw: 160g) hypophysis (adeno- /AdH/, and neurohypophysis /NH/ monolayer) and T-lymphocyte (/Tly/ suspension) primary cell-cultures were used as models, which were prepared by enzymatic (Trypsine, DNAse I, II, Collagenase) and mechanical (nylon-blutex d: 80 and 40 μm) digestion; and sedimentation separated methods (with Percoll gradient). The monolayer cultures were sustained in DMEM + 10% FCS + Pen-Strep. The Tly suspension-cultures were sustained in RPMI 1640 + 10% own-Se + Pen-Strep. The cultures were treated with PUH [10–6 M, for 120 min]. The changes of hormone content (adrenocorticotrop hormone: ACTH; oxytocin: OT, vasopressin: VP) were detected by RIA and LIA methods from the supernatant media. The cellular immune function was tested by Tly mitogen activated Methods. Protein contents were measured by protein assay kit.

Results

The results showed, that the herbicides increased the basal ACTH hormone release in AdH. The VP and OT release were increased by effects of PU in the NH cultures. The VP secretion was decreased by MU and DU. The alteration of OT secretion by MU and DU was changed more discrete. The Tly modulations by herbicides were significant.

Conclusion

These results suggested that, the PUH can carry strongly EDC risk, which was connected to the disturbance of immune-cell activity. The effects of PUH were relevant on ACTH/corticosterone system of the hypophysis-adrenocortical axis. These results represent connections between the endocrine diseases (e.g. obesity) and the environmental loadings. This work was supported by: EFOP-3.4.3–16–2016–00014; EFOP-3.6.1–16–2016–00008

Obes Facts. 2018 May 26;11(Suppl 1):210–211.

T3P61 Childhood obesity and the risk of stroke

G Özata Uyar 1, Ö Mengi 1, H Yıldıran 2

Introduction

Stroke is one of the leading cause of death and disability worldwide(1). World Health Organization predicts that the stroke mortality rate will increase by 78% in women and 106% in man between 1990 and 2020 (2). Unhealthy diet, low physical activity, hypertension, cigarette smoking and use of alcohol are modifiable risk factors for stroke and most of these habits are gained during the late adolescence period (3).

Methods

A literature review was conducted on several databases (Pubmed, Science direct, Web of Science).

Results

Nutirition has an effective role in prevention and control of the risk of stroke (2). Poor nutrition in the first year of a mother's life and undernutrition in utero, infancy, childhood affects the risk of stroke in individuals in the future. At the same time, overnutrition also increases the risk of stroke by accelerating the development of obesity, hypertension, hyperlipidemia and diabetes (4). The prevalence of obesity, the leading modifiable risk factor for stroke, is increasing in many countries, especially in childhood, and in many studies, the risk of developing ischemic stroke during adulthood is associated with childhood body mass index (BMI) (3,6,7,8). In a large cohort study in Denmark, at all ages from 7 to 13 years, an above-average BMI z score was positively associated with early ischemic stroke (≤55 years) (7). Similarly, a cohort study in Swedish men found that many risk factors known for stroke were acquired in late adolescence period. The strongest risk factors in the study were low physical activity, high BMI, diabetes, low annual income and a maternal history of stroke (3).

Conclusion

Therefore, in order to prevent early stroke, the increase in BMI during the childhood should be considered and healthy body weight gains should be provided. Individuals should be informed about the effects of factors such as unhealthy nutrition, sedentary lifestyle, smoking and alcohol use on stroke development. REFERENCE 1. Feigin, Valery L., et al. “Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013: the GBD 2013 study.” Neuroepidemiology 45.3 (2015): 161–176. 2. Foroughi, Mehdi, et al. “Stroke and nutrition: a review of studies.” International journal of preventive medicine 4. Suppl 2 (2013): S165. 3. Högström, Gabriel, et al. “Risk factors assessed in adolescence and the later risk of stroke in men: a 33-year follow-up study.” Cerebrovascular Diseases 39.1 (2015): 63–71. 4. Hankey, G. J. (2012). Nutrition and the risk of stroke. The Lancet Neurology, 11(1), 66–81. 5. Apostolopoulou, Martha, et al. “Nutrition in the primary and secondary prevention of stroke.” Maturitas 72.1 (2012): 29–34. 6. Falkstedt, D., Hemmingsson, T., Rasmussen, F., & Lundberg, I. (2007). Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men. International journal of obesity, 31(5), 777–783. 7. Gjærde, Line K., et al. “Association of Childhood Body Mass Index and Change in Body Mass Index With First Adult Ischemic Stroke.” JAMA neurology 74.11 (2017): 1312–1318. 8. Ohlsson, Claes, et al. “BMI increase through puberty and adolescence is associated with risk of adult stroke.” Neurology89.4 (2017): 363–369.

Obes Facts. 2018 May 26;11(Suppl 1):211.

T3P62 Perspectives on complementary feeding among parents from disadvantaged backgrounds: a qualitative study

L Tully 1, V Allen-Walker 2, PM Kearney 3, JV Woodside 2, MC McKinley 2, M Dean 2, S McHugh 3, E Spyreli 2, C Kelly 4

Introduction

In Ireland and the UK, Introduction of complementary foods (those other than milk) to the infant diet is recommended close to six months, and not before four months of age. Early complementary feeding (CF) has been associated with an increased risk of obesity (Moss, 2014; Wang, 2016). Low socioeconomic status is a determinant of non-adherence to CF recommendations and obesity (O’Donovan, 2015; Keane, 2014), but there is an evidence gap in the reasons for non-adherence among parents on the island of Ireland. This cross-border study, investigated barriers and facilitators for following formal CF recommendations, particularly among disadvantaged families, in both the Republic of Ireland and Northern Ireland.

Methods

Parents of infants aged 3–14 months were recruited via community groups using purposive and snowball sampling aimed at those experiencing disadvantage. Semi-structured focus groups aided by vignettes were used to assess parental knowledge, attitudes and practices to CF and related advice. An inductive thematic approach was used for analysis.

Results

Nineteen focus groups took place with parents (n = 83) of both breast- and formula-fed infants, ranging from ages 3–16 months. Six major themes were identified from the data: 1. Choosing baby foods can be challenging; 2. ‘Everybody has an opinion on what you should be doing’; 3. Guidance needs to be accessible, timely and respectful; 4. Formal CF guidelines are insufficient; 5. CF can highlight feelings of inadequacy, embarrassment and guilt; 6. Parents ultimately base CF decision on their own personal circumstances.

Conclusion

This study highlights areas for improvement in the dissemination of CF guidance, such as practical, key information to be included in addition to the need to empower and support parents as they navigate parenthood. This research was funded by Safefood, the food safety promotion board.

Obes Facts. 2018 May 26;11(Suppl 1):211.

T3P63 The relationship between asthma and obesity among Teenagers in Taiwan

P Liu 1

Introduction

The concurrence of obesity and asthma during the past decades has risen a growing concern among healthcare providers. Yet the findings discovered among pediatric populations are more inconsistent compared to those found in adult populations.

Methods

We conducted a cross-sectional study and recruited college students between Mar. 2016 till Jul. 2016. Their self-reported heights and weights, dietary intake, physical activities, daily stress levels and personal/family histories were recorded by an online questionnaire.

Results

A total number of 559 college students were recruited. Nearly 10% of students were diagnosed with asthma and 20% of students were overweight or obese according to their self-reported heights and weights. The final model shows that students who had ever been diagnosed with asthma, sleep duration < 5.4 hour or > 6.9 hours/per night, intake more food condensed with high oil and sugar, and experience more pressure from their classmates are more prone to be obese or overweight.

Conclusion

The study found positive evidence supporting the relationship between asthma and obesity among college students in Taiwan. Related risk factors including the pattern of food intake, life pressure levels and night sleep times are also correlated with a higher prevalence of obesity among this population.

Obes Facts. 2018 May 26;11(Suppl 1):211–212.

T3P64 Childhood obesity rates of elementary school age children in Famagusta, North Cyprus

U Altunc 1, M Hocaoglu 1, B Sezgin 1

Introduction

Body mass index (BMI) is a measure used to determine childhood overweight and obesity. Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. There is a well-known rising global trend in obesity prevalence amongst school-age children. Despite Mediterranean-type nutrition traditions in the region, North Cyprus has a high rate of cardiac diseases, hypertension and diabetes. Childhood obesity is a risk factor for the mentioned health problems.

Methods

BMI values are measured and calculated in children aged 6–7 and 10–11 attending to the elementary schools in Famagusta, North Cyprus.

Results

are gathered and presented. National data of different countries are compared with our regional statistics.

Conclusion

Childhood obesity is an emerging issue successible for future healthcare problems such as cardiac diseases, hypertension and diabetes. Although Cyprus is a meditterranean island with traditions of mediterranean nutrition habits, prevalence of childhood obesity is rising in the last decade. Precautions in the schools and parental education and awareness campaigns should be thoroughly carried out in order to prevent many important health problems in the future.

Obes Facts. 2018 May 26;11(Suppl 1):212.

T3P65 The approach to childhood obesity by general pediatricians : Understanding physicians’ attitudes

M Yafi 1, K Smith 2, J Sanders 2, A Guardiola 2, N Rubio 1, R Yetman 2

Introduction

Addressing pediatric obesity during a regular office visit remains the cornerstone in its management. While obesity is an obvious feature to the examiner, recognizing it as a medical problem and screening for comorbidities may not be pursued by all practitioners. The attitude of the health care provider towards dealing with pediatric obesity is the most important key in its management. Some providers may view obesity as a family or self-inflicted problem, therefore not worth dealing with it during regular office visits. Other providers may provide some counselling or initiate select medical work up to evaluate comorbidities. Finally, in some cases a referral to a weight management clinic or to pediatric endocrinology may be initiated. These referrals, however, may be a way to avoid dealing with time consuming obesity counselling, especially if not preceded by screening for comorbidities.

Methods

We surveyed primary care pediatric providers (pediatricians, nurse practitioners) in our academic practice setting to outline their initial approach and attitudes when dealing with pediatric obesity by asking them to prioritize their steps for approaching obesity into one of two categories: Category I 1- Counsel patient directly for diet and exercise 2-Obtain screening tests (glucose; Hba1c; lipid, thyroid, and liver profiles) 3- Referral to weight management clinic and/or pediatric endocrinology clinic AFTER screening Category II Immediate referral to weight management clinic and/or pediatric endocrinology clinic without counselling or obtaining screening tests.

Results

Twelve primary care providers participated in the survey. All felt that immediate counselling and laboratory screening were of paramount importance. The number and type of screening tests that were ordered varied but all agreed that immediate referral outside the primary care setting for obesity work up was not needed initially.

Conclusion

The attitude of the primary care pediatric provider remains the most important factor in dealing with obesity. When the pediatrician decides to address obesity, they usually start with counselling and screening laboratory testing to look for comorbidities. A referral to a specialized obesity clinic may be the next step of management if the initial counselling and follow up visits fail. If the work up shows any hormonal abnormality, a referral to pediatric endocrinology may be necessary. Starting the process by referring the patient and family outside the primary care setting without providing any counselling or screening may indicate the physician is not comfortable with or willing to be directly involved in obesity management. The delivery of appropriate evaluation and treatment by the primary care provider is an important step towards placing obese patients and their families on the right path to better health. Removing the primary care provider from this process may deter the family altogether from seeking help or accepting obesity as a health problem.

Obes Facts. 2018 May 26;11(Suppl 1):212.

T3P66 Body composition in children and adolescents with obesity

O Oleynik 1, J Samoylova 1, D Podchinenova 1

Introduction

The purpose of Assessment of body composition depending on the body mass index with bioimpendancemetria. The purpose of Assessment of body composition depending on the body mass index with bioimpendancemetria.

Methods

we surveyed 150 children and adolescents living in the Tomsk region in the age from 7 to 17 years - 80 girls and 70 boys using anthropometric methods (measurement of height and weight with calculation of body mass index) and bioimpedance body composition analysis using «Inbody 770». Distribution of respondents examined groups was performed in accordance with the classification of obesity in children and adolescents (WHO, 2003) as follows: overweight (SDS BMI 1.0–2.0), I degree of obesity (SDS BMI 2.0 – 2.5), II degree of obesity (SDS BMI 2.6 – 3.0), III degree of obesity (SDS BMI 3.1 – 3.9) and IV degree of obesity (SDS BMI ≥ 4.0).

Results

Average values of body weight, the amount of water and visceral fat according bioimpedance analysis of the examined children with varying degrees of obesity, represented in the figure, had no statistically significant difference by gender. The average number of skeletal muscles depending on the degree of obesity and sex of the respondents presented in the table.

Conclusion

According to the conducted research among children in Tomsk in age from 7 years to 17 an increase in the degree of obesity (BMI SDS increase) accompanied by increased water stress, reducing the amount of muscle mass and an increase in the proportion of visceral fat in the body of the examined children, which may be risk factors for the formation of metabolic disorders. Correction of violations shall be a required component of programs of rehabilitation of children and adolescents with obesity.

Tab. 1.

№
 Gender
 Average number of skeletal muscle (kg)
I degree of obesity
 II degree of obesity
 III degree of obesity
 IV degree of obesity
1. Boys 14,3 20, 1 18,6 20,5
2. Girls 20,4 16,95 18,7 18,9
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Obes Facts. 2018 May 26;11(Suppl 1):212–213.

T3P67 Secondary level care of paediatric obesity: a pragmatic implementation study

KA Sim 1, S Alexander 2, A Gill 3, G Leong 4, M Cretikos 5, H Robertson 5, ID Caterson 6, L Baur 2

Introduction

Childhood obesity remains one the most important public health challenges globally, potentially affecting 60 million children by 2020. Increasingly, children are becoming overweight at a relatively young age, which affects metabolic health, both in childhood and later life. In New South Wales (NSW), Australia, one in four school-aged children and adolescents are overweight or have obesity. Noticeably, the prevalence of severe obesity continues to increase in this age group. Despite this prevalence, weight issues are rarely recognised or managed when patients attend clinical services and there are few appropriate clinical services available. Several Local Health Districts (LHDs), across socio-economic and culturally diverse populations, are implementing a new service. This presents a unique opportunity to research the implementation and integration of these new services alongside established services to determine the clinical effectiveness and impact of the services.

Methods

This study will ascertain what factors affect acceptability, reach, and participation and retention rates and measure clinical effectiveness through changes in child weight outcomes. The study aims to: 1. Audit existing tertiary and secondary care models for managing children above a healthy weight. 2. Evaluate the newly established secondary care clinics, models of care and healthcare pathways. 3. Determine what factors, including acceptability, reach, participation and retention rates, effectiveness and sustainability, are important for different models of care through focus groups and stakeholder interviews. 4. Undertake economic analysis to determine cost of services. A range of process and economic cost measures will be collected from: i) routinely collected data; ii) document review; and iii) surveys, key informant interviews and focus groups with clinical staff, health service managers, and patients and families. For the clinical effectiveness component, the primary outcome will be change in body mass index, adjusted for age and sex, at 6 months from baseline. The secondary outcomes will be change in key food and physical activity behaviours at 6 months from baseline. The study has successfully secured funding through the NSW Health Translational Research Grant Scheme.

Results

are forthcoming.

Conclusion

The findings will provide an understanding of the most effective design and delivery of local services, enhancing the accessibility, acceptability, reach and impact of paediatric weight management services. This will enable recommendations to be made for future services planning to optimise scalability and sustainability of integrated, responsive and effective care of paediatric patients with overweight or obesity.

Obes Facts. 2018 May 26;11(Suppl 1):213.

T3P68 Adaptation of the ToyBox pre-school obesity prevention programme for use in Scotland: Intervention adaptation processes and baseline results of a feasibility cluster randomised controlled trial

S Malden 1, J Reilly 1, AM Gibson 1, A Hughes 1

Introduction

Obesity rates for children under ten years of age in Europe were reported to be approximately 20%, with Scotland having one of the highest levels of childhood obesity within this region, highlighting the need for prevention in the early years. ToyBox is a theory-based, pre-school obesity prevention intervention, which improved physical activity and sedentary behaviour in European pre-schoolers. The present study aimed to first adapt the ToyBox intervention for use in the Scottish pre-school setting, before testing the feasibility of the intervention to determine whether progression to a full-scale randomised control trial in Scotland is merited.

Methods

Intervention adaptation processes: Regular meetings were held with Glasgow Council to discuss context-specific requirements of the intervention and a pre-school practitioner workshop was conducted to refine the intervention content. An experienced pre-school practitioner was recruited to co-produce the materials for use in ToyBox-Scotland, with all sessions trialled in a pilot nursery. Pre-school visits were conducted and classroom health behaviours observed. Design: Feasibility cluster randomised controlled trial (3 intervention vs 3 control pre-schools). Setting and participants: All 3–5 year old children were eligible for participation provided they had no serious health conditions, and parental consent was provided. Methodology: Outcomes at baseline (January 2018) and follow-up (June 2018) included: pre-school and home physical activity, sedentary time and sleep via an activPAL worn for seven consecutive days; BMI z-score; body composition via bioelectrical impedance analysis; home snacking, water consumption and screen-time via parental questionnaire and overall feasibility and acceptability of the intervention.

Results

Adaptations to the intervention: Intervention adaptation efforts led to substantial changes being made to the original ToyBox intervention to reflect the contextual differences between Scottish and European pre-schools. Classroom-based activities were simplified and reduced to reflect the younger age of the children, and a stronger focus was given to influencing behaviour change in the home environment through the use of parent-child homework activities and sticker incentives. Baseline results on feasibility of ToyBox in Scotland and cluster RCT outcome data are expected in May 2018, and will be presented in comparison to guidelines for child physical activity, sedentary behaviour and sleep.

Conclusion

Interventions that have shown promise in improving obesity-related health behaviours should be applied to other settings. However, for effectiveness to translate from one setting to another, the appropriate environmental adaptations need to first be made, a step in intervention development, which is often overlooked in the published literature. This study details the steps taken to adapt a pre-school obesity prevention intervention from one setting to another, with the intention of testing and reporting its feasibility.

Obes Facts. 2018 May 26;11(Suppl 1):213.

T3P69 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):213–214.

T3P70 Tertiary level management of severe paediatric obesity: Interventions must focus on younger children and address attrition rates

K Chisholm 1, S Alexander 2

Introduction

The prevalence of severe obesity in Australian children continues to increase, thus it is imperative we determine optimum weight management interventions. Data from tertiary level treatment programs can help inform patient and service characteristics most likely to yield successful outcomes. As part of ongoing service improvement we evaluated data from our NSW tertiary paediatric multi-disciplinary weight management services clinic CHOOSe Health, to determine potential identifiable criteria predictive of greater weight loss Results.

Methods

A retrospective audit with analysis of data (demographics and anthropometry) collected on 270 children ages 1–15 years from 2012–2016 attending CHOOSe health. Parents attend 3 workshops, then 9 scheduled individually tailored sessions, over 6 months, with the team's health professionals. Mixed models were used to assess the statistical changes from the base line using SAS version 9.

Results:80% of the children had morbid obesity (ITOF). Mean baseline Body Mass Index (BMI) z-score and Waist-to-height ratio (WHtR were 2.7 (range 1.2–6.4) and 0.78 (range 0.49–1.0) respectively. Greater than 93% had a waist circumference >80cm. Younger patients (≤6 yrs) had higher baseline BMI z-scores. Only 43% of families attended the initial (triage) appointment, whereas 29% of families attended at least 5 appointments. For multiple attenders, there was a significant (p < 0.0001) mean change in BMI z-score from visit 2 to last visit being greatest in those ≤ 6 years of age. With increasing number of visits there was a mean reduction in BMI z-score of 0.04 units (95% CI 0.04 to 0.051).

Conclusion

Tertiary level care is effective in management of childhood obesity with significant reductions in BMI z-score. There was a high level of morbid obesity particularly in the younger age group but this cohort responds well to treatment. Lifestyle interventions need to target younger ages to manage childhood obesity.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):214.

T3P71 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):214.

T3P72 Case report: effects of a 12-week strength and neuromuscular exercise programme on body composition and nutritional intake

A Kreissl 1, A Jorda 1, K Truschner 1, G Skacel 1, S Greber-Platzer 1

Introduction

This case report shows the outcome acquired within the Children's KNEEs study. Aim of this study was to investigate the effects of a 12-week strength and neuromuscular exercise programme on body composition and nutritional intake.

Methods

This case report presents a patient, who completed an intensive 12-week strength and neuromuscular exercise programme for the lower extremity for obese children and adolescents at the Department of Pediatrics and Adolescent Medicine in Vienna during the period from September to December 2015. Body composition measurement was performed with bioelectrical impedance analysis BIA-BIACORPUS and nutritional evaluation was calculated with Nutrisurvey-EBISpro.

Results

The patient was a 14-year-old boy with a BMI of 36.9 kg/m2 and he participated 65% of the training sessions. After the 12-week training, the BMI decreased by 2.4%, hip circumference by 3%, and body fat percentage by 7.7%. Fat free mass increased by 3.8%, body cell mass by 5.4%, extracellular mass by 1.7%, total body water by 4.1% and basal metabolic rate by 2.9%. Protein intake was exceeding the daily recommendations by 30% (daily intake: 70.9 g vs. recommended: 54.4 g), fat by 47% (daily intake: 91.7 g vs. recommended: 62.5 g), carbohydrates by 6% (daily intake: 278.8 g vs. recommended: 263.1 g), and energy by 24% (daily intake: 2287.5 kcal vs. recommended: 1843 kcal). Fibre intake was 39% (daily intake: 11.6 g vs. recommended: 30 g) below the daily recommendations. After a 12-week training, daily protein intake decreased by 37.5%, fat intake by 22.1%, and cholesterol intake by 90.3%. Carbohydrates daily intake increased by 4.1%, energy by 4.8% and dietary fibre intake by 191.4%.

V1 … Baseline; V2 … after 12 weeks; BIA, bioelectrical impedance analysis; BFP, body fat percentage; FM, fat mass; FFM, fat free mass; BCM, body cell mass; ECM, extracellular mass; TBW, total body water; BMR, basal metabolic rate; PUFAs, poly unsaturated fatty acids

Conclusion

The body composition and nutritional intake have improved after 12 weeks of physical activity. Greater potential for enhancement is possible if the patient had demonstrated an increased training compliance.

Tab. 1.

Body Composition and Nutritional Intake

Body composition
 Nutrition
BIA V1 V2 % Intake/d V1 V2 %
BFP (%) 33.9 31.3 -7.7 Protein (g) 70.9 44.3 –37.5
FM (kg) 34.1 31.4 -7.9 Fat (g) 91.7 112.0 –22.1
FFM (kg) 66.4 68.9 3.8 Carbohydrates (g) 278.8 290.3 4.1
BCM (kg) 37.2 39.2 5.4 Energy (kcal) 2287.5 2397.4 4.8
ECM (kg) 29.2 29.7 1.7 Fibre (g) 11.6 33.8 191.4
TBW (kg) 48.8 50.8 4.1 Cholesterol (mg) 426.7 41.6 –90.3
BMR (kcal) 1707 1756 2.9 PUFAs (g) 4.0 47.7 1092.5
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Obes Facts. 2018 May 26;11(Suppl 1):214–215.

T3P73 Telemedicine Therapy for Overweight Adolescents: First Results of a Novel Smartphone App Intervention using a Behavioural Health Platform*

K Heldt 1, DJ Büchter 1, B Brogle 1, CI Shih 2, D Rüegger 2, A Filler 3, P Gindrat 4, D Durrer 4, N Farpour-Lambert 4, T Kowatsch 3

Introduction

Despite improved therapy measures since 2014 the prevalence of overweight and obesity in Swiss adolescence stabilized on 19%. Particular challenges are lack of adherence to therapy in youth who are in difficult life situations or live further from specified centres. Therefore it is essential to find simple and novel therapeutic approaches. But although the number of digital based health information systems increases steadily, the effectiveness in reaching long term health goals or life style change mostly remain unproven. The aim is to test a novel design of a health app for overweight adolescents, whether it supports their motivation to participate in a lifestyle intervention including relaxation and activity exercises.

Methods

Based on an open source platform with a text-based healthcare chatbot (THCB), a mobile chat app with a serious game character was designed for Android smartphones. Patients were able to chat with the THCBs Anna or Lukas with the help of pre-defined answer options. Direct communication between patients and health professionals (HP) was also enabled via a second chat channel. Sensor integration provided measurement of physical activity. In a 12-month randomized controlled study, the THCBs encourage patients to achieve daily challenges during 24 weeks (steps per day, breathing exercises, photos of nutrition and home environment, questions on well-being and eating habits) to earn virtual rewards. Effects on therapy adhesion during the 5.5-month intensive phase of intervention with 4 on-site visits will be compared to a treatment-as-usual group with monthly visits.

Results

At start, in 22 patients (39% girls) age and BMI-SDS were not significantly different: 14.2 years (11.9 – 17) and 2.56 SD (1.7 – 3.5). At 5.5 months (13 THCB; 7 controls), almost 67% of the patients had >4 THCB conversational turns per day and 43% fulfilled daily challenges completely and successfully. Only during the first month, open chat questions, mainly on technical issues, took place in 3.4% of roughly 18.064 conversational turns.

Conclusion

Interim analysis of the THCB intervention group of an ongoing RCT shows a high compliance with the app services over half a year. This may be explained by the rewarding game system, the peer character of the THCBs and the perceived usefulness of the THCBs on the smartphone, a familiar medium for adolescents.

Obes Facts. 2018 May 26;11(Suppl 1):215.

T3P74 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):215.

T3P75 Effect of exenatide on BMI-SDS and 2-hour postprandial glucose in obese adolescents

D Weghuber 1, A Forslund 2, H Ahlstrom 3, A Alderborn 4, S Brunner 1, J Cadamuro 5, I Ciba 2, M Dahlbom 2, V Heu 1, J Hofmann 1, H Kristinsson 4, J Kullberg 3, F Lagler 1, M Lidström 2, H Manell 4, K Paulmichl 1, H Vilén 2, K Widhalm 1, F Zsoldos 1, P Bergsten 4

Introduction

Pharmacologic treatment options for adolescents with obesity are very limited. Glucagon-like peptide-1 (GLP-1) receptor agonist, especially the extended-release form, could be a treatment option for obesity in adolescents. Its safety, tolerability and effect has not been assessed in this patient group, however. The study aimed to investigate the effects of exenatide extended-release on body mass index (BMI) and glucose metabolism as well as its safety and tolerability in obese adolescents.

Methods

A six months, randomized, double-blinded, parallel, placebo-controlled clinical trial was performed at two academic pediatric centers. Patients received lifestyle intervention and were randomized to exenatide 2 mg s.c. injections given once weekly (n = 22) or placebo (n = 22). Patients were aged 10 to 18 years (22 females) with BMI-SDS >2.0 or age-adapted BMI>30 kg/m2 according to WHO were included.

Results

Exenatide given once weekly reduced BMI-SDS, and 2-hour plasma glucose levels during oral glucose tolerance test in comparison to placebo in adolescents with obesity. Safety and tolerability profile of exenatide was comparable to experience in the adult population.

Conclusion

Treatment of obese children and adolescents with extended-release exenatide is safe, generally well tolerated and leads to reduction in BMI-SDS and improvement in glucose tolerance. The study indicates a novel treatment strategy for this patient group.

Conflicts of Interest

The study has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement number 279153 (Beta-JUDO), Uppsala-Örebro Regional Research Council, the Swedish Diabetes Foundation (grant number 2016-146), EXODIA

Obes Facts. 2018 May 26;11(Suppl 1):215.

T3P77 Case report: 13 year old obese girl presenting with neurological symptoms

S Greber-Platzer 1, N Walleczek 1, M Breu 1, R Seidl 1

Introduction

Presentation of an obese girl with increasing neurological symptoms diagnosed as brain pressure elevation and need for neurosurgical interventions. We want to point out that neurological symptoms with visual dysfunction in obese children are very seldom, but with a high risk for loss of vision.

Methods

We describe an obese girl with increasing headache, nausea, vomiting and visual dysfunction since several weeks and diagnosis of papilledema caused by elevated brain pressure. Clinical history, physical and additional examinations could confirm the diagnosis. Neurosurgical interventions were necessary for a successful treatment.

Results

The 13 years old obese girl (BMI 33kg/m2) presented clinically with increasing neurological symptoms caused by an elevated brain pressure and a high risk for loss of vision. The clinical examination defined characteristic obesity related skin alterations, malposition of the spine, a divergent strabismus and visual field defects. Visual examination could show reduced pupils reactivity, prominent and unsharp papilla and also limited abducens function. Diagnosis of elevated brain pressure was confirmed by a cerebral MRI. Other obesity related comorbidities were elevated uremic acid (7.8mg/dl), mild glucose intolerance (fasting glucose 103mg/dl) and insulin resistance (fasting insulin 36.8µlU/ml), mild dyslipidemia (triglyceride 191mg/dl, cholesterol 200mg/dl), hypertension (150/100mmHg), no steatosis hepatis (regular echography, no elevated transaminases). Hypertension was treated. Because of the high risk for loss of vision and no successful drug-therapy to reduce brain pressure, neurosurgical interventions were necessary. Lumbal puncture didn’t reduce the symptoms, also a lumbal drainage had limited success. So a ventriculo-peritoneal shunt was implanted at day 18. Thereafter the clinical symptoms and the papilledema diminished. The vision was stabilized and no residual abnormalities remained.

Conclusion

Pseudotumor cerebri is a seldom related comorbidity by childhood obesity, but must be diagnosed in time and treated intensively to prevent loss of vision. The only curative therapy may be weight loss achieved by strict diet and physical activity.

Obes Facts. 2018 May 26;11(Suppl 1):215.

T3P78 What impact would use of a threshold based on % of median BMI have on the prevalence of child overweight and obesity at different ages?

C M Wright 1, A Adamson 2, L Basterfield 2, A Jones 2, K Parkinson 2

Introduction

While the healthy upper limit for BMI is well established in Northern European adults, it is ill-defined for children, and historically BMI centiles have been used instead to set upper thresholds. When compared to the original reference sample, centiles identify a fixed percentage of children at all ages as being above the normal range. What is not known is how common actual obesity is at different ages. It is assumed that children with higher BMI at one age will track and progressively increase in BMI towards adulthood. However, tracking of preschool BMI has been shown to be weak. At age 2 the upper end of the UK 1990 BMI range (+2 SD) is 19% above the median, while at age 18 the adult overweight threshold of 25 kg/m2 is also ~19% above the median. Similarly BMI 40% above the median at age 2 extrapolates to BMI 30 at age 18. We propose that these represent more valid thresholds to use in childhood. We aimed to examine the proportion of children with %median BMI in the overweight and obese range at different ages within the same recent UK birth cohort.

Methods

The overweight (median + 20%) and obese (median + 40%) thresholds were applied to data from the Gateshead Millennium study, a population representative cohort of 1029 infants born in 1999–2000. The thresholds were then compared to the British 1990 centile / SD clinical thresholds for overweight (91st; +1.33 SD) and obesity (98th; +2 SD).

Results

Across five waves at ages 2.5, 5, 8, 9 and 12 years there were between 225 (22%) and 722 (70%) children with measured BMI. The prevalence of overweight and obesity based on centiles was relatively stable from age 2.5 to 9, but higher at 12. In contrast only 6% of children were above median + 20% BMI at age 2.5, rising to 32% at age 12, of whom 11% exceeded median + 40% (see figure).

Conclusion

Using %median thresholds, very few preschool children were overweight or obese until the age of 8. The use of centiles for BMI greatly exaggerates the prevalence of obesity in preschool children and obscures the marked rise in obesity prevalence with age. The use % median thresholds may be more valid.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):216.

T3P79 How well do BMI centile and %median thresholds correspond to body fat in children?

C M Wright 1, TJ Cole 2, M Fewtrell 2, J Wells 2

Introduction

While the healthy upper limit for BMI is well established in Northern European adults, it is ill-defined for children, and historically BMI centiles have been used to set upper thresholds, which identify a fixed percentage of children at all ages as being above the normal range, when compared to the original reference sample. The aim of these thresholds is to identify children with excess adiposity, but limited findings to date suggest that the correspondence between body fat mass and BMI is weak for healthy children in mid childhood, and little is known about younger children or those with BMI above the normal range. We have proposed new thresholds for overweight and obesity using % of the median that map closely to adult BMI thresholds at age 18. These suggest that very few preschool children have BMI in the overweight or obese range, but over a quarter are overweight or obese by age 12. We aimed to describe how Z score-based and the proposed %median- thresholds correspond to body fat levels at different ages. We hypothesised that for any given Z score threshold, younger children would have lower fat mass index (FMI = fat mass/height2) than older, but that %median thresholds would predict the same FMI at all ages.

Methods

A body composition database was collated from various studies of children aged 2–19y, with over- representation of obese individuals aged 7–16y. Fat mass was measured using the 4-component model, except for children under 5 where deuterium dilution was used. Fat mass was expressed as FMI. Height and weight were converted to BMI Z scores using the British 1990 growth reference.

Results

Out of 923 children, 413 (42%) were under 10y; 319 (32%) had BMI Z score (BMIz) ranging from 1 to 4.7, and 260 (26%) had %median BMI ranging from 110 to 271. Within the normal range (-2 SD to +1 SD) the relationship of both BMIz and %median BMI with FMI was weak (BMIz r2 = 18%; %median BMI r2 = 23%) though significant (p < 0.001). For BMIz >1 the association of BMIz with FMI was stronger overall (r2 = 72%) but varied widely with age, being linear under 9y but nonlinear at later ages (see figure). The youngest children had much lower FMI and this increased little with increasing BMIz. %median BMI showed a stronger association overall with FMI (r2 = 88%) that was linear at all ages, though the slope increased with age.

Conclusion

Children under 10y have much lower FMI than older children in the same BMIz category. %median BMI correlates more closely with FMI, though a high %median BMI value still corresponds to greater fatness in older, compared to younger children.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):216–217.

T3P80 Patterns of weight change from childhood to early adulthood and the risk of prostate cancer

J Aarestrup 1, BW Jensen 1, TIA Sørensen 3, MB Cook 3, JL Baker 1

Introduction

Elevated body mass index (BMI) in adult life may be associated with an increased risk of prostate cancer, however, findings are inconsistent and depend on the severity and/or aggressiveness of the disease. In our prior investigations we have not found evidence that BMI during childhood and early adolescence significantly affects prostate cancer risk, but extending the window of exposure beyond age 13 years is of great interest given that this is a key period of prostate gland development. It is currently unexplored whether changes in body size from childhood to early adulthood influence prostate cancer risk. We therefore evaluated how patterns of weight status in childhood and early adulthood are related to later risk of prostate cancer.

Methods

A total of 61,216 boys from the Copenhagen School Health Record Register were identified in the Danish Conscription Database (including all Danish men born 1939–1959 and examined for their suitability for military service). Weight and height were measured at age 7 and 13 years and in early adulthood (17–26 years). Through linkage to the Danish National Cancer Register we identified cases of prostate cancer. Based on cut-offs from the International Obesity Task Force (< 18 years) and the World Health Organisation (≥18 years) the boys and men were categorised as normal-weight or overweight with boys remaining normal-weight in both child- and adulthood serving as the reference. Cox proportional hazard regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results

During 36 years of follow-up, 2,119 men were diagnosed with prostate cancer (mean age.65 years). Compared with normal-weight boys who remained normal-weight in early adulthood, we did not find indications of increased risks of prostate cancer among a) overweight boys at age 13 years who became normal-weight as young men (HR = 0.89, 95% CI: 0.65–1.21), b) normal-weight boys who became overweight in early adult life (HR = 0.83, 95% CI:(0.66–1.03), or c) boys who were overweight and remained overweight as young men (HR = 0.94, 95% CI: 0.71–1.25). Findings were similar for weight status patterns with size at age 7 years and in early adulthood.

Conclusion

This study does not provide evidence that prostate cancer risk in adulthood is affected by changes in BMI from childhood to early adult life, despite this period being crucial for prostate gland development.

Obes Facts. 2018 May 26;11(Suppl 1):217.

T3P81 Dietary intake and lifestyle factors in obese Czech adolescents: Relationship to their metabolic health

H Zamrazilova 1, V Hainer 1, M Kunesova 1, I Aldhoon-Hainerová 2

Introduction

Obesity and obesity-associated health complications are common in adolescents. There are, however, individuals despite being obese, present favorable metabolic profile. This phenomenon is called metabolically healthy obesity (MHO). Several studies, mainly carried out in adults, have tried to identify determinants and predictors of MHO. The aim of our study was to reveal potential determinants of MHO with respect to data of personal and family history, dietary and lifestyle parameters.

Methods

Total of 710 obese Czech individuals aged 13.0–17.9 years participated in the study. From this cohort 43 girls and 57 boys were classified as metabolically unhealthy (abdominal obesity and ≥ 2 risk components of metabolic syndrome). MHO (absence of any cardiometabolic risk factor) was found in 211 girls and 131 boys regardless of waist circumference and in 33 girls and 27 boys without abdominal obesity. Dietary records and various lifestyle factors (e.g. total hours of sleep, bedtime and snoring, daily screen time, skipping breakfast, regular pattern of meal intake, presence of night eating, time of the last daily meal, Eating Inventory questionnaire) were compared between MHO and those with metabolically unhealthy obesity.

Results

The prevalence of MHO regardless of waist circumference was higher in girls than in boys (53.1 vs. 41.9%) but comparable when abdominal obesity was excluded (8.3 vs. 8.6%). Boys with MHO presented with longer sleep duration, earlier time of the last daily meal and bedtime, more regular meal consumption and lower protein intake than those with unhealthy metabolic profile. In comparison to girls with unhealthy metabolic obesity girls with MHO had significantly higher intakes of energy, carbohydrates, fat and calcium, higher screen time and lower frequency of snoring. In obese adolescents, data of personal (birth weight and length, duration of breastfeeding) and family history was not found to be related to metabolic health.

Conclusion

Metabolic health in obese adolescents was found to have only weak associations with most of the lifestyle factors studied. Energy intake and intake of nutrients was paradoxically significantly higher in girls with MHO than in those metabolically unhealthy. Few factors related to healthy lifestyle was more often found in boys with MHO than their metabolically unhealthy counterparts. Supported by AZV 17–31670A, MH CZ-DRO (Institute of Endocrinology – EÚ 00023761)

Obes Facts. 2018 May 26;11(Suppl 1):217.

T3P82 ‘It's the same with almost anything; you're going to have to want to do it’: A preliminary qualitative exploration of barriers and enablers influencing a healthy lifestyle in adolescents with obesity

M Kebbe 1, A Perez 1, T McHugh 2, S Scott 2, M Dyson 1, C Mohipp 3, A Buchholz 3, C Richard 2, G Ball 1

Introduction

Many adolescents do not meet recommendations for nutrition, physical and sedentary activities, and sleep, habits that influence successful weight management. The purpose of our study was to explore barriers and enablers that influence the adoption of a healthy lifestyle among adolescent patients with obesity.

Methods

This multi-centre, qualitative, descriptive study includes 13–17 year olds with overweight or obesity (body mass index ≥85th percentile) receiving multidisciplinary clinical care from two pediatric weight management clinics located in Edmonton and Ottawa, Canada. We used purposive sampling to recruit Anglophone and Francophone adolescents who participated in one-on-one, in-person, semi-structured interviews. Interviews lasted 30 – 60 minutes, were audio-recorded, transcribed verbatim, translated to English (when applicable), and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive thematic analysis.

Results

Overall, 19 adolescents (12 Anglophone − 14.9 ± 1.5 years old, 3.3 ± 0.5 BMI z-score, 67% female, 50% Caucasian and 7 Francophone – in progress) participated in our study. Barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits were grouped into five themes, including (i) Controllability and competence beliefs (e.g., perceived lack of skills), (ii) Physiological mechanisms and physical health status (e.g., physical discomforts), (iii) Self-regulation for behaviour change (e.g., habit formation), (iv) Adolescent-family-social relationships and interactions (e.g., modelling behaviour), and (v) Accessibility to and availability of opportunities for lifestyle improvement (e.g., financial status).

Conclusion

Our interim analyses revealed a range of barriers and enablers reported by adolescents with obesity that were either within or beyond their control. In general, participants attributed barriers and enablers to individual- and interpersonal-level factors, highlighting areas that health care providers may find useful in their clinical work when building on strengths and addressing challenges to help adolescents with obesity improve their lifestyle habits.

Obes Facts. 2018 May 26;11(Suppl 1):217–218.

T3P83 Fussy eating in a sample of obese children with and without anxiety, depression, autism or ADHD

A S Olafsdottir 1, S Thorsteinsdottir 1, B Brynjolfsdottir 2, R Bjarnason 2, U Njardvik 3

Introduction

Fussy eating has been identified as a possible factor for contributing to and maintaining obesity in children. Furthermore, research has indicated that fussy eating is possibly related to emotional- and/or behavioral disorders. Limited variety in the diet and low consumption of fruit and vegetables has been associated with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Especially, rejecting bitter tastes and food types such as vegetables is common in children with autism. However, no studies have been published to date on the association of fussy eating in obese children with and without these disorders, and mental disorders such as anxiety and depression.

Methods

Participants were obese children (n = 105) who were referred for family-based obesity treatment at the Children's Medical Centre in Iceland between 2011 and 2016. The children were aged 4 to 18 years (mean 12.0; SD 3.0). Mean BMI-SDS (Body Mass Index Standard Deviation Score) was 3.53 (SD 0.86). The primary outcome measure was fussy eating i.e. being a fussy eater or not as measured by a questionnaire based on Kauer et al (2015). Logistic regression was used to estimate the relationship between fussy eating and number of disorders (mental and/or neurodevelopmental disorders), adjusting for gender and age.

Results

Fussy eating was common in the group; 30.8% according to behavioral definition and 39.8% as experienced by parents. The number of mental and/or neurodevelopmental disorders with obesity was directly related to children's fussy eating. Having three or more disorders was associated with increased odds of fussy eating in obese children [odds ratio (OR), 5.50; 95% confidence interval (CI), 2.00;16.70]. After adjusting for gender and age, the odds of fussy eating when having three or more disorders remained significant but slightly lower (OR, 4.06; 95% CI, 1.33–13.08). Having two disorders still raised the odds of fussy eating in the unadjusted model (OR, 4.81; 95% CI, 1.53;16.50) but not in the adjusted model. When analysing the difference between those who rejected bitter taste, based on disorders, it was evident that 80.0% of children with autism rejected bitter taste as described by parents, compared with 37.8% of those who did not have autism (p = 0.029). This difference was not seen for other disorders. Only 2% of participants rejected sweet taste irrespective of type of disorders.

Conclusion

Fussy eating was common in this sample of children attending obesity treatment and increased with number of disorders. Future research and clinical care models should explore ways to work with tastes in pediatric obesity treatment since fussy eating may result in lower adherence to dietary advice.

Obes Facts. 2018 May 26;11(Suppl 1):218.

T3P84 Can anxiety and screen time predict children's weight change in obesity treatment?

S Thorsteinsdottir 1, B Brynjolfsdottir 2, R Bjarnason 2, T Helgason 3, AS Olafsdottir 1

Introduction

Raised anxiety levels in children have been associated with longer screen time (time spent in front of computers, laptops, tablets). This can contribute to overweight and obesity. Research on screen time and anxiety in relation to obesity status in children attending pediatric obesity treatment is lacking.

Methods

Medical reports were analysed retrospectively. Children (n = 265) aged 4 to 18 years (mean 11.5; sd 3.1) were referred for family-based obesity treatment at the Children's Medical Centre in Iceland between 2011 and 2016. Mean BMI-SDS (Body Mass Index Standard Deviation Score) was 3.51 (sd 0.84) and mean treatment duration was 14.7 months (sd 12.4). The primary outcome measure was losing weight or not during treatment i.e. < 0 or ≥ 0 in BMI-SDS [change in BMI-SDS during treatment]. Logistic regression was used to estimate the relationship between screen time and obesity status, adjusting for anxiety, physical activity, treatment length and initial BMI-SDS.

Results

Screen time ≥ 2 hours per day was associated with increased odds of not losing weight (≥ 0 BMI-SDS) during obesity treatment [odds ratio (OR)], 2.57; 95% confidence interval (CI), 1.59–4.25]. After adjusting for anxiety, treatment length, physical activity and initial BMI-SDS, the odds remained significant but slightly lower (OR, 2.49; 95% CI, 1.49–4.26). Children with anxiety in addition to ≥ 2 hours screen time per day had the highest likelihood (55%) of not losing weight during obesity treatment. Children without anxiety had a 30% likelihood of not losing weight. Children with anxiety who had < 2 screen time per day had a 33% likelihood of not losing weight during treatment. Children without anxiety had the lowest likelihood (16%) of not losing weight during treatment. Increased screen time and having anxiety predicted raised odds of children not losing weight during obesity treatment, after adjusting for confounding variables (figure 1).

Conclusion

It is important to identify and measure anxiety and screen time usage in children attending obesity treatment as they are at raised risk of not losing weight during treatment. Educating parents in family-based treatment on the importance of parental screen time control should be emphasised. It is possible that increased anxiety and screen time in obese children point to a common, underlying cause which needs to be identified and treated.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):218–219.

T3P85 Intermittent energy restriction in adolescents with obesity: a pilot study

H Jebeile 1, ML Gow 2, N Lister 1, K Chisholm 2, A Grunseit 2, S Alexander 2, MM Haghighi 1, J Ayer 2, CT Cowell 2, L Baur 3, SP Garnett 1

Introduction

Intermittent energy restriction (IER) in adults is as effective as continuous energy restriction. This is the first study to investigate the effectiveness and acceptability of IER in adolescents with obesity.

Methods

During weeks 1–12, participants followed an IER dietary plan consisting of a Very Low Energy Diet (VLED) 3 days/week (500–600kcal/day) and a standard healthy diet 4 days/week. For weeks 13–26, participants were given a choice to continue with 1–3 days of VLED/week or follow a standard healthy diet. Outcomes measured at 0, 12 and 26 weeks were body composition, cardiovascular risk, vascular function and diet acceptability.

Results

30 participants, aged 12–17 years (mean [SD] 14.5yrs [1.4], female n = 25) with a median BMI 34.9kg/m2 (range: 27.7–52.4), were recruited. Compared with baseline, body weight and BMI expressed as a percentage of the 95th percentile (BMI %95th) were significantly reduced at 12 weeks (mean [SD], n = 23, −3.3kg [3.7] p < 0.0001, −5.4 (2.2), p < 0.0001), with a reduced BMI %95th maintained at 26 weeks (n = 21, −5.0 [9.3], p = 0.02). Improved body composition, with reduced fat mass (n = 17, −4.31kg [6.4], p = 0.025) and maintenance of fat free mass (p = 0.937), was seen at 26 weeks. Triglycerides and brachial systolic blood pressure were reduced at 26 weeks compared with baseline (n = 21, −0.22mmol/L[0.31], p = 0.008, n = 13 −5.6mmHg [8.9], p = 0.042). Moderate correlations were seen between reduced BMI %95th and improved vascular function (pulse wave velocity, rho = 0.63, p = 0.022).

Conclusion

Intermittent energy restriction is effective at achieving improved BMI and cardiometabolic risk, and is an acceptable dietary intervention in adolescents with obesity. A randomised controlled trial is required to compare intermittent with continuous energy restriction in this population. This study was funded by the Financial Markets Foundation for Children and the Heart Foundation of Australia Vanguard Grant.

Fig. 1.

Fig. 1

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Tab. 1.

Summary of Results at 26 weeks

Mean (SD)
 Baseline, n = 30
 12 weeks, n = 23
 26 weeks, n = 21
Weight (kg) 101.67 (20.4) 95.43 (18.6) 97.5 (20.8)
BMI (kg/m2) 37.0 (6.8) 34.41 (5.9) 34.89 (7.0)
BMI %95th percentile *.4 (22.2) 124.0 (19.8) 125.2 (23.0)
Body fat percentage 47.8 (8.8) 46.4 (9.5) 43.7 (8.0)
Fat free mass (kg) 52.6 (7.3) 50.1 (6.8) 53.2 (7.8)
Fat mass (kg) 50.7 (18.7) 45.5 C8.D 42.6 (14.9)
Triglycerides (mmol/L) 1.6 (1.4) 1.3 (0.5) 1.1 (0.5)
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At 12 weeks, all participants chose to continue IER with 2 days/week (n = 12) or 3 days/week (n = 10) of VLED. Adolescents found IER acceptable, rating it as easy (mean [SD] n = 19, +2.1 [1.2]) and pleasant (n = 19, + 1.9 [1.2]) on a Likert scale from −4 to +4.

Obes Facts. 2018 May 26;11(Suppl 1):219.

T3P86 What are the most useful psychological constructs in a pediatric obesity service

G Minshall 1

Introduction

This Introduction will briefly describe the challenges facing the Weight Management Service in Sydney, Australia and how these challenges are being addressed. General prevalence and service data will be added where appropriate. There will be some specific case information provided. Sydney Australia provides an extremely challenging environment for the treatment of severe child and adolescent obesity. While prevalence levels of paediatric obesity are stabilising, social disparity is increasing – levels are declining in high SES youth and increasing in lower SES groups. Also of note – extreme obesity – defined as BMIs over 35, is reaching high levels in some population subgroups. So some of our most vulnerable youth are also becoming heavier. It is not unusual for our service to encounter 12 year old weighing 120kg or even in one case 140kg. The Weight Management service must effectively treat these young people and their families in the context of no extra resources and no scientific consensus on which psychological variables are most important to address. This abstract will describe how we try to meet that challenge.

Methods

Service outcome data will be touched on but is being presented in detail in another abstract. General Australian prevalence data that describes the rise in severe obesity will be presented. We will then drill down to the amount of referals to our service, number of appointments, and what is the psychological content of these parent group and individual sessions. The major challenges to treatment (mental health, psycho-social stresses, health literacy) will be described and examples given.

Results

The results section will describe each treatment challenge, present basic data, what the service has done to address this and what the outcome has been. The presenter will do this for rise in referrals rise in severe obesity which constructs can be addressed under currently resourcing (parental obesity) and which barriers to treatment often cannot be addressed such as co-morbid psycho-social distress co-morbid mental health difficulties in children adolescents.

Conclusion

This abstract aims to share the reasoning of why we do what we do and discuss whether our interventions are the best application of science within the confines of our service. Inspiration from European colleagues and services will be described. Any useful analysis will include what we need to do more of next. We can't do everything so what should the next improvement be? And what are the most important and urgent psychological treatments?

Obes Facts. 2018 May 26;11(Suppl 1):219.

T3P87 Cost of tertiary care in Irish children who are obese

L Tully 1, J Sorensen 2, G O'Malley 1

Introduction

One in four Irish children are overweight or obese. The aim of this study was to examine the cost of tertiary paediatric care including emergency, in-patient and outpatient services by children with obesity.

Methods

A retrospective observational, longitudinal analysis of the cost of hospital service utilisation among a sample of children with BMI >98th centile was undertaken. Hospital attendance (outpatient department, inpatient stay and emergency department) 24 months prior to, and 12 months after referral for obesity treatment were obtained from patient records. Unit costs were obtained from the Health Service Executive of Ireland and an annual cost was calculated. Variation in resource use and costs of service utilisation was explored using generalised regression models to compare costs between children with clinical and severe obesity (>99.6th centile) adjusting for age, gender, and comorbidities.

Results

Data were obtained for 335 children (mean age 11.8 years) and the mean annual cost of hospital utilisation was €5331 (95% CI: €3539-€7122) per child. Those who were severly obese had lower costs compared to those with less severe obesity (€4287 annually versus €9343, p = 0.02). In those with severe obesity, children with co-morbid conditions had higher costs but this was not statistically significant (p = 0.2).

Conclusion

Cost data as presented here are important to inform health service delivery and strategic planning of paediatric services. It is relevant to assess the efficiency of resource utilisation and the effectiveness of assessment and intervention.

Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P88 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P89 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P90 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P91 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P92 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P93 Metabolic health of metabolically healthy overweight adolescents: beyond metabolic syndrome definition and components

A Videira-Silva 1, S Freira 2, H Fonseca 3

Introduction

Metabolically healthy overweight (MHO) adolescents may be at a lower risk of cardiovascular disease compared to those metabolically unhealthy. However, many overweight adolescents may be wrongly defined as MHO, since MHO definitions are usually just based on the absence of Metabolic Syndrome (MS) or MS-related components. The aims of this study were: (i) to determine the prevalence of MHO adolescents in a sample of overweight adolescents attending a Pediatric Obesity Clinic according to the two most widespread definitions; (ii) and to investigate the presence of abnormal metabolic indicators, other than those included in the definition of Metabolic syndrome (e.g. total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), insulin, HOMA-IR, Alanine aminotransferase (ALT) and C-reactive protein (CRP).

Methods

Anthropometric and clinical data from 327 overweight adolescents (51.4% girls), mean BMI z-score 2.81 (± .84), mean age 14.3 (± 2.2), were retrospectively analyzed. Two criteria were used to define MHO: Criterion 1, up to one of the MS components; Criterion 2, absence of any MS component. TC ≥ p95, LDL-C ≥ p95, IR as HOMA-IR ≥ p90, ALT ≥ p95 for age/pubertal status and gender, and CRP >.30 mg/dl were considered as abnormal.

Results

According to Criteria 1 and 2, 271 (82.9%) and 122 (37.3%) adolescents were considered as MHO, respectively. Independently of the criteria used, MHO adolescents shown a lower BMI z-score (C1- 2.73 ± .80 vs 3.02 ± .94, p = 0.016; C2- 2.56 ± .70 vs 2.91 ± .86, p = < 0.001) and body fat mass (C1- 41.7 ± 6.8 vs 43.9 ± 6.7, p = 0.042; C2- 40.6 ± 6.8 vs 42.9 ± 6.8, p = 0.005). According to Criterion2, MHO adolescents also shown to be younger (165 ± 24.6 vs 173 ± 26.6, p = 0.007) and with a lower waist circumference (97.2 ± 11.2 vs 104.3 ± 14, p < 0.001). With the exception of insulin resistance, which prevalence was lower among MHO adolescents (C1–44.9 vs 68.5%, p = 0.002; C2–37.8 vs 55.8%, p = 0.003), all the other non-MS related indicators were not significantly statistically different between MHO and non-MHO adolescents. Around one-quarter (C1–26.2%; C2–24.6%) of the MHO adolescents presented two or more metabolic comorbidities not included in the MS definition (Figure 1). Only 13.5% of the adolescents had none of the components either those included in the definition of MS or the ones we have considered for this study.

Conclusion

MHO definition should not be only based on the MS definition, and may benefit from the inclusion of other metabolic indicators commonly impaired in this population. The stratification of overweight adolescents based on their metabolic health phenotype may be crucial to determine the most appropriate therapeutic strategy, and to identify those who should be targeted as a priority for a more intensive weight management.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):220.

T3P94 Dietary Factors, Visceral Adiposity Index (VAI) and A Body Shape Index (ABSI) in The Definition of Cardiometabolic Risk in Adult Individuals

D Bilgin 1, M Bas 1

Introduction

In this study, it was aimed to investigate the importance of dietary factors, Visceral Adiposity Index (VAI) and A Body Shape Index (ABSI) in defining cardiometabolic risks in adult subjects.

Methods

In the study, 224 adult (58 with cardiovascular risk, 166 without cardiovascular risk) were enrolled between 19 and 65 years who applied to Duygu Medical Center Nutrition and Diet Polyclinic. A questionnaire form and a 24-hours food consumption form were applied to determine the cardiovascular risk factors related to general information, smoking status, family history, nutrition habits and physical activities of all participating participants in the study. Anthropometric measurements of individuals have been obtained, body content analyses have been made, and blood pressure and biochemical parameters have been evaluated.

Results

The relationship between diabetes and high blood pressure and cardiovascular risk was statistically significant (p < 0.05). When nutritional habits and cardiovascular risk situations are compared; The relationship between the amount of milk, yoghurt and fruit consumed at one time and cardiovascular risk was statistically significant (p < 0.05). The relationship between the consumption of rice, pasta and cardiovascular risk was statistically significant (p < 0.05). ABSI, VAI and BMI were not statistically significant in relation to cardiovascular risk factors (p > 0.05), with no association with cardiovascular risk factors. VAI had a statistically significant association with total cholesterol, HDL, VLDL, TG, Fasting Blood Glucose and lean body mass (p < 0.05). BMI had a statistically significant association with HDL, body fat mass/percentage and lean body mass (p < 0.05).

Conclusion

As a result, the effect of waist circumference on cardiovascular risk is higher than VAI, ABSI, BMI.

Obes Facts. 2018 May 26;11(Suppl 1):221.

T3P95 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):221.

T3P96 Severe obesity in Taiwanese children: prevalence and relation to serum alanine aminotransferase level

Y Lin 1

Introduction

To describe the prevalence of severe obesity and its association with serum alanine aminotransferase levels among Taiwanese children and adolescents.

Methods

The Nutrition and Health Survey in Taiwan (NAHSIT), 2010–2012, was used. A total of 2893 (1440 boys and 1453 girls) students aged 6–18 years participated in the study. Weight status was defined as follows: overweight as ≥85th percentile for age- and sex-specific BMI in Taiwan; class I obesity as ≥95th percentile; class II obesity as ≥120 of the 95th percentile, or BMI ≥35; and class III obesity as ≥140% of the 95th percentile, or BMI ≥40. Elevated alanine aminotransferase (ALT) was defined as >25.8 U/L for boys and 18.1 U/L for girls.

Results

The prevalence rates of overweight, class I, class II and class III obesity were 13.89%, 11.88%, 5.42% and 1.11% for boys and 12.80%, 9.98%, 2.41% and 0.48% for girls, respectively; boys had a higher prevalence than girls (P < 0.001). Weight status was associated with serum ALT levels; the prevalence of elevated ALT increased from 12.0% (boys) and 7.0% (girls) in the overweight group, to 25.2% (boys) and 10.3% (girls) in the class I obesity group, 56.4% (boys) and 42.9% (girls) in the class II obesity group and 68.8% (boys) and 71.4% (girls) in the class III obesity group. Students with severe obesity (class II and class III) were 41.7 times more likely to have elevated ALT (95% CI 27.1–64.4) than were normal weight students.

Conclusion

Nationally representative data showed the prevalence rates of severity obesity were 6.53% in boys and 2.59% in girls in Taiwan. Severe obesity in children and adolescents was associated with a markedly increased risk of elevated serum ALT levels.

Obes Facts. 2018 May 26;11(Suppl 1):221.

T3P97 Pre-pregnancy body mass index and gestational weight gain relations with gestational diabetes mellitus in Southwest China

Y Liang 1, D Li 1, M Chen 2, Y Gong 3, X Zhang 4, W Yang 5, G Cheng 1, D Yang 5

Introduction

Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse pregnancy and perinatal outcomes and long-term adverse health consequences for both mothers and their children. Thus, the identification of modifiable risk factors that may contribute to the prevention of GDM is important. Several studies suggest that pre-pregnancy body mass index (BMI) and weight gain during pregnancy are associated with increased risk of GDM. However, data are limited in Chinese people. The objective of the study was to investigate the association of pre-pregnancy BMI and gestational weight gain (GWG) before the OGTT screening for GDM with the incidence of GDM among women in the Southwestern China.

Methods

We conducted a nested case–control study (3593 women with GDM and 15346 women in the control group) within a cohort of women between 2013 and 2015 who were screened for GDM at 24–28 weeks of gestation. Women's weights, plasma glucose levels, and heights data were measured by local medical workers. Multivariate logistic regression analysis was used to analyze the relationship between pre-pregnancy body mass index GWG and GDM.

Results

Pre-pregnancy overweight and obesity were associated with GDM (OR 2.44 95%CI 1.98–2.99 OR 4.98 95%CI 2.52–9.91). According to IOM criteria, excessive GWG occurred in 8.46% of women in the first trimester and occurred in 55.07% of women in second trimester. After adjusting for age at delivery, pre-pregnancy BMI, the high rates of GWG in the first trimester was a risk factor for GDM (OR 1.33 95%CI 1.03–1.70). Similar Conclusions were also obtained in the second trimester (OR 1.48 95%CI 1.26–1.72). The association was stronger in advanced maternal age (age at delivery ≥ 35). The OR and 95% CI were 1.42 (1.02–2.28) vs 1.23 (0.91–1.66) in the first trimester, and 1.59 (1.14–1.88) vs 1.49 (1.20–1.72) in the second trimester.

Conclusion

Pre-pregnancy overweight and obesity, excessive GWG during early pregnancy or excessive GWG during the second trimester of pregnancy may increase the risk of GDM among women in the Southwestern China.

Obes Facts. 2018 May 26;11(Suppl 1):221–222.

T3P98 Oxidative stress markers in preschools from 3 to 5 years old with obesity in a CDMX Hospital

E Carmona-Montesinos 1, S Rivas-Arancibia 2

Introduction

The aim of this work was to identify the disturbances in the oxidative stress markers, the anti-oxidant systems, the lipid profile, C-reactive protein, and insulin, as well as in the calculation of insulin resistance using indirect methods in pediatric obese patients of preschool age at the Pediatric Hospital CDMX.

Methods

To do so, one hundred children between ages 3 and 5 were selected and divided into two groups (n = 50 per group): one group of eutrophic children (< 84th percentile) and one group of children with obesity (> 95th percentile). We conducted an anthropometric evaluation and a quantification of plasma in glucose, cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins, C-reactive protein, and uric acid. All of these were compared between the study groups. In addition, we determined oxidative stress markers: peroxidized lipids, oxidized proteins, reduced glutathione, oxidized glutathione and oxidized low-density lipoproteins. We also determined the serum concentrations of these antioxidants: GSH, GSH-PX 3, Cu/Zn SOD, catalase, and HO-1. Additionally, we determined the enzymatic activities of: peroxidase 3, Cu/Zn SOD, and catalase. Finally, the modifications to insulin in serum in obese children aged between 3 and 5 were evaluated. We compared the results with those from children with normal weight and calculated HOMA-IR, HOMA-%B, HOMA-%S and TG/HDL, T/G and QUICKI indices, which are indirect methods to diagnose insulin resistance.

Results

The data obtained from the obese children show a significant increase in terms of size (p < 0.047), weight (p < 0.0001), body mass index (p < 0.0001), BMI/Age percentile (p < 0.0001), z-score/BMI (p < 0.0001), glucose (p < 0.0001), triglycerides (p < 0.15), ultra-sensitive C-reactive protein, as well as a decrease in the high-density lipoproteins levels (p < 0.039) when compared to the levels of the children from the control group. Additionally, the results demonstrate that obese children show a statistically considerable increase in the serum concentrations of lipid peroxidation (p < 0.0001), oxidized proteins (p < 0.0001), oxidized glutathione (p < 0.0006) and oxidized low-density lipoproteins (p < 0.02), as well as a decrease of the reduced glutathione (p < 0.0003) when compared with the children from the control group. In contrast, obese children show a significant increase in antioxidants as total glutathione and heme oxygenase (p < 0.0001), as well as a decrease of the enzymatic activity of glutathione peroxidase 3 (p < 0.002) and the serum concentration of catalase (p < 0.0001). The calculation to diagnose insulin resistance using indirect methods indicates that obese children present a statistically considerable increase when compared to the children from the control group in terms of: serum insulin (p < 0.0001), HOMA-IR (p < 0.0014), HOMA-%B (p < 0.0001), TG/HDL index (p < 0.0001), TG/G index (p < 0.042), and QUICKI index (p < 0.0001).

Conclusion

With the results obtained, we can conclude that the obese preschool children have a chronic oxidative stress state and show an inflammatory process as well as an early state of insulin resistance.

Obes Facts. 2018 May 26;11(Suppl 1):222.

T3P99 Prevalence of hypertension in Italian obese children and its association with atherogenic index of plasma

G Ippolito 1, S Vizzuso 1, C Lassandro 1, M Brambilla 1, D Zambelli 2, G Banderali 1, S Carugo 2, E Verduci 1

Introduction

Childhood obesity is associated with cardiometabolic abnormalities. Atherogenic index of plasma (AIP) is a strong predictor of cardiovascular risk in adults [Onat A, et al. J Clin Lipidol. 2010;4(2):89–98]. The aim of the present study was to evaluate the prevalence of white coat and masked hypertension and to investigate a possible association between hypertension and AIP in a population of Italian obese children.

Methods

A cohort of 38 obese children (18 boys and 20 girls) was recruited. For each child blood pressure measurements (BP office mean of 3 measurements) [Flynn JT et al. Pediatrics. 2017;140(3)] and 24 hours ambulatory blood pressure monitoring (24h-ABPM) Flynn JT et al. Hypertension. 2014;63(5):1116–35] were performed. Fasting blood samples were analyzed for lipids, insulin and glucose. The Atherogenic Index of Plasma, intended as Log(Triglycerides/HDL), was calculated. Logistic regression models were used to analyze the association between hypertension and AIP. Values of p < 0.05 were considered to indicate statistical significance. The statistical package for social sciences (SPSS) package version 22.0 was used for the statistical analysis.

Results

Mean (SD) age and BMI z-score of recruited children were 11.6 (1.9) years and 2.9 (0.6), respectively. Out of 38 children, 11 (28.9%) were classified as hypertensive with both Methods; 3 children (7.9%) were diagnosed as white-coat hypertensive and 12 children (31.6%) were classified as masked hypertensive. The prevalence of hypertension according to office BP measurements and 24h-ABPM was of 36.8% (14 children) and 60.5% (23 children), respectively. Hypertension diagnosed by 24h-ABPM was associated with AIP (p = 0.044). This result did not change when age, sex and Tanner stage were included (p = 0.048). Hypertension, evaluated by office BP measurements, was not associated with AIP (p = 0.401).

Conclusion

Prevalence of hypertension evaluated by 24h-ABPM and masked hypertension were in line with existing literature. Moreover, preliminary data of this study show, for the first time in literature, that only hypertension evaluated by 24h-ABPM and not that evaluated by office BP measurements is associated with higher values of AIP in obese children. These results suggest a prominent role of a combined cardiologic and blood analysis evaluation in detecting children at cardiovascular risk, underlying the importance of using 24h-ABPM in obesity follow-up also during paediatric age.

Obes Facts. 2018 May 26;11(Suppl 1):222.

T3P100 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):222.

T3P101 Reduction in SBP and DPB are more correlated with BMI reduction than WC reduction in children with excessed body mass

A Gac 1, P Metelska 2, M Brzezinski 3

Introduction

Coexisting of high percentile of BMI and/or waist circumference (WC) with hypertension is well documented both in adults and children. Association between reduction of blood pressure with body mass and waist circumference reduction is not well documented in children in different age groups.

Methods

Within our work we present results from body mass reduction program „6–10–14 for Health” run in Gdańsk from year 2011. 3200 of children with overweight and obesity were engaged in one year long interdisciplinary body mass reduction programme. The blood pressure measurements and anthropometric parameters are performed on each visit as a part of the full intervention process.

Results

2718 children aged 5–16 took part in 4 visits during a year of being a patient in “6–10–14 for Health”. Between first and last visit a significant reduction of BMI z-score from1,68 to 1,44 (p < 0.001) and waist circumference z-score from 1,67 to 1,43 (p < 0.0001) was observed as well as reduction in SBP (0,60 to 0,46 p = 000.3) and DBP (0.98 to 0.88 p = 0.0117) z-score. We observed correlation between decrease of DBP and SBP and both BMI percentile and WC. Although a stronger correlation was observed in case of BMI percentile. Influence of z-score BMI reduction is stronger comparing to z-score WC reduction (bigger beta index with BMI z-score reduction) (Tab. 1).

Conclusion

Presented results show that the most important element in reducing blood pressure in children and adolescents with overweight and obesity is reducing the excess body mass and not only abdominal adiposity.

Tab. 1.

Relationships in SBP and DBP z-score reduction (comparison between visit 1 and visit 4) with waist and BMI z-score reduction; controlled for age and sex

 SBP z-score
 DBP z-score
Explanatory variables β p β p
waist z-score reduction 0.25 0.014 0.20 0.074
BMI z-score reduction 0.35 0.006 0.42 0.004
age 0.04 0.001 0.02 0.161
sex 0.10 0.175 0.18 0.029
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Obes Facts. 2018 May 26;11(Suppl 1):222–223.

T3P102 Effect of 10-week weight loss treatment on Fibroblast Growth Factor 21 plasma levels in obese children

L Morell-Azanza 1, A Ojeda-Rodriguez 1, T Rendo-Urteaga 2, M Chueca 3, JA Martínez 1, MC Azcona-Sanjulián 3, A Marti 3

Introduction

Fibroblast growth factor 21 (FGF21) is a cytokine produced by live, skeletal muscle, pancreas and adipose tissue. FGF21 could regulate glucose uptake and lipid metabolism. Serum levels of FGF21 are increased in obese children in comparison with normal weight. There are few studies evaluating the effects of weight loss interventions on this cytokine. For this reason, the purpose of the study was to examine changes on plasma FGF21 levels and other cytokines after a weight loss program.

Methods

thirty-eight obese children (mean age 11.42 (2.68), 48% males) were enrolled in a 10-week weight loss program. The intervention consists on a moderate energy-restricted diet, nutritional education and family involvement. Anthropometric, biochemical parameters, TNF-α, irisin and FGF21 levels were measured at baseline and after 10 weeks. Participants were divided as metabolic health obese participants or Metabolic Syndrome (MetS) following the International Diabetes Federation (IDF) definition for children aged between 6 to 16 years.

Results

subjects with MetS at baseline had higher FGF21 levels in comparison with obese without metabolic syndrome participants (p = 0.024). A successful weight loss was achieved after the 10-week intervention (Δ BMI-SDS: −0.50 ± 0.44, p < 0.001) which was accompanied by a reduction of all anthropometric parameters and glucose, cholesterol and HOMA-IR. Regarding FGF21 levels, no significant changes on FGF21 were achieved (Δ −2.68, CI: −15.02 to 3.76) after the weight loss intervention. Moreover, positive correlations between changes in FGF21 and TNF-α (R2 = 0.390; p = 0.020), irisin (R2 = 0.617; p = 0.008) were found. Interestingly when all participants were analyzed, multiple-adjusted model showed an association between changes in FGF21 with changes in irisin levels (B: −1.334; p = 0.004, CI: −2.16 to -0.50).

Conclusion

childrens with MetS showed increased levels of FGF21. Despite of the fact that weight loss intervention was effective, no significant changes on FGF21 levels were found.

Obes Facts. 2018 May 26;11(Suppl 1):223.

T3P103 Prevalence of hypertension in children with overweight and obesity aged 5–16 years leaving in Gdańsk, Poland

M Brzezinski 1, A Gac 2, P Metelska 3

Introduction

Coexisting of obesity and hypertension in children and adolescence is well documented, especially in the US population. Little data are available from a big population studies from Europe, specially CE Europe. Prevalence of hypertension or high blood pressure in obese or overweight children can be an important risk factor of developing health complications early in adulthood or even earlier.

Methods

During the performance “6–10–14 for Health” health programme run in Gdańsk from year 2011, 30 000 of children were screened for overweight and obesity. In this paper we present the prevalence of prehypertension (preHT) and hypertension (HT) in children aged 5–16 years with excess body weight. 3088 children that entered an obesity intervention programme. Blood pressure was assessed with proper automated oscillometric device, that has been validated for use in children.

Results

Both the prevalence of prehypertension and hypertension depended on age and sex as presented in table 1, but it was systematically increasing with age. In children with obesity preHT and HT criteria were fulfilled more often than in children with overweight. Hypertension was more often observed in obese girls than in boys in all age groups.

Conclusion

Our results support the general observation that hypertension is a frequent health issue in children with increased body mass level and should be assessed and taken under consideration in both clinical and outpatient settings.

Tab.1.

Frequency (%) of prehypertension (preHT) and hypertension (HT) according to sex, age group and body mass indexcategories (overweight 85–95cc of BMI, obesity >95 cc of BMI)

 boys
age 5–8 years age 9–12 years age 13–16 years
BMI category preHT (%) HT (%) preHT (%) HT (%) preHT(%) HT (%)
overweight 14.29 20.00 8.33 25.64 15.26 36.84
obesity 17.11 25.00 10.18 40.27 13.45 49.71
Girls
overweight 14.77 12.50 13.28 21.80 10.29 38.24
obesity 17.21 29.30 12.69 46.19 10.20 54.59
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Obes Facts. 2018 May 26;11(Suppl 1):223–224.

T3P104 The relationship between BMI, Metabolic Syndrome and Compliance to Mediterranean Diet in a sample of overweight children in Greece

E Papadopoulou 1, M Sifaki 2, K Kefalianou 3, E Politi 4, ME Petraki 4, I Maniadaki 1, A Markaki 5

Introduction

Metabolic Syndrome (MS) is defined as the co-occurrence of metabolic risk factors for type-2 diabetes and cardio-vascular disease. These factors include abdominal obesity, hyperglycemia, dyslipidemia and hypertension. Past literature suggests a significant, positive association between MS and increased weight. Furthermore, high compliance to Mediterranean Diet (MD) protects against high BMI and MS. This study aimed to explore the relationship between BMI, MS and compliance with MD, in overweight children living in Crete, Greece.

Methods

Participants were 98 overweight children, 50 boys and 48 girls, with their mean age being 11.3 (SD = 3.22), and 11.1 (SD = 2.49) years respectively. All children attended monthly appointments at the Pediatric Clinic, University Hospital of Crete, due to their increased weight. Data were obtained from the clinicians, after parental consent, by interviewing both children and parents. BMI was calculated by children's weight in kilos divided by height in square meters. Depending on their BMI, participants were classified as “overweight”, “obese” or “morbidly obese” based on the International Obesity Task Force (IOTF) cut off points. MS status was defined according to International Federation Diabetes (IDF) criteria. Compliance with MD was evaluated through the KIDMED Index, a 16-item Mediterranean Diet Quality Index which ranges from 0 to 12, with higher scores meaning higher compliance.

Results

In total, 25.3% of the participants were overweight, 35.8% obese and 38.9% morbidly obese. Out of the boys, 16.3% were overweight, 34.7% obese and 49% morbidly obese. For the girls, 34.8% were overweight, 37% were obese and 28.3% morbidly obese. There were no significant differences between them. 35.43% out of the whole sample had MS, 43.4% presented risk and 21.2% did not present any risk. 36% of the boys had MS, 38% presented risk, and 26% did not present any risk. For girls, 34.7% had MS, 49% presented the risk, and 16.3% did not present any risk. No significant differences between genders were found. The mean score for compliance to MD was 4.4 (SD = 2.24). For boys, it equaled 4 (SD = 2.19) and for girls, 4.7 (SD = 2.26), with no significant difference between them. There was a significant relationship between MS and BMI [χ2(4) = 11.8, p < 0.05]. In the overweight category, there were significantly more children without any MS risk (37.5%). Among obese children, 61.8% presented risk and only 5.9% did not present any risk. In the morbidly obese category, 43.2% had MS. Findings are demonstrated at Table 1.

The relationships between BMI and compliance with MD and between MS and compliance with MD, were not significant.

Conclusion

Findings are in accordance with past literature when it comes to the relationship between BMI and MS. However, they did not support the role of MD, which could be attributed to the small sample size and the absence of normal-weight children. Replicating this study, using a larger sample size, would provide more insightful Conclusions for the pediatric population.

Tab. 1.

Relationship between BMI and Metabolic Syndrome

MS Status Overweight Obese Morbidly Obese
MS 29.2% (7) 32.4% (11) 43.2% (16)
Risk MS 33.3% (8) 61.8% (21) 35.1% (13)
No MS Risk 37.5% (9) 5.9% (2) 21.6% (8)
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Obes Facts. 2018 May 26;11(Suppl 1):224.

T3P105 Human adenovirus 36 in children with type 1 diabetes: metabolic and glucose control

I Aldhoon-Hainerová 1, RL Atkinson 2, V Hainer 3, M Kunesova 3, H Zamrazilova 4

Introduction

Human adenovirus 36 (Adv36) increases adiposity, insulin sensitivity and reduces hepatic lipid accumulation in children and adults. Adv36 infection in humans is also associated with better glycemic control via E4orf1 protein that increases glucose uptake in pre-adipocytes, adipocytes and myoblasts and reduces an output of glucose from liver cells. The aim of our study was to assess the prevalence of Adv36 antibody positivity in children with type 1 diabetes. Additionally, lipid profile, liver function tests, body mass index (BMI), insulin dose requirements and glycated hemoglobin (HbA1c) were compared between Adv36+ type 1 diabetics (Adv36+T1DM) and Adv36- type 1 diabetics (Adv36-T1DM).

Methods

Adv36 antibodies were assayed using the competitive enzyme-linked immunosorbent assay method in 203 consecutively collected children with T1DM (95 girls/108 boys, age median 12.6 years, duration of diabetes 3.7 years). Anthropometric (body weight, body height, BMI) and biochemical parameters (lipids, liver function tests and HbA1c) were investigated. Diabetes control was studied based on the insulin dose requirements and HbA1c. Non-parametric Mann-Whitney test was used.

Results

The prevalence of Adv36 seropositivity in T1DM children was 22.4% (23.2% in girls, 14.0% in boys). In the total cohort, we found a tendency to a lower HbA1c in Adv36+T1DM than in Adv36-T1DM (51 vs. 56 mmol/mol, p = 0.081). In Adv36+T1DM boys levels of total cholesterol and low-density lipoprotein cholesterol were significantly lower than in Adv36-T1DM boys (3.7 vs. 4.3, p = 0.044; 1.7 vs 2.1, p = 0.034, resp.). No other differences in studied parameters were identified.

Conclusion

This is the first study that analyzed Adv36 status in children with T1DM. We found a tendency to a better glycemic control in Adv36+ T1DM children but no difference in insulin dose requirements. Adv36+T1DM boys presented with significantly lower lipid levels than their Adv36-T1DM counterparts. No association of Adv36 to BMI was revealed. Follow-up data of this pilot study will be analyzed and evaluated in the future. Supported by AZV 17–31670A, MH CZ-DRO (Institute of Endocrinology – EÚ 00023761).

Obes Facts. 2018 May 26;11(Suppl 1):224.

T3P106 Incidence of NAFLD in obese children and adolescents: A Single Centre experience in Northeast of Brazil

N A Boa-Sorte 1, BB Goes 1, JE Rocha 1, DL Silva 1, ME Faria 1, AP Queiroz 2

Introduction

Non-Alcoholic Fatty Liver Disease (NAFLD) consist in accumulation of fat into the liver. Paediatric obesity is the major risk factor for NAFLD on childhood and adolescence. We aimed to describe incidence of NAFLD among obese children and adolescents and to determine if severity of obesity and laboratorial parameters can predict the occurrence of NAFLD.

Methods

Ambispective cohort conducted in Fima Lifshtiz Metabolic Unit, Federal University of Bahia, Brazil, between 2006 and 2017. Inclusion criteria were age 5.0 to 18.9 years old and diagnosis of obesity, according WHO definitions (BMI/age indicator > = +2 z-scores). Exclusion criteria were syndromic obesity, abnormal ultrasound scan (USS) in baseline (presence of hepatic steatosis) and insufficient data at medical records. USS was used to determine presence of NAFLD (outcome). Seric Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total cholesterol, HDL-cholesterol and triglycerides and glycaemia baseline levels (first evaluation) were used as predictors. Severe obesity was defined by BMI/age WHO index > = +3 z-scores. T-test or Mann-Whitney tests, when indicated, were used to compare laboratorial profile between NAFLD incidents with non-NAFLD cases. Severe obesity was evaluated as a risk factor and relative risk (RR) with respective 95% Confidence Interval (CI95%) was calculated.

Results

In total, 103 patients were enrolled in the protocol. Thirty subjects were excluded (27 had abnormal USS at first evaluation, one had Prader-Willi Syndrome and two others had incomplete data at medical records). At baseline, mean (SD) age was 8.7 (4.3) years, 66.8% were boys and 66.3% were aged < 10y. Mean (SD) BMI/age index was 3.86 (1.12), ranging from 2.00 to 8.24. After a mean (SD) follow-up of 4.5 (2.7) years and 3.8 (1.5) ultrasound exams performed, 48.1% (40/83) presented abnormal USS hepatic description (92.3% classified as having mild hepatic steatosis). Despite of no statistical significance, higher levels of fasting glycaemia [88,6 (10,0) versus 83,8 (11,2) mg/dl; p = 0.093] and GGT [47.6 (61.4) versus 30.6 (20.1) units/L; p = 0.222] were observed in incident NAFLD patients. AST, ALT, cholesterol and triglycerides levels were not able to discriminate children and adolescents who evolved with USS alteration. Severe obesity was associated with NAFLD incidence (crude RR 2.31; CI95%:1.42 – 3.75).

Conclusion

Severity of obesity was the only factor associated with incidence of NAFLD, among this group. Thus, this condition requires special attention already in the first evaluation of the obese child or adolescent.

Obes Facts. 2018 May 26;11(Suppl 1):224–225.

T3P107 Comorbidities of obesity in adolescents in northeast Romania

O Frasinariu 1, M Moscalu 2, L Trandafir 1

Introduction

Obesity is now one of the most frequent chronic diseases of our century. Obesity in children has a strong impact on all system and organs. The aim of this study was to identify the prevalence of comorbidities in obese children in northeast Romania.

Methods

The study cohort consists of 104 adolescents, 58 boys and 46 girls, evaluated for obesity in Saint Mary Children's Hospital Iasi. Anthropometric examination (weight, height, waist circumference, body mass index), blood pressures, liver aminotransferase levels, glucose and lipid profile were assessed. Hepatic steatosis was defined diffusely hyper echogenic liver at ultrasonography with persistently elevated transaminases. Obesity and overweight was defined according to CDC recommendations.

Results

From the study group 84.61% were obese and 15.39% were overweight, 47% being severe obesity. There was no significant difference between female and males in obesity prevalence (43.19% vs. 56.81%). Serum lipid profiles were changed in 63% of patients. 24.5% of patients had borderline values of cholesterol and 10.4% had high cholesterol, and 10.6% had high LDL-cholesterol. 17% of patients had hypertriglyceridemia and 6 patients had mixed dyslipidemia. Moreover 13.45% of the patients had higher values of serum glucose. From the study group, 27,3% had high transaminases of the evaluation, more prevalent in boys than in girls, and 9 patients had hepatic steatosis. High blood pressure was identified in 4 adolescents and pre-hypertension in 5 children. 7.5% of the patients had epicardial fat at echocardiography. Psychological consequences of obesity were identified in 5 female patients and 4 male patients with influenced mental status and negative self-image. Also 3 patients had modified thyroid tests and 13 patients had high serum levels of uric acid.

Conclusion

The prevalence of obesity comorbidities and components of the metabolic syndrome in adolescents in northeast Romania is high. Early identification of risk factors and early investigation of adolescents with obesity allows for the right therapeutic interventions on diabetes and cardiovascular risk factors, reducing mortality and morbidity at younger age.

Obes Facts. 2018 May 26;11(Suppl 1):225.

T3P108 Sex specific association of adiposity and cardiometabolic risk in healthy adolescents

I Kjartansdottir 1, SA Arngrimsson 2, R Bjarnason 3, AS Olafsdottir 2

Introduction

Obesity rates in children and adolescents have soared globally over the last decades. To reduce the risk for future morbidity a physically active lifestyle, good cardiorespiratory fitness and healthy nutrition has been recommended from a young age. Metabolic syndrome (MetS) is a cardiovascular risk assessment tool to identify those at highest risk for future morbidity and in need of close attention. The purpose of the study was twofold, to estimate the prevalence of MetS in a population-based cohort of 16-year-old adolescents and to examine the joint associations of body composition, cardiorespiratory fitness, inflammation and diet with clustered cardiometabolic risk score.

Methods

This cross-sectional study consisted of 221 healthy 16-year-old adolescents (52% boys) from two upper secondary schools in Reykjavik, Iceland. The anthropometric variables measured were BMI, waist circumference (WC) and body fat percentage (%BF). A cardiometabolic z-score that reflected the adult MetS criteria using MAP, HDL, triglycerides, and HOMA-ir was calculated separately for boys and girls. MetS was defined by the International Diabetes Federation guidelines for adults. C-reactive protein (CRP) was used as a marker of systemic inflammation. Cardiorespiratory fitness (CRF) was assessed on a stationary testing bike (VO2max, ml/kg/min). Data on dietary habits and sedentary behaviour were self-reported.

Results

Of the entire cohort 12 (5.4%) fulfilled the MetS criteria, five boys (4.3%) and seven girls (6.6%; p = 0.460). All boys with MetS were obese compared with 6/7 of the girls were overweight and one obese (p = 0.015). Accordingly, the gender combined prevalence of MetS among overweight adolescents was 15.0% (6/40) and for the obese 50.0% (6/12), (p = 0.020). Multiple linear regressions with cardiometabolic z-score as outcome variables showed that BMI, WC and %BF remained as independent predictors after adjusting for VO2max and other lifestyle variables in both sexes. With further adjustments for eating habits and sedentary behaviour the predictability improved slightly in girls only. CRP was initially added to the regression analysis but proved to be a non-significant predictor with almost no effect on the models and therefore dropped from further analysis.

Conclusion

MetS was found in 50% of the obese adolescents. Our results suggested body composition to be independently associated with metabolic risk in this age group where CRF was an important predictor. Association of dietary habits and sedentary behaviour with cardiometabolic risk was only noticeable in girls. Our results did not reveal the inflammation marker CRP to be associated with the cardiometabolic risk in these otherwise healthy adolescents.

Obes Facts. 2018 May 26;11(Suppl 1):225.

T3P109 Early Pregnancy Dietary Intakes and the Maternal Microbiome

S E Maher 1, R Moore 1, AA Geraghty 2, EC O'Brien 3, C Walsh 4, C Feehily 4, P Cotter 4, FM McAuliffe 1

Introduction

Over the last decade, advancement in sampling technology has allowed for a more in-depth analysis of the human bacterial, viral and fungal community also known as the microbiome. With these sampling advancements links between non-communicable diseases, like obesity, and the microbiome have been established. The exact modulators of the microbiome are yet to be fully elucidated, however diet and long term dietary patterns are continuously reported as having an effect on the microbial species in the gut. While research shows that the gut physiology changes dramatically during pregnancy to allow for growth of the fetus, gestational changes in microbiome is yet to be fully described. The aim of this study is to fully explore the links between maternal diet during pregnancy and maternal microbiome.

Methods

Thirty-nine women were recruited in early pregnancy (16 weeks’ gestation) as they presented for antenatal care in a tertiary level maternity unit, The National Maternity Hospital, Dublin. Microbial samples were collected from stool and analysed using 16s RNA technology. Dietary data was collected using a three day food diary. Dietary analysis was conducted using Nutritics Research Edition v4.315. Pearson's correlations were used and false discovery rate corrected with Benjimani-Hochberg procedure.

Results

The mean participant age was 34 years (± 4.3) with a mean BMI of 24.8 kg/m2 (± 3.0). Mean energy intake was 1847 (± 364) kcals/day. The percentage of energy coming from protein, fat and carbohydrates were 17%, 37% and 44%, respectively. Many dietary factors during pregnancy were associated with the microbiome. Intakes of non-starch-polysaccharides (NSP), found primarily in wholegrain foods, were positively correlated with the Lachnospiraceae.AC2044 species (r = 0.59, p = 0.018). Free sugar (all monosaccharides and disaccharides added to food and those found in honey, syrups, fruit juice) was negatively correlated with the Ruminococcus speices (r = −0.574, p = 0.03).

Conclusion

This analysis indicted that higher intakes of non-starch polysaccharides during pregnancy were associated with increased Lachnospiraceae species which has previously been shown to have anti-inflammatory properties. In this small cohort we found evidence that diet during pregnancy is associated with the maternal microbiome, potentially benefiting the mother. With maternal diet during pregnancy also being linked with many developmental milestones for the fetus, these results highlight the need for further research on the role of maternal nutrition and microbiome during pregnancy.

Conflicts of Interest

The research conducted is data taken from a larger trial partly sponsored by food group Alimentary Health. They are not actively involved in the research process.

Obes Facts. 2018 May 26;11(Suppl 1):225–226.

T3P110 The effect of weight loss on endothelial function and sleep-disordered breathing in obese children

M K Ysebaert 1, A Van Eyck 1, L Bruyndonckx 2, B De Winter 1, A De Guchtenaere 3, S Vantieghem 4, S Provyn 4, K Van Hoorenbeeck 1, S Verhulst 2

Introduction

Obese adolescents can exhibit impaired endothelial function, an early marker of atherosclerosis. Sleep disordered breathing (SDB) is a prevalent condition in childhood obesity. Studies in normal weight children have shown that SDB is associated with endothelial dysfunction (ED). No studies have yet confirmed this finding in an obese pediatric population. Brain derived neurotrophic factor (BDNF) and leptin both have a role in energy homeostasis and food intake, and could also be involved in ED and SDB. The objective of this study was to investigate the effects of an intensive weight loss treatment program on SDB and ED, and evaluate the role of BDNF and leptin herein.

Methods

Obese adolescents, aged 11 to 19 years, were recruited at the start of an in-patient weight loss treatment program. All subjects underwent body composition measurements, a sleep screening using a portable device (ApneaLink™, ResMed, Switzerland) and evaluation of endothelial function measured by peripheral arterial tonometry (EndoPAT 2000, Itamar Medical, Israel) at baseline and after 6 months of treatment. A fasting venous blood sample was taken at baseline and after 6 months of treatment to determine the levels of BDNF and leptin.

Results

A total of 62 children were recruited at baseline. Mean age was 15.8 years (11.7 – 19.0), 68% of subjects were boys. BMI z-score at baseline was 2.86 ± 0.41. In 39% of the children SDB was detected. After six months there was a mean decrease in BMI z-score of 0.8 or 26%. Eighty-six percent of cases showed resolution of earlier diagnosed SDB. All children showed significant improvement of endothelial function after an intensive 6 month period of weight loss regimen (p < 0.001). No correlations between the presence of SDB and improvement in endothelial function could be found. There was no difference in baseline endothelial function between children with and without SDB. BDNF and leptin both decreased after weight loss therapy (p < 0.001). BDNF correlated with mean baseline PWA independent of the level of obesity at baseline (r = −0.31; p = 0.02).

Conclusion

Endothelial function in obese youngsters is significantly improved after intensive weight loss treatment. In this population SDB could not be linked to endothelial function impairment. However, BDNF was independently associated with mean baseline PWA, indicating a role for this protein in endothelial function in an obese pediatric population.

Obes Facts. 2018 May 26;11(Suppl 1):226.

T3P111 Body composition assessment by bioelectrical impedance spectroscopy and dual-energy X-ray absorptiometry in overweight and obese children

M K Ysebaert 1, A Van Eyck 2, L Bruyndonckx 2, B De Winter 1, M Van Helvoirt 3, A De Guchtenaere 3, S Verhulst 2, K Van Hoorenbeeck 2

Introduction

Dual enery X-ray absorptiometry (DXA) is commonly used for the assessment of body composition. The application of this method is limited by technical requirements and expensive equipment. In addition, a significant number of obese individuals can not be scanned by DXA, because they exceed the weight limitations or their body size exceeds the scanning area. Therefore, there is a need for accurate and reliable techniques for measuring body composition that are less expensive and suitable for bedside investigation. Bioelectrical impedance spectroscopy (BIS) is a simple and non-invasive technique that measures body composition. It is an attractive tool because it is inexpensive, portable, rapid and highly reproducible. The technique has been validated in healthy subjects. Few studies have investigated the accuracy of BIS in children. In obese and non-obese pediatric populations, BIS is found to underestimate body fat mass in comparison to DXA. The objective of this study was to compare BIS with DXA in assessing body composition in an overweight and obese pediatric population.

Methods

In this cross-sectional study, a total of 97 overweight and obese children (aged 10 to 19 years; mean BMI SDS 2,7 ± 0,04) were included. All subjects underwent simultaneous DXA (Lunar Prodigy Advance, GE Healthcare, USA) and BIS (Body Composition Monitor, Fresenius Medical Care, Germany) assessment of body composition. Limits of agreement analysis was used to compare both techniques.

Results

Mean fat mass percentage (FM%) assessed by DXA was 50.0 ± 0.5%, compared to 44.1 ± 0.6% measured by BIS. Estimate of FM% was significantly correlated between the two methods (r = 0.644; p < 0.0001). Bland Altman analysis (Fig. 1) showed a large bias (-5,9 ± 4,3) and wide limits of agreement between the methods (-14.4 to 2.6), indicating an underestimation of FM% measured by BIS compared to FM% measured by DXA.

Conclusion

Fat mass percentage assessed by DXA and BIS is significantly correlated in a population of overweight and obese children. However, BIS significantly underestimates fat mass percentage in these subjects compared to DXA. In conclusion, DXA and BIS are not interchangeable for the assessment of FM% in an overweight and obese pediatric population.

Fig. 1.

Fig. 1

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Bland Altman analysis of dual-energy X-ray absorptiometry (DXA) fat mass percentage (FM%) and bioelectrical impedance spectroscopy (BIS) FM%. X-axis displays the average of FM%; Y-axis displays the difference between FM% by DXA and FM% by BIS; Dotted lines display the 95% limits of agreement.

Obes Facts. 2018 May 26;11(Suppl 1):226.

T3P112 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):226–227.

T3P113 Family workshops supporting parenthood improve management and perception of childhood obesity: a pilot study

C Desbles 1, S Beraud 1, C Jeannot 1, A Rigal 1, E Bertrand 2, A Mulliez 3, Y Boirie 1, M Miolanne 1

Introduction

The optimal management of obesity is based on a multidisciplinary approach including medical, dietary, psychological and physical aspects. Concerning children, the involvement of their parents implies that the family must be considered as a whole. The PROXOB project aims at helping and preventing obesity progression in childhood through family workshops at home. Parenthood is a recent concept that refers very broadly to the “function of being a parent”, a concept born as our society evolved in terms of morals and law concerning family structure. So, new workshops to support parenting have completed the classic themes of dietetics and physical activity, consisting in: the benevolent communication within the family, the rhythm of life (sleep time, mealtimes), the family life rules, food sensations experienced by the 5 senses, recognition and management of emotions. Our objective was to explore how support for parenting could improve the management of childhood obesity. We used the parenting self-assessment questionnaire for the quantitative study and the semi-structured interviews for the qualitative analysis.

Methods

The prospective descriptive study included 20 families (69 people: 37 adults, 15 adolescents, 17 children). The quantitative analysis was based on a parenting self-assessment questionnaire: Parenting Sense of Competence Scale (P.S.O.C) completed by the 20 mothers and 17 fathers of these 20 families. This score gives 5 levels of feeling of parental effectiveness: “very high”, “high”, “medium”, “low”, and “very low”. The qualitative analysis is based on semi-structured interviews with 12 of the 20 families. We collected the anthropometric data and the EPICES precariousness score. All the data were statistic allyanalyzed.

Results

Of the 31 parents, 10 were overweight and 16 were obese. The average BMI was 28.48 ± 6.97 kg/m2 (min 20.4 to max 44.3 kg/m2) in men and 34.8 ± 8.5 kg/m2 in women (21.6 to 59.3 kg/m2]. Of the children and adolescents, 19% were obese, 16% were overweight and 65% were non obese. Precariousness affected 30% of families. The feeling of parental effectiveness was “medium” for 46.4% and “high” for 42.9% of parents, using the P.S.O.C. It was significantly higher among younger parents (40 versus 46, p < 0.05). There was a non significant trend of association between precariousness and a high sense of parental efficiency. The words “family”, “time” “envy”, “positive”, “parents”, “difficult”, “love”, “life”, “to do”, “to see” were most often cited in interviews, during which the parents essentially testified to the improvement of communication between the members of the family and a better understanding of the problem of the obesity by the non concerned members, limiting stigma and discrimination.

Conclusion

Support for parenthood and the involvement of the entire family unit in the management of childhood obesity is a new and encouraging way to improve child obesity management and prevention. Specific questionnaires need to be created and validated to better target this population.

Obes Facts. 2018 May 26;11(Suppl 1):227.

T3P114 Parents’ role in obese children's eating behaviour and weight status

A Ojeda-Rodriguez 1, L Morell-Azanza 1, L Regent 1, MC Azcona-Sanjulián 2, A Marti 3

Introduction

Family environment is a factor of vital importance that influences eating behaviour and childhood obesity. Therefore, the main objective is to examine the influence of parents’ eating attitudes in their children's eating behaviour and weight status.

Methods

A hundred and twenty-two obese children and adolescents were enrolled in a lifestyle intervention program (7 to 17 years old, 62% female). At baseline, 80 participants and their parents were examined though questionnaires (Child Eating Behaviour Questionnaire (CEBQ) and the Adult Eating Behaviour Questionnaire (AEBQ). Both validated questionnaires consist of 35 items that evaluate eight dimensions of the eating behaviour: Food responsiveness, Enjoyment of food, Emotional overeating, Desire to drink, Satiety responsiveness, Slowness in eating, Emotional undereating and Food fussiness. The first four dimensions are related to a positive inclination to food consumption and contribute to the “Food approach” score, while the other four are in the opposite direction lowering food intake, contributing to the “Food avoidant” score.

Results

In obese children and adolescents, the “Food approach” score were significantly higher than their parent scores, as well as Food responsiveness, Enjoyment of food and Desire to drink dimensions (p < 0.001). However, the “Food avoidant” dimensions were significantly (p < 0.05) lower in the obese children. In addition, the “Food approach” dimensions in obese children and their parents were (p < 0.050) positive associated. Moreover, three out of four “Food avoidant” dimensions showed (p < 0.050) positive associations in children and parents scores. Thus, the ratio (sum of the “Food approach” dimensions divided by the sum of the “Food avoidant” dimensions) showed a positive association in children and their parents (R2 = 0.357; B = 0.653; p < 0.001). Finally, a positive association was found between children's standard deviation score for body mass index and parents’ body mass index (R2 = 0.162; B = 0.053; p = 0.009).

Conclusion

There was a positive association between parents and children's weight status and eating behaviour, although children seemed to have a significant higher inclination towards food intake.

Obes Facts. 2018 May 26;11(Suppl 1):227.

T3P115 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):227.

T3P116 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):227.

T3P117 Nutritional status, fitness, school performance, anxiety level and health habits in primary school in the Bio Bío province of Chile: A cross-sectional study

R E Zapata Lamana 1, II Cigarroa 2

Introduction

In recent years, obesity has increased and its presence has been associated with poor physical condition, psychological problems and poor school performance. The aim of this study was to describe nutritional status, physical condition, school performance, anxiety level, and health habits in primary schoolchildren (6–7 years old). We also determined differences among overweight/obese and normal weight groups.

Methods

Two studies were conducted among 1st and 2nd graders (n = 276). In both studies we measured: anthropometry, physical fitness, and academic performance. In addition, in the first study, waist circumference was measured and, in the 2nd study, health habits and anxiety symptoms were obtained.

Results

Boys and girls had high levels of overweight and obesity. Those who had higher levels of BMI/age had worse physical fitness, spent less hours per week in scheduled physical activity, ate more unhealthy foods. There were no differences in academic performance. Overweight/obese girls had lower anxiety symptoms than normal weight girls.

Conclusion

While these results shed light on current nutritional status, physical, academic and mental condition of a sample of primary school children, further studies are needed to confirm the elevated levels of obesity and overweight detected.

Obes Facts. 2018 May 26;11(Suppl 1):227.

T3P118 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):227–228.

T3P119 The Influence of Different Strength Training Densities in Heart Rate Acute Response of Adolescents with Obesity

SS Martins 1, PN Ribeiro 2, A Raimundo 3, TL Branco 4, AL Palmeira 5, H Fonseca 6

Introduction

International guidelines for the prevention and treatment of pediatric obesity recommend a minimum of 60 minutes per day of moderate to vigorous physical activity (AAP, 2015). Strength training in youth contributes to the improvement of cardiorespiratory fitness, body composition, blood lipid profile, and metabolic rate (Behm et al., 2008), but an increased exercise intensity is needed to achieve better results (Faigenbaum et al., 2009). The aim of the present study was to analyze heart rate (HR) acute response to two circuit strength training sessions with different exercise density.

Methods

Participants were 12 adolescents (8 girls), 15.9 ± 1.4ys, with BMI>95th percentile for age and gender, and total percent fat mass (FM) estimated by DXA of 38.8 ± 7.7%. HR was monitored with Polar Team2 Pro devices. OMNI-resistance exercise scale (Robertson et al., 2005) was used to monitor rate of perceived exertion (RPE). Two assessment sessions were performed to determine 10-RM (Kaminsky, 2010) through 6 exercises with the main muscle groups, one session to get familiar with collection protocols, and 2 circuit strength training sessions, 50% 1-RM, 2 sets, 8 exercises each, one alternating 30sec exercise:30sec active pause (30:30), and the other with 40sec exercise:20sec active pause (40:20). The same exercises were performed in both sessions, which lasted 16 min, and all the sessions were 1 wk apart.

Results

Higher results were observed in the 40:20 for mean %HRmax (t = −4.302; p = 0.001), and maximum HR result during the training session (t = −3.736; p = 0.003), which also occurred for RPE concerning %HRmax (t = −3.322; p = 0.007), and maximum HR result achieved (t = −2.590; p = 0.025). Differences in %HRmax and RPE occurred from the 5th to the 16th minute (p = ≤.05) of the exercise sessions. Gender comparisons revealed no differences for %HRmax and RPE (p > .05). Higher training volume was achieved for boys in both sessions (t = −5.970; p ≤.001). Body composition differences indicated higher percent FM in girls (t = 7.112; p≤.001), and greater lean body mass in boys (t = −4.624; p = 0.001). A positive association was found between lean mass and training volume in the total sample (r = 0.903; p = ≤.001). No association was observed for FM (p > .05).

Conclusion

In adolescents with obesity, acute responses for HR and RPE indicated that it is possible to achieve a higher exercise intensity with the same exercise plan, while maintaining the total exercise duration, through the increase of training density (e.g., increment duration and decrease time for pause between exercises). Shorter bouts of exercise could contribute to rise time in moderate to vigorous physical activity allowing for greater improvements in fitness and health of adolescents with obesity (Faigenbaum et al., 2009).

Obes Facts. 2018 May 26;11(Suppl 1):228.

T3P120 Trends in heart rate recovery in schoolchildren aged 11: a retrospective from 1996 to 2016

JC Fernández-García 1, PJ Ruiz-Montero 2, A Castillo-Rodríguez 3

Introduction

Heart rate recovery (HRR) is the reduction of heart rate immediately after any kind of exercise. HRR has been considered a valid indicator of both physical fitness level and cardiovascular health and it was inversely associated with obesity traits and related cardio-metabolic risk factors mainly in healthy children and teenagers. A recent study (1) demonstrates an association of attenuated 1-min HRR with higher BMI in a children population, suggesting a possible link between healthy body weight and faster HRR. Thus, the main aim of the present study is to compare the differences in HRR between normal boys (NB) and obese boys (OB) after performing maximal multistage 20-m shuttle-run test (20-MST) according to the procedures described in EUROFIT and with a difference in time of 20 years. Children's body mass index (BMI) was classified according to the International Obesity Task Force.

Methods

The sample studied included 610 boys (in 1996:203; in 2016:275), aged 11, NB (in 1996 n = 640; weight = 36.3 ± 5.1 kg; height = 143.5 ± 6.6 cm; in 2016 n = 213; weight = 38.7 ± 6.3 kg; height = 147.8 ± 8.3 cm;) and OB (in 1996 n = 71; weight = 49.7 ± 7.0 kg; height = 145.1 ± 6.7 cm; in 2016 n = 139; weight = 54.96 ± 8.7 kg; height = 150.5 ± 7.2 cm). The sample was wearing during the 20-MST, and the next two minutes, a heart rate monitor (POLAR FS2c). Pulse beats per minute (BPM) were recorded at the end of the test and every minute during recovery. Paired sample T-test was performed to compare values between NB and OB in both moments.

Results

In the course of this time period, significant differences have been found in the NB in the number of periods performed in 20-MST (5.1 vs. 4.8) although not in OB. However, differences were found in the number of reduced pulsations at the end of the test and throughout recovery for both groups (table 1).

Conclusion

The main findings of this study are that over the course of 20 years NB score worse on the cardiorespiratory screening test and have lower cardiac efficacy, on the other hand OBs despite getting almost the same result on the shuttle run test recover worse than their peers of 20 years ago. The recommendations for aerobic exercise would be applicable to both groups today, both to improve their cardiac efficacy and to achieve a better post-exercise recovery.

Tab. 1.

Heartbeat differences per minute (bpm) during recovery

NB OB
1996 2016 1996 2016
Final to first minute (bpm) 43.6 ± 24.1 33.41 ± 22.4* 45.1 ± 17.6 32.3 ± 21.9*
First to second minute (bpm) 21.8 ± 12.6 11.74 ± 15.5* 22.1 ± 9.4 9.1 ± 14.1*
Final to second minute (bpm) 65.5 ± 22.9 45.15 ± 21.8* 67.2 ± 16.4 41.5 ± 22.1*
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Data are mean ± SD

*

p < 0,05

References

  • 1.Singh TP, Rhodes J, Gauvreau K. Determinants of heart rate recovery following exercise in children. Med Sci Sports Exerc. 2008;40((4)):601–605. doi: 10.1249/MSS.0b013e3181621ec4. [DOI] [PubMed] [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):228–229.

T3P121 The Impact of Running a mile-a-day in School on Attitudes to Physical Activity

JA Potter 1, M Gault 1, M Lauder 1

Introduction

Physical inactivity and sedentary behaviours in children are thought to be key contributors to obesity (Must & Tybor, 2005; Int J Obesity, 29(2):84–86). Also, more recently there is evidence to suggest positive associations among physical activity, fitness, cognition, and academic achievement (Donnely et al., 2016; Med Sci Sports Exer, 48(6):1197–1222). The mile-a-day initiative has been introduced into UK primary schools since it was first trialled in Scotland in response to rising obesity and declining fitness levels in 2012. There have been a number of anecdotal reports of positive outcomes but there is a lack of scientifically gathered evidence base. The aim of this research is to explore the impact of running a mile-a-day on attitudes towards physical activity and education.

Methods

This paper reports on the attitudes of year 5 pupils (age 9–10 years) in two primary schools: one in which the pupils were running a mile-a-day as well as their usual in school activities and the second school, a control, matched for age and a nearby location (3.5km). Data were collected from 9 boys and 11 girls from each school in January and July 2017 using the SPARK student survey (Sallis et al. (1993) Res Q Exerc Sport, 64, 25–31) and body composition as measured by BMI (kg/m2). Each class teacher also participated in semi-structured interviews considering the children's engagement and achievement in physical activity in school.

Results

Findings indicate that although there were no differences in body composition between groups there were positive changes towards attitudes to physical education (PE) and other physical activities. With boys in the mile-a-day school reporting more positive feelings towards PE in July than January while the opposite was true in the control school F(1,16) = 0.694, p = 0.024. The girls in the intervention school revealed an improved attitude to running activities, while their control counterparts dropped F (1,20) = 4.246, p = 0.05. Following 6 months of running a mile-a-day the boys attitude to undertaking activities that made them tired and sweat were more positive, while those in the control school maintained a dislike of the idea F(1,16) = 4.985, p = 0.04. Interestingly the reverse was true in the girls F(1,20)0.458, p = 0.05) suggesting that they had been put off the idea of intense activity during the intervention. Semi-structured interviews with the class teachers revealed an increased confidence in undertaking physical activity for the intervention pupils, but a fatigue with the repetitive of the nature of the activity.

Conclusion

It appears as though 6 months of daily running can have a positive effect on attitudes towards PE and physical activity in boys and girls however, there is a need to be conscious of not turning pupils against certain type of activities by too much repetition.

Obes Facts. 2018 May 26;11(Suppl 1):229.

T3P122 Links between motor performance, external environment factors, and biological factors in children with various levels of BMI

E Ciesla 1, E Suliga 2

Introduction

In recent decades, the level of motor performance in children has decreased dramatically, and the frequency of overweight and obesity occurrence has increased significantly. The development of motor performance is conditioned by multiple factors. Research has demonstrated that genetics, the intrauterine environment, perinatal factors and the pace of biological development of body structures play an important role. Factors in the external environment are important too. These factors can influence the development of overweight or obese children to different degrees in comparison with children with a normal body mass. The aim of this research was to determine the influence of the external environment and biological factors on the level of development of motor performance in correlation with the level of BMI in children from Poland, aged 5.5–7.5.

Methods

The study involved 30911 children (15082 girls, 15829 boys) and it took into account height, body mass, balance, speed of hand movements, running speed, flexibility, as well as the strength of lower extremities, the abdomen and arms. Data regarding the state of health and the external environment in which the children are being brought up in were obtained from questionnaires filled in by the parents. The following data were obtained: place of living, living conditions, the age of the parents and their education, the number of children in the family and birthweight of the child. Information about present air pollution (O3, PM10) was taken from the Polish National Agency for Environmental Protection. For each child, the LMS method was utilized and the children were allocated into one of four groups: underweight, normal weight, overweight and obese children. Using factor analysis, the number of factors was reduced to 3 main ones: socio-demographic, ecological-educational and biological. In order to determine the influence of the factors on the level of motor performance regarding the child's BMI, multiple regression analysis was utilized and Statistica 13.5 software was used.

Results

Underweight was more common among girls (13.45%vs13.44%), overweight and obesity was more characteristic for boys (12.94%12.57%; 6.54%vs5.34%). The variables selected for the factor analysis explained 51,47% of the variance. Regardless of the kind of the motor performance and the category of BMI, the biological factor, appeared to be the most significant. Except for balance, the higher the level of the biological factor, the better the results in fitness tests (p < 0,001). The other two factors were more significant for the level of motor performance only in the group of children with normal body mass. In overweight and obese children, the strength of arms (p < 0.00) and lower extremities (p < 0.000) were significantly influenced by the ecological-educational factor. The better the conditions, the higher the level of both strengths.

Conclusion

The most important predictor of motor performance in children, regardless of their BMI, is the biological factor. The results of our study show that excess body mass in children is such a strong determinant of motor performance that the influence of the other factors, such as social conditions and ecological-educational was visible only in the group of children with a normal BMI.

Obes Facts. 2018 May 26;11(Suppl 1):229.

T3P123 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):229.

T3P124 Obesity in childhood Relationship between mother's body composition and children's body composition

N Möstl 1, E Pail 1, M Hatz 1, M Wallner 1

Introduction

An increased parental Body Mass Index (BMI), a short duration of breastfeeding and a low social status are relevant drivers in the origin of childhood overweight [1–3]. Regarding the body composition of the mother, as a possible influencing factor, hardly any data is available [1]. The aim was to find out whether the body composition of the mother is linked to the body composition of the child.

Methods

The body composition (fat mass%) was determined by air displacement plethysmography, the Bod Pod®. Additionally, important anthropometric variables were recorded: height (m), weight (kg) and waist circumference (cm) of the children and their mothers, the calculation of the body mass index (BMI) and the waist-to-height ratio (WHtR), as well as a relevant questionnaire including self-reported BMI of the father. This study was a pilot study and was conducted at the Health Perception Lab at the FH JOANNEUM Graz (ethic approval: 29–305 ex 16/17).

Results

The sample consisted of 26 children and their mothers (n = 26). 14 children (53.8%) were male and 12 (46.2%) were female. They were between 5 and 10 years old. The average BMI of the children was 16.4 ± 1.7 kg / m2. 21 children were classified as normal weight (< 90th BMI percentile) and five as overweight (>90th BMI percentile). The body fat percentage of the children and the body fat percentage of the mothers did not correlate significantly (r = 0.133, n.s.) but a trend is recognizable. There was no significant correlation between WHtR of the children and that of the mothers (r = 0.235, p < 0.1). The BMI of the children correlated significantly with the BMI of the fathers (r = 0.408, p < 0.05) but not with the BMI of the mothers (r = 0.206, p < 0.1).

Conclusion

The body fat percentage, the BMI and the WHtR of the children did not correlate significantly with the results of the mothers. Interestingly, a significant correlation between the BMI of the children and the BMI of their fathers was found. These results indicate that an intra-familial pattern of body composition or mass is evident and an inclusion of parental data is important to further define risk factors in childhood obesity. For a clear statement, a bigger sample is necessary.

Obes Facts. 2018 May 26;11(Suppl 1):229.

T3P125 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):229–230.

T3P126 Factors influencing obesity prevalence in 7 year children in the CR (COSI CR)

M Kunesova 1, R Taxova Braunerova 2, H Zamrazilova 2, B Prochazka 3, J Vignerova 1, J Parizkova 1, M Hill 1, A Steflova 4

Introduction

Factors influencing obesity prevalence in childhood are important target for obesity prevention. Representative sample of the Czech 7 year old children was examined during the 4th round of the WHO Europe project COSI.

Methods

In total 1783 children were examined by 93 primary care paediatricians who were selected according to region and size of residential location. Weight, height and waist were measured, questionnaires were filled by parents. Overweight and obesity prevalence was compared with previous rounds of COSI. Characteristics of children obtained from family questionnaires from 2016 were evaluated by orthogonal projection to latent structures (OPLS).

Results

Obesity prevalence evaluated according to the Czech reference values* in four rounds of COSI is shown in table. Factors positively predicting BMI percentile were history of obesity in family, birth weight, hours of screen time/week and weekends, negative predictors were playing outside during weekend, breakfast consumption, fat milk consumption and education of mother. Waist circumference was positively predicted by male gender, obesity in family, age, height, birth weight, screen time during weekdays and weekend, the only negative predictor was education of mother.

Conclusion

In 7 year old Czech children education of mother is factor influencing negatively BMI percentile and waist circumference, while family history of overweight and obesity and screen time are positive predictors of overweight and obesity and waist circumference.

Supported by by grants of Ministry of Health CR MH CR AZV 17–31670A and MH CZ - DRO (Institute of Endocrinology - EÚ, 00023761).

Tab. 1.

Year
 Boys
 Boys
 Girls
 Girls
Overweight % (95% CI) Obesity % (95% CI) Overweight % (95% CI) Obesity % (95% CI)
2016 6.4 (4.9, 8.3) 8.8 (6.9, 10.9) 7.2 (5.6, 9.0) 6.5 (5.0, 8.3)
2013 6.8 (5.7, 8.0) 7.6 (6.4, 8.7) 5.6 (4.6, 6.6) 7.7 (6.5, 8.8)
2010 6.5 (6.0, 9.0) 6.9 (6.5, 7.2) 8.0 (6.6, 9.7) 6.9 (5.6, 8.5)
2008 7.6 (5.9, 9.7) 7.2 (5.5, 9.3) 6.1 (4.6–8.1) 5.0 (3.7–6.9)
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References

  • 1.Bláha P., Vignerová J., Riedlová J., et al. Nation-wide Anthropological Survey of Children and Adolescents 2001, Czech Republic. Basic body parameters Praha: Státní zdravotní ústav. (National Institute of Health, 2005. 71 pp. [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):230.

T3P127 Overall and abdominal obesity indicators among university students

D Vondrova 1, D Kapsdorfer 2, J Babjakova 1, L Argalasova 1, K Hirosova 1, M Samohyl 1, A Filova 1, L Sevcikova 1, J Jurkovicova 1

Introduction

Abdominal obesity is form of overall obesity mostly associated with increased risk of cardiovascular morbidity and mortality. There is strong evidence that abdominal obesity is linked to insulin resistance, hypertension, dyslipidemia and higher incidence of type 2 diabetes and cardiovascular disease. The aim of this study was to evaluate prevalence of overall and abdominal obesity in university students using fast and non-invasive measurement Methods.

Methods

The sample included 642 university students (175 males, 467 females; mean age = 22.9 ± 1.5 years) with no health issues. Body mass index (BMI) and waist circumference (WC) were determined using standard Methods, body fat mass (BF), body fat percentage (BFP) and visceral fat area (VFA) were estimated by bioimpedance analyzer InBody720. Subjects were grouped into BMI and WC categories using WHO cut-off points. VFA and BFP values were categorized in accordance with InBody720 methodology.

Results

According to BMI, 37.1% of men and 7.1% of women were overweight/obese. Abdominal obesity determined by WC was estimated in 14.3% of men and 6.2% of women. Values of VFA had shown 13% of men and 5.1% of women in high risk of abdominal obesity. Prevalence of obesity according to BMI and abdominal type of obesity were significantly higher in men (p < 0.001). Men had significantly lover BFP (18.38%) compared to women (25.18%) (p < 0.001). Excessive levels of BFP were indicated in 35.4% of men and 30.8% of women, with no significant differences. After splitting the file in two BMI categories (optimal weight and overweight/obesity), optimal category contained 3 males (2.7%) and 11 females (2.5%) with abdominal obesity. Optimal BMI category also included 21.8% of men and 26.3% of women with excessive amount of body fat. On the other hand, 66% of men and almost 45% of women in overweight/obese BMI category had no indication of abdominal obesity and 41.6% of men (9.1% of women) had normal BFP values. Using Pearson's correlation, WC was positively correlated with VFA, BFP, BF and BMI (p < 0.001), while the strongest correlation was seen with VFA (r = 0.729, p < 0.001).

Conclusion

BMI is commonly used indicator of overweight and obesity. However, measures that reflect abdominal obesity have been suggested to being superior to BMI in predicting cardiovascular and metabolic diseases. Early diagnostics of abdominal obesity in young adults can arrange successful intervention process and decrease the incidence of premature morbidity and mortality.

Obes Facts. 2018 May 26;11(Suppl 1):230–231.

T3P128 The association between parental separations during childhood in adulthood – a Danish twin study

ME Vamosi 1

Introduction

Studies have showed that adverse psychological factors as being bullied and perception of parental care in childhood may predispose the development of adult obesity. The purpose of this study was to examine if parental separation during childhood was associated with obesity in adulthood. Study design In the Danish Twin Registry twins (monozygotic as well as dizygotic) discordant for obesity, i.e. one twin had a normal BMI (between 20 and 25) and the other had a BMI over 30. A total of 146 complete pairs fulfilled the criteria for election and were invited to an interview and a physical examination in 2006. Childhood parental separation prior to age 17 was performed by self- reported questionnaire. results In total 236 twin individuals participated, giving a participation rate of 81.7%. The twin who was separated from the father at least 1 year prior to age 17 had a 22% higher risk [OR = 1.22, 95%CI (0.46–3.34), p = 0.65] of developing obesity in adulthood, as compared to the co-twin who did not experience separation from the father. Separation from the mother showed reverse results [OR = 0.90, 95%CI (0.32–2.46)p = 0.82]. None of these results were significant. Perspectives Generally, while controlling for genetic and shared environmental factors, separation from parents in childhood was unrelated to obesity in adulthood. Further studies with bigger sample sizes are needed to examine this in greater detail.

Methods

In the Danish Twin Registry twins (monozygotic as well as dizygotic) discordant for obesity, i.e. one twin had a normal BMI (between 20 and 25) and the other had a BMI over 30. A total of 146 complete pairs fulfilled the criteria for election and were invited to an interview and a physical examination in 2006. Childhood parental separation prior to age 17 was performed by self- reported questionnaire.

Results

In total 236 twin individuals participated, giving a participation rate of 81.7%. The twin who was separated from the father at least 1 year prior to age 17 had a 22% higher risk [OR = 1.22, 95%CI (0.46–3.34), p = 0.65] of developing obesity in adulthood, as compared to the co-twin who did not experience separation from the father. Separation from the mother showed reverse results [OR = 0.90, 95%CI (0.32–2.46)p = 0.82]. None of these results were significant.

Conclusion

Generally, while controlling for genetic and shared environmental factors, separation from parents in childhood was unrelated to obesity in adulthood. Further studies with bigger sample sizes are needed to examine this in greater detail.

Obes Facts. 2018 May 26;11(Suppl 1):231.

T3P129 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):231.

T3P130 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):231.

T3P131 Sex specific differences exist in BMI trajectories from childhood to young adulthood among type 1 diabetes patients – a longitudinal group-based modeling approach based on the DPV registry

M Fritsch 1, N Prinz 2, A Schwandt 3, M Becker 4, C Denzer 5, M Flury 6, A Lemmer 7, M Papsch 8, A Galller 9, T Reinehr 10, J Rosenbauer 11, RW Holl 2

Introduction

The prevalence of obesity was shown to increase in paediatric patients with type 1 diabetes (T1D) over the last decades. Thus, we aimed to investigate whether there are distinct body mass index (BMI) trajectories in T1D from childhood to young adulthood and to explore relations to demographic and disease related factors.

Methods

A total of 5,665 subjects (51% males) with T1D from the DPV system were followed up from the age of 8 to 20 years. Inclusion criteria were diabetes duration >1 year and a documented BMI z-score at 8 years. Exclusion criterion was a missing BMI in more than 5 follow-up years. BMI z-scores were calculated based on national pediatric reference data from the KiGGS study. The LCGM (latent class mixture model) approach was applied to model BMI z-score trajectories over time and to identify distinct subgroups following similar patterns.

Results

Six distinct trajectories of BMI z-score could be identified (Figure 1A). The “overweight” group comprised 9.9%, the “stable high” group 25.1% and the “weight gain” group 19.7% of the subjects. Sex specific analysis revealed 6 BMI z-score trajectories in girls with patterns similar to the whole group (Figure 1B). For boys, only 5 nearly stable BMI z-score trajectories were found (Figure 1C). Multinomial regression showed that boys were more likely to be in the “low stable” (Figure 1A orange line; OR 1.4 (1.1;1.8)) and the “weight loss” group (Figure 1A purple line; OR 1.3 (1.1;1.5)) whereas girls more often showed pubertal “weight gain” (OR 2.0 (2.0;2.5), a “stable high BMI” (OR 2.0 (1.7;2.5) or “chronical over-weight”(OR 1.7 (1.4–2.0). “Stable high” BMI or “chronic overweight” were related to higher frequencies of dyslipidemia (OR 1.4 (1.1;1.7) and 2.0 (1.5;2.7)) and hypertension (OR 2.0 (1.6;2.5) and 2.8 (2.0;3.7)). Furthermore, subjects in the chronic overweight group were more often treated with the long-acting insulin analogue glargine (OR 1.7 (1.1;2.7)).

Conclusion

As shown before, the majority of type 1 diabetes youths had a BMI z-score trajectory above the average age- and gender-specific BMI of the national reference group. Distinct sex specific BMI-z-score trajectories indicate the need for personalized treatment.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):232.

T3P132 Evidence-Informed School Policies for Childhood Obesity Prevention in Lebanon: Moving from Knowledge to Policy through Knowledge Translation, Citizen Consultations & Advocacy

R K Saleh 1, R Nakkash 2, F El Jardali 1

Introduction

Childhood overweight & obesity in Lebanon has reached alarming levels of 34.8% & 13.2% respectively. Currently, it is one of the highest percentages in the EMR & has increased by approximately two folds in the past decade. Existing policies addressing this public health problem in schools are top-down, weak & fragmented. This presentation outlines the work of the Knowledge to Policy- K2P- Center to push for the adoption of Evidence-Informed Policies (EIP) at school level through Knowledge Translation (KT), citizen engagement & advocacy.

Methods

Working along the Knowledge to Policy continuum we: 1) developed a Policy Brief for effective school policies for childhood obesity prevention, 2) conducted 4 Citizen Consultation (CC) meetings, 3) implemented an advocacy strategy & 4) held a national Policy Dialogue.

Results

1) A Policy Brief for childhood obesity prevention (Table 1) using high-quality evidence along with 10 key informant interviews with decision makers. 2) Citizen Consultation meetings across different Lebanese governorates resulted in the identification of key implementation considerations needed to enhance the uptake & implementation of identified elements. The majority of participants thought that the CCs were successful in supporting Discussions with citizens about the evidence available to inform policies around childhood obesity prevention. Furthermore, the CCs were believed to support in setting the issue on the policymakers’ agenda (61%) & allowing joint decision making (66%). 3) An advocacy strategy was implemented across the initiative. A number of different advocacy tactics were effective in influencing the policy agenda. 4) A Policy Dialogue convened key policymakers to discuss the policy & their role in the uptake.

Conclusion

Citizen Engagement & advocacy are standard KT tools necessary for completing the policy cycle & adopting national policies for childhood obesity prevention in Lebanon. KT tools are important but not sufficient to influence policy & action. Using an integrated KT approach (Figure 1) requires engaging citizens in the decision-making & the implementation of advocacy strategies. Citizen engagement strategies provide citizens with an opportunity to inform the policy-making process. Advocacy strategies serve as a facilitator to set the issue on the policy agenda & to ensure the uptake in the Policy Dialogue. This approach can inform the KT work on public health priorities in other countries.

Fig. 1.

Fig. 1

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Tab. 1.

Elements of a comprehensive EIP to prevent childhood obesity in schools

Element 1: Controlling standards, availability, accessibility, affordability & marketing of food and drinks in schools
1.1 Banning sweetened beverages & reducing portion sizes, fat content & frequency of selling competitive foods
1.2 Increasing the availability, accessibility & affordability of fresh fruits &vegetables &healthy snacks
1.3 Setting nutritional guidelines for children & providing school meals
1.4 Strict control of marketing & advertising
Element 2: Incorporating nutrition & physical activity PA programs in the curricula
2.1 Integrated school curriculum with nutrition behavioral change programs
2.2 Integrated school curriculum with PA education & opportunities
2.3 Support parents & teachers on how to approach children
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Obes Facts. 2018 May 26;11(Suppl 1):232–233.

T3P133 Gradual reduction of free sugars in beverages on sale by implementing the beverage checklist as a public health strategy

E Winzer 1, M Luger 2, M Schätzer 2, N Moser 2, J Schätzer 2, C Putzhammer 2, L Angelmaier 3, M Lechleitner 4, A Rieder 1, F Hoppichler 2

Introduction

Sugar-sweetened beverages (SSBs) are a major source of free sugar intake and contribute to obesity and obesity-related diseases. The objective was to analyse the effect of a gradual sugar reduction strategy on free sugar content in beverages on sale in Austria from 2010 until 2017.

Methods

The beverage checklist was implemented in 2010 to display the supply and each year research in all main supermarket chains on beverages sweetened with free sugars (including unsweetened fruit juice) and artificial sweeteners was carried out from product packaging (0.20–0.75 L serving sizes). Information from industry was also gathered and two guiding criteria were implemented to get the industry to decrease the amount of free sugars: 1) free sugar content ≤7.4 g/100 ml and 2) no artificial sweeteners.

Results

From 2010 until 2017 free sugar content in SSBs on sale decreased significantly [7.53 (SD 2.86) vs. 6.75 (2.79) g/100 ml; 10.4%; p < 0.001; Figure 1] and also in those beverages followed up over the whole study period [n = 100; 7.55 (2.46) vs. 7.28 (2.44) g/100 ml; 3.5%; p < 0.001]. The percentage of beverages fulfilling the guiding criteria increased by 12.8% (p < 0.001) and of those containing sweeteners decreased by 13.3% (after 2012; p = 0.034).

Conclusion

This public health strategy, conducted by a small non-profit organisation, showed a reduction in the mean free sugar content by working with the industry to voluntarily reformulate beverages. More beverages with less added sugars were brought to the market which implies healthier choices. The challenge now is to further engage the industry and also policy makers to achieve a greater reduction in the future.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):233.

T3P134 Childhood obesity in Macedonia – urban versus rural prevalence

I Spiroski 1, S Spirovska 2, F Eftimijadoska 2

Introduction

Regular anthropometric measurements may indicate if the progress of children's growth is following recommended patterns. The aim of our study was to compare the prevalence of obesity of urban versus rural children in two rounds of data collection of the WHO's Childhood Obesity Surveillance Initiative (COSI).

Methods

Children attending second grade of primary school, aged 7 to 8 years, were measured for their height and weight in school years 2010/2011 and 2015/2016. Measurements were done in the same schools in both rounds. WHO's growth references were used to assess the nutritional status of measured children.

Results

42.2% of urban boys and 33.4% of urban girls were overweight or obese in 2010. 22.1% and 14.2% were obese, respectively. In 2016 41.6% of urban boys and 33.6% of urban girls were overweight or obese, 22.3% and 15.2% were obese, respectively. For the rural children, 27.8% of boys and 26.8% of girls were overweight or obese in 2010. 13.6% and 10.6% were obese, respectively. In 2016 33% of rural boys and 30.7% of rural girls were overweight or obese, 15.5% and 15.1% were obese, respectively.

Conclusion

Overweight and obesity in Macedonia are more prevalent among boys than among girls and among urban children compared to the rural ones. The prevalence is similar among urban children when 2010 and 2016 rounds are compared but it has increased in rural children. The disparities between the growth of rural versus urban obesity need to be further more thorowly investigated in order to draw Conclusions about the reasons for that phenomenon.

Obes Facts. 2018 May 26;11(Suppl 1):233.

T3P135 Prevalence of Abdominal Obesity among 7-year-old Bulgarian Schoolchildren in 2016

E N Chikova-Iscener 1, VL Duleva 2, SP Petrova 2, LS Rangelova 1, P Dimitrov 1

Introduction

Childhood obesity is emerging as one of the serious health problems in the last decades worldwide. Central adiposity among children is associated with higher prevalence of cardiometabolic risk factors and complications later in life. The present study aims to evaluate the prevalence of abdominal obesity among a nationally representative sample of 7-year-old Bulgarian schoolchildren using age- and sex- specific, yet internationally comparable for the European population reference standards.

Methods

Cross-sectional study was carried out on a nationally representative sample of Bulgarian schoolchildren aged 7-years (n = 3378) in 2016 under the protocol developed by the World Health Organization (WHO) as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). Height, weight, waist and hip circumference were measured with standardized anthropometric equipment. Overweight and obesity were assessed by BMI for relevant age and sex, using both International Obesity Task Force (IOTF) and WHO cut-off points. Abdominal obesity was defined according to the 90th percentile cut-off of the age- and sex-specific reference standards of the waist-to-height-ratio (WHtR) for European children, based on the IDEFICS cohort.

Results

The prevalence of abdominal obesity was 29.3% for boys (n = 494) and 29.4% (n = 497) for girls with no gender differences (p = NS). The prevalence of overweight and obesity: IOTF cut-offs - 22.0% (n = 371) for boys vs. 23.3% (n = 395) for girls; WHO cut-offs - 29.8% (n = 502) for boys vs. 28.7% (n = 486) for girls. The prevalence of obesity: IOTF cutoffs - 8.3% both among boys (n = 140) and girls (n = 141), WHO cut-offs – higher in boys compared to girls (15.4% (n = 259) vs. 11.4% (n = 193), respectively; p < 0.001).

Conclusion

The present study demonstrates very high prevalence of abdominal obesity among Bulgarian 7-year-old schoolchildren. The results allow for comparison with other European populations. The prevalence of abdominal obesity is significantly higher than the one of the BMI-defined obesity, which justifies the use of complimentary measures other than height and weight in clinical practice and epidemiological surveys when screening for childhood obesity.

Obes Facts. 2018 May 26;11(Suppl 1):233–234.

T3P136 Prevalence of overweight and obesity in Austrian 8–9-year old children. Results from the Austrian Childhood Obesity Surveillance Initiative (COSI)

K Maruszczak 1, K Schindler 2, I Sulz 3, D Weghuber 4

Introduction

Obesity rates exploded in the past also affecting children and adolescents. The World Health Organization (WHO) established a surveillance program, “European Childhood Obesity Surveillance Initiative (COSI)”, to monitor and portray the growing obesity epidemic and thus enable inter-country comparison. Up to date, Austria has not participated in the surveillance initiative, therefore our aim of this cross-sectional study is to establish prevalence data of overweight and obesity among 8–9-year-old children in Austria.

Methods

According to COSI protocol a national representative sample of pupils aged 8,0–9,9 years (n = 2530, m = 52%) were sampled with a stratified cluster sampling approach. Overweight and obesity according to BMI was estimated using both WHO and International Obesity Task Force (IOTF) cut-off points.

Results

The overall prevalence rates for overweight (OW) and obesity (OB) vary notably between genders. (All: OW+OB WHO 28,5%, OW+OB IOTF 24,4%, OB WHO 9,3%, OB IOTF 6,7%). According to both WHO and IOTF cut off values and age groups, boys demonstrate higher overall overweight and obesity values (OW+OB WHO 32,9%, OW+OB IOTF 22,6%, OB WHO 10,1%, OB IOTF 6,7%) than girls (OW+OB WHO 29,1%, OW+OB IOTF 22,2%, OB WHO 9,2%, OB IOTF 5,4%). Also, 9-year-old boys (IOTF 7%) and girls (IOTF 6%) compared to 8-year-old boys (IOTF 6%) and girls (IOTF 4,5%) demonstrate higher obesity rates.

Conclusion

These findings present nationally and internationally representative data on overweight and obesity prevalence values among 8 and 9-year-old pupils and will allow longitudinal monitoring. The results underline the need for systematic actions to stop obesity trends.

Obes Facts. 2018 May 26;11(Suppl 1):234.

T3P137 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):234.

T3P138 Prevalence and geographic variation of obesity in 6- to 8-year-old children in Hungary (COSI Hungary)

G Erdei 1, M Bakacs 1, É Illés 1, C Kaposvári 1, Z Cserháti 1, V A Kovacs 1

Introduction

There have been previous representative nutritional status surveys conducted in Hungary, but this is the first one that examines overweight and obesity prevalence according to geographic regions among 6–8-year-old children.

Methods

Our survey followed the Childhood Obesity Surveillance Initiative (COSI), which was established by the WHO Regional Office for Europe in 2007. COSI provides data on the prevalence of overweight and obesity based on standardized measurements on national representative samples of children aged 6–9 years. In 2016, only the mandatory COSI elements were carried out in Hungary. These are the anthropometric measurements (body height and body weight) and the COSI mandatory school record form the collected information about the school environment. Data were gathered between 3rd and 31st October, 2016. Anthropometric measurements were carried out by 134 school nurses. Body weight and height were measured according to WHO standardized techniques. A total of 5332 children aged 6.0 to 8.99 years (51.6% boys; age 7.54 ± 0.64 years) were measured from the seven geographic regions. The geographic distribution followed the Nomenclature of Territorial Units for Statistics (NUTS) (N = 7). The prevalence rates are presented according to the International Obesity Task Force (IOTF) cut-off points.

Results

The prevalence of overweight 12.0 (95% CI: 10.2, 14.0) - 15.2 (95% CI: 11.1, 20.6) and obesity 6.2 (95% CI: 4.7, 8.0) – 12.0 (95% CI: 8.1, 17.5) is in wide range among 7 NUTS regions. The result was statistically significant P = 0.0402. Northern Hungary and Southern Transdanubia were the regions with the highest obesity prevalence of 11.0% and, 12.0%, while Central Hungary was the one with the lowest obesity rate (6.1%). To explain the observed regional differences, we also examined GDP per region and other factors which show substantial variation across geographic regions. We observed the lowest prevalence of overweight and obesity in the region where GDP was the highest (19,532.7 USD per capita) and the highest prevalence rates in the area where GDP was one of the lowest (8,286.8 USD per capita).

Conclusion

Overweight and obesity are emerging problems in Hungary. Remarkable differences were observed in the prevalence of obesity by geographic regions. Given the differences between the prevalence of overweight and obesity in these areas, the necessity of designing and implementing targeted strategies are required for different areas to reduce regional inequalities. Although it is already clear that there are regions where more intensive interventions are needed.

Obes Facts. 2018 May 26;11(Suppl 1):234–235.

T3P139 The relationship between social/educational status, BMI and Compliance to Mediterranean Diet in a sample of overweight children in Greece

A Markaki 1, M Sifaki 2, K Kefalianou 1, A Krontiris 1, S Koinaki 1, I Maniadaki 3, E Papadopoulou 4

Introduction

Few studies so far suggest that there might be a positive association between BMI, Compliance to Mediterranean Diet (MD) and various social/educational (S/E) factors in children. The present study aimed to explore these links in a sample of overweight children living in Crete, Greece. The S/E factors examined were academic attainment, special educational needs (SEN), sociability, family disruptions or bullying.

Methods

Participants were 98 overweight childrenb, 50 boys and 48 girls, with mean age being 11.3 (SD = 3.22), and 11.1 (SD = 2.49) years respectively. All children attended monthly appointments at the Pediatric Clinic, University Hospital of Crete, due to their increased weight. Data were obtained from the clinicians, after parental consent, by interviewing both children and parents. BMI was calculated by children's weight in kilos divided by height in square meters. Depending on their BMI, participants were classified as “overweight”, “obese” or “morbidly obese” based on the International Obesity Task Force (IOTF) cut off points. Compliance with MD was evaluated through the KIDMED Index, a 16-item Mediterranean Diet Quality Index which ranges from 0 to 12, with higher scores meaning higher compliance. Information on all S/E factors was obtained through parental interviews.

Results

In total, 25.3% of the participants were overweight, 35.8% were obese and 38.9% morbidly obese. Out of the boys, 16.3% were overweight, 34.7% obese and 49% morbidly obese. For the girls, 34.8% were overweight, 37% were obese and 28.3% morbidly obese. There were no significant differences between them. The mean score for compliance to MD was 4.4 (SD = 2.24). For boys, it equaled 4 (SD = 2.19) and for girls, 4.7 (SD = 2.26), with no significant difference between them. 12.1% of the participants had SEN, while 10.1% experienced family disruptions or bullying. Children's academic attainment was described as “poor” for 9.5%, “moderate” for 30.2%, “good” for 42.9%, “very good” for 11.1% and “outstanding” for 6.3% of them. In terms of sociability, it was “poor” for 14.9% of the sample, “moderate” for 48.9%, “good” for 23.4% and “very good” for 12.8%. There was a significant relationship between BMI and sociability, [χ2(6) = 24.35, p < 0.001]. The majority of overweight children (71.4%) had good or very good sociability. Nonetheless, in “obese” and “morbidly obese” categories, most had poor or moderate sociability. Findings are presented at table 1. All other relationships were insignificant.

Conclusion

There was a significant relationship between sociability and BMI, with overweight children having better sociability than obese and morbidly obese children. A limitation is that no standardized measurements for S/E factors were used, inducing reporter-bias. Conducting the same research with the use of a bigger sample and comparing with normal-weight children could highlight more significant effects.

Tab. 1.

Sociability Overweight Obese Morbidly Obese
Poor 7.1% 45.5% 4.8%
Moderate 21.5% 45.4% 66.6%
Good 35.7% 0% 28.6%
Very Good 35.7% 9.1% 0%
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Obes Facts. 2018 May 26;11(Suppl 1):235.

T3P140 Using social media in the clinical setting: Experiences of visual self-presentation among adolescent patients with obesity

C Holmberg 1, CM Berg 1, T Hillman 2, L Lissner 3, JE Chaplin 4

Introduction

Social media has a potential in the healthcare setting to improve interaction between pediatric patients and clinicians. However, weight stigmatization and appearance norms can make adolescents with obesity uncomfortable about using these predominantly visual-based media. It is therefore important to explore adolescents’ perspectives to better understand implications for the use of social media in clinical settings. Aim: To explore experiences of adolescents in treatment for obesity in terms of how they present themselves on social media, their rationale behind their presentations, and their feelings related to self-presentation.

Methods

Individual interviews were conducted with 20 adolescents, 13 to 16 years old, 11 girls and 9 boys. The participants were recruited from a pediatric outpatient obesity clinic in Sweden, and a majority of participants had morbid obesity. The interviews focused on concrete experiences and participants used a laptop with screen-recording software to show their online self-presentation practices. The interview material, transcriptions and screen-recordings, were analyzed by means of qualitative content analysis and Goffman's dramaturgical model of front- and backstage.

Results

A gender difference was apparent. The girls described experiences resembling weight stigma and reacted with self-presentation strategies that aimed to conceal weight-related content such as not sharing photos of their bodies and images of ‘fattening’ foods. The participants also expressed that they did not want to risk disclosing their patient status in their social media. Generally, the participants believed that using social media platforms in the healthcare setting as problematic.

Conclusion

The findings emphasize the need for a sensitive approach to the implications of adopting visual-based social media in the healthcare setting. Considering the complexity of adolescent use of visual-based social media, health care should primarily focus on working with more restricted instant-messaging. Another aspect to be considered before adopting groups on social media for adolescent patients is that not all young patients self-identify as typical patients and might not wish to engage with communities that reinforce their patient status.

Obes Facts. 2018 May 26;11(Suppl 1):235.

T3P141 Is there social transmission of anti-fat attitudes between young and older children?

AJ Hill 1, M Kilmurray 1

Introduction

Research showing that some young children express anti-fat attitudes is suggestive of the reach of obesity stigma. How do children acquire these values? Observational learning is the likely main route with the media, parents/other influential adults, and peers as the primary carriers. While there are studies describing representations of fatness in children's films and TV, there is little research on social transmission and almost none on peers. Accordingly, this study used a paired reading task to investigate the transmission of negativity within young children's conversations with older peers about a story book character drawn as either fat or healthy weight.

Methods

N = 172 children from 7 Primary schools in the north of England took part in the study. Each same sex pair included a younger child (aged 5–7, m = 6.1 yr) reading a story to an older child (aged 9–11, m = 9.5). They read one of two picture books that differed only in the body shape of the main character, Alfie. The story included prompts for the older child, half way through, to ask the younger child what each of the 3 story characters did next and, at the end, what their favourite part of the story was and why. Conversations were recorded and coded using thematic analysis.

Results

The majority of responses to story prompts related to the characters actions rather than their feelings. In terms of emotional tone, 3 of the 5 story prompts led to significantly fewer positive comments and 1 to significantly more negative comments in the story with fat Alfie. However, negative comments occurred in only 5 of the 45 pairs who read about fat Alfie. In two pairs both children made negative comments but only 1 pair talked specifically about Alfie being fat (both boys). Significantly more of the pairs reading the story with fat Alfie laughed during reading (40 vs 20% of pairs; girls more than boys) but only 2 pairs referenced (pointed to) body shape while laughing about the story. There was no evidence of the older child coaching the younger child in anti-fat attitudes.

Conclusion

Overtly expressed anti-fat attitudes are uncommon in young children. Just one pair of boys spoke negatively and repeatedly about Alfie being fat. Any influence on their peers is unknown. More laughter during reading about fat Alfie, together with less positivity in what children said, suggests a more common and subtle bias. There was no evidence that older children passed negative attitudes to younger children. Considered alongside other studies, young children are aware of and will comment on differences in people's appearance. This includes obesity. Actions to mitigate obesity stigma and its behavioural consequences should join with other efforts to promote equality on behalf of differences between people.

Obes Facts. 2018 May 26;11(Suppl 1):235–236.

T4P1 Longitudinal trends in reward-related feeding behavior and palatability after weight loss surgery

G Ribeiro 1, M Camacho 1, S Torres 2, AB Fernandes 1, A J Oliveira-Maia 1, T Food Reward In Weight Loss Surgery Portuguese Study Group 1

Introduction

The increasing prevalence of obesity highlights the complexity of its determinants, among which food reward is highly recognized. Currently, bariatric surgery is the most effective intervention to treat obesity, leading to a shift in eating habits away from energy-dense foods. While hedonic changes are thought to play an important role in this process, studies addressing this question typically lack adequate sample sizes and/or control groups, as well as comparisons between distinct surgical procedures. This is particularly true in studies addressing palatability, that have led to inconclusive findings. Here we assessed longitudinal trends in reward-related eating behavior and palatability following conventional or surgical treatment of obesity, specifically gastric bypass (GB) or sleeve gastrectomy (SG).

Methods

A total of 212 severely obese subjects from three bariatric centers participated in the study. Of these, 96 were patients on the surgery wait list, receiving medical, dietary and psychological intervention (control group), while 116 patients were assessed before and after either GB or SG (surgical group). At baseline and follow-up (after 4 and/or 12 months) patients were assessed with measures of food reward (Power of Food Scale and Yale Food Addiction Scale), eating behavior traits (Dutch Eating Behaviour Questionnaire) and food acceptance (Food Action Rating Scale). Palatability was also studied through psychophysical ratings of intensity and pleasantness of several simple tastants dissolved in filter paper, namely citric acid (sour), sodium chloride (salt), quinine (bitter) and sucrose (sweet). Thresholds for taste sensitivity were assessed using an electrogustometer.

Results

At baseline, the surgery and control groups were similar regarding demographic, clinical and self-report measures, as were the GB and SG surgery subgroups. Bariatric surgery resulted in a significant percentage of weight loss at both endpoints, accompanied by a large reduction in self-reported reward-related feeding behavior, obesity associated eating traits and decreased acceptance for energy dense foods, namely sweets, fried foods and sauces. Furthermore, these effects of surgery did not differ between patients receiving GB and SG. No such effects were found in the control group, in whom no consistent changes were found for weight or self-report measures of behavior. Contrary to weight and self-report measures of behavior, regarding the measures of palatability there were no differences between the control and the surgical groups. However, within the surgical group there was a trend in sweet pleasantness to increase at 12 months that was observed for SG, but not GB patients.

Conclusion

These results show that bariatric surgery, either GB or SG leads to decreased hedonic drive to consume highly palatable foods and improve eating behavior traits, that may play an important role in changing food preferences towards lower energy density foods. Despite these expressive changes, palatability is not significantly affected by bariatric surgery nor by lifestyle intervention. Nevertheless, the potential effect of different surgical procedures, namely sleeve gastrectomy, in hedonic preference for sweet taste is worthy of further research.

Obes Facts. 2018 May 26;11(Suppl 1):236.

T4P2 Unhealthy pre-operative eating behaviour, and early postoperative increase in nucleus accumbens reactivity to low-energy foods predict longer-term weight loss after gastric bypass surgery for obesity

TD Parastika 1, N Chhina 1, B Zaki 1, N Onokwai 1, A P Goldstone 1

Introduction

There is some variability in the weight loss response to Roux-en-Y gastric bypass (RYGB) surgery for obesity. Some previous studies have related less successful post-RYGB weight loss to baseline or persistent early post-operative unhealthy eating behaviour or poorer post-operative increases in anorexigenic gut hormones. We investigated in a comprehensive multi-modal phenotyping study whether pre-operative or early post-operative changes in eating behaviour, appetite, food intake, food reward and hedonic responses, or aversive symptoms, might predict longer-term weight loss after RYGB surgery.

Methods

Longitudinal, observational study of 14 adults (13 female, mean (range) BMI 44.9 kg/m2 (38.8 - 50.9; age 49 years (31–63), 64% European Caucasian) assessed at baseline, and at ~3 months after RYGB surgery to look for predictors of % weight loss at ~1 year post-RYGB. Variables assessed at included: (i) appetite visual analogue scale (VAS) ratings when fasted, and after a fixed 600 kcal liquid meal; (ii) energy intake at ad libitum test lunch; (iii) eating behaviour questionnaires: Yale Food Addiction Scale (YFAS), Power of Food Scale (PFS), external eating sub-scale of Dutch Eating Behaviour Questionnaire (DEBQ-External), Binge Eating Scale (BES); (iv) anticipatory food reward responses towards high-energy (HE) and low-energy (LE) with appeal rating and reward system activation during food picture evaluation functional MRI task (Goldstone AP et al. 2009, 2014, 2016; Scholtz S et al. 2014); (v) symptoms of dumping syndrome (modified Arts and Sigstad scores); (vi) fasting and post-prandial glucose concentrations and insulin resistance measured by homeostasis model assessment (HOMA-IR).

Results

RYGB resulted in % weight loss median (range) 17.5% (13.0–24.9) at median 14.9 weeks (11.0–17.4) post-RYGB, and 29.9% (21.6–40.0) at 52.2 weeks (40.1–65.9) post-RYGB, with baseline median weight 124.0 kg (91.3–152.4) and estimated weight at exactly 52 weeks 82.6 kg (57.2–111.7). Baseline predictors of less % weight loss at ~1 year post-RYGB were: (i) higher fasting appetite VAS (r = −0.66, P = 0.10), (ii) higher energy intake (as % of estimated resting energy expenditure) at ad libitum meal (r = −0.70, P = 0.007), (iii) higher YFAS (r = −0.55, P = 0.043) and higher BES (r = −0.58, P = 0.029) scores, and (iv) higher appeal rating of HE food vs. LE food (r = −0.58, P = 0.029), but not baseline food reward system activation to HE or LE food. The only outcome measure change over the first ~3 months post-RYGB that predicted weight loss at ~1 year was the brain response to LE foods. A smaller increase in nucleus accumbens activation during evaluation of LE foods at ~3 months post-RYGB predicted less % weight loss at ~1 year (r = +0.69, P = 0.009).

Conclusion

Baseline characteristics of greater appetite, higher food intake, unhealthy eating behaviour and greater appeal of HE foods were associated with less weight loss at 1 year after RYGB. Interestingly, the increase in reward system response to LE foods but not the reduction in response to HE foods predicted longer term weight loss. However, aversive symptoms related to food intake did not predict more successful weight loss after RYGB. These results may help identify additional interventions that could help improve weight loss outcomes after RYGB.

Obes Facts. 2018 May 26;11(Suppl 1):236–237.

T4P3 Long-term relapse of type-2 diabetes after bariatric surgery: prediction and clinical significance

J Debédat 1, N Sokolovska 1, L Genser 2, G De Turenne 1, J Bouillot 3, C Poitou 4, J Oppert 5, J Zucker 6, K Clément 1, J Aron Wisnewsky 1

Introduction

Bariatric surgery (BS) enables type-2 diabetes remission (DR) in around 60% of patients after one year. However, these metabolic improvements fade with time, and some patients relapse their type-2 diabetes (T2D). Clinical parameters have been associated with poor or transient responses, such as T2D duration and severity. DR predictive scores post-BS are now proposed. Whereas scores such as the DiaRem, the ABCD score or the Ad-DiaRem are accurate at 1 year, they have either not been tested or have decreased accuracies at predicting long-term DR. It is now crucial to develop new scores to estimate patient's potential of LTDR (long-term DR) to propose individualized follow-up. Our objectives were (i) to identify baseline and post-BS kinetic parameters involved in the LTDR and/or T2D relapse, and (ii) to use them to develop a new score accurate at predicting LTDR.

Methods

Among our BARICAN cohort, we followed patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) before May 2013 (n = 175; age = 48 ± 10 years, 29% male, BMI = 47 ± 7 kg/m2, follow-up = 5 ± 0,7 years). An extensive phenotyping was performed (i.e. medical history and comorbidities, body composition, bioclinical data, treatments) before RYGB and 3, 6, 12 and 60 months after. We used the 2009 ADA's definition of DR. We included in the score variables strongly associated with LTDR based on their odd-ratios values and statistical significance between our groups (LTDR, non-remission or relapse). We applied machine learning algorithms to attribute the optimal intervals and weights, as described in Aron-Wisnewsky et al., 2017.

Results

61% (n = 106) of our patients were in DR 1-year post-RYGB (concordant with the literature), and 25% (n = 27) relapsed between the 1st and 5th year. Patients who relapsed had a only slightly more severe T2D condition at baseline, but lost less weight during the 1st year (-22% vs. -30%, p < 0,0001, respectively) and regained more weight afterwards, compared to LTDR patients. One-year fasting glycemia, number of anti-diabetic treatments and remission status were strongly associated with being in relapse or in non-DR at 5-years, and were included in a new score, along the % of weight lost during the 1st year. This new score, called the 5 years Ad-DiaRem, was found to be accurate (AUROC 0.90, accuracy 0.85) at predicting long-term T2D outcomes (LTDR or long-term non-DR) and performed better than both the DiaRem and the Ad-DiaRem (AUROC 0.81 and 0.84, accuracy 0.79 and 0.78, respectively). Compared to the DiaRem, it corrected 15 of the 41 misclassifications. Below the threshold of 11 (out of 26), patients were predicted to enter LTDR at 5-year (accuracy 0.9), while a score of 18 was with being in non-remission (accuracy 0.92).

Conclusion

We here propose the 5y Ad-DiaRem score, to predict 5-year diabetes remission. While the Ad-DiaRem allows to inform the patient, prior BS, on their probable T2D outcomes at 1-year, the 5y Ad-DiaRem predicts the long-term outcome and can be used to identify patients at risk of relapse, and further intensify their follow-up after the first year, as we showed that weight regain is deeply associated with the relapse.

Obes Facts. 2018 May 26;11(Suppl 1):237.

T4P4 The effects of formula diet on body fat and skeletal muscle mass after laparoscopic sleeve gastrectomy in Japanese severe obese patients

A Saiki 1, R Kanai 2, S Kawakubo 2, M Hayashida 2, K Yamaura 2, E Seo 2, M Sameda 2, T Ohshiro 3, S Okazumi 3, I Tatsuno 1

Introduction

Bariatric surgery remarkably reduces body fat mass and consequently improves obesity-related diseases such as diabetes. However, the bariatric surgery may also reduce skeletal muscle mass. The aim of this study is to investigate retrospectively the effects of formula diet (FD) on body fat and skeletal muscle mass for 1-year post-operation.

Methods

Twenty-four Japanese patients with BMI of 35 kg/m2 or greater and obesity-related disease, who attended the Toho University Sakura Medical Center and underwent laparoscopic sleeve gastrectomy were enrolled (male/female: 13/11, mean body weight: 119.1 kg, mean BMI: 44.3 kg/m2, mean HbA1c: 6.6%). Subjects were divided into FD group (13 cases) and non-FD group (11 cases). In FD group, a pack of MicroDiet (Sunny Health Co., Ltd.) or ObeCure (US Cure Inc.) was replaced with one of three daily low-caloric meals. InBody 720 (InBody Japan Inc.$$ was used as the body composition analyzer. Visceral fat area (VFA) was determined using computed tomography.

Results

In the whole subjects, mean body weight reduced from 119.1 to 84.7 kg and mean HbA1c decreased from 6.6 to 5.6%. And mean skeletal muscle mass also reduced from 32.6 to 29.6 kg. On the other hand, the change of body weight, VFA and skeletal muscle mass in FD group tended to be smaller than in non-FD group (Δbody weight: −36.2 vs -32.1 kg, ΔVFA: −109.97 vs -87.40 cm2, Δskeletal muscle mass: −1.7 vs -4.2 kg). The change in skeletal muscle mass to body weight ratio was significantly smaller in FD group. And the decrease in urine albumin was greater in FD group. Daily energy intake at 1-year post-operation was 1254 kcal/day in FD group and 1443 kcal/day in non-FD group, and daily protein intake was 67.0 g/day and 59.7 g/day, respectively. And there were inverse relationships at 1-year post-operation between the change in body weight and daily energy intake, and between the change in skeletal muscle mass and daily protein intake.

Conclusion

These results suggested that the replacing one meal with FD was effective on body fat reduction, metabolic improvement and prevention of skeletal muscle loss after laparoscopic sleeve gastrectomy. And these favorable effects might be associated with the low-energy and high-protein content of FD.

Obes Facts. 2018 May 26;11(Suppl 1):237–238.

T4P5 Features of oral glucose tolerance test in patients with and without late dumping after Roux-en-Y gastric bypass: it's all about speed

I Mariën 1, E Dirinck 1, G Hubens 2, C De Block 1, L Van Gaal 1

Introduction

Hypoglycemia is a well-known complication of Roux-en-Y gastric bypass (GB). This study aimed at evaluating the glucose and insulin profiles during an oral glucose tolerance test (OGTT) in patients with and without hypoglycemia symptoms, both before and after GB.

Methods

This retrospective study has 2 groups. Hypoglycemia symptoms were assessed using the Sigstad questionnaire. The dumping group (n = 27) presented with symptoms of hypoglycemia after GB, ranging from 10 to 150 months after GB. The control group (n = 99) had an OGTT 1 year after GB due to enrollment in another study, and displayed no hypoglycemia symptoms. Both groups had an OGTT pre-operatively. Blood samples were obtained for glucose and insulin at 0, 15, 30, 60, 120, 150 and 180 minutes.

Results

Preoperatively, glucose and insulin were at any point similar in both groups. The speed glucose increased from fasting to peak and decreased from peak to minimum showed no difference between the two group (p = 0.611 and p = 0.967 respectively). The speed insulin increased from fasting to peak was similar for the two groups (p = 0.235); the speed insulin decreased was lower in the dumping group (p = 0.003). Postoperatively, weight loss was similar in both groups (28% versus 25%, p = 0.265). Glucose levels were significantly higher in the dumping group at 0, 15, 30 and 60 minutes (p < 0.001 for all). Insulin levels were higher at 30 and 60 minutes in the dumping group (p = 0.010 for both). The speed glucose increased from fasting to peak and decreased from peak to minimum was significantly higher in the dumping group (p = 0.006 and p < 0.001 respectively) The speed insulin increased from fasting to peak and decreased from peak to minimum was significantly higher in the dumping group (p = 0.040 and p = 0.014 respectively).

Conclusion

Assessing hypoglycemia after gastric bypass is challenging. Our study indicates that the main difference between patients with and without dumping symptoms, is the speed of glucose and insulin increment and decline during OGTT, rather than the absolute values obtained.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):238.

T4P6 Resilience and social support are determinants of quality of life after bariatric surgery: results of the 9-year follow-up of a Brazilian cohort

R Sônia Rodrigues Álvares 1, AM Beleigoli 1, M De Moura Nigri Hilário Ferreira 1, L Guilherme De Oliveira Freitas 1, V Gama Van Eijk 1, L De Araújo Silva 1, M De Fátima Haueisen Sander Diniz 1

Introduction

Quality of life (QoL) is a complex and important outcome after bariatric surgery (BS). Like physical, psychosocial changes are common after BS and might affect QoL in the long-term. Resilience, which is defined as an individual trait, characterized by the ability to undo negative emotional experiences, and social support, which is information that leads the individual to believe that he is cared for, loved, esteemed and belongs to a social network with mutual obligations, might help patients in the coping processes after BS. Objective: To evaluate the association of QoL, resilience and social support in patients who underwent BS in a public hospital in Brazil.

Methods

Participants with ≥ 5 years of BS were selected. Questionnaires, physical examination and review of medical records were applied to participants who signed an informed consent form. SF-36 was used to assess physical and mental QoL component. Resilience was assessed by the ER-89 questionnaire and social support by the Medical Outcome Study (MOS) questionnaire. Ordinal logistic regression models were performed to investigate the association between the physical and mental components of QoL with resilience and social support adjusted for age, sex,% excess BMI loss (EBL), marital status, schooling, improvement of metabolic and psychological comorbidities and of cardiorespiratory, gastrointestinal, orthopedic and sleep apnea symptoms and changes in medication use after surgery.

Results

A total of 136 patients (114; 83.8% women) with mean (SD) age 42.2 (11.8) years and mean surgery time of 9 (3) years were included. Mean schooling time and family income was 8 (4) years and 2.5 (1.8) minimum wages, respectively. Most of the participants were married (80; 58.8%) by the time of QoL assessment. Mean BMI reduced from 52.1 (8.6) before to 36.5 (7.2) after surgery with 57.5% (21.9) EBL. The mean (SD) increase in the number of medications and reduction in the number of comorbidities were 2.1 (2.7) and 2 (3.3), respectively. The mean physical and mental components of SF-36 were 47.3 (10.5) and 42.7 (16), respectively. results of the associations of QoL components are shown in Table 1.

Conclusion

Social support and resilience were associated with long-term QoL after BS. These findings suggest that these psychosocial issues should be addressed in the clinical follow-up of BS patients. Strategies to improve resilience and social support might contribute to the success of BS.

Tab. 1.

Associations (odds ratio and 95% confidence interval) between QoL components and determinants

Determinant Physical QoL Component Mental QoL Component
Resilience NSA 1.09 (1.01–1.18)
Social support 1.03 (1.01–1.05) NSA
% excess BMI loss 1.02 (1.00–1.05) 1.03 (1.01–1.06)
Number of medications NSA 0.78 (0.64–0.95)
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NSA: Not significantly associated

Obes Facts. 2018 May 26;11(Suppl 1):238.

T4P7 Overall treatment satisfaction five years after bariatric surgery

PA Hegland 1, A Aasprang 2, JR Andersen 2, R Kolotkin 3

Introduction

Bariatric surgery is a widely used treatment for severe obesity. However, a significant minority of the patients undergoing bariatric surgery are not satisfied with their treatment outcomes. There is limited knowledge on characteristics of these patients. The aim of the study was to analyse the characteristics of patients five years postoperatively with respect to their overall treatment satisfaction.

Methods

A cross-sectional study was conducted with 264 patients, five years after they had undergone bariatric surgery. Patients were operated with the Duodenal Switch (DS) or Laparoscopic Sleeve Gastrectomy (LSG). The main outcome was overall treatment satisfaction assessed with the question: “How satisfied are you, all things considered, with the treatment outcomes after bariatric surgery?” The response categories were very satisfied, satisfied, uncertain and dissatisfied. In a multiple logistic regression analysis, this variable was dichotomized into very satisfied/satisfied versus uncertain/dissatisfied. Independent variables were operation procedure, age, gender, body mass index (BMI), mental and physical health-related quality of life (HRQOL) measured with the Short-Form-36, and obesity-specific HRQOL measured with the Obesity Problem Scale (OP). The estimates for the continuous independent variables represent the odds ratios (OR) per 2-standard deviation change in these variables.

Results

For the main outcome overall treatment satisfaction, 51% were very satisfied, 30.8% were satisfied, 14.4% were uncertain and 3.8% were dissatisfied. Patients operated with LSG had significantly higher risk for low treatment satisfaction (uncertain/dissatisfied) with the overall treatment results compared to those with DS (OR = 3.7, 95% CI = 1.3–10.4, P = 0.04). Further, higher BMI (OR = 6.0, 95% CI = 2.6–13.7, P < 0.001), better mental HRQOL (OR = 0.24, 95% CI = 0.08–0.7, P = 0.011) or more bother related to obesity-specific HRQOL (OR = 2.9, 95% CI = 1.1–7.5, P = 0.029) were associated with treatment satisfaction. Age, gender and physical HRQOL did not seem to be independently associated with treatment satisfaction

Conclusion

Patients with high overall treatment satisfaction five years postoperatively were most likely treated with DS, having lower BMI, and having better mental HRQOL as well as obesity-specific HRQOL. Low physical HRQOL did not seem to influence overall satisfaction with the treatment outcomes independently of mental HRQOL.

Obes Facts. 2018 May 26;11(Suppl 1):238–239.

T4P8 Effects of lifestyle modification- versus liraglutide-induced weight loss and subsequent weight maintenance on hepatic steatosis and inflammation in obese adults with non-alcoholic fatty liver disease

J Khoo 1, J Hsiang 2, N Law 2, C Tao 3, T Ang 2

Introduction

Non-alcoholic fatty liver disease (NAFLD) is associated with insulin resistance, and is a leading cause of cirrhosis and liver cancer. NAFLD is increasing worldwide due to rising obesity rates, particularly in Asia. Dieting and exercising to lose and maintain weight decreases hepatic steatosis and inflammation, but requires greater efforts to supervise and maintain compared with taking medications. Liraglutide, a glucagon-like peptide-1 agonist which induces weight loss and decreases insulin resistance, has been shown to reduce hepatic steatosis and inflammation. We aimed to compare the effects of liraglutide with that of supervised lifestyle modification on weight loss, hepatic steatosis and inflammation, and insulin resistance over 26 weeks, and sustainability of benefits for another 26 weeks of weight maintenance after discontinuing the interventions.

Methods

Twenty-six abdominally obese Asian (mean age 40.7 ± 9.1 years, BMI 33.2 ± 3.6 kg/m2, waist circumference WC 108.5 ± 9.6 cm) non-diabetic normotensive adults with NAFLD, as diagnosed with elevated serum transaminase levels and liver fat fraction (LFF) > 5% using magnetic resonance imaging (MRI) in the absence of other causes of hepatic steatosis, were randomized to dieting (restriction by 400 kcal/day) plus moderate-intensity exercise (200 minutes/week) with regular supervision by dieticians and trainers to induce ≥ 5% weight loss (DE group, n = 13), or to receive liraglutide 3 mg daily (LI group, n = 13) with standard diet and exercise advice, for 26 weeks. The program or liraglutide was then stopped and all subjects were followed up for another 26 weeks, during which they followed diet and exercise advice to prevent weight regain but were unsupervised. LFF (measured using MRI), transaminase levels, and insulin resistance estimated by homeostasis model assessment (HO-MA-IR) calculated from serum glucose and insulin, were measured at baseline, 26 and 52 weeks.

Results

At 26 weeks, both DE and LI groups had significant (p < 0.01) and similar reductions in weight (-3.5 ± 3.3 vs. -3.5 ± 2.1 kg), WC (-4.8 ± 3.5 vs. -5.5 ± 3.8 cm), LFF (-9.0 ± 13.6 vs. -7.7 ± 6.9%), serum alanine aminotransferase ALT (-42 ± 33 vs. -42 ± 34 IU/L), serum aspartate aminotransferase (-20 ± 16 vs.- 23 ± 23 IU/L) and HOMA-IR (-2.98 ± 2.57 vs. -2.78 ± 2.22). At 52 weeks, there was significant weight regain from 26 week-values in the LI group (1.7 ± 1.9 kg, p = 0.004) compared to none in the DE group (-0.4 ± 3.2 kg, p = 0.65). The LI group had significant regains in LFF (5.3 ± 5.4%, p < 0.001), ALT (12 ± 26 IU/L, p = 0.007) and HOMA-IR (0.80 ± 1.78, p = 0.01) after stopping liraglutide, whereas the DE group maintained LFF (-2.8 ± 6.2%, p = 0.15), ALT (0.6 ± 23 IU/L, p = 0.95) and HOMA-IR (-0.58 ± 1.35, p = 0.16) at 52 weeks.

Conclusion

Once-daily liraglutide was as effective as supervised dieting and exercise over 26 weeks for decreasing weight, hepatic steatosis and inflammation, and insulin resistance in obese Asian adults with NAFLD, but these benefits were not sustainable after discontinuing liraglutide despite advice on weight maintenance. In contrast, lifestyle modification was associated with maintenance of reductions in weight, liver fat and inflammation, and insulin resistance for another 26 weeks without supervision.

Obes Facts. 2018 May 26;11(Suppl 1):239.

T4P9 The Effect of Semaglutide on Liver Enzymes in Subjects With Obesity and Elevated Alanine Aminotransferase: Data From a Randomised Phase 2 Trial

L Van Gaal 1, S Harrison 2, S Rasmussen 3, T Monk-Hansen 3, P Newsome 4

Introduction

The glucagon-like peptide 1 analogues semaglutide and liraglutide improve glycaemic control and reduce elevated liver enzymes in subjects with type 2 diabetes (T2D), and reduce body weight in subjects with or without T2D. Histological resolution of non-alcoholic steatohepatitis has also been seen for liraglutide in subjects with or without T2D. A randomised, placebo-controlled Phase 2 trial (NCT02453711) of once-daily subcutaneous semaglutide (0.05, 0.1, 0.2, 0.3, or 0.4 mg following 4-weekly escalations) in subjects with obesity without T2D, showed mean weight losses of –6.0% (0.05 mg) to –13.8% (0.4 mg) with semaglutide vs –2.3% with placebo at week 52. The effect of semaglutide on liver enzymes in subjects with elevated baseline alanine aminotransferase (ALT) was evaluated in a post hoc sub-analysis from this trial.

Methods

Baseline fibrosis was categorised by the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and Fibrosis-4 (FIB-4) score. Changes in ALT were estimated at week 52 (mixed model on log-transformed data) and semaglutide-to-placebo group ratios and 95% confidence intervals (95%CI) calculated from this model for subjects with high baseline ALT (>30 U/L [male]; >19 U/L [female]).

Results

Mean (range) baseline characteristics of the 957 treated subjects (35% male) were: age 47 (18–86) years, weight 111 (70–244) kg, body mass index 39 (30–80) kg/m2, mean NFS –0.49 (–4.70–4.66) and mean FIB-4 0.72 (0.14–3.31); 52% (n = 499) had high ALT, 18% a high NFS (>0.676), and < 1% a high FIB-4 (>3.25) at baseline. ALT ratios (95%CI) at week 52 in those with high baseline ALT were: 0.88 (0.76–1.01; 0.05 mg); 0.94 (0.82–1.08; 0.1 mg); 0.82 (0.71–0.95; 0.2 mg); 0.79 (0.68–0.91; 0.3 mg), and 0.82 (0.70–0.95; 0.4 mg). P values were < 0.01 at doses >0.1 mg, unadjusted for multiple testing. ALT changes at week 52 were broadly comparable across weight loss categories from < 2% to ≥10% of baseline weight. Normalization of high baseline ALT was seen at week 52 in 29% (17/58; 0.05 mg), 25% (15/59; 0.1 mg), 38% (19/50; 0.2 mg), 43% (23/54; 0.3 mg), and 46% (21/46; 0.4 mg) of subjects on semaglutide, versus 18% (14/76) of subjects on placebo.

Conclusion

In this obese population 52% had elevated liver enzymes at baseline and 18% had a high NFS score. In subjects with obesity and high ALT, semaglutide 0.2–0.4 mg daily reduced ALT to an extent that was broadly comparable across weight loss categories, and resulted in dose-related ALT normalization in up to 46% of subjects after 52 weeks. These data suggest a potential role for semaglutide in the treatment of NAFLD with elevated liver enzymes.

Conflicts of Interest

LVG has served on advisory boards and speakers’ bureaux for Novo Nordisk (NN), SH has received grants from NN, PN is a consultant for NN, and SR and TM-H are NN employees and stockholders.

Obes Facts. 2018 May 26;11(Suppl 1):239–240.

T4P10 The Effectiveness of iNCKU System® Assisted Behavior Change and Risk Reduction among Obese Subjects with Metabolic Syndrome

Y Yang 1, P Tsai 2, C Chen 2, HL Huang 3, J Wang 4

Introduction

The uprising prevalence of physical inactivity, obesity and metabolic syndrome has precipitated future disease burden. There are some studies tackling the internet technology application on health promotion, such as using wearable devices combined with the use of Facebook, tablets and smartphones to provide health message, remind recording, facilitate behavior change and self-health management. However, the effectiveness of internet technology application in health promoting in the weight control groups from both workplace and community has not yet been fully validated.

Methods

We enrolled subjects aged 20–65 year-old with BMI higher than 25 and complicated with metabolic syndrome to receive the weight control course. All the study subjects received self-administered structured questionnaire which included lifestyle habit, physical activities status, quality of life, self-efficacy on exercise etc. Anthropometric data, blood pressure and physical fitness status were collected, and biochemistry data included blood sugar, insulin level and lipid profiles. Physical activity information were collected via international physical activity questionnaire and validated wearable mobile activity monitor device. Weekly 2-hour nutrition and exercise program were given during first 2 months coupled with traditional hand writing self-recording about personal food intake and exercise status. During the following 2 months, the iNCKU systems were applied to monitor, feedback and promote physical activity and elective weight-reduction special clinic was also offered.

Results

From March to September, 2017, this study recruited 80 subjects, 34 from workplace (aged 39.6 ± 9.9) and 46 from community (aged 46.1 ± 12.4). After 4-month intervention, the body weight, body fat percentage, body mass index, waist circumference, blood pressure, uric acid level and hemoglobin A1c were all significantly improved in community group, while only waist circumference was improved in the workplace group. In terms of physical fitness and physical activity, only sit and reach performance test reach the statistically significant improvement, and the sedentary time reduced but not reached the statistically significant.

Conclusion

For obese subjects with metabolic syndrome, the nutrition and exercise intervention program with mobile activity feedback device may improve the reduction of body weight and body fat, body mass index, waist circumference, blood pressure, uric acid level and hemoglobin A1c. The extent of weight reduction was similar to previous studies in this hospital (around average 2–4 kilogram in 4 months), but the effect of weight reduction maintenance and health promotion need further evaluation in the subsequent follow-up study.

Obes Facts. 2018 May 26;11(Suppl 1):240.

T4P11 Effects of a multidisciplinary program on hospitalized elderly subjects affected by obesity

SL Budui 1, F Bigolin 2, F Giordano 1, S Leoni 1, E Sartori 1, M Berteotti 1, L Franceschini 1, M Taddei 1, S Salvetti 1, M Lovisi 1, F Castiglioni 1, F Gilli 3, S Skafidas 3, ML Petroni 1, L Busetto 4, F Schena 3

Introduction

Obesity is an important risk factor of disability in older adults. Nevertheless, there is little evidence on the benefits of weight-loss intervention regarding improvements in cardiovascular risk factors and a better control of obesity-associated morbidities. The aim of the study was to analyses the short-term effectiveness of an intense inpatient rehabilitation program, including behavior interventions as education on diet and exercise and lifestyle counseling, specifically developed for older patients affected by severe obesity compared to younger subjects.

Methods

elderly patients with severe obesity and obesity-associated morbidities were hospitalized for 3 weeks, during which time they underwent rehabilitation interventions, based on group therapy and followed by a multi-disciplinary team (physician, nutritionist, psychologist, physiokinetotherapist). All patients were analyzed at admission and discharge for changes in the following domains: anthropometry (weight, body mass index BMI, waist and neck circumferences), cardiovascular risk factors (glucidic and lipidic profile, blood pressure), quality of life, eating behavior and physical performance (cycle ergometer test), 6min walking test (6MWT), chair stands test (CST), arm curl (ACT), and body composition.

Results

The study included 215 young patients (32.6%men, average age 48,2 ± 18.5years, mean BMI 43.9 ± 9.4kg/m2) and 44 elderly subjects (36.4%men, average age 69.3 ± 3.5years, mean BMI 41.9 ± 14.9kg/m2). Comparing the clinical and metabolic parameters at the beginning and end of the treatment, we observed an improved glycaemic control (HbA1c young – 4.7%, elderly -3.0%), with a reduced LDL-cholesterol average (young -16.8%, old -17.5%), total cholesterol (young -15% old -14%) and triglycerides (young -10.5%, old 0.8%). We also observed a reduction in body weight (young -4.3%, old -3.8%), BMI (young -4.4% old -3.9%), waist circumference (young -4.1% old -3.4%) and neck circumference (young -3.5% old -2.7%). By comparing the parameters of body composition, a decrease in fat (young -6.2%, old 6.7%) and lean (young -2.4%, old -1.7%) mass was observed. The evaluation of physical parameters showed an increase in the distance traveled in 6MWT (young 15.3%, old 28,7%), number of elevations in CST (young 26.9, old 24.8%) and the number of flexions in ACT (young 27,3%, old 15,2%). In young subjects, we observed a statistically significant improvement in the physical performance of the cycloergometer, a change not present in the elderly patients. Psychometric test showed an improvement in the perception of health-related quality of life (young 35,1%, old 27,6% in SF36 score).

Conclusion

Our data proved that a 3-week rehabilitation program, extended to the elderly patients, determined a clinically significant multidimensional improvement in patients with severe obesity. Nevertheless, long-term follow-up data are needed to confirm the efficacy of this therapeutic stetting.

Obes Facts. 2018 May 26;11(Suppl 1):240–241.

T4P12 Modelling ‘stopping rules’ to optimise type 2 diabetes remission rate with an intensive weight management programme: the Diabetes Remission Clinical Trial (DiRECT)

M E Lean 1, R Taylor 2, WS Leslie 1, AC Barnes 2, G Thom 1, N Brosnahan 1, L McCombie 1, N Sattar 3, I Ford 4, A McConnachie 4

Introduction

The DiRECT study intervention, an intensive weight management programme within routine primary care, showed a striking effect of weight loss on remission of recent onset (diagnosis < 6 years) type 2 diabetes (T2DM): 46% remissions at 12 months overall, 86% in those with weight loss >15kg. We now investigate whether insufficient early weight loss might identify patients who will ultimately be unsuccessful.

Methods

Weight losses during the first 4, 6, and 8 weeks of the intervention were extracted from patient management records. Two measures of treatment success/failure were used: (i) weight change ≥15kg at 12 months, and (ii) remission of T2DM at 12 months. Early weight loss thresholds of 2, 4, 6, 8, and 10kg were examined as potential predictors of success/failure.

Results

Weight losses at 4, 6, and 8 weeks, were significantly associated with treatment success, in terms of ≥15kg weight loss and remission of diabetes at 12 months. Sixteen patients (11%) failed to achieve 2kg weight loss at 6 weeks, none of whom achieved ≥15kg weight loss, or remission of diabetes at 12m. A < 2kg weight loss threshold therefore had 100% sensitivity and 20% specificity for identifying those who would achieve remission. However, 14 of these patients either did not start the intervention, or had withdrawn within 6 weeks, so the < 2kg threshold only identified two patients who were actively engaged with the intervention at that time (1.5%). At 8 weeks, 31 patients (21%) had failed to achieve 6kg weight loss, of whom none achieved ≥15kg weight loss at 12 months, and only five achieved diabetes remission (95% sensitivity, 32% specificity). However, 15 of these patients were self-selected withdrawals from treatment; and none of the 16 who were still engaged with the intervention but had < 6kg weight loss at 8 weeks went on to achieve ≥15kg weight loss at 12 months; 5 (31%) did achieve diabetes remission. Excluding withdrawals from treatment within 8 weeks, achieving < 6kg weight loss had only 17% specificity for identifying those who failed to achieve remission. Stopping the intervention for those who failed to achieve ≥6kg weight loss at 8 weeks would have excluded 12% of those still engaged with the intervention, and 5% of those who ultimately achieved diabetes remission.

Conclusion

Early weight loss is a predictor of treatment success. However, patients who fail to achieve early weight loss targets are also the most likely to withdraw from treatment of their own accord, and some go on to be successful. Routinely excluding patients who are engaged with the intervention, but fail to achieve specified early weight loss targets, would deny treatment to a significant minority who could benefit from continued weight loss support. This abstract is submitted on behalf of the entire DiRECT study team.

Conflicts of Interest

The study was supported by Diabetes UK, with support-in-kind from Cambridge Weight Plan. ML reports personal fees for consultancy services to Counterweight Ltd, and departmental research funding from Cambridge Weight Plan outside the submitted work. NB reports funding from Counterweight and Cambridge Weight Plan, outside the submitted work, and employment by Counterweight prior to the study. GT reports funding from Cambridge Weight Plan outside the submitted work. HMR reports employment by Counterweight during the study, and is shareholder in Counterweight. NS reports grants and personal fees from Boehringer Ingelheim; personal fees from Janssen, Eli Lilly and Novo Nordisk; and grants from AstraZeneca, outside the submitted work. LM reports employment by Counterweight prior to the study, and employment from Cambridge Weight Plan outside the submitted work. All other authors declare no competing interests.

Obes Facts. 2018 May 26;11(Suppl 1):241.

T4P13 The role of adjuvant pharmacotherapy in the management of patients with a partial response to bariatric metabolic surgery- the first Australian experience

G Rigas 1, ML Talbot 2, C Tam 3

Introduction

Bariatric /metabolic surgery induces clinically significant weight-loss in the majority of patients, but is known to be individually variable in its effectiveness. In the estimated 5–10% of patients with a sub-optimal/partial response to surgery, there are few adjuvant options other than lifestyle modification and consideration of surgical revision. The aim of this study was to investigate the efficacy and tolerability of liraglutide as an adjunct in patients with a partial response to metabolic surgery.

Methods

We performed a retrospective audit of patients after laparoscopic sleeve gastrectomy (LSG), laparoscopic gastric bypass (GBP) or laparoscopic gastric band (LAGB) who had earlier than anticipated weight-loss plateaus and were motivated to undertake adjuvant therapy to augment weight loss. Patients commenced liraglutide (1.8- 3.0 mg /day up to 28 weeks) between May 2016 - December 2017 and were followed up after 1, 4 and 7 months of liraglutide treatment.

Results

Data was collected from n = 67 patients, 48 of which had a primary bariatric procedure (18LAGB, 26LSG, 4GBP) and were included for analysis. There were 43 females and 5 males. The median age was 40 years (range = 17 to 68), median pre-op BMI was 42.3kg/m2 (31.4–63.5). After liraglutide treatment, the median percent weight loss was -3.7% (range = −11.5 to 2.3) at 1 month (n = 40), -10.2% (range = −15.1 to 0.6) at 4 months(n = 16) and –13.4% (range = −32.8 to –7.2) at 7 months (n = 6). The most common reasons for discontinuing adjuvant pharmacotherapy were: cost(n = 16), sufficient weight loss according to the patient (n = 8) and side effects (n = 7); nausea (n = 3/7) and lethargy (n = 2/7).

Conclusion

In the context of limited treatment options, liraglutide can be used effectively as an adjuvant to induce further weight loss in patients who have had a partial response to bariatric surgery, and is an overall well-tolerated pharmacotherapy. Follow-up of metabolic surgery patients on liraglutide treatment is ongoing.

Conflicts of Interest

I have received travel grants and honoraria to present at conferences and meetings locally and internationally.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):241.

T4P14 A systematic review of long-term technology-enabled weight management interventions for an obese population

J Silver 1, WL Hall 1, K L Johnston 1

Introduction

27% of adults in the UK were obese in 20151 putting them at greater risk of significant morbidity and mortality. Technology-enabled interventions for weight management have become popular, with some implemented by commercial weight-loss companies and others by primary care providers. However, the evidence supporting their effectiveness over the longer term remains unclear.

Methods

A systematic review of randomised controlled trials (RCTs) was performed to test the hypothesis that technology-enabled behavioural weight management programmes deliver superior outcomes compared to non-technology enabled care. The Cochrane Library, EMBASE, MEDLINE and PsycINFO databases covering the medical, scientific and psychology fields were searched to identify all RCTs published in English from inception to 31st January 2017. Studies which measured the effects of weight loss or weight management interventions in obese adults for twelve months or more and which utilised a technology-component were identified and screened.

Results

In total, 7,293 unique citations were identified from electronic databases and other sources; 6 studies (n = 2,347) were found to be eligible for inclusion, all conducted in primary care and compared to usual care controls. Due to the substantial heterogeneity of the interventions and a lack of active non-technology-enabled controls, it was decided not to pool results for meta-analysis. Two studies2,3 showed that website-only interventions, without additional human support, were not superior to usual care. The two most successful technology-enabled interventions4,5 incorporated regular coaching and feedback and delivered adjusted mean difference weight loss at 12 months of: 4.5 kg (95% CI, 2.9 to 6.1; P < 0.001) and 3.8 kg (95% CI, 2.5 to 5.1; p < 0.0001) respectively, compared to usual care on an intention-to-treat basis.

Conclusion

Technology-enabled interventions can deliver superior outcomes to usual care but certain features are more common in successful interventions. As more high quality long-term RCTs emerge, our understanding of what works well and can be delivered in a cost-effective manner improves, as does our understanding of the limitations of these interventions. More high quality studies are needed to build upon existing knowledge.

Conflicts of Interest

Kelly Johnston is employed by LighterLife UK Ltd

References

Obes Facts. 2018 May 26;11(Suppl 1):242.

T4P15 Inflammation and metabolic health in pregnant women with overweight and obesity, and the impact of a lifestyle intervention

A Sherry 1, AA Geraghty 1, KM Ainscough 1, M Kennelly 1, KL Lindsay 1, F M McAuliffe 1

Introduction

The association of increased inflammation with poorer metabolic health may explain adverse maternal outcomes in overweight and obese pregnancies. Interventions changing lifestyle behaviours may improve these pregnancy outcomes. This study had two aims; to assess whether there was an association between inflammation and metabolic health during pregnancy, and to assess whether a lifestyle intervention supported by a smartphone-app would improve inflammation and metabolic health in overweight and obese pregnancies and in their offspring.

Methods

This is a secondary analysis of the Pregnancy, Exercise And nutrition Research study with smart phone app support (PEARs). This was a single centre randomised control trial conducted with 565 pregnant women with a BMI 25–39.9kg/m2. The intervention involved a healthy lifestyle package with nutritional and physical activity advice, supported by a smartphone-app. Blood samples were collected in early and late pregnancy, and from the cord at delivery. Blood lipid profiles and metabolic markers were measured, along with inflammatory markers complement component 3 (C3) and C-reactive protein (CRP). Associations between metabolic and inflammatory markers were investigated and differences between intervention and control groups in maternal and cord bloods were examined. All statistical analyses were performed using IBM SPSS software.

Results

Early pregnancy C3 was positively associated with insulin, HO-MA-IR, triglycerides, total cholesterol, and LDL cholesterol (P < 0.001), and negatively associated with HDL cholesterol (P = 0.009). Late pregnancy C3 was positively associated with insulin, triglycerides, total cholesterol, LDL cholesterol, and C-peptide (P < 0.05). C3 and CRP were both negatively associated with HDL cholesterol (P = 0.037, P = 0.009, respectively). Regarding the intervention, there was a significant difference in the change from early to late pregnancy in maternal insulin concentration (P = 0.024), insulin resistance (P = 0.047) and C-peptide (P = 0.044). Total cholesterol in cord blood was also significantly lower in the intervention group (P = 0.01).

Conclusion

Increased inflammation was associated with poorer metabolic health in this cohort. Our findings also suggest that a healthy lifestyle intervention package with a smartphone-app, delivered during pregnancy, may improve metabolic health of pregnant mothers with overweight and obesity, and potentially the health of the offspring. These findings may prove useful in treatment of high-risk obstetric groups.

Obes Facts. 2018 May 26;11(Suppl 1):242–243.

T4P16 The Impact of Being Overweight and Obese on Patients with Sepsis

Y Lin 1

Introduction

About 25% of adults admitted to intensive care units in the United States(US) have overweight and obesity, while sepsis is commonly the cause for admission. Although obesity reduces overall lifespan, it is unclear whether it also impacts the outcome of critically ill patients in general, or with sepsis specifically. According to Pepper et al studies (n = 7165 patients) that overweight and obesity can decrease ICU mortality but high heterogeneity is seen across studies. This study aims to determine the impact of being overweight and obese on sepsis patients, by conducting a population-based 1:1:1 propensity score (PS) matched cohort study.

Methods

Using the Nationwide Readmission database of the US from 2013 to 2014, we identified patients hospitalized with sepsis. We define sepsis by either implicit ICD-9 CM codes for both infection and acute organ dysfunction or explicit ICD-9 CM codes for severe sepsis, septicemia, or septic shock. Hospitalized patients with sepsis were categorized into normal, overweight (BMI ≥25 and < 30), and obese (BMI ≥30). To minimize baseline imbalance between patients with different body weight, we carried out PS-matched analysis, using 1:1:1 PS matching technique. PS contains 41 variables including demographics, social economic status, chronic comorbidities, and severity of sepsis. We assess the association between body weight and 30-day in-hospital mortality by univariate Cox proportional-hazards model stratified on the PS-matched pairs.

Results

A total of 3,712,763 sepsis hospitalization episode fulfilled the inclusion criteria, of which 52,101 were overweight, 511,140 were obese, and 3,149,523 were normal weight. Compared with normal weight patients, overweight (hazard ratio [HR], 0.77; 95% CI, 0.73–0.81) and obese (HR, 0.78; 95% CI, 0.77–0.80) patients were associated with an improved survival in the 1:1:1 PS-matched cohort. 30-day readmission rate were also lowered for overweight and obese patients, but total cost of hospital stay were highest in obese patients (Table 1). To investigate whether there was a differential risk of 30-day mortality among different obese populations, we stratified patients into different subgroups (Figure 1). In general, the effect of obesity on mortality is consistent among different subgroups.

Conclusion

Using a large and nationally representative sample of over 1,000 hospitals in the US, we found that increase in BMI was significantly associated with improved survival and lowered readmission among hospitalized patients with sepsis. Our results suggest that BMI may be used for risk stratification of patients with sepsis.

Fig. 1.

Fig. 1

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Risk of 30-day mortality in different patient subgroups in obesity vs. normal weight patients. HR refers to hazard ratio, LCL refers to lower confidence interval and UCL refers to upper confidence interval.

Tab. 1.

Comparison of sepsis related outcomes after three-way propensity score matching

Normal Weight, N = 23686 Overweight patients, N = 23686 Obese patients, N = 23686 P-value
Inhospital mortality y, No. (%) 3336 (14.08%) 2664 (11.25%) 2598 (10.97%) <.0001
Length of hospital stay, median (IQR), Days 8(5,14) 8(5,14) 9(5,15) <.0001
Readmission within 30 days 2114 (8.93%) 1914 (8.08%) 2039 (8.61%) 0.0040
Total cost of hospital stay, median (IQR), USD 13794(7325,28927) 15265 (8290, 30239) 16246(8625,33086) <.0001
Cost per day for hospital stay, median (IQR), USD 1748(1263,2498) 1853(1331, 2599) 1836(1324,2600) <.0001
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Obes Facts. 2018 May 26;11(Suppl 1):243.

T4P17 The comparative effects of intermittent versus continuous energy restriction on body weight and dietary intakes among obese patients within a NHS Tier 3 weight management setting

R Antoni 1, KL Johnston 2, C Steele 3, D Carter 3, MD Robertson 1, M Capehorn 3

Introduction

Weight-loss through continuous energy restriction (CER) has notoriously poor outcomes. Intermittent energy restriction (IER) as a method of weight loss has attracted considerable attention because short spells of severe energy restriction alternated with days of habitual intake may be easier to follow. This is the first intervention trial comparing IER versus CER for weight loss and dietary intakes in obese patients registered with an NHS tier 3 weight management setting –Rotherham Institute for Obesity (RIO).

Methods

200 (n = 47 male) obese patients who had been referred via their GP to the RIO weight loss clinic, volunteered to participate and in accordance with standard RIO care were allowed to choose which of the two dietary intervention they wished to follow. The IER intervention was a formula based very low-energy diet (LighterLife Fast) consisting of 2638 kJ two days per week alongside five days unrestricted healthy eating (n = 100) and the CER intervention was a healthy daily diet 2510 kJ below estimated energy requirements (n = 100). Anthropometry and dietary intakes were measured before and during a 24-week intervention period. Completer data were analysed using repeated measures ANOVA (for between group comparisons) and paired t-tests (for within-group comparisons).

Results

27 IER patients and 39 CER patients completed the study. Body weight data are presented in Fig 1. Mean (SEM) weight-loss loss was greater in the IER group (5 ± 1%) relative to the CER group (3 ± 1%) (p = 0·001). Dietary intake data are presented in Table 1. By week 24 of the intervention period, reductions in energy intake tended to be greater in the IER group (p = 0.076), with similar trends noted for carbohydrate (p = 0.029), sugars (p = 0.037), fat (p = 0.081) and salt (p = 0.028). groups during the intervention are underway as well as the impact of this six month weight loss intervention on participants longer-term weight loss maintenance.

Conclusion

The IER intervention facilitated greater weight-loss than CER and this is in accordance with the dietary intake data which showed significant reductions in energy and macronutrient intakes compared with the CER group. Further investigations into the dietary quality of both

Conflicts of Interest

Kelly Johnston is employed by LighterLife UK Ltd. Matthew Capehorn is a consultant for LighterLife UK Ltd. Some financial support towards the running costs of the trial were provided by LighterLife UK Ltd.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):243.

T4P18 Hepatic Steatosis and Steatohepatitis Are Significantly Associated with Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes

JH Lee 1, Y Lee 2, H Shin 3, Y Shin 4

Introduction

Relationship between hepatic steatosis or fibrosis and cardiac dysfunction in relation to insulin resistance has been poorly understood. We aimed to investigate whether hepatic steatosis or fibrosis is associated with left ventricular (LV) diastolic dysfunction in patients with type 2 diabetes (T2DM).

Methods

We studied 454 patients with T2DM, aged 55 years or older (men 22.0%, mean age 64.9 years old), who had undergone liver ultrasonography, pulsed-wave doppler echocardiography, short insulin tolerance test (SITT), and bioimpedance analysis. Simple hepatic steatosis and steatohepatitis were sonographically defined in the presence or absence of fibrosis according to NAFLD fibrosis scores. Diastolic dysfunction was defined by using peak early (E) to late (A) ventricular filling ratio (E/A) and E-wave deceleration time (DT).

Results

Of 454 patients, 284 (62.6%) had hepatic steatosis, and 273 (60.1%) had diastolic dysfunction. The prevalence of diastolic dysfunction progressively increased according to the presence of hepatic steatosis or fibrosis (52.9%, 62.0%, and 65.3%; normal, simple steatosis, and steatohepatitis, respectively; P for trend < 0.05). Multivariate logistic regression analysis showed significant association between diastolic dysfunction and hepatic steatosis (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.02–3.90, P < 0.05), after adjusting for glycometabolic parameters, abdominal fat percentages, and SITT. Furthermore, subjects with steatohepatitis had a significantly higher odds for diastolic dysfunction (OR = 2.06, 95% CI = 1.04–4.11, P < 0.05) compared to subjects with normal or simple steatosis. However, this association was attenuated when SITT was added to the model.

Conclusion

In conclusion, hepatic steatosis and steatohepatitis are independently associated with LV diastolic dysfunction in older adults with T2DM, and insulin resistance is a significant confounding factor.

Obes Facts. 2018 May 26;11(Suppl 1):244.

T4P19 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):244.

T4P20 Multispecies probiotic supplementation exerts dose-dependent effect on anthropometric parameters and metabolic profile in obese postmenopausal female patients

M Szulińska 1, M Kręgielska-Narożna 1, K Skrypnik 2, D Skrypnik 1, J Suliburska 2, M Sobieska 3, I Łoniewski 4, P Bogdański 1

Introduction

Gut microbiota exerts a range of effects on human health state. However, its influence on cardiovascular health in obesity remains unknown. The objective of the study was to determine the effects of multispecies probiotic supplements on metabolic parameters and risk factors for cardiovascular diseases in obese postmenopausal female subjects.

Methods

120 women with body mass index (BMI)≥ 30 kg/m2 were enrolled and randomly assigned to receive multispecies probiotic: 2,5×109CFU daily (low dose group - LD); 1×1010CFU daily (original group-O) and placebo – P for 3 months. Anthropometric parameters: body mass, BMI, waist, % fat, kg fat, total body water (TBW), visceral and subcutaneous fat were quantified at baseline and at completion of the trial. Also at baseline and after 3-months intervention blood samples were collected and serum lipids profile (total cholesterol- TCH, low-density lipoproteins- LDL, high-density lipoproteins- HDL, triglycerides- TG), glucose, insulin and uric acid levels were determined and HOMA-IR was calculated.

Results

Analyzing studied parameters in original group before and after intervention, significant decreases in following parameters were observed: kg fat (p < 0.03), subcutaneous fat (p < 0.0002), waist (p < 0.01), total cholesterol (p < 0.0019), TG (p < 0.014), LDL (p < 0.01), glucose (p < 0.0001), insulin (p < 0.001), HOMA-IR (p < 0.0004), uric acid (p < 0.0001). Similar alterations were observed in low dose group, except uricacid, TG, and glucose level. No significant changes in the registered parameters were observed in the placebo group. When the mean changes were compared between the three groups there were significant differences in visceral fat (p < 0.0001), glucose (p < 0.017), insulin (p < 0.0001), HOMA-IR (p < 0.0001), uric acid (p < 0.0009). In term of the mean changes of studied parameters following significant differences between original and low dose groups were found: glucose (p < 0.0008), insulin (p < 0.0155), HOMA-IR (p < 0.0008), uric acid (p < 0.0016).

Conclusion

In this randomized, placebo-controlled, double-blind, 12-weeks intervention was observed that supplementation with multispecies probiotic favorably affects glucose metabolism, lipid profile, decreases waist circumference, visceral fat and serum uric acid level in obese post-menopausal women. The multispecies probiotic supplements appears to be useful in cardiometabolic diseases prevention for obese patients.

Obes Facts. 2018 May 26;11(Suppl 1):244.

T4P21 Differential effect of a very low-calorie ketogenic (VLCK) diet or bariatric surgery on circulating FGF21 in obese patients

AB Crujeiras 1, D Gomez-Arbelaez 2, MA Zulet 3, MC Carreira 1, I Sajoux 4, D De Luis 5, AI Castro 1, M Macias-Gonzalez 6, D Bellido 7, FJ Tinahones 8, JA Martínez 9, FF Casanueva 1

Introduction

Fibroblast growth factor 21 (FGF21) has been suggested to be an endocrine signal of nutritional status and an active regulator of metabolism. However, there is no agreement on the effect of weight-loss therapies on circulating levels of FGF21 in humans. The objective of this study was to assess FGF21 circulating levels in adiposity excess and after different weight-loss strategies prescribed in five different groups from four independent centers.

Methods

Body composition, ketosis, insulin sensitivity and FGF21 were evaluated in 181 excess body weight and 14 normal-weight subjects. From the excess body weight patients, two independent groups (discovery cohort; n = 20 and validation cohort; n = 28) undertook a very low-calorie ketogenic (VLCK) diet, a third group followed a low-calorie (LC) diet (n = 84) and other two groups underwent bariatric surgery (discovery cohort; n = 24 and validation cohort; n = 25). The follow-up was 4 to 6 or 12 months, respectively.

Results

FGF21 levels were higher in excess body weight patients than in normal-weight subjects. The energy-restriction therapy to lose weight induced a significant decrease, with respect to baseline, in circulating levels of FGF21 (VLCK: −62.5 pg ml-1 or -14.8 pg ml-1 and LC diet: −67.9 pg ml-1). There were no differences in FGF21 levels between both energy-restriction treatments. On the contrary, after bariatric surgery morbidly obese patients showed a significant increase in FGF21, especially 1 month after surgery (148.8 pg ml-1 higher than baseline). The FGF21 differential changes occur concomitantly with a non-induced ketosis situation (0.66 ± 0.56 mm) in bariatric surgery, and an improvement in adiposity and insulin sensitivity induced by the three therapies.

Conclusion

FGF21 levels were reduced after energy-restricted treatments and severely increased after bariatric surgery, independently of the weight reduction magnitude, insulin sensitivity or ketosis. Therefore, FGF21 appears to be a marker of severe nutritional stress.

Conflicts of Interest

ABC, DG-A, DB, FJT and FFC received advisory board fees and or research grants from Pronokal Protein Supplies Spain. IS is Medical Director of Pronokal Spain. The remaining authors declare no conflict of interest.

Obes Facts. 2018 May 26;11(Suppl 1):245.

T4P22 Early improvement in liver parameters after laparoscopic sleeve gastrectomy for morbid obesity

A Sirbu 1, E Sava 1, I Soare 2, S Martin 2, C Barbu 2, B Smeu 3, C Copaescu 4, S Fica 2

Introduction

Severe obesity is associated with various degrees of hepatic disfunction, with hepatic steatosis having a projected incidence of 60–90%. Bariatric surgery is associated with important weight loss and a significant reduction in steatosis prevalence and improvement of liver function. The aim of our study was to investigate if the impact of weight loss on liver parameters can be identified as early as 6 months after surgery and to identify factors associated with this improvement.

Methods

We evaluated 241 (157 women) severely obese patients (mean age = 41.82 ± 11.04 years, mean preoperative BMI = 44.52 ± 8.49 kg/m2), before and approximately 6 months after sleeve gastrectomy. Anthropometric markers (weight, height, waist and hip circumference) were recorded and a comprehensive battery of metabolic and hepatic parameters were measured. Hepatic ultrasound was performed by the same investigator and liver size, as well as the degree of hepatic steatosis, were determined

Results

After 6 months, mean BMI decreased to 31.85 ± 6.74 kg/m2 (mean excess body weight EBW reduction: 73.58 ± 22.9%). This was accompanied by a significant improvement in all metabolic parameters (HOMA-IR: 4.39 ± 4.62 vs 1.16 ± 1.02; total cholesterol: 206.38 ± 40.75 mg/dl vs 190.81 ± 38.18 mg/dl; HDL-cholesterol: 49.57 ± 12.70 vs 51,22 ± 11.12 mg/dl, triglycerides: 158.54 ± 77.98 mg/dl vs 104.56 ± 48.8 mg/dl, p < 0.05 for all). Out of 152 (63%) patients initially diagnosticated with moderate or severe steatosis, only 24 (16%) remained in the same condition after 6 months. We also noticed a significant decrease in liver enzymes level (mean reduction: AST:24.03 ± 32.08%; ALT:34.29 ± 51.03%; GGT:45.10 ± 31.98%, p < 0.01 for all), as well as in liver size (right lobe AP diameter: from 168 ± 20.73 mm to 149.03 ± 15.62 mm; left lobe diameter from 89.23 ± 15.8 mm to71.99 ± 12.73 mm). Variation of liver enzymes levels was significantly corelated with BMI decrease (r = 0.145 for AST, r = 0.277 for GGT; p < 0.05) as well as triglyceride's decrease (r = 0.292 for AST, r = 0.304 for GGT). Interestingly, change in liver size was not associated with the amount of weight loss but with HOMA variation (r = 0.177 for right lobe, r = 0.174 for left lobe, p < 0.05)

Conclusion

Sleeve gastrectomy is associated with an early improvement in liver functional parameters as well as in hepatic size and the degree of liver steatosis. The causal relationship between this amelioration and the change in metabolic factors needs further investigations

Obes Facts. 2018 May 26;11(Suppl 1):245.

T4P23 Autopsy findings of a non-diabetic severe obese patient with intractable obesity-related cardiomyopathy and glomerulopathy treated with laparoscopic sleeve gastrectomy

H Imamura 1, A Saiki 1, R Kanai 1, K Hayashi 1, T Oshiro 1, N Hiruta 1, I Tatsuno 1

Introduction

Severe obese patients with heart and renal failure are often encountered even though they have no metabolic disorders. Obesity-related cardiomyopathy and glomerulopathy are specifically shown in obese patients. Bariatric surgery is an option to improve these comorbidities. However, heart and renal failure are important causes of death in severely obese patients. This case report showed the clinical course of a non-diabetic obese patient with treated with laparoscopic sleeve gastrectomy (LSG), who died of severe obesity-related cardiomyopathy and glomerulopathy, and the autopsy findings of these comorbidities.

Methods

A 49-yaer-old man admitted to our hospital for treatment of heart and renal failure. Since 33 years old, he increased BW and repeated hospitalization due to heart failure without coronary artery disease. He had no diabetes and hypertension. At first visit, his BW was 186.9 kg and BMI was 62.5. Chest XP showed congestive heart failure and echocardiography showed dilated cardiomyopathy-like heart with 25% of ejection fraction. Serum Cr was 1.64 mg/dl, eGFR was 37 ml/min/1.73m2 and severe proteinuria was observed. Clinical diagnosis was obesity related-cardiomyopathy and glomerulopathy, and weight-loss treatment was planned. Under hospitalization, his BW drastically decreased with the improvement in cardiac and renal function. However, weight regain with aggravating these comorbidities was observed after discharge, therefore, LSG was performed after 4 months of first visit. After 6 months of surgery, BW and serum Cr decreased to 125.5 kg and 1.08 mg/dl, respectively. There was no dyspnea whereas cardiac function was still low. After 9 months of surgery, his BW gradually increased with decrease in cardiac function. His comorbidities were never responded to any intensive care treatment. He died from multiple organ failure after 12 months of surgery.

Results

The autopsy was performed. Fat accumulation in the renal pelvis, cortical atrophy and curability change were observed. The glomerulus was enlarged, curable lesions similar to focal glomerulosclerosis and renal tubular necrosis were observed. These findings were compatible with obesity-related glomerulopathy. Enlarged heart with thin walls, less pericardial fat and the heart weighed 940g, which was three times higher than normal, were observed. Any plaques and infarction in coronary arteries were not observed. Nucleus enlargement and various sizes of myocardium stained with HE were observed. There are many collagen fibers in the whole myocardium by Azan Mallory staining. Intercellular lipid accumulation in the heart was conspicuous. These findings were not inconsistent with obesity related-cardiomyopathy. Furthermore, any atherosclerotic plaques in the aorta were not observed.

Conclusion

This case indicates that severe obesity may lead to obesity-related cardiomyopathy and glomerulopathy without diabetes, hypertension and any atherosclerotic diseases. And medical and surgical weight-loss treatment may improve these comorbidities, although the effectiveness was transient. In autopsy findings of the heart, intercellular lipid accumulation and less pericardial fat indicate that there may be some sort of abnormal lipid metabolism in obesity-related cardiomyopathy.

Obes Facts. 2018 May 26;11(Suppl 1):245–246.

T4P24 Protein intake and its effect on weight loss among obese patients underwent Rou-En-Y gastric bypass and laparoscopic sleeve gastrectomy surgery in Khoo Teck Puat Hospital, Singapore

H Cheng 1, CS Tan 1, A Cheng 2

Introduction

Adequate protein intake post bariatric surgery is emphasized to preserve lean body mass and to promote weight loss. As per clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical of the bariatric surgery patient 2013 updates, it recommends minimal 60g protein intake and up to 1.5 g/kg ideal body weight (IBW) per day. This study aims to investigate protein intake and its effect on weight loss among patients underwent bariatric surgery in Khoo Teck Puat Hospital (KTPH), Singapore.

Methods

A total of 60 patients who underwent Rou-En-Y gastric bypass (RYGB) and laparoscopic sleeve gastrostomy (LSG) in KTPH from January to December 2016 were retrospectively studied. Body weight, height and dietary recall were collected for each patient. Data were collected at different time points: pre-surgery, 2 weeks, 6 weeks, 3 months, 6 months, 9 months and 12 months post-surgery. Weight loss (WL), percentage of excess weight loss (%EWL) and daily protein intake were subsequently calculated. Patients were divided into 2 protein intake groups: < 60g/d and ≥60g/d, means of WL and %EWL were compared between two groups at each time point.

Results

Among the 60 patients, 40(67%) were females with the mean age of 41.8 ± 10.7 years old. Majority patients (n = 23, 38%) were Malay race. 38(63%) patients underwent RYGB and 22(37%) patient underwent LSG. Pre-surgery, the mean BW was 113.4 ± 29.4 kg with mean BMI of 41.8 ± 9.1kg/m2. Dietitian follow up rate was 92%, 82%, 47%, 33% and 12% at 2 weeks, 6 weeks, 3 months, 6 months, 9 months and 12 months respectively. Mean daily protein intake were 44.1 ± 25.5g, 45.9 ± 25.6g, 51.9 ± 25g, 54.0 ± 14.5g, 62.6 ± 15.7g, 64.5 ± 18.6g, percentage of patients had ≥60g/d were 24%, 27%, 29%, 40%, 65% and 71% at 2 weeks, 6 weeks, 3 months, 6 months, 9 months and 12 months respectively. Although an increase trend of protein intake was noted, more than 50% of patients failed to meet 60g protein intake per day at 2 weeks, 6 weeks, 3 months and 6 months. The mean WL for < 60g/d and ≥60g/d group were 8.4 ± 3.4kg and 8 ± 3.7kg, 12.9 ± 3.9kg and 11.2 ± 4.2kg, 17.8 ± 4.5kg and 22 ± 5.1kg, 20.6 ± 8.4kg and 25.4 ± 8.7kg, 29.9 ± 12.5kg and 26.4 ± 11.9kg, 23.8 ± 3.7kg and 29.3 ± 3.3kg at 2 weeks, 6 weeks, 3 months, 6 months, 9 months and 12 months respectively. The mean %EWL for < 60g/d and ≥60g/d group were 17 ± 5.2% and 16.4 ± 6.3%, 27.2 ± 9.8% and 27.9 ± 11.6%, 39.4 ± 13.4% and 42.8 ± 11%, 46.3 ± 13.2% and 58.4 ± 17.6%, 56.9 ± 12.8% and 53.8 ± 27%, 64.2 ± 1.8% and 57.9 ± 14.9% at 2 weeks, 6 weeks, 3 months, 6 months, 9 months and 12 months respectively (refer Figure 1&2). Higher mean weight loss was observed at 3 months, 6 months and 12 months, higher mean %EWL was observed at 6 weeks, 3 months and 6 months in >60g/d group. However, no significant differences were detected in WL and %EWL between two protein intake groups at each time points (p < 0.05).

Conclusion

Higher protein intake group was found to have better weight loss outcome at certain time points, but no significance difference was detected. This study was limited due to small sample size, and it was not powered to detect difference. On-going research with larger sample size is needed. Also, majority of patients failed to meet the protein recommendation 60g/d, emphasising strategies in increasing protein intake in the first 6 months post-surgery may be particularly important.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):246.

T4P25 Fat mass and distribution predicting metabolic outcome and weight loss after Roux-en-Y gastric bypass

D J Eriksson Hogling 1, M Rydén 1, J Bäckdahl 1, A Thorell 2, P Arner 1, DP Andersson 1

Introduction

Bariatric surgery, including Roux-en-Y Gastric Bypass (RYGB), is still the most effective treatment of obesity and associated comorbidities. Body fat distribution associates with metabolic function, with visceral obesity being unfavorable. We aimed to investigate if pre-operative body fat mass and distribution measured by dual-energy X-ray absorptiometry (DXA) predict weight loss and metabolic outcome after RYGB, and if DXA provides additional information compared with simple anthropometric measures.

Methods

We included 215 women scheduled for RYGB. Clinical evaluations were performed before and two years after RYGB; including determination of insulin sensitivity by the homeostatic model assessment of insulin resistance (HOMA-IR), blood pressure, plasma lipids and anthropometric measures including body mass index (BMI), waist circumference, waist-to-hip-ratio (WHR) and fat percentage estimated by a formula. Body fat mass and distribution, including estimated visceral adipose tissue mass (EVAT), were determined by DXA.

Results

Two years after surgery 166 patients (77.2%) were followed-up. Clinical and anthropometric measures and fat depots (including EVAT/total and android/gynoid (AG) fat mass ratios) improved after RYGB (all P < .0001). Baseline AG-ratio and WHR predicted improved HOMA-IR (P = .0028 and .0014, r2 .056 and .063), independently of BMI and age. Body fat percentage, measured by DXA or estimated by formula, predicted % weight loss (%WL, P < .0001 and .0083, r2 .09 and .042). Baseline BMI associated with %WL and % excess BMI lost (P = .0022 and < .0001, r2 .056 and .10).

Conclusion

Body fat distribution is altered favorably after RYGB. AG-ratio and WHR predict improved insulin sensitivity two years after RYGB. Fat percentage, DXA measured or estimated by formula, predicts %WL. Baseline BMI predicts weight loss. DXA provided predictive values similar to those obtained using simple anthropometric measures, indicating that DXA has limited additional value for prediction of improved insulin sensitivity and weight loss.

Obes Facts. 2018 May 26;11(Suppl 1):246–247.

T4P26 Long-term outcomes of laparoscopic adjustable gastric banding for morbid obesity from a single centre

SS Ching 1, ASY Wong 1

Introduction

In our institution, the laparoscopic adjustable gastric banding (LAGB) procedure was performed for morbid obesity from the year 2000 to 2009. This procedure is currently no longer offered for the treatment of morbid obesity due to its disadvantages and possible complications. It has since been replaced by laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass procedures in our institution. The long-term results of LAGB are reviewed for its efficacy in weight loss and improvement in metabolic disorders.

Methods

Data were prospectively collected on all patients who had undergone LAGB in our institution. The patients’ demographics, duration of follow-up, absolute weight loss (AWL), percentage of excess weight loss (%EWL), body mass index (BMI) changes and improvement/remission of metabolic disease were analysed for up to 10 years after LAGB.

Results

Thirty-one patients underwent LAGB as a primary bariatric surgery procedure from September 2000 to August 2009. There were 5 males and 26 females, aged between 23 and 63 (mean 39.3) years, and BMI ranged from 29.1 to 53.6 kg/m2. The cohort consisted of 9 Chinese, 7 Malays, 6 Indians and 9 from other ethnic groups. There was no perioperative complication. The mean follow-up duration was 64 months, with 14 patients (45%) completed 5 years follow-up and 9 patients (29%) completed 10 years follow-up. The mean AWL was 22 kg at 5 years and 9 kg at 10 years. The mean %EWL was 48% at 5 years and 24% at 10 years. The mean BMI reduced from 40.6 kg/m2 pre-operatively to 31.6 kg/m2 at 5 years and 36.5 kg/m2 at 10 years. Six patients had preoperative type 2 diabetes mellitus. Of these, two were in remission, two had improvement in the disease control and required lower number of medications, one had no improvement at all, and one patient was lost to follow-up after LAGB. Only 1 out of 11 patients with hypertension had not required continued medical treatment after LAGB. All of the 7 patients who were on medication for hyperlipidaemia continued to be prescribed statin during follow-up. Delayed complications include anterior slippage of band (n = 4), gastric pouch dilatation (n = 6), oesophageal dilatation (n = 6), and gastro-oesophageal reflux symptoms (n = 6). There were no patients who developed band erosion or port site infection. Five patients (16%) had their gastric band removed between 2.5 and 8.6 years. Among these, one had band slippage with dilated gastric pouch and oesophagus, one had hiatal herniation of the gastric pouch with oesophageal dilatation, one had oesophageal dilatation and pseudoachalasia with reflux symptoms, and one had reflux symptoms only. Another two patients (6%) required repeat surgery, one was for readjustment of port-site connector leakage at 7 months and the other underwent repositioning of a flipped gastric banding port at 4 months due to failure of an anchoring suture.

graphic file with name ofa-0011-0001-gu01.jpg

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Conclusion

The long-term results of LAGB were poor to modest for weight loss, and poor for remission or improvement of the obesity related metabolic disorders. The side effects of dysphagia, reflux symptoms, gastric pouch and oesophageal dilatation from LAGB were common. Anterior slippage of the band was also common. These side effects and complications were treated by removal of the band in 16% of patients. LAGB was no longer being offered since 2010.

Obes Facts. 2018 May 26;11(Suppl 1):247.

T4P27 Long-term incidence of hospitalizations due to fall-related injuries after bariatric surgery in Swedish Obese Subjects

K Sjöholm 1, LM Carlsson 1, S Ahlin 1, P Jacobson 1, J Andersson-Assarsson 1, L Karlsson Lindahl 1, C Maglio 1, C Karlsson 1, S Hjorth 1, M Taube 1, B Carlsson 1, P Svensson 1, M Peltonen 2

Introduction

Obesity is associated with increased risk of falling, but the effect of bariatric surgery on fall-related injuries is unknown.

Methods

We used registers to determine the incidence of fall-related injuries and conditions associated with falling in the nonrandomized prospective controlled Swedish Obese Subjects study. Twenty-five surgical departments and 480 primary health care centers participated in the study. At inclusion, body-mass index was ≥34 kg/m2 in men and ≥38 kg/m2 in women. The surgery per-protocol group (n = 2007) underwent gastric bypass (n = 266), banding (n = 376) or vertical banded gastroplasty (n = 1365), and controls (n = 2040) received usual care. At the time of analysis (December 31, 2013), median follow-up was 19 years (maximal 26 years).

Results

There were 1130 first time falls with higher incidence in the surgery group than in controls (adjusted hazard ratio (adjHR 1.21, 95% CI, 1.07 to 1.36; P = 0.002). The incidences differed between treatment groups (P < 0.001, log-rank test) and were lower after usual care, banding and vertical banded gastroplasty than after gastric bypass (adjHRs 0.50–0.52, P < 0.001 for all three comparisons). Compared to gastric bypass, the other three groups had lower incidences of micronutrient-related neurological complications (adjHRs 0.60–0.70; P≤0.005), hypoglycemia-related events (adjHRs 0.44–0.57; P≤0.007) and substance abuse (adjHRs 0.31–0.50; P≤0.003). The incidence of fall-related injuries was higher in participants who were exposed to these risk factors compared to those who were not (adjHRs between 1.97–2.59; P≤0.005).

Conclusion

Gastric bypass was associated with increased risk of injurious falls requiring hospital treatment and higher incidence of conditions that increase risk of falling. Healthcare professionals in all disciplines should be aware of these side effects so that the link between falls and gastric bypass is recognized and preventive measures can be taken.

Conflicts of Interest

LMSC has obtained lecture fees from AstraZeneca, Johnson&Johnson and MSD. BC and CK are employed by AstraZeneca and hold stocks in the same company. SH holds stocks in AstraZeneca. MT holds stocks in Umecrine AB, and has a patent licensed to Umecrine AB.

Obes Facts. 2018 May 26;11(Suppl 1):247–248.

T4P28 Real world evidence data on losing weight with Liraglutide treatment in patients who regained weight after their bariatric surgery at Glycemia clinic/Kuwait

A Shaghouli 1, R Aranky 2

Introduction

Obesity has become a global health problem that contributes to numerous life-threatening diseases.1 It is one of the most important underlying risk factors for chronic disease. Body mass index of 30 kg/m2 or more is used to classify individuals with obesity.2 According to World Health Organization, in 2016 there were over 1.9 billion overweight adults worldwide with 650 million adults were obese.3 Patients with obesity seek treatment through a different commercial, medical and surgical approaches.4 Studies suggest that currently, bariatric surgeries (BS) offer the best and most effective treatment to produce sustained weight loss in patients who are obese.5 However, Weight regain was observed within 24 months after surgery in approximately 50% of patients.6 Liraglutide, has proven to reduce body weight by 5 to 10% in a population of obese patients7, yet there is no enough evidence on the effect of Liraglutide on patients who regained weight post BS.8,9

Methods

A retrospective case study was done on patients who have undergone bariatric surgeries, regained weight and then attended Glycemia Clinic in order to lose weight. Patients were given Liraglutide injections, a once-daily human GLP-1 analogue, dosage between 0.6 up to 3mg/day for weight loss with lifestyle management. Patients follow up in the clinic in 2 to 3 weeks.

Results

Patients, who have done different bariatric surgeries, have experienced further weight reduction after using Liraglutide. Average weight reduction in 3 months: 6.8% Average weight reduction in 6 months: 9.9% Average weight reduction in 9 months: 9.5% Average weight reduction in 12months: 10.2% Average weight reduction in 15 months: 14.8% Diabetic patients who were involved in the study showed reduction in HbA1c levels by 1.37%

Conclusion

Despite the successful results patients reach post bariatric surgeries, many patients re-gain weight after 2 years, using Liraglutide Injection experienced a good percent of weight reduction and maintained it for almost 15 months according to available data till date.

Obes Facts. 2018 May 26;11(Suppl 1):248.

T4P29 Outcome and risks of surgical reintervention for weight regain after RYGB

DM Felsenreich 1, F Langer 1, M Eilenberg 1, M Arnoldner 2, G Prager 1

Introduction

Weight regain occurs after Roux-en-Y gastric bypass (RYGB) in a significant number of patients. As dietary counseling is successful in only some of them, surgical reinterventions, performed as common limb reduction (CLR), pouch banding (PB), pouch remodeling (PR) and as a combination of these procedures might be more successful. PR was defined as pouch resizing, rebuilding of the anastomosis or resection of the blind limb. The aim of this analysis is to assess the outcome and the risks of these interventions.

Methods

In a total number of 65 patients, surgical reinterventions for weight regain after RYGB were common limb reduction (n = 22), pouch banding (n = 35), and pouch remodeling (n = 8). Within these main groups, some patients had an additional procedure: 11 common limb reduction patients had PB, another 3 had PR and 26 of the pouch banding patients additionally had PR.

Results

In a total of 6 patients (27%) in the CLR group, severe malnutrition led to revisional surgery to increase alimentary and common limb length. 6 PB patients (17%) had to have their pouch band removed due to stenosis and vomiting. In total, 5 out of the 65 (8%) participating patients needed an additional malabsorptive procedure. The final follow-up rate as well as data on patients’ weight development are currently being reviewed and will be presented by the time of the congress.

Conclusion

The methods of CLR, PB, PR and a combination of them may successfully induce additional weight loss, however, they may also cause the need for further surgical interventions. Thus, they should only be performed in experienced bariatric centers. A final Conclusion, including a comparison of these methods based on data on patients’ weight development, has yet to be drawn.

Obes Facts. 2018 May 26;11(Suppl 1):248.

T4P30 Favorable effect of metabolic surgery on cardiorespiratory fitness regardless of the existance of type 2 diabetes

S Polovina 1, I Nedeljkovic 2, D Micic 3, M Sumarac Dumanovic 1, M Rastovic 4, J Milin Lazovic 5, D Micic 6

Introduction

Improvement of cardiorespiratory fitness (CR) after metabolic surgery is one of the many positive effects of this therapy for extreme obese patients. Earlier studies have shown that improvement of CR parameters is less significant in T2DM compared to patients without T2DM. We have examined change in cardiorespiratory parameters according to patient's diabetic status 6 months after roux-en-Y gastric bypass (RYGB).

Methods

The group of 54 patients underwent RYGB was devided into two subgroups, with T2DM (n = 34; 70.4%) and without T2DM (n = 16; 29.6%). BMI, waist circumference, hip circumference, glucose, insulin levels and cardiorespiratory parameters were measured before and six months after RYGB.

Results

There was statistically significant decrease in BMI, waist and hip circumference, insulin, HOMA IR and HbA1c in whole group and in both subgroups (p < 0.001). Levels of glycaemia significantly decrease in whole group ((p = 0.040) and in diabetic subgroup (p = 0.005). There was statistical significant increase in VAT/VO2, peak Vo2, RER, Met parameters (p = < 0.001) 6 months after metabolic surgery. Rest HR, VAT Hr, max SBP, bas DBP, max DPB, and vevCO2sl (p < 0.05) were statistically significant lower 6 months after surgery. SBP bas was lower after the surgery but this difference was close to conventional level of statistical significance (p = 0.045). Max HR and proc VO2 did not change after surgery. There was no statistical significant interaction between changes in cardiorespiratory parameters and diabetes.

Conclusion

RYGB as restrictive and malabsorbtive bariatric/metabolic surgery procedure has favorable effect on cardiorespiratory fitness regardless of the existance of type 2 diabetes before surgery.

Obes Facts. 2018 May 26;11(Suppl 1):248–249.

T4P31 Postprandial Interstitial Glucose Response in Gastric Bypass and Duodenal Switch Patients

I Nilsen 1, A Haenni 2, M Sundbom 3, N Abrahamsson 4

Introduction

In patients with BMI ≥35 kg/m2, bariatric surgery, in combination with lifestyle treatment, provides substantial long-term weight loss and relief of comorbidities such as type 2 diabetes, cardiovascular disease, cancer in women, and all-cause mortality. However, there are also side effects such as episodes of postprandial hypoglycemia. Previously we reported that gastric bypass-operated (RYGBP) patients had much higher daily interstitial glucose variability than patients treated with duodenal switch (DS) (1). The aim of the present study was to investigate the effect of dietary intake on postprandial interstitial glucose (IG) levels in free living individuals by analyzing data from continuous glucose monitoring (CGM). 1. Abrahamsson, N., et al., Hypoglycemia in everyday life after gastric bypass and duodenal switch. Eur J Endocrinol, 2015. 173(1): p. 91–100.

Methods

RYGBP and DS patients were recruited at the outpatient Obesity unit, Uppsala University Hospital (Table 1). CGM (Medtronic Minimed IPRO-2) measures IG concentration every 10 second and presents the average value for every period of 5 minutes. CGM was registered for three days and postprandial IG values, i.e. 0–120 minutes after meals were analyzed. During the study period, patients were instructed to live and eat as usual and recording their intake of food and beverages in a food diary. The dietary records were processed by using The meal pattern questionnaire where meals are categorized as main meals, light meals, snack meals and drink meals.

Results

The preprandial IG was higher in the RYGBP-treated group compared to the DS group, 6.0 ± 1.6 vs 4.8 ± 0.9 mmol/L (p < 0.01). The postprandial IG was significantly higher in the RYGBP group during the entire period of 120 minutes, with a mean concentration of 6.3 ± 1.8 mmol/L compared to 5.0 ± 1.0 mmol/L in the DS group. The mean maximum values in the two groups were registered at a similar time point, 30–40 minutes after meal ingestion. The mean net increase in IG concentration was larger in RYGBP than in DS-patients 0.4 ± 1.4 vs 0.2 ± 0.6 mmol/L, and significantly during 30 – 90 minutes after meals (p < 0.01). The variability between individual IG differences was much more pronounced in RYGBP-treated patients than in DS-patients.

Conclusion

The variability in postprandial interstitial glucose response was more pronounced after RYGBP than DS. The RYGBP group showed significantly higher pre- and postprandial interstitial glucose concentrations as well as postprandial net increase. These differences, which could be due to the anatomical and hormonal differences between these two bariatric surgical Methods, might be of importance when discussing mechanisms behind episodes of postprandial hypoglycemia observed after bariatric surgery.

Tab. 1.

Patient characteristics, median (range)

RYGBP (n = 15) DS (n = 14)
Age (years) 46 (36–63) 42 (24–63)
Gender (female/male) 12/3 7/7
Years since surgery 1.5 (1.0–2.0) 1,9 (1,1–7)
BMI (kg/m2) 29 (26–38) 32 (26–38)
BMI loss (units kg/m2) 13 (7–17) 23 (9–27)
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Obes Facts. 2018 May 26;11(Suppl 1):249.

T4P32 Relationship of preoperative BMI to obesity-related comorbidities and psychosocial background in Japanese severely obese patients undergoing laparoscopic sleeve gastrectomy

A Saiki 1, T Yamaguchi 1, S Tanaka 1, N Ishihara 1, A Sasaki 2, T Naitoh 3, Y Seto 4, K Yokote 5, H Matsubara 6, S Okazumi 7, S Ugi 8, H Yamamoto 9, M Ohta 10, K Kasama 11, Y Seki 11, M Tsujino 12, H Shimizu 13, Y Miyazaki 14, I Tatsuno 1

Introduction

Japanese obese patients with obesity-related comorbidities such as type 2 diabetes are increasing similar to other countries, despite obese population is smaller in Japan. Bariatric surgery is still uncommon in Japan, on the other hand, laparoscopic sleeve gastrectomy (LSG) has become the main procedure due to the Japanese insurance system. Patient's background, the target comorbidities of LSG and the effectiveness may differ depending on preoperative BMI, however, the situation is still unclear in Japan. The aim of this study is to investigate the relationship of preoperative BMI to the comorbidities and background in Japanese obese patients undergoing LSG.

Methods

A retrospective study group Japanese Survey of Morbid and Treatment-Resistant Obesity (J-SMART) was established. In this study, 369 Japanese cases who underwent LSG at 10 bariatric institutions from January 2011 to December 2014 with a follow-up period of more than 2 years were enrolled. Patients whose BMI was 30–34.9 kg/m2 with at least one obesity-related comorbidity or more than 35 kg/m2 at the first visit and who were between 18 and 65 years old were included in this study.

Results

Mean characteristics at baseline were as follows: age, 46.9 years; male, 43.9%; body weight, 119.3 kg; BMI, 43.7 kg/m2; HbA1c, 7.07%; prevalence of type 2 diabetes, dyslipidemia and hypertension, 52.9%, 80.2% and 52.6%, respectively. Baseline BMI was divided into 4 groups (BMI of 30.0–34.9, 35.0–39.9, 40.0–49.9 and 50.0-). In lower BMI groups, high VFA/SFA ratio, high HbA1c, low serum C-peptide, worse lipid metabolism, high percentage of insulin, high number of antidiabetic, lipid-lowering and antihypertensive medications were shown. On the other hand, high uric acid, high apnea hypopnea index (AHI) in sleep apnea syndrome (SAS) patients, high prevalence of heart failure, joint disorders and SAS, low full IQ and performance IQ, low percentage of economic independence, marriage and regular exercise, and high percentage of childhood-onset obesity were shown in higher BMI groups. For 2 years after LSG, mean BMI and HbA1c were significantly decreased from 43.7 to 30.3 kg/m2 and 7.07 to 5.67%, respectively. Complete remission (CR) rate of diabetes in each BMI groups was 60.0, 71.2, 74.5 and 93.2%, respectively (p < 0.05). Remission rate of dyslipidemia and hypertension were also low in BMI of 30.0–34.9 (39.4 and 25.0%, respectively).

Conclusion

These results suggest that tendencies for the patients with preoperative higher BMI were high subcutaneous accumulation, mild metabolic abnormalities, high prevalence of joint disorders and SAS, low IQ and childhood-onset obesity. On the other hand, the tendencies for the patients with BMI less than 35 kg/m2 were visceral obesity, severe metabolic abnormalities and low remission rate of metabolic abnormalities after LSG.

Obes Facts. 2018 May 26;11(Suppl 1):249–250.

T4P33 Background characteristics and the low effectiveness on obesity-related comorbidities in Japanese obese patients with insufficient weight loss after laparoscopic sleeve gastrectomy

A Saiki 1, T Yamaguchi 1, S Tanaka 1, N Ishihara 1, A Sasaki 2, T Naitoh 3, Y Seto 4, K Yokote 5, H Matsubara 6, S Okazumi 7, S Ugi 8, H Yamamoto 9, M Ohta 10, K Kasama 11, Y Seki 11, M Tsujino 12, H Shimizu 13, Y Miyazaki 14, I Tatsuno 1

Introduction

Laparoscopic sleeve gastrectomy (LSG) leads to significant weight loss and the improvement of comorbidities in obese patients. Although bariatric surgery is still uncommon in Japan, LSG has become the main procedure due to the Japanese insurance system. However, insufficient weight reduction is not unusual after LSG and the characteristics is not fully investigated. The aim of this study is to clarify the obesity-related comorbidities and psychosocial background in obese patients with insufficient weight loss after LSG.

Methods

A retrospective study group Japanese Survey of Morbid and Treatment-Resistant Obesity (J-SMART) was established. In this study, 369 Japanese cases who underwent LSG at 10 bariatric institutions from January 2011 to December 2014 with a follow-up period of more than 2 years were enrolled. Patients whose BMI was 30–34.9 kg/m2 with at least one obesity-related comorbidity or more than 35 kg/m2 at the first visit and who were between 18 and 65 years old were included. Mean age, 46.9 years; male, 43.9%; body weight, 119.3 kg; BMI, 43.71 kg/m2; HbA1c, 7.07%.

Results

For 2 years after LSG, mean body weight and BMI were significantly decreased from 119.2 to 82.6 kg and 43.7 to 30.3 kg/m2, respectively. The percent of total body weight loss (%TWL) was 29.9%. HbA1c was significantly decreased from 7.07 to 5.67% and complete remission (CR) rate of diabetes (defined as no medication required and HbA1c < 6.0%) was 75.3%. Remission rate of dyslipidemia and hypertension were 59.7 and 41.8%, respectively. And VFA, SFA, lipid parameters, transaminases, urine albumin, number of medications, heart failure, SAS, menstrual disorder in female and joint disorders were also improved. To clarify the characteristics of patients with insufficient weight loss after LSG, 2-year %TWL was divided into 5 groups (%TWL of -14.9, 15.0–19.9, 20.0–24.9, 25.9–29.9 and 30.0-). In lower %TWL groups, preoperative HbA1c, number of antidiabetic and lipid-lowering medications, daily calorie intake, prevalence of joint disorders, mental disorder, mental retardation and developmental disorders were high. In higher %TWL groups, preoperative BMI, VFA, prevalence of SAS and AHI were high. Especially in %TWL of -14.9 group, CR rate of diabetes, remission rate of dyslipidemia and hypertension (57.1, 17.7 and 33.3%, respectively) were extremely lower and prevalence of mental disorder (54.6%) was extremely higher than other groups. Serum creatinine, urine protein, BP and prevalence of SAS decreased only in the patients with %TWL of 30.0- group.

Conclusion

There might be insufficient metabolic improvement and high prevalence of mental disorder in the patients with %TWL of less than 15 after LSG. On the other hand, %TWL of more than 30 could improve the renal function and SAS.

Obes Facts. 2018 May 26;11(Suppl 1):250.

T4P34 Multidisciplinary program for bariatric-metabolic surgery for the Bulgarian Public Health System

T Handjieva-Darlenska 1, K Grozdev 2, Z Kamenov 3, E Ivanova 4, O Georgiev 5, N Khayat 2, G Todorov 2, K Angelov 2

Introduction

Obesity is one of the greatest public health problems in the Bulgarian adult population. Bariatric-metabolic surgery is currently the gold standard treatment for severe and morbid obesity. In Bulgaria the access to surgery remains difficult. Our team was the first in the country to develop and apply a multidisciplinary program for bariatric-metabolic surgery.

Methods

From September 2016 we started to apply a multidisciplinary program for bariatric patients consisted of comprehensive preoperative evaluation including weekly consultations and proper examinations carried out respectively by surgeons, dietologists, psychiatrists, endocrinologists, cardiologists and pulmonologists. Six females and four males patients underwent laparoscopic bariatric procedure. Seven Roux-en-Y gastric bypass, two sleeve gastrectomies and one mini (omega) gastric bypass were performed. The mean age was of 44,3 +/- 12,2. The mean preoperative BMI was of 48,8 +/- 6,4 kg/m2 with a mean preoperative weight of 142,8 +/- 34,5 kg. The studied variables included hospital stay, intraoperative and early postoperative complications (within the first 30 days), mortality. %EWL (percentage of excess weight loss) and metabolic marker data were abstracted at 3 and 6 months postoperatively.

Results

T No intraoperative and early postoperative complications were registered. There was no mortality. The %EWL at 3 and 6 months was 41,5% and 53,9%. All metabolic markers showed improvement with complied type 2 diabetes resolution in three of three patients in one month.

Conclusion

Bariatric-metabolic surgery allows substantial short-term reduction in body weight and amelioration in the metabolic markers.

Obes Facts. 2018 May 26;11(Suppl 1):250.

T4P35 Five Year Anthropometric Outcomes After Bariatric Surgery

CEH Fang 1, O McAnena 2, MF Rafey 1, T O'Brien 1, C Collins 2, FM Finucane 1

Introduction

Medium term outcomes in Irish patients undergoing bariatric surgery for treatment of severe obesity are not well described. We sought to determine changes in weight, body mass index (BMI) and percentage excess body weight (%EBW) in patients with severe obesity who underwent bariatric surgery. A secondary objective was to determine the timing of the weight loss nadir after surgery.

Methods

We conducted a single-centre, retrospective cohort study, obtaining data relating to weight and height at the time of bariatric surgery and at subsequent clinic visits in 174 patients who underwent surgery in University College Hospital Galway between 2008 and 2017.

Results

Over ten years, 174 bariatric surgical procedures were performed in 128 females and 46 males with a mean age at surgery of 45.6 (range 21–72) years. 155 patients had sleeve gastrectomy, 18 had laparoscopic adjustable gastric banding and one had Roux en Y gastric bypass. Anthropometric measures at different time points up to five years are presented only for patients who continued to attend our bariatric service (Table 1). By five years, 66% of patients were lost to follow up, consistent with other studies.

Conclusion

Weight loss outcomes in our centre were consistent with those described elsewhere, with an absolute reduction of 75% in excess body weight by two years, in the 70% of patients who were still attending our service at that time. Longer term weight loss maintenance appears good. The weight loss nadir occurred between 12 and 24 months, as anticipated. The impact of these anthropometric changes on metabolic and health economic outcomes remains to be determined.

Obes Facts. 2018 May 26;11(Suppl 1):250–251.

T4P36 “A new life in a new body”: The evolution of pregnancy following bariatric surgery in obese females

M Velasquez 1, E Fidilio 2, M Guerrero 2, N Castillejo 1, M Comas 1, M Goya 3, O Gonzalez 4, J Mesa 1, C Hernandez 5, R Simo 5, A Ciudin 6

Introduction

Maternal obesity (MO) increases the risk of gestational and neonatal complications. Bariatric surgery (BS) is currently the most effective long-term treatment of MO. The sustained weight loss after BS reduces the risk of maternal comorbidities during pregnancy. Nevertheless, BS is associated with an important risk of nutrients deficiency, and some data indicate that might increase the risk of prematurity and low birth weight. The objective of the present study is to evaluate the evolution of the pregnancy ending with a living child following bariatric surgery in obese females following BS in our center.

Methods

We performed a retrospective observational study by reviewing the medical records of MO females that underwent BS between January 2004- October 2016 in our center and that had a pregnancy that finalized with a living child.

Results

A total of 20 pregnancies that finalized with a living child were registered. All the pregnancies were spontaneous, after 3.4 ± 2,9 years following BS. The BMI pre-BS was 43.9 ± 4.7 kg/m2. At the moment of conception the maternal mean age was 33 ± 4.6 years and the BMI was 30.6 ± 4.9kg/m2. The course of gestation was normal and full term in all cases. Of all the patients, 8 (40%) underwent Sleeve gastrectomy (SG) and 12 (60%) underwent Roux-en-Y gastric bypass (RYGB). Gestacional diabetes was registered in 3 (15%) cases, similar to the general population. The birth weight of the children was 3032 ± 3.81g. The incidence rate of small-for-gestational age birth was 25%, higher than 10% in the general population. There were no significant differences between the two surgical techniques regarding the evolution of pregnancy and the need of vitamin supplements. No neonatal complications were observed.

Conclusion

In our study BS did not increased the risk of prematurity or complications during pregnancy. We found an increased risk of small-for-gestational-age compared with general population.

Obes Facts. 2018 May 26;11(Suppl 1):251.

T4P37 Different trajectories of body mass index, excess weight loss and body fat percentage have different impact on metabolic outcomes 3 years after gastric bypass

J Gómez-Ambrosi 1, P Andrada 2, V Valenti 3, F Rotellar 3, C Silva 4, V Catalan 1, A Rodriguez 1, B Ramirez 1, R Moncada 5, J Escalada 4, J Salvador 6, G Frühbeck 1

Introduction

Body weight, body mass index (BMI) and excess weight loss (EWL) are the mainly used measures to evaluate bariatric surgery outcomes. However, these variables do not provide accurate information on body composition (BC). We have previously shown that body fat (BF) determines the levels of cardiometabolic risk factors. Our aim was to analyse the evolution of BC after Roux-en-Y Gastric Bypass (RYGB) and its influence on the changes of cardiometabolic risk factors in comparison to BMI and EWL.

Methods

A sample of 81 obese Caucasian subjects (19 males/62 females) aged 45 ± 1 y undergoing RYGB was prospectively followed-up for a period of three years. BC was determined by air-displacement plethysmography. Cardiometabolic risk factors were measured.

Results

BF was markedly decreased (P < 0.001) after the first year, increasing progressively during the second and third years after RYGB, following a different trajectory than body weight, BMI and EWL that decreased up to the second year postsurgery. Glucose metabolism markers decreased during the first month and continued to decrease during the first year (P < 0.05) remaining stabilized between the second and third years following RYGB. Interestingly, markers of lipid metabolism decreased (P < 0.05) notably during the first year, increasing thereafter in parallel to the changes observed in BC, with the exception of HDL-C which increased progressively throughout the 3-y period.

Conclusion

The detrimental switch in the changes in BC between the first and the second year after RYGB may explain the changes observed in cardiometabolic risk factors. Tracking of adiposity during the follow-up of bariatric/metabolic surgery may provide clinically relevant information to better identify patients in need of treatment intensification.

Obes Facts. 2018 May 26;11(Suppl 1):251.

T4P38 Relationship between cortisoluria, anthropometric parameters and weight loss one year after bariatric surgery in patients with morbid obesity

MJ Ferreira 1, D Salazar 2, JS Neves 2, J Pedro 2, P Souteiro 2, D Magalhães 2, V Gonçalves 2, S Belo 2, A Varela 3, P Freitas 2, D Carvalho 2

Introduction

Bariatric surgery (BS) is a treatment option for morbid obesity. Excess serum cortisol is associated with central obesity. Urinary Free Cortisol (UFC) is a screening test for hypercortisolism that is correlated with serum cortisol. The objective of this study was to determine the relationship between cortisoluria and anthropometric parameters (weight and BMI) before BS and weight loss one year after surgery.

Methods

This is a retrospective study evaluating the levels of cortisoluria in patients having undergone bariatric surgery between January 2010 and June 2016. All patients with no preoperative UFC, with Cushing's Syndrome, under treatment with corticoids or tests with non-reproducible values were excluded. UFC values were divided into tertiles. We performed x2-squared test, linear regression models and logistic regression models. results were adjusted for sex, age and initial BMI.

Results

Our sample encompassed a total of 1380 patients, 84.2% female, with mean age 42.4 ± 10.6 years, mean weight of 116.4 ± 18.8 kg and mean BMI of 44.1 ± 5.6 kg / m2. Patients in the upper two tertiles of UFC had higher BMI and weight before surgery compared to the lower tertile (p = 0.029, p = 0.033, respectively). Weight loss one year after surgery was higher in patients with cortisoluria values in the mean tertile and upper tertile (p < 0.001 and p = 0.004). This difference remained statistically significant when adjusted for gender, age and baseline BMI for patients with intermediate tertile (p = 0.045), which did not occur in patients with cortisoluria in the upper tertile (p = 0.196).

Conclusion

The relationship between endogenous cortisol production, obesity and CB response is complex. Patients with higher levels of cortisoluria had a higher BMI before surgery, but this group also showed greater weight loss one year after surgery.

Obes Facts. 2018 May 26;11(Suppl 1):251–252.

T4P39 Improvements in cardiorespiratory fitness and physical function 4 and 12 months post bariatric surgery: association with habitual physical activity

T Steele 1, DJ Cuthbertson 1, V Sprung 1, A Irwin 1, J Wilding 1

Introduction

The impact of bariatric surgery induced weight loss on cardiorespiratory fitness (CRF), habitual physical activity (PA) and functional capacity has not been well studied. Understanding changes in these outcomes and identifying how they relate to weight loss may help optimise peri-and post-operative lifestyle interventions.

Methods

17 patients (14 female, age 49.9 ± 8.3 years, BMI 47.8 ± 5.1) undergoing Roux-en-Y-gastric bypass (n = 15) or sleeve gastrectomy (n = 2) were recruited and assessed prior to and 4 and 12 months following surgery. This observational study offered no specific intervention to increase PA. Body weight and body composition (bio-impedance analysis) were measured. CRF (maximal oxygen consumption), habitual PA (>3 METs; SenseWear armband), 6-minute walk distance (6MWD), sit-to-stand test (STS), and grip strength (dynamometer) were assessed. Data were analysed using paired t-tests and simple correlation; data is presented as mean (95% CI).

Results

Mean weight loss was 30.1kg (27.9, 33.9) at 4 months (P < 0.001) and 42.0kg (35.0, 49.0) at 12 months (P < 0.001); percent weight loss from fat was 78.4% (70.7, 86.2) and 79.1% (71.2, 87.0) at 4 and 12 months, respectively. CRF improved at 4 months [+3.6ml/min/kg−1 (2.4, 4.8); P < 0.001] and 12 months [+7.26ml/min/kg−1 (5.2, 9.1); P < 0.001]; baseline 17.2 (15.9, 18.4). There was no significant difference in habitual daily PA at 4 months [+3.7 minutes (−3.9, 11.3); P = 0.32] or 12 months [+8.6 mins (−9.7, 26.9); P = 0.33]. 6MWD improved by 86.5m (64.9, 108.1; P < 0.001) at 4 months and 114.4m (86.5, 142.3; P < 0.001) by 12 months; baseline 394.8m (346, 443). STS improved by 20.8% (15.5, 26.2; P < 0.001) at 4 months and 43.3% (33.3, 53; P < 0.001) at 12 months. No significant change in grip strength was observed. Greater relative increases in PA time were associated with greater improvements in 6MWD but not CRF at both 4 (r = 0.77; P < 0.001) and 12 months (r = 0.78; P < 0.001). There was no correlation between degree of weight loss and measures of physical function or CRF.

Conclusion

Weight loss following bariatric surgery is associated with improvements in physical fitness and functional capacity, despite no change in habitual PA. Improvements in physical function were evident within 4 months, but these changes were not related to the magnitude of weight loss. Together, these findings could suggest improvements are largely related to biomechanical factors. Further work should explore whether increasing PA could further enhance improvements in physical function and CRF following bariatric surgery.

Obes Facts. 2018 May 26;11(Suppl 1):252.

T4P41 The Newfoundland and Labrador Bariatric Surgery Cohort Study: Gender differences in weight loss and health related quality of life (HRQoL) outcomes two years after laparoscopic sleeve gastrectomy

LK Twells 1

Introduction

Newfoundland and Labrador has the highest prevalence of severe obesity in Canada. In May 2011, Eastern Health the province's largest health authority started offering laparoscopic sleeve gastrectomy (LSG) to eligible patients as a treatment for severe obesity. 100–150 laparoscopic sleeve gastrectomies are conducted each year.

Methods

TTo assess gender differences in weight loss and HRQoL outcomes post-surgery using a prospective cohort study design. Data collection began in May 2011. Measures of weight and health related quality of life (HRQoL) were collected on patients with a BMI ≥35kg/m2 (with comorbid conditions) or BMI ≥ 40kg/m2 over a 2-year time period. Quality of life measures included: EQ-5D, Visual Analogue Scale (VAS 1–100), SF12v2, physical compoment score (PCS) and mental component score (MCS) and the Impact of Weight on Quality of Life-lite (IWQOL-lite 1–100).

Results

Baseline (n = 200) and 24-month data are presented. The sample was female (84.0%), average age: 43.8yrs (SD9.6). Average baseline weight(kgs): female:130.0kgs(SD20.4), male 162.9kgs(17.2), p < 0.05; average BMIkg/m2: female: 49.1(SD6.4); male 52.0 (SD5.3). Gender differences in comorbid conditions such as sleep apnea, dyslipidemia, hypertension and gout existed (p < 0.05). Pre-surgery women reported fewer problems with self-care on the EQ-5D (9.5% vs. 25.0%, p < 0.05), and better overall health on the EQ-5D (VAS 61.5 vs. 52.0, p < 0.05) and on the SF12v2: General Health (39.3 vs. 32.9, p < 0.05), but greater impairment in self-esteem (27.3 vs. 44.1, p < 0.01) and sexual life (49.2 vs. 63.6, p < 0.05). At 24 months: the majority of women and men lost ≥ 50% Excess Weight (men 55.8% vs. 73.3% p > .05); the VAS increased for both women and men but was significantly different (78.7 vs. 89.9, p < 0.05). Women's mental health improved less than mens's (SF12: MCS 45.4 vs. 54.0, p < 0.05). Total IWQoL-lite score increased less for women commpared to men (84.0 vs. 95.6, p < .05.)

Conclusion

Two year follow-up results of the Newfoundland and Labrador Bariatric Surgery Cohort study in Canada, report successful weight loss in the majority of patients, both women and men undergoing laparascopic sleeve gastrecomty. Significant improvements in all areas of HRQoL were reported by women and men, but significant gender differences in some areas of HRQoL exist.

Obes Facts. 2018 May 26;11(Suppl 1):252.

T4P42 Superior improvement in fasting and postprandial glycemic and lipid profile after Roux-en-Y gastric bypass versus sleeve gastrectomy for morbid obesity

C Koliaki 1, E Athanasopoulou 1, C Liaskos 1, K Alexiadou 1, G Argyrakopoulou 1, N Tentolouris 1, T Diamantis 2, N Katsilambros 1, A Kokkinos 1

Introduction

Bariatric surgery is the most effective method for the long-term treatment of morbid obesity. Apart from profound weight loss, it also leads to substantial improvements in glycemia and lipid profile. The aim of the present study was to compare the effects of the two most popular bariatric modalities, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), on weight loss, as well as fasting and postprandial glycemic and lipid profile in morbidly obese non-diabetic patients.

Methods

Seventy one patients were consecutively recruited. Of these, 28 underwent RYGB (7 males, age: 38 ± 2 years, BMI: 46.9 ± 1.1 kg/m2, mean ± SEM), and 43 SG (9 males, age: 38 ± 1 years, BMI: 50.2 ± 1.1 kg/m2, mean ± SEM, p = NS for all comparisons with RYGB). They were studied preoperatively, as well as 3, and 6 months after surgery. On each occasion, a standard mixed test meal was consumed, and blood samples were taken before, as well as every 30 minutes after meal ingestion, up to 180 minutes postprandially, for the measurement of glucose, insulin, and lipids. The overall postprandial glucose, insulin, and triglyceride (TG) responses were assessed as area under the concentration-time curve (AUC).

Results

Baseline metabolic parameters were similar between RYGB and SG. Both groups experienced profound and comparable weight loss (RYGB BMI3months: 38.7 ± 1.1, 6months: 34.7 ± 1.0, mean ± SEM, vs SG BMI3months: 41.9 ± 1.1, 6months: 37.4 ± 1.0 kg/m2, mean ± SEM, p = NS for all comparisons with RYGB). Glucose AUC at 3 months was lower for the RYGB vs the SG group (16794 ± 524 vs 19213 ± 731 mg/dl*min, p = 0.04), and there was a similar trend at 6 months (15785 ± 504 vs 17535 ± 458 mg/dl*min, p = 0.08). TG AUC was lower for the RYGB group at 3 (18881 ± 1236 vs 26730 ± 1378 mg/dl*min, p < 0.001) and 6 months postoperatively (15536 ± 1130 vs 24199 ± 1870 mg/dl*min, p = 0.005). Total and LDL cholesterol levels were lower 6 months after RYGB compared to SG (TChol: 169 ± 6 vs 200 ± 7 mg/dl, p = 0.02, LDL-Chol: 108 ± 6 vs 136 ± 6 mg/dl, p = 0.035). There were no differences between groups in fasting glucose, fasting insulin, HOMA-IR index, insulin AUC, fasting triglycerides, and HDL cholesterol levels at any time point of postoperative follow-up.

Conclusion

Roux-en-Y gastric bypass leads to superior improvements in fasting and postprandial glycemic and lipid profile than sleeve gastrectomy, for the same amount of weight loss. This may imply procedure-specific effects, such as the malabsorptive nature of RYGB and a different incretin postoperative response.

Obes Facts. 2018 May 26;11(Suppl 1):252–253.

T4P43 The changing face of Bariatric Surgery in the UK over the last decade: influence of guidelines, evidence and surgical trends

R Zakeri 1, A Pucci 1, M Adamo 2, M Elkalaawy 2, M Hashemi 2, A Jenkinson 2, RL Batterham 2

Introduction

Bariatric surgery is the most effective treatment for people with severe obesity, producing significant long-term weight loss, reduced mortality and improvement in obesity-associated comorbidities, particularly type 2 diabetes (T2D). In 2007, Roux-en-Y gastric bypass (RYGB) was the most common bariatric operation undertaken globally and standalone sleeve gastrectomy (SG) almost unheard of. SG has since soared in popularity, superseding RYGB worldwide.1 Importantly, the last decade has witnessed a marked reduction in operative mortality and complications such that bariatric surgery is now viewed as low-risk surgery and not purely a last resort. In 2014, the National Institute for Health and Care Excellence (NICE) recommended expedited referral for surgical assessment for people with severe obesity and recent onset T2D.2 However, the impact of improved evidence for efficacy and safety, changing global procedure trends and NICE guidelines upon real-world referral patterns and bariatric procedure choice in the UK is unclear. Thus, we examined demographic characteristics and surgical procedure undertaken in patients undergoing bariatric surgery.

Methods

Retrospective observational study of patients undergoing primary bariatric surgery over a 10-year period (2007–2016) in a large UK tertiary centre. Trends in patient demographics, anthropometrics, T2D history and surgical procedure were evaluated by year of referral. Between-group analysis was conducted for surgical procedure.

Results

During the 10-year period, 1628 patients underwent bariatric surgery (RYGB n = 728, SG n = 898). Over this time-frame, mean BMI at referral decreased (50.0 ± 7.3kg/m2 to 44.6 ± 6.1kg/m2, p < 0.001). No change in age (overall mean 44.0 ± 11.4 years) or gender (mean 27.0 ± 7.5% male) occurred, but the proportion of patients aged ≥60 years increased (p < 0.001). Patients with T2D tended to form a smaller proportion of cases operated each year (38.3% in 2008 vs. 13.7% in 2016). Procedure undertaken changed markedly from RYGB to SG over the 10-year period (SG 28.1% 2007 vs. 62.7% 2016, p < 0.001). Undergoing SG was positively associated with higher BMI (OR 1.043, p < 0.001) and male gender (OR 1.445, p = 0.003) but less likely in patients with T2D (OR 0.744, p = 0.006) and unrelated to age. Multivariate analysis adjusted for year of referral, BMI, gender and T2D status revealed all factors remain significantly associated with procedure choice.

Conclusion

Our findings of reduced BMI at referral suggest that healthcare professionals recognise the role of bariatric surgery earlier in the management of severe obesity. However, surgical treatment for T2D appears to be falling suggesting NICE guidance is not being followed. We show a marked shift in procedure to SG in line with global trends, but RYGB remains the procedure of choice for T2D.

References

  • 1.Angrisani L, et al. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25:1822–1832. doi: 10.1007/s11695-015-1657-z. [DOI] [PubMed] [Google Scholar]
  • 2.NICE. Obesity: identification, assessment and management. Clinical Guideline. 2014;CG189 [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):253.

T4P44 Short term follow up reporting loss weight and micronutrients post Bariatric surgery in a hospital of Spain

I Calvo 1, P Chavez 2, D Meneses 1, AI Cos 1

Introduction

Bariatric surgery (BS) is a procedure that has gained popularity in the last decades as a treatment for obesity and is generally regarded as safe and effective in the short term, though the complications on the long term have been described as the regain weight and nutritional deficits. The prevalence of obesity has increased in recent decades, and obesity is now one of the leading public health concerns on a worldwide scale. There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgery procedures performed has risen dramatically in recent years.

Methods

We collected several charachteristics (age, sex, type of procedure and initial and final BMI, percentage of excess of weighth loss) of obese patients that underwent BS from 2011 through 2013. In order to evaluate the nutritional status of patients, we compared the blood level of several markers of nutritional status before and 2 years after BS. The values are expressed in percentages, mean +/- SD and median (p25-p75). To compare the results we calculated paired T-test with normal values and Wilcoxon test for those who are not. A p < 0.5 was considered statistically significant.

Results

A total of 121 patients (67% women), whose pre-surgery weight was 130 +/− 25.41 kg, with a BMI of 47.33 +/− 7.32 kg/m2. 65.9% underwent laparoscopic gastric bypass, 20.6% sleeve gastrectomy and 4.9% adjustable gastric banding. The baseline levels of iron, ferritin, vitamin B12, vitamin D, vitamin A and vitamin E were: 75.14 +/− 27.81 ug/dL, 66 (34–141.5), 441.98 +/− 184.37, 18.44 +/− 9.07, 0.87 +/− 0.24 and 6.98 +/− 1.87, respectively. The mean percentage of excess of weight loss after 3 years was close to 65%, with a weight of 88 +/− 19.02 kg and a BMI of 32.34 +/− 5.53 kg/m2. The levels of iron, ferritin, vitamin B12, vitamin D, vitamin A and vitamin E were: 82.94 +/− 34.45 ug/dL, 79 (15.25–79.75), 359.18 +/− 189.96, 24.07 +/− 8.77, 0.85 +/− 0.16 and 7.37 +/− 1.76, respectively. Baseline levels of ferritin and vitamin B12 were different compared with those at 2 years of BS (p < 0.05). There were no difference between baseline levels of iron (p = 0.134), vitamin A (p = 0.235) and vitamin E (p = 0.604) with those at 3 years of BS.

Conclusion

As opposed to expected after a malabsortive procedure such as BS, the nutritional status does not deteriorate with adecuate surveillance in a specialized unit of obesity care.

Obes Facts. 2018 May 26;11(Suppl 1):253.

T4P46 Nutrition management in bariatric metabolic surgery

M Dankova 1, B Patkova 1, A Haskova 1, A Sadilkova 1, M Matoulek 1

Introduction

Bariatric surgery is considered to be one of the most effective ways to treat extreme obesity. The surgical procedures modify the gastrointestinal anatomy and physiology including the alteration of the nutrient digestion and absorption. We work on the presumption that morbidly obese often have nutritional deficiencies, particularly in fat soluble vitamins.

Methods

Two hundred patients underwent an elective bariatric surgery (adjustable gastric band, sleeve gastrectomy, gastric plication and gastric bypass) were included in the study. The available data from pre- and postoperative measurements of serum 25 hydroxyvitamin D have been analysed. As a satisfactory levels of serum 25 (OH) D was determined ≥ 30 ng/ml. All levels bellow this value have been evaluated as insufficient. Further, the serum levels of other vitamins, micronutrients and hormones (vitamins A, E, B12, folic acid, iron and parathyroid hormone) were observed as their metabolisms may also be deteriorated. The collected data were evaluated and analysed.

Results

The high prevalence of nutritional abnormalities in levels of all followed micronutrients has been detected. Most of them have been observed in gastric bypass patients, the least in gastric plication patients. Vitamin D deficiency and abnormal parathyroid hormone levels were the most common nutrient deficiency in our bariatric patients.

Conclusion

There is an obvious need for a long term vitamin D levels monitoring as well as of other mentioned nutrients, as the levels are affected after bariatric surgeries. A careful nutritional follow-up is mandatory and should optimize nutritional status and significantly decrease a risk of nutritional deficiencies following bariatric surgery. The designed nutritional protocol works on the assumption that all bariatric patients would be best served by receiving perfect nutritional intervention and monitoring of serum nutrients starting preoperatively, ideally through the whole life.

Obes Facts. 2018 May 26;11(Suppl 1):254.

T4P47 Long-term weight loss after bariatric surgery and the effect of gender, age, DM and surgical technique

V Guerreiro 1, JS Neves 1, J Pedro 1, D Salazar 1, MJ Ferreira 2, D Magalhães 1, P Souteiro 1, A Varela 1, S Oliveira 1, S Belo 1, F Correia 3, P Freitas 1, D Carvalho 1

Introduction

Bariatric surgery is the most effective treatment for morbid obesity, but the percentage of lost weight shows great variability. The objective of this study was to evaluate weight loss and percentage of lost weight according to gender, age, surgical technique and presence of diabetes mellitus (DM), over 4 years of follow-up.

Methods

This prospective study included a population of morbidly obese patients submitted to bariatric surgery between January 2010 and June 2016 in our hospital. Their characteristics are presented as mean and standard deviation. Continuous variables were compared using the Student's t-test and the analysis of variance. The linear regression model was used for the adjustments for confounding factors.

Results

Of the 1837 patients included, 1561 (85%) were women. The Roux-en-Y gastric bypass (RYB) was used in 1100 (59.9%) of the patients, the gastric sleeve (GS) in 461 (25.4%) and the gastric band (GB) in 271 (14.4%). The average age (± standard deviation) was 42.5 ± 10.6 years, the mean initial BMI 44.0 ± 5.8 kg/m2, the mean waist circumference 123.3 ± 13.4 cm, and the mean hip circumference 706.4 ± 11.6 cm. Regarding co-morbidities, 29.7% of the patients had DM, 42.9% had dyslipidemia and 58.4% had hypertension. The mean percentage of weight lost over the 4 years was 29.7 ± 10.8 at 12 months, 29.8 ± 11.6 at 24 months, 27.4 ± 12.1 at 36 months and 25.9 ± 11.6 at 48 months (p < 0.001). Considering the procedure used, the mean percentage of lost weight for RYB, GS and GB was, respectively, 32.9 ± 8.7, 29.8 ± 9.8 and 16.2 ± 9.6 at 12 months, 34.1 ± 8.7, 28.7 ± 10.8 and 16.8 ± 10.4 at 24 months, 32.4 ± 9.4, 24.3 ± 11.3 and 15.6 ± 10.5 at 36 months, and 30.6 ± 9.1, 22.7 ± 10.0 and 15.8 ± 10.8 at 48 months (p < 0.001). Older patients had less weight loss (p < 0.001), except at 48 months, when the difference was not statistically significant (p = 0.066). Patients with DM had less weight loss after adjustment (sex, age and surgical technique) at 24 months and 36 months (p = 0.021 and 0.02, respectively). There was no statistically significant difference regarding sex.

Conclusion

Over the 4-year follow-up, RYB was the surgical procedure that caused the highest weight loss, being negatively influenced by age and diabetes but not by sex.

Obes Facts. 2018 May 26;11(Suppl 1):254.

T4P48 Time to glycemic control – an observational study of 3 different operations

A Celik 1, S Pouwels 2, FC Karaca 1, E Cagiltay 3, S Ugale 4, I Etikan 5, D Büyükbozkırlı 1, Y E Kılıç 1

Introduction

Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT).

Methods

Included patients had a body mass index (BMI) ≥30 kg/m2; T2DM for ≥3 years, HbA1C >7% for ≥3 months, and no significant weight change (>3%) within the prior 3 months. Surgical procedures performed were SG (n = 49), MGB (n = 93), and DSIT (n = 109). The primary endpoint was the day within the first postoperative month on which mean fasting capillary glucose levels reached < 126 mg/dL. Multivariate logistic regression analysis was used to identify predictors of glycemic control.

Results

The cohort included 251 patients with a mean BMI of 36.04 ± 5.76 kg/m2; age, 52.84 ± 8.52 years; T2DM duration, 13.09 ± 7.54 years; HbA1C, 8.82 ± 1.58%. On the morning of surgery, mean fasting plasma glucose was 177.63 ± 51.3 mg/dL; on day 30, 131.35 ± 28.7 mg/dL (p < 0.05). Mean fasting plasma glucose of < 126 mg/dL was reached in the DSIT group (124.36 ± 20.21 mg/dL) on day 29, and in the MGB group (123.61 ± 22.51 mg/dL), on day 30. The SG group did not achieve the target mean capillary glucose level within postoperative 30 days.

Conclusion

During the first postoperative month, glycemic control (< 126 mg/dL) was achieved following DSIT and MGB, but not SG. Pre-operative BMI and postprandial C-peptide levels were independent predictors of early glycemic control following DSIT

Obes Facts. 2018 May 26;11(Suppl 1):254.

T4P49 Can the age of onset of obesity influence bariatric surgery outcomes?

D Salazar 1, MJ Ferreira 1, J Neves 1, J Pedro 1, V Gonçalves 1, S Oliveira 1, S Belo 1, A Varela 1, P Freitas 1, D Carvalho 1

Introduction

Bariatric surgery is an effective treatment in morbid obese patients. Patient related factors may influence the surgical outcomes.

Objective

To evaluate the influence of the age of obesity onset in weight loss and remission of comorbidities after bariatric surgery.

Methods

Retrospective study of obese patients submitted to bariatric surgery between January 2010 and June 2016. The patients (n = 1394) were divided in 2 groups according to the age obesity onset: before 20 years-old (n = 727) and after 20 years-old (n = 667). We evaluated the impact the age obesity onset in weight loss percentage and in the remission of diabetes mellitus (DM), high blood pressure and dyslipidaemia one year after surgery. Statistical analysis was done with Student's t test and X2 before and after pairing by propensity score for age, sex, body mass index (BMI) and type of surgery.

Results

After pairing we obtained comparable groups in sex (87.2% vs 87.7% women, p = 0.844), age (42.2 ± 8.3 vs 43.1 ± 9.4 years p = 0.119), BMI (43.8 ± 5.4 vs 43.8 ± 5.3, kg/m2, p = 0.937), history of DM (26.2% vs 32.0%, p = 0.05), high blood pressure (40.7% vs 45.4%, p = 0.147) and dyslipidaemia (61.4% vs 56.8%, p = 0.156), and type of surgery (15.7% vs 15.7% gastric band; 61.3% vs 61.1% Roux en Y gastric bypass; 23.0% vs 23.2% gastric sleeve; p = 0.997). Benefits of bariatric surgery were similar, independently of the group of the age of obesity onset (before and after 20 years), both with regard to the percentage of weight loss (29.9 ± 10.2 vs 30.1 ± 10.4, p = 0.875), as to remission of DM (59.6% vs 65.5%, p = 0.326), high blood pressure (54.1% vs 51.8%, p = 0.458) and dyslipidaemia (67.2% vs 65.2%, p = 0.678).

Conclusion

We found no differences in bariatric surgery outcomes according to the age of obesity onset concerning percentage of weight loss, contrary to what has been suggested by previous studies. We evaluated for the first time the impact of the age obesity onset in remission of cardiovascular complications, such as DM, high blood pressure and dyslipidaemia, showing that the benefit one year after surgery is maintained regardless obesity age of onset. Surgical treatment of morbid obesity is no less beneficial in patients with onset of obesity before adulthood, whereby it can also be an option in this group of patients.

Obes Facts. 2018 May 26;11(Suppl 1):255.

T4P50 Predicting Post-Surgical Alcohol Use Problems Using Pre and Post-Surgical Psychosocial Factors, Alcohol Use and Eating Behaviours

D L Reaves 1, PR Christiansen 1, JCG Halford 1, RL Batterham 2, CA Hardman 3

Introduction

Bariatric surgery is a recommended treatment for people with severe obesity leading to sustained weight reduction, reduced obesity-associated morbidity and mortality. Post-surgery neuroimaging studies indicate this is also associated with reduced reward to food cues. However, emerging data suggest that alcohol problems (AP) increase post-surgery. The psychological and physiological substrates of this increase in alcohol use are poorly understood, although pre and post-surgical depression and life stresses have been suggested as potential contributors to post-surgical AP. Thus we undertook a retrospective observational study of routinely-collected health data held by a bariatric centre in the United Kingdom.

Methods

Data sources were a prospectively collected clinician bariatric database, and hospital electronic health records. The sample included patients with minimum 2 years post-surgery outcome data. Age, gender, surgery type (Roux en Y gastric bypass = RYGB and Sleeve gastrectomy = SG), weight change and pre-surgical alcohol use were included from these sources. Clinical records were qualitatively reviewed and assigned a dichotomous ‘present’ (1) or ‘absent’ (0) code for pre-surgical depression or low mood, anxiety, increase in post-surgical life stress, and suicide idealisation or attempt. Alcohol problems were determined using the database, general practitioner (GP) or dietician clinical notes and comprised the dependent variable.

Results

A total of 250 complete records were available (male n = 54, female n = 196; Age at surgery 45.27 (+ 23.76); RYGB n = 120, SG n = 130). AP was present in 5.6% of the cohort (14 cases; male n = 7, female n = 7; Age at surgery = 44.34 (+ 10.28); RYGB n = 7, pre-surgery BMI = 45.46 (+ 10.76); SG n = 7, pre-surgery BMI = 48.62 (+ 7.54)). Data were analysed using the Firth's penalized likelihood regression, as AP were a rare event, and two models of predicting post-surgical AP were created. The first model predicted post-surgical AP using pre-surgical data and demonstrated that suicide attempt/idealisation, and heavy or moderate drinking patterns were both associated with increased prevalence of AP. The second model predicted post-surgical AP using post-surgical data (controlling for the significant pre-surgical predictors). This model found that additional post-surgical depression and increased life stress both predicted increased AP, while post-surgical “grazing,” or repetitive and frequent snacking behaviour, had a negative relationship with the likelihood of developing post-surgical AP.

Conclusion

Low prevalence in cohort. Pre-surgical moderate to severe alcohol use was significantly associated with increased odds for post-surgical alcohol problems. In addition, pre-surgical suicidal ideation or attempt and post-surgical increased life stress and depression had a positive association with post-surgical AP. Interestingly, post-surgical grazing significantly reduced likelihood for AP, which could represent a substitute coping behaviour among those whom do not or cannot engage in grazing-type eating patterns as a means of alleviating psychological distress. Future research within this subgroup would benefit from exploring additional distal risk factors also implicated in studies of alcohol use disorder.

Conflicts of Interest

One of the contributing authors to the poster, Prof Rachel Batterham, has included the following disclosures - Participated in Speakers’ Bureau or consulted for Novo Nordsisk, Orexigen, Ethicon, Medronic and Nestle. None of the other authors (Danielle L. Reaves, Paul Christiansen, Jason C. G. Halford and Charlotte A. Hardman) declare any relevant conflicts of interest.

Obes Facts. 2018 May 26;11(Suppl 1):255.

T4P51 Bowel function and health-related quality of life ten-years after Duodenal Switch

A Aasprang 1, V Våge 2, RL Kolotkin 3, PA Hegland 4, TN Flølo 5, JR Andersen 6

Introduction

To our knowledge, there are no long-term data on bowel function and health-related quality of life (HRQL) after Duodenal Switch (DS). The aim of this study was to investigate whether bowel function might influence HRQL ten years after DS.

Methods

The sample consisted of 31 patients (15 females). The main outcome was troublesome bowel function for daily well-being assessed with the question: “How troublesome is your bowel function for daily well-being? A Bowel function questionnaire was applied and the response categories were not bothered, a little bothered, moderately bothered and very bothered. In a multiple regression analysis, this independent variable was dichotomized into “not bothered/ a little bothered” versus “moderately bothered/very bothered”. HRQL was measured with the Short-Form-36. Outcomes were the physical component score (PCS) and the mental component score (MCS). Differences in HRQL between the groups after 10-years were adjusted for pre-operative HRQL scores and body mass index (BMI) after ten years.

Results

The mean BMI ten years after DS was 32.9 (SD 5.3) and mean age was 49.6 years (SD 9.1). Twenty-one of the patients (68%) reported “not bothered/ a little bothered” bowel function and ten (32%) reported “moderately bothered/very bothered” bowel functioning. Mean MCS score in the “not bothered/ a little bothered” group was 50.5 (95% CI; 46.1–55.1) compared to 34.8 (95% CI; 27.5–42.0) in the “moderately bothered/very bothered” group (P < 0.001). Mean PCS score in the “not bothered/ a little bothered” group was 49.2 (95% CI; 44.4–53.9) compared to 30.0 (95% CI; 22.1–37.8) in the “moderately bothered/very bothered” group (P < 0.001). Only the group with “not bothered/ a little bothered” in bowel function had HRQL scores within the normal range compared to the general population ten years after surgery.

Conclusion

s: The study shows that “moderately bothered/very bothered” bowel function after DS was strongly associated with lower physical and mental HRQL.

Obes Facts. 2018 May 26;11(Suppl 1):255–256.

T4P52 Effect of omega-loop gastric bypass surgery on CVD risk factors in vitamin D deficient morbidly obese patients within a double blind placebo-controlled trial

R Kruschitz 1, M Luger 2, K Schindler 3, M Krebs 3, B Ludvik 4

Introduction

Bariatric patients often suffer from vitamin D (VD) deficiency (VDD), and both, morbid obesity and VDD, are related to an adverse effect on cardiovascular disease (CVD) risk. Currently limited data are available regarding best strategies for treating VDD and the change of CVD risk factors after surgically induced weight loss, particularly, in bariatric patients undergoing omega-loop gastric bypass (OLGB). Therefore, we examined the change of CVD risk factors and its associations in a bariatric population during the first 12 months following OLGB.

Methods

A total of 50 bariatric patients recruited for a randomized controlled trial of vitamin D supplementation were included in this analysis. All patients were vitamin D insufficient or deficient due to the inclusion criterion at baseline (25-hydroxy vitamin D (25(OH)D) < 75 nmol/l). All variables depicted in Tab.1, as well as medical history (e.g., comorbidities, prescribed medication) and body composition data from dual energy X-ray absorptiometry were included in the analysis.

Results

Table 1 Evaluated CVD risk factors and its associations in vitamin D deficient morbidly obese patients during the first 12 months following OLGB In total, 80% were females with a mean age of 42 (13) years and BMI of 44 (4) kg/m2 at baseline. Significant changes could be observed in most of the CVD risk factors after 6 and 12 months (Tab. 1) towards a significant improvement except for diastolic blood pressure. The calculated Framingham 10-year CVD risk showed a significant reduction of 3% after 12 months. A reduction of 17% in the prevalence of diabetes mellitus could be found. Serum 25(OH)D concentration and total body fat-% (TBF%; r = −0.312, p = 0.001), weight loss-% (r = −0.407, p < 0.001), as well as waist circumference (r = −0.319, p < 0.001), were associated. HOMA-IR correlated with TBF% (r = 0.513, p > 0.001) and lean body mass-% (r = −0.511, p > 0.001).

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Conclusion

The present data indicates that OLGB induces a substantial improvement in CVD risk factors due to weight loss and its related effects in body composition during the first postoperative year. However, more research is needed to assess long-term effects of OLGB on CVD risk factors, additionally with the discrimination between VDD and those with sufficient VD-status.

Obes Facts. 2018 May 26;11(Suppl 1):256.

T4P53 Evolution of CRP after bariatric surgery: effect of sex, age, diabetes mellitus, dyslipidemia, hypertension and surgical technique – a 1-year follow-up

V Guerreiro 1, JS Neves 1, J Pedro 1, D Salazar 1, MJ Ferreira 2, P Souteiro 1, D Magalhães 1, S Oliveira 1, S Belo 1, A Varela 1, F Correia 3, P Freitas 1, D Carvalho 1

Introduction

Obesity is associated with a proinflammatory state, with an elevation of markers such as the C-reactive protein (CRP). Studies have suggested an association between weight reduction and decreased CRP. However, the impact of bariatric surgery is still not well characterized. This study evaluated the role of bariatric surgery in the reduction of CRP, as well as the effect of gender, age, surgical technique and presence of diabetes mellitus (DM).

Methods

This retrospective study included obese subjects submitted to bariatric surgery between January 2010 and June 2016 in our hospital. Only patients with weight and CRP assessment at baseline and 1 year after bariatric surgery were included. The patients’ characteristics are presented as median and interquartile ranges. Variables with normal distribution were compared using Student's t-test and analysis of variance; for variables with non-normal distribution, the Mann-Whitney and Kruskal-Wallis tests were used. The linear regression model was used for adjustments for confounding factors.

Results

Of the 1837 included patients, 518 (28.2%) met the inclusion criteria, 453 (87.5%) of which were women. The Roux-en-Y gastric bypass (BYR) was used in 323 (62.3%) of patients, the gastric sleeve (GS) in 183 (35.3%) and the gastric banding (GB) in 12(2.3%). The average age (± standard deviation) was 42.1 ± 10.5 years, the mean initial BMI was 43.6 ± 5.9 kg/m2 and the mean initial CRP was 11.9 ± 10.1 mg/dL. Regarding associated conditions, 58.1% of the patients had hypertension, 45.3% dyslipidemia and 28.0% diabetes mellitus (DM). One year after surgery, CRP decreased (11.9 vs. 3.4 mg/dL, p < 0.001) and a statistically significant correlation was found between CRP and weight loss (coefficient ß, after adjusting for age, sex, initial BMI and surgical technique: 0.16, p = 0.001). The CRP reduction was greater in patients with hypertension (8.9 ± 9.8 mg/dL vs. 7.6 ± 9.5 mg /dL in patients without hypertension, p = 0.018), even after adjusting for sex, age, surgical technique and percentage of lost weight. No association with surgical technique, presence of DM, dyslipidemia, gender or age was found.

Conclusion

There was a statistically significant reduction of CRP throughout the first year after surgery, associated with weight loss but not with surgical procedure. CRP decreased more in patients with hypertension, even after adjustment for gender, age, surgical technique and percentage of lost weight.

Obes Facts. 2018 May 26;11(Suppl 1):256–257.

T4P54 Morbidly obese men have lower weight loss and different predictors of success after bariatric surgery

J Pedro 1, F Cunha 2, JS Neves 3, V Guerreiro 3, D Salazar 3, MJ Ferreira 3, P Souteiro 3, D Magalhães 3, S Oliveira 3, S Belo 3, P Freitas 3, A Varela 3, D Carvalho 3

Introduction

Although obesity has a similar prevalence between genders, fewer men undergo bariatric surgery (BS). Little is known about the characteristics of this group or whether the results after BS are similar to those of women. We intend to compare men and women and to study predictors of success 1 year after BS.

Methods

Retrospective study of patients submitted to BS between January/2010 and June/2016. Excluded patients with no weight data or revision surgery. Collected socio-demographic, anthropometric and clinical data. Overweight lost (EPP): [(overweight-weight lost 1 year) / overweight] x100. Success was defined as an EPP > 75% 1 year after BS. Compared males and females: χ2 test and t test. A multivariate logistic regression model was developed to evaluate predictors of success in men and women (variables included: age, gastric bypass (GB), smoking, type 2 Diabetes (DM2), hypertension, dyslipidemia, depression and initial BMI.

Results

1438 patients were studied, 14.7% men, age 42 ± 11 years. Men were more often single, had higher level of education and lower unemployment. Men had more cardiovascular risk factors (DM2 40%, hypertension 47.5%, dyslipidemia 62.3%, smoking 24.7%), lower history of depression or lower anxiolytic drugs intake than women. The BMI of men was higher (45.1 ± 6.4 kg / m2 vs 43.8 ± 5.2 kg / m2, p = 0.005) and 1 year after CB (31.8 kg / m2 ± 5.6 vs 30, 2 ± 5.0 kg / m2, p < 0.001) and had lower PPE (67.4 ± 24.7% vs 74.3 ± 25.1%, p < 0.001) than women. CB success was lower in males (39.6% vs 51.9%, p = 0.001). In the multivariate analysis, age OR 0.97 (95% CI 0.96–0.99) p < 0.001, BG 3.22 (2.48–4.18) p < 0.001, dyslipidemia 0.65 (0.50 -0.84) p = 0.001 and IMC 0.89 (0.86–0.91) p < 0.001 were predictors of success. In women, these variables maintained the association, but in men only initial BMI was associated with success after BS 0.93 (0.88–0.98) p = 0.01.

Conclusion

Men submitted to BS are a distinct group, in which the predictors of success are different. For every 1 kg/m2 of additional initial BMI, the risk of failure increases by 7%.

Obes Facts. 2018 May 26;11(Suppl 1):257.

T4P55 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):257.

T4P56 May we believe in all the results of the systematic reviews of bariatric surgery? Preliminary results of cross sectional systematic survey

M Storman 1, D Storman 2, M Swierz 2, K Jasinska 2, MM Bala 3

Introduction

Obesity is a rapidly growing worldwide pandemic. In 2014, over 600 million adults worldwide were obese (WHO). Bariatric surgery (BS) includes a variety of procedures performed on people who have morbidly obesity. Despite an enormous growth in the number of published systematic reviews (SR) and metaanalyses (MA) in the field of bariatrics, no research on the quality of such studies published have been reported so far. The aim of this study is to answer the question: what is the quality of studies published as SR or MA, which were published since the beginning of 2016 to 2017.

Methods

Following a protocol published in PROSPERO (CRD42017080394) we identified SA and MA in the field of bariatric surgery. We searched electronic databases (Ovid MEDLINE, Embase, Cochrane) with no language restrictions. For this sub-analysis our inclusion criteria are: papers identified as SR or MA, which included primary studies with control group, in which participants of all ages with morbid obesity, were subject to any current or previous BS compared to those with any surgical or non-surgical control. Two authors independently: reviewed all titles and abstracts, assessed the full text of potentially eligible studies and assessed the quality of included studies, any discrepancies were resolved with Discussion and help from the third reviewer. The quality of each SR and MA was scored using the AMSTAR checklist (total score from 0 to 11).

Results

of pilot sub-analysis of cross-sectional systematic survey: Out of 638 identified papers (388 papers in 2016 and 250 - in 2017) for the entire project in this sub-analysis we finally included 23 papers with a control group (14 were published in 2016 and 9 in 2017). Figure 1 shows VOSviewer Heat Map Visualization showing the frequency and relatedness of words of 638 identified papers. Studies published in 2017 scored higher in AMSTAR checklist than studies published in 2016 (mean 4.67 vs 4.0). In 2016 majority of published SR and MA were of low quality (< 5 points; 71.43%), in 2017 - medium (> = 5 points; 55.56%) and one study was of high quality according to AMSTAR scoring (> = 9 points). Conflict of interest statement was common problem in 2016–2017. In addition item “using the quality of primary studies in formulating Conclusions” was most frequently scoring 0 (70.83%). Score 1 was most frequently observed for the items: “study characteristics” (95.83%), “search strategy” (75.0%) and “combining the findings of studies” (66.67%).

Conclusion

The quality of studies published as SR and MA in 2016–2017 is still unsatisfactory. We highly recommend that journal editors and peer reviewers pay more attention to the methodological quality of accepted SR and MA.

Conflicts of Interest

This study supported by MNiSW 2017/101/DIR/NN2.

Fig. 1.

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Obes Facts. 2018 May 26;11(Suppl 1):257–258.

T4P57 Austrian bariatric surgeons’ self-assessment-Results on the integration of sexual dysfunction in disease-management

L Ucsnik 1, F Langer 1, A Kotmel 2, T Dorner 3, J Bitzer 4, B Teleky 1, G Prager 1

Introduction

Bariatric surgery does have an impact on sexual health, hormones, fertility, contraception and reproduction. This this issue needs to be integrated in holisitc daily treatmend of morbid obese patients.

Methods

At the annual Austrian Congress for Surgeons the integration of sexual health problems in daily disease-management programs were self-assessed by the surgeons participating in 2 metabolic surgery sessions via 3-parted questionnaire with questions on the patients treated, the treatment offered and the surgeon's professional profile.

Results

11 of 34 surgeons participated in the survey (return rate 31, 42%), 73% male, 55 working at university hospital, 36% in public hospital. 73% of the metabolic surgeons asked up to 20% of the patients about sexual problems, 18% did not ask them at all, 9% asked between 81 and 100% of their patients. 63% of the surgeons were asked by up to 20% of the patients about sexual problems, 36,6% were not asked at all. 36% of the surgeons suggested in 21–40% of the patients sexual dysfunction. The reasons for bringing the topic up by the patients were assessed by the doctors: others topic more important (8), lack of time (7), language-barrier (3). Occations for addressing sexual health issues by the doctors were rated: concrete diagnoeses 55%), prevetion (36%), andro/menopause (36%), before and after surgery (27% each). 55% referred the patients to gynecologists / urologists, 36% to andrologists, 27% to specialists in psychosomatic medicine. 45,5% of the metabolic surgeons rated the topic “sexuality and intimacy” in up to 20% of the patients relevant for their profession. Noone had further training in thei field of sexual medicine.

Conclusion

In only 9% of bariatric surgeons sexual medicine treatment is part of daily disease-management. 80% of the morbid obese patients are actually not asked at all about their sexual health. There's a need for raising awareness for the importance of sexual helath issues in the field of metabolic surgery as well as specific medical trainings in the field of sexual medicine.

Obes Facts. 2018 May 26;11(Suppl 1):258.

T4P58 Weight reduction by sleeve gastrectomy rapidly reverse hypogonadism in morbidly obese men

M Rossato 1, A Di Vincenzo 1, M Granzotto 1, R Fabris 1, R Serra 1, M Foletto 2, S Merigliano 2, R Vettor 1

Introduction

Male obesity is associated to hypogonadism with increased estrogen and reduced testosterone plasma levels. These effects seem to be due to the direct interference of adipose tissue with sex steroids metabolism leading to the increase aromatization of androgens to estrogens within th adipose tissue. Given these pathophysiological basis, weight reduction should improve this hormonal unbalance thus contributing to the reversal of hypogonadism. All the studies performed so far have evaluated the effects of weight reduction on male hypogonadim long time after weight reduction and it is still not known how rapid these reversal effects might be in human. In the present study we investigated sex steroids changes after rapid weight loss in a group of obese men undergoing bariatric surgery.

Methods

An observational study was conducted before and one month after sleeve gastrectomy in a group of 29 obese men (aged 40.5 ± 9.9, with BMI 43.4 ± 8.5 kg/m2). We determined total testosterone, DHT, estradiol, LH, FSH, SHBG, prostatic-specific antigen (PSA) and leptin. As control we considered a group of 19 healthy age matched male subjects.

Results

Among obese men, 51.6% showed hypogonadism and among those with reduced total testosterone, those with metabolic syndrome (45.2%) showed lower testosterone plasma levels with respect to obese subjects without metabolic syndrome. BMI and waist circumference correlated negatively with total testosterone and LH plasma levels. Obese males showed reduced total testosterone plasma levels with respect to healthy lean men (10.8+3.5 vs 15.7+4.2 nMol, p < 0.05), higher estradiol plasma levels (124.4+46.5 vs 78.7+39.6 pMol, p < 0.01), higher LH and FSH plasma levels (3.6+1.3 and 2.5+0.9 vs 5.2+2.4 and 5.9+3.8 U/L, respectively, p < 0.05). No differences with healthy lean subjects were present for DHT and PSA plasma levels. One month after sleeve gastrectomy, obese subjects showed a significant weight reduction (−17.2+6.7 Kg) and only 11.6%of patients showed hypogonadism, with significantly increased testosterone (from 10.8+5.2 to 18.9+4.9 pMol, p < 0.001).), significantly reduced estradiol (from 128.5+44.4 to 96.1+34.3 pMol, p < 0.05), and significantly increased PSA (from 0.74+0.38 to 1.0+0.51 ug/L, p < 0.01) plasma levels.

Conclusion

The results of the present study demonstrate that obese males show an elevated prevalence of hypogonadism that is rapidly reversed (one month) after significant weight loss by bariatric surgery with increased total testosterone and reduced estradiol plasma levels. These reversal effects on sex steroids metabolism in obese men after weight loss is due to the rapid and significant loss of fat mass and the consequent decrease of androgen aromatization to estrogen that typically occurs within the adipose tissue. The clinical significance of the rapid increase in PSA plasma levels observed after one month from bariatric surgery is still obscure and has to be confirmed on a larger number of subjects and after a longer period of observation after surgery and weight reduction maintenance. Nonetheless this observation has not to alert since it could be due to the rapid testosterone increase stimulating the prostate and/or to the rapid reduction of volume distribution after weight loss.

Obes Facts. 2018 May 26;11(Suppl 1):258.

T4P59 Perioperative lifestyle and nutrition interventions in patients undergoing bariatric surgery - systematic review - protocol and current stage

M Swierz 1, D Storman 1, M Storman 1, K Jasinska 1, MM Bala 2

Introduction

According to 2014 WHO report, the obesity was prevalent in over 600 million people in the world. With respect to morbid (severe) obesity, the currently most effective treatment is bariatric surgery. This systematic review focuses on behavioral lifestyle and nutrition interventions, applied perioperatively, to enhance sustainable, long-term results of an operation.

Methods

We systematically searched electronic databases (Ovid MEDLINE, Embase, CENTRAL, Web of Science) using adequate search strategies with no restrictions on the language and date. We will manually search references of relevant guidelines/recommendations/systematic reviews to identify additional papers. Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions associated with obesity such as diabetes, hypertension, metabolic syndrome, etc. Studies designed as RCTs, where any type of lifestyle (individual/group sessions aiming to change diet or physical activity through behavioral strategies) or nutrition intervention was provided during perioperative period to morbidly obese patients undergoing bariatric surgery in comparison with control conditions will be included. The primary outcome will be weight loss measured as change in kg/BMI/percentage weight loss from baseline weight/percentage of excess weight loss, change in fat free mass, fat mass. Secondary outcomes will encompass change in comorbidities, quality of life, anthropometric parameters. Screening of titles/abstracts and full texts, data extraction, risk of bias (RoB) assessment and GRADE assessment will be performed independently by two reviewers. Conflicts will be resolved by Discussion or/and help from third reviewer. Screenings, extraction, RoB and GRADE assessments will be preceded by calibration process. All relevant data of included studies on the design, methodology of the study, participant characteristics, interventions, study outcome measures, and data on the outcomes will be extracted. For RoB assessment we will use Cochrane Risk of Bias Tool. We plan to perform a qualitative and quantitative analysis with meta-analysis and subgroup analysis, if possible. The certainty of evidence will be assessed using GRADE instrument. The authors are benefits of European Operational Programme Knowledge Education Development 2014 - 2020 - grant for presenting the results of the project - Systematic Insight into Obesity -which encompasses this paper.

Results

MEDLINE, Embase, CENTRAL and Web of Science searches yielded 1046, 3099, 493 and 2160 results respectively. The deduplication provided final 5030 titles/abstracts to screen. The current stage is finishing title/abstract screening.

Conclusion

The full protocol has been submitted to PROSPERO and is currently awaiting for acceptance.

Obes Facts. 2018 May 26;11(Suppl 1):258–259.

T4P60 The Economic Impact of Bariatric Surgery: Two Year Results from the Newfoundland and Labrador Bariatric Surgery Cohort Study

LK Twells 1, K Lester 1

Introduction

Individuals living with severe obesity (BMI ≥ 35kg/m2) report impaired health related quality of life, increased health services use and an increased out of pocket or indirect costs (e.g., purchase of weight loss projects, mobility aids). In addition there is a societal impact (e.g., requiring the assitance of others). The objective of this study is to determine the impact of bariatric surgery on short term (two years) economic outcomes in patients undergoing laparoscopic sleeve gastrectomy (LSG) in one tertiary care centre in one province of Canada.

Methods

A cohort study was conducted to examine the effect of LSG on economic outcomes in the first 200 patients to undergo laparascopic sleeve gastrecomy in a newly established bariatric surgery program in one province of Canada. Data collection began in May 2011. Data was collected pre-surgery and every six months for two years on weight, health status, health related quality of life and select economic variables using standardized case report forms. Patients consented to provide self-reported data on: the purchase of weight loss interventions and mobility aids, workforce productivity, home productivity and employment status. Economic outcomes were compared pre- and post-surgery to determine the impact of bariatric surgery on the indirect costs to patients.

Results

Two hundred one patients were recruited: 81.6% female and 91% Caucasian. Average age and BMI of 44yrs and 48.78 kg/m2, respectively. Patients presented with: sleep apnea (59.7%), hypertension (49.3%), back pain (48.3%), dyslipidemia (48.5%), osteoarthritis (44.2%), GERD (40.6%) and T2DM (35.8%). Pre-surgery, the majority (76%) of patients had purchased weight loss products in the previous twelve months compared to 43.8% and 23.8% at one and two years post-surgery, (p < 0.05). Over one in ten patients (13.2%) requried the use of a mobility aid before surgery which was decreased to 5.2% at one year and 3.6% of patients two years post -surgery, (p < 0.05). From a societal perspective, post-surgery patients required less assistance/help from others, (15.4% and 8.3% at one and two years after surgery, compared to 17.3% before surgery, p < 0.05). At two years post-surgery, %Excess Weight Loss (%EWL) and %Total Weight Loss (%TWL) was 52.2% (24.7–85.2), and 26.5%(13.8–43.1), respectively. The majority of patients lost ≥ 50EWL%.

Conclusion

For patients living with severe obesity, the significant weight loss assoicated with bariatric surgery reduced both the financial burden on individuals living with severe obesity through a reduction of weight loss products and mobility aids as well as the indirect financial burden placed on others who provide assitance. Bariatric Surgery demonstrates positive benefits by reducing the impact of indirect costs on individuals living with severe obesity.

Obes Facts. 2018 May 26;11(Suppl 1):259.

T4P61 Is bariatric surgery safe and effective for patients with super obesity?

M Tan 1,2, A Sainsbury 3,4, S Hocking 1,2, N Kormas 5,6, J Franklin 1, E Manson 1, C-A Badcock 7, D Martin 8,9, C Taylor 8, D Joseph 8,9, P Le Page 8, NR Fuller 4, D Kim 3, ID Caterson 1,2, TP Markovic 1,2

Introduction

While the prevalence of super obesity (BMI ≥ 50 kg/m2) is increasing, there is a dearth of literature on weight management for patients with this degree of obesity as they are often excluded from clinical trials. Bariatric surgery is the most durable and effective treatment for obesity, but there are some concerns over its safety and efficacy for patients with super obesity. We aimed to assess the long-term safety and efficacy of bariatric surgery in this population.

Methods

This is a prospective longitudinal follow-up study of 140 patients, divided into those with severe obesity (BMI 30–49.9 kg/m2) or super obesity (BMI ≥ 50 kg/m2), who underwent bariatric surgery as public patients from 2009–2017 in Sydney, Australia. Patient demographics, pre-surgical comorbidities, medications, and peri- and post-operative outcomes were examined.

Results

The overall mean age ± SD of both groups combined was 52.4 ± 11.3 years with most patients being Caucasian (77%) and female (66%) with no difference in age or sex between groups. In the obese group (n = 94), the mean pre-operative BMI ± SD was 42.8 ± 4.3 kg/m2 and that of the super obese group (n = 46) was 58.2 ± 7.5 kg/m2. On average, patients were diagnosed with a median of five comorbidities pre-surgery, the most common of which were diabetes/pre-diabetes (75%), hypertension (70%), obstructive sleep apnoea (69%), osteoarthritis (67%), dyslipidaemia (60%), gastro-oesophageal reflux disease (46%) and depression (39%). 134 patients underwent a single bariatric surgical procedure, with sleeve gastrectomy the most common surgery in both groups ((80% (n = 75) versus 85% (n = 39)). Six patients underwent reoperation, of which 4 had obesity and 2 had super obesity prior to surgery. Substantial weight loss was achieved by patients in both groups at all time points (p < 0.001 versus pre-surgery), with no significant difference between groups in weight loss expressed as a percent (%) of pre-surgical weight (Table 1). There were no significant differences in early or late complication rates between the groups (9% and 15% in obese versus 2% and 13% in super obese patient groups, respectively).

Conclusion

Bariatric surgery appears to be equally safe and effective in patients with super obesity as in those with less severe obesity.

Tab. 1.

Mean weight loss after bariatric surgery in obese and super obese patients (n = 140)

Time post-surgery (years) Obese (BMI 30–49.9 kg/m2) (n = 94)
 Super obese (BMI ≥ 50 kg/m2) (n = 46)
Weight loss ± SEM (% baseline) Weight loss ± SEM (kg) Weight loss ± SEM (% baseline) Weight loss ± SEM (kg)
1 24.1 ± 1.0 28.9 ± 1.3 25.7 ± 1.4 43.1 ± 3.6
2 23.2 ± 1.0 27.6 ± 1.7 25.7 ± 1.5 43.3 ± 5.2
3 22.1 ± 1.1 26.2 ± 2.2 22.9 ± 1.6 34.8 ± 5.6
4 19.9 ± 1.2 26.8 ± 2.7 21.4 ± 1.8 33.5 ± 6.6
5 20.0 ± 1.3 21.1 ± 3.0 20.4 ± 2.0 33.0 ± 6.2
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Obes Facts. 2018 May 26;11(Suppl 1):260.

T4P62 What happens to patients who do not attend follow-up after bariatric surgery?

M Tan 1,2, A Sainsbury 3,4, S Hocking 1,2, N Kormas 5,6, J Franklin 1, E Manson 1, C-A Badcock 7, D Martin 8,9, C Taylor 8, D Joseph 8,9, P Le Page 8, JP de Bruin 10, SH Barclay 10, NR Fuller 4, ID Caterson 1,2, TP Markovic 1,2

Introduction

While nonadherence to follow-up after bariatric surgery is common, review after bariatric surgery is necessary for management of obesity-related co-morbidities, treatment of post-operative complications and monitoring of nutritional status and bone health and may assist with long-term weight maintenance. The aims of this study were to identify the reasons for failure to attend review after bariatric surgery and to assess whether weight loss outcomes are greater in patients who attend for regular review (RR) compared to those who attend for irregular review (IR), defined as not attending the bariatric clinic for ≥2 years.

Methods

A prospective longitudinal follow-up study was conducted on 140 patients with severe obesity who underwent bariatric surgery at a publicly funded service in Australia from 2009–2017. Patients who attended for IR were contacted by telephone or email, and a clinic visit was scheduled. If a patient was uncontactable, a questionnaire was sent. A generalised linear model including fixed and random effects was used to model the changes in weight and BMI over time. results are expressed as mean ± SD.

Results

Patients were aged 21–73 (mean 52.4 ± 11.3) years with BMI 48.2 ± 9.5 kg/m2. 66% were females, 77% Caucasian and 81% had a sleeve gastrectomy performed as their primary procedure. The majority of the study population (85%) had Edmonton Stage 2 or 3 obesity, with 3 – 8 obesity-related co-morbidities (range 0 – 13). 32 (23%) patients attended for IR. Baseline BMI was not different between those who attended for IR and RR (50.0 ± 10.1 kg/m2 vs 47.6 ± 9.3 kg/m2, respectively). Patients who attended for RR had a greater number of co-morbidities compared to the IR group (p = 0.001). Patients experienced low rates of serious adverse events after surgery, with no differences observed between the groups. Mean weight loss was not significantly different between the IR and RR groups (36.6 vs 33.1 kg at 1 year, 35.9 vs 32.7 kg at 2 years, 34.3 vs 30.4 kg at 3 years, 31.7 vs 27.5 kg at 4 years and 28.2 vs 27.9 kg at 5 years, respectively). 19 IR patients responded to the questionnaire. The most common reasons for not attending follow-up were distance (n = 5), family-related issues (n = 3), imprisonment (n = 2) and unwillingness to return to follow-up (n = 2). Only one mortality was reported.

Conclusion

Contrary to expectations, there were no differences in weight loss in patients who attended for review regularly or irregularly after bariatric surgery. This suggests that regular review is unnecessary for long-term weight maintenance after bariatric surgery. However, this finding may be biased as, compared to patients who attended irregularly, those attending for regular review had a greater number of co-morbidities, which may affect successful weight loss maintenance.

Obes Facts. 2018 May 26;11(Suppl 1):260.

T4P63 Does weight loss before bariatric surgery matter?

M Tan 1,2, A Sainsbury 3,4, S Hocking 1,2, J Franklin 1, E Manson 1, N Kormas 5,6, C-A Badcock 7, D Badcock Martin 8,9, C Taylor 8, D Joseph 8,9, P Le Page 8, NR Fuller 4, ID Caterson 1,2, TP Markovic 1,2

Introduction

Despite the efficacy of bariatric surgery, the vast majority (around 90%) of bariatric surgeries in Australia are performed in private hospitals. Bariatric surgery is only available at a limited number of public hospitals and is only offered when all other weight loss methods have failed, in individuals whose health is threatened by their obesity. Whether preoperative weight loss results in better outcomes is unclear. The identification of any predictive association would improve patient selection and help develop interventions targeting those most likely to benefit from bariatric surgery. In this study, we address the knowledge gap regarding the association between pre-operative weight loss and long-term weight loss after bariatric surgery in publicly-funded patients with prospective standardized assessment and follow-up.

Methods

140 patients with extreme obesity were enrolled into an established one-year weight management programme. After bariatric surgery, mandatory multidisciplinary post-operative follow-up occurred at 2 weeks, 4 weeks, 8 weeks, 3 months, 6 months, 1 year, 1.5 years, 2 years and annually thereafter. Surgeries were undertaken between 2009 and 2017. Patients’ socio-demographic, medical profiles and clinical measurements were assessed prospectively. A generalised linear model (repeated measures) was used to determine if pre-operative weight loss predicted weight loss after bariatric surgery. All results are expressed as mean (± SD).

Results

In our cohort, 66% were female and 77% Caucasian with initial weight 146.7 ± 35.5 kg and BMI 53.0 ± 11.4 kg/m2. At baseline, 75% of patients had diabetes/pre-diabetes, 70% hypertension, 69% obstructive sleep apnea, 67% osteoarthritis, 60% dyslipidaemia, 46% gastro-oesophageal reflux disease, 39% depression, 24% asthma and 16% coronary artery disease. Weight loss after the one-year weight management programme was 13.2 ± 11.6 kg. Age at surgery was 52.4 ± 11.3 years, weight 133.5 ± 30.4 kg, BMI 48.2 ± 9.5 kg/m2 and the mean follow-up after surgery was 3.6 ± 2.1 years. The most commonly performed procedure was sleeve gastrectomy (81%). There were no life-threatening complications, and the only death was not related to the bariatric procedure. There were no significant correlations between pre-operative and post-surgical weight loss at all time-points.

Conclusion

Weight loss through lifestyle prescription did not predict the amount of weight loss achieved by bariatric surgery or successful weight loss maintenance after bariatric surgery. However, patients attending this service may not be representative of other cohorts of obese patients underwent bariatric surgery, as they needed to commit to a weight management programme for 12 months and be free of significant psychological disorders that may adversely affect bariatric surgery outcomes.

Obes Facts. 2018 May 26;11(Suppl 1):261.

T4P64 Small bowel necrosis after acute intestinal intussusception at delivery in a pregnant women post bariatric surgery: A case report

B Le Tinier 1, M Claver 1, A Ditisheim 1, N Farpour-Lambert 1, B Martinez De Tejada 1

Introduction

In Switzerland, bariatric surgery currently concerns about 4000 individuals and 80% of them have Roux-en-Y Gastric Bypass (RYGB). The majority of patients undergoing bariatric surgery are women, and up to 80% of them are of childbearing age. Pregnancy following bariatric surgery is associated with improved maternal and foetal outcomes, compared to women with untreated obesity, however post-surgical complications are enhanced by pregnancy, particularly during the 3rd trimester, related to the increasing intra-abdominal pressure and to anatomical abdominal changes induced by gravid uterus.

Methods

This is a case report of a 39-year old woman, nulliparous, who underwent a RYGB in 2008. One year later, she had an internal herniation treated by a laparoscopic closure of mesenteric windows. In 2017, she was spontaneously pregnant and developed gestational hypertension treated two times in emergency. At 37 weeks, she was referred in emergency to the University Hospitals of Geneva for upper abdominal pain, hypertension (170/100 mmHg) and uterine contractions. The medical examination revealed a depressible abdomen, a painful epigastrium, defenseless or relaxing, no surgical emergency criteria and bright osteotendinous reflexes. She had a positive urinary protein/creatinine ratio and an elevated lipase level without liver cytolysis suggesting a preeclampsia and an acute pancreatitis. Fetal vitality was preserved with a good heart rate monitoring and ultrasound.

A treatment of magnesium sulphate was given, the labor was induced and the patient delivered in 2 hours a healthy newborn. As she complained of a persistent upper abdominal pain in the immediate post-partum period, an emergency CT-scan was requested. An intussusception of the pancreatic-bilio loop was diagnosed (see Figure), with a mechanic occlusion and signs of hypoxia of the small bowel. A 40-cm bowel resection was then performed by the visceral surgery team due to bowel necrosis. Antibioprophylaxy, surveillance and parenteral nutrition were provided during the first 24h post-surgery. Finally, the patient was discharged on day 8 after surgery with a normal transit and a fiber free diet during 10 days.

Conclusion

Intestinal intussusception is a rare (1%) and delated complication after bariatric surgery (3–4 years) with a mortality rate ranging from 1 to 16%. It is more frequent in the 3rd trimester of pregnancy, due to increasing uterine volume, which combined with weight loss leads to the displacement of intestinal loops through peritoneal deficiencies. Symptoms are non-specific and can mimic some obstetrical conditions such as preeclampsia or hyperhemesis gravidarum. A multidisciplinary team may be needed, including a visceral surgeon and an obstetrician. The realization of an injected CT-scan should not delay a surgical exploration, which allows diagnosis and treatment at the same time. One of the biggest challenge is the diagnosis complexity of an upper abdominal pain in a pregnant women with a clinical exam limited by a gravid uterus. Obstetricians need to be aware of post bariatric surgery complications and careful consideration should be given to women presenting with abdominal pain in pregnancy.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):261.

T4P65 Nutrition and physical activity counselling by general practitioners in Lithuania, 2000–2014

V Kriaucioniene 1, J Petkeviciene 2

Introduction

Primary health care plays a crucial role in the provision of individualised dietary and physical activity recommendations to assist patients in weight management

Methods

The eight postal surveys in independent nationally representative random samples aged 20–64 were conducted. The data of 5867 participants who visited GP at least once during the last year and had BMI ≥ 25.0 kg/m2 were analysed. Respondents were asked about GP advices on nutrition and physical activity and about changes in their health behaviours during the last year.

Results

About a third of overweight persons reported GPs advice on nutrition and every tenth – on both behaviours. The prevalence on GP advices increased from 2000 to 2008, then decreased slightly. The likelihood of being advised was higher in respondents living in urban areas, having higher BMI, more chronic conditions and frequent contacts with GP. Older and highly educated women were also more likely to be advised. Individuals who received advice were more likely to report health behaviour changes.

Conclusion

GP advices on health behaviours are uncommon and are given more often to obese, having comorbidities and living in urban areas individuals. The prevalence of GPs advices need to be increased taking into account determinants of counselling.

Obes Facts. 2018 May 26;11(Suppl 1):262.

T4P66 Using interactive digital technology as adjuvante tool to the clinical practices to prevent inflammatory state in obese women: a preliminary data

S O Rhein 1, PP Machado 2, R MDS Campos 3, LM Oyama 1, V Boldarine 1, DCL Masquio 4, L Tock 1, AR Dâmaso 1

Introduction

Obesity is a complex disease associate to imbalance between pro/anti-inflammatory adipokines, which may lead to cardiometabolic risk in obese women. The use of interactive digital technology as adjuvante tool to the clinical practices in weight loss therapy emerges as an innovative strategy. However, it was note fully investigated if this kind of approach can contribute to decrease inflammatory markers in obese women. To evaluate the effects of clinical interdisciplinary therapy associated to use the eletronic means on inflammatory biomarkers in women with simple obesity.

Methods

Obese women (n = 37), age (32 ± 6.26 years); BMI (31.4 kg/m2 ± 4.58 kg/ m2), were enrolled in an interdisciplinary therapy consisted of follow-up with endocrinologist, nutritionist and exercise physiologist, associated to digital media support by facebook®, instagram® and whatsapp®; with a duration of 12 weeks. The study was approved by Research Ethics Committee of the Federal University of São Paulo – Paulista Medicine School (0305/2017). The clinical behavior therapy was conducted face-to-face counseling (monthly) and by permanent virtual information using the educational videos about eating consumption and exercise training in view to promote lifestyle changes (#12weeksfor; eat, fit, life®). Body composition was analyzed by bioelectrical impedance (BIA), anthropometric measures and blood samples to measure lipid profile and leptin concentrations were performed at baseline (I) and after therapy (F).

Results

There were significant reductions in body composition including: body mass (I = 89.87 ± 11.79; F = 86.07 ± 12.01 kg; p = 0.00), waist (I = 95.05 ± 8.99; F = 90.78 ± 7.85 cm; p = 0.00), abdominal (I = 107.3 ± 9.65; F = 103.68 ± 9.41 cm;p = 0.00), hip (I = 119.78 ± 9.46; F = 116.74 ± 9.13 cm;p = 0.00); and neck (I = 36 ± 1.89;F = 35.22 ± 1.65 cm;p = 0,00) circumferences; and waist/hip ratio (I = 0.79 ± 0.07; F = 0.77 ± 0.06; p = 0,03). For the biochemical variables it was shown an improvement in the lipid profile: total cholesterol (I = 208.8 ± 30.47; F = 199.76 ± 35.8 g/dL; p = 0.03); VLDL (I = 27.57 ± 12.4; F = 22.8 ± 8.25 g/dL; p = 0.02); triacylglycerol (I = 138.04 ± 60.97; F = 114.66 ± 41.55 g/dL; p = 0.02). Moreover, leptin concentration was significantly reduced, from 61.17 ± 16.53 to 46.78 ± 17.72 ng/mL; p = 0,00.

Conclusion

the clinical approach associated with web-based information can improve inflammatory state related do obesity in women. However, it need to be confirmed in a large cohort. Financial Support FAPESP: 2017/07372–1 and CNPq 409943/2016–9.

Obes Facts. 2018 May 26;11(Suppl 1):262.

T4P67 The influence of session-by session diet adherence, weight loss and weight-loss satisfaction on weight maintenance

R Dalle Grave 1, S Calugi 1, G Marchesini 2, M El Ghoch 1, I Gavasso 1

Introduction

The maintenance of body weight lost is recognized as a challenge in the management of obesity. Several researchers hypothesized that cognitive mechanisms, interacting with specific changes in diet and adherence to physical activity, may play a pivotal role in weight loss maintenance, but these has been studied only with a retrospective assessment. The aim of this study was to assess the session-by-session association between weight maintenance and diet adherence, weight loss, and weight-loss satisfaction scores during weight loss in patients with severe obesity.

Methods

This study includes fifty-eight patients who participated in a randomized controlled trial and lost at least 10% of their baseline weight. The sample was grouped in weight-loss ‘Maintainers’ (i.e., those who maintained a weight loss of ≥10% of baseline body weight at 6 months after the weight-loss phase) and ‘Regainers’ (i.e., those who did not maintain >10% weight loss at 6 months after the weight-loss phase). Body weight, adherence to diet and weight-loss satisfaction were measured session-by-session during the weight-loss phase.

Results

Twenty-two percent of the patients were classified as ‘Maintainers’ (n = 13), and 77.6% (n = 45) as ‘Regainers’. ‘Regainers’ had a lower adherence to diet after the initial 11 weeks, and a declining weight loss and weight-loss satisfaction from week 15 or 19 of the weight-loss phase, compared to ‘Maintainers’. Both 11-week dietary adherence and 15-week weight loss were independently related to weight maintenance. Similar results were obtained using the amount of weight change as dependent variable.

Conclusion

The weight-loss maintenance was associated with adherence to diet, weight loss and weight-loss satisfaction measured during the late weight-loss phase.

Obes Facts. 2018 May 26;11(Suppl 1):262.

T4P68 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):262–263.

T4P69 “Change for well being”: a therapeutic education program delivered in social centers: two-year Results

M Romon 1, S Gogalis 2, D Valerie 3, E Chazard 3

Introduction

Obesity affects more people in social difficulty who consult late and develop severe obesity. We develop a short therapeutic education program: 9 weekly sessions, led in the social centers by a team consisting of a sport coach, a dietician and a psychologist, The setting in social centers facilitates the support of patients in the long term because of organisation of activities such as physical activity or cooking lessons. This program has proven its effectiveness in the short term The objective of this work is to study the effects of this program on a longer term.

Methods

Subjects: Patients with BMI> 25 kg / m2, having completed the education program between September 2013 and May 2014. They were weighed at the beginning (V1) and end of cycle (.V2). They were contacted by phone 24 months later (V3) and were asked about weight and management since V2.and answer to questionnaire about eating behaviour (Three-factor eating questionnaire, TFEQ which measures cognitive restraint CR, uncontrolled eating UE and emotional eating EE) and physical activity (Ricci and Gagnon questionnaire) comparisons were calculated by analysis of variance

Results

One hundred and seventy-four subjects were included, 66 were lost to follow-up, the analysis was carried out on 108 subjects (including 99 women). After the program, 10 had a bariatric surgery(BS), 10 were followed by a nutritionist, (N) 88 did not have specialized follow-up. (No). Patients lost an average of 0.340 kg at V2 (p < 0.0001) and 6.49 kg V3 (p < 0.0001). The evolution of the BMI according to the post session management and of the TFEQ scores is shown in the table

Conclusion

After two years, there was an increase in physical activity and a decrease in uncontrolled eating. furthermore BMI was still decreasing even in absence of specialized follow-up. This study highlights the interest of a therapeutic education inserted in a social setting that accompanies patients.

Tab. 1.

V1 V2 V3 P
BMI No 36,5 (35–38) 35,9 (34,2–37,6) 34,9 (33,6–36,3) <0,05
BMI BS 41,8 (37,3–46,2) 41,9 (37,2–46,6) 31,9 (28,38–35,44) <0,05
BMI N 37,5 (33,2–41,8) 36,8 (28–40,5) 35,4 (31,1–39,6) NS
CR 47,5 (41,9–53,6) 36,2 (30,9–41,5) 46 (41,2–50,7) NS
UE 45,7 (40,2–51,2) 31,8 (27,9–35,8) 30,45 (25,8–35,1 <0,05
EE 61 (54,2–67,9) 42,3 (36,4–48,3 50,5 (43,8–57,2) NS
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There was a progressive increase in physical activity : V1 8,98 (7,27–10,7), V3 18?55 (17,59–19,5), p < 0,05

Obes Facts. 2018 May 26;11(Suppl 1):263.

T4P70 Effectiveness and transferability of at-home supervised physical activity program for adult obese patients with Prader-Willi syndrome

A Bellicha 1, M Coupaye 2, V Lemoine 3, L Hocquaux 4, F Specter 4, J Oppert 3, C Poitou 3

Introduction

Physical activity is an essential component of the management of obese patients, including those with syndromic obesity. Prader-Willi syndrome (PWS) is the most common form of syndromic obesity and is characterized by hyperphagic obesity, functional impairment (excessive fat mass, hypotonia, scoliosis) and psychosocial disability (cognitive disability and compulsive behaviour) that require a specific management approach. This before-after study aimed to assess the effectiveness and transferability of at-home supervised physical activity program in adults with PWS.

Methods

The physical activity program included two 1-h training sessions/week during 16 weeks. Sessions included both endurance and resistance training, were conducted at home on an individual basis and were supervised by a specifically trained physical activity instructor. The program was provided free of charge to the patient. Body weight, body composition (DXA), habitual physical activity (Actigraph GT3x accelerometer), functional capacity (6-min walk test), quality of life (SF-12 questionnaire) and eating behaviour (Dykens questionnaire) were assessed before and after the training program. Transferability was assessed using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. The following indicators were measured: participation to sessions (Reach), satisfaction of participants (Efficacy), satisfaction of physical activity instructors (Adoption), adaptations made throughout the study (Implementation), maintenance of the program after the end of the study (Maintenance).

Results

Twelve patients were included in the study (6 women, mean [SD] age 30 [9] years, BMI 37.5 [7.1] kg/m2). We found a significant decrease in sedentary time (−26 [34] min/d, p < 0.05) and an increase in the 6-min walk test distance (+ 30 [49] m, p < 0.05) but no significant change in body weight, body composition, quality of life and eating behaviour. Patients participated on average to 91% of sessions and expressed a high level of satisfaction for the program (4.5 on a 5-point scale). The main aspects of the program were implemented as intended, even though some adaptations had to be made by physical activity instructors. Schedule of sessions was sometimes modified according to patients’ availability and activities performed during the sessions according to weather conditions, patients’ preferences or progress. Two patients have extended the program after the end of the study with the same instructor, at their own expense.

Conclusion

These results suggest that an individualised and supervised physical activity program is effective to improve functional capacity and decrease sedentary time in adult obese patients with PWS. The ability of professionals to adapt exercise sessions appears as essential for the success of such programs.

Obes Facts. 2018 May 26;11(Suppl 1):263.

T4P71 Does menstrual cycle affect Healthy Eating Index?

B Kocaadam 1, S Sözlü 1, Y Serin 1, E Koksal 1, O Kucukerdonmez 2

Introduction

Changes in energy and macro nutrient content of the diet during the menstrual cycle were examined; however, there is no study evaluating diet quality. The aim of the study is to compare the scores of Healthy Eating Index (HEI-2010) at different stages of menstrual cycle.

Methods

Thirty-seven healthy university students (18–26 years) were enrolled. Participants were questioned during menstruation (2–4. days), in follicular phase (days 1–3) and in luteal phase (1–3 days before anticipated menstruation, based on self reported historical cycle data). In order to assess the HEI-2010, three consecutive day 24-h dietary recalls from individuals were used for each period. The HEI-2010 includes 12 components, 9 of which assess adequacy of the diet, including 1) total fruit; 2) whole fruit; 3)total vegetables; 4) greens and beans; 5) whole grains; 6) dairy; 7) total protein foods; 8) seafood and plant proteins; and 9) FAs. The scores of the 12 components are summed to yield a total score, which has a maximum value of 100. The HEI-2010 score is classified as 50 and below 50 ‘poor’, 51–80 ‘needs improvement’, and over 80 ‘good’. Friedman's Two-way Analysis of Variance was used for comparision the menstrual cycle stages.

Results

Energy, carbohydrate, and protein intake increased during the luteal phase (p > 0.05). The lowest HEI-2010 score was in the menstrual period (median (IQR), 45.7 (45.8)) (p < 0.01), and the majority of the women (67.6%) were in the ‘poor’ categorization in this period.

Conclusion

This study suggests an increase in energy, protein and carbohydrate intake in luteal phase. The decrease in HEI-2010 score in menstruation period may be related to the increase in consumption of junk food.

Tab. 1.

The median and IQR values of daily intake of energy, macro nutrients, and HEI-2010 scores

Luteal Phase Median (IQR) Menstruation Median (IQR) Follicular Phase Median (IQR) p
Energy (kcal) 1787.9 (920.4) 1679.0 (786.0) 1586.0 (570.6) 0.245
Carbohydrate (g) 217.0 (111.6) 206.3 (80.3) 195.0 (73.5) 0.132
Protein (g) 68.2 (27.5) 63.3 (24.5) 57.3 (24.8) 0.266
Fat (g) 64.5 (45.0) 64.6 (38.9) 56.3 (32.2) 0.214
HEI-2010 scores 60.1 (60.7) 45.7 (45.8) 57.6 (59.4) 0.000*
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Obes Facts. 2018 May 26;11(Suppl 1):263–264.

T4P72 Behavioral and weight change after diagnosis of type 2 diabetes

E Govers 1, J Schildkamp 1, S Peters 1

Introduction

Type 2 diabetes is a chronic disorder that requires lifelong treatment. Trials have shown that half of the patients can achieve remission from the disease by weight reduction and lifestyle interventions [Lean et al Lancet 2017]. So far, there is no clear explanation why this success rate is not higher. In this study reaction to the diagnosis and the effect of the disease on the attitude, lifestyle and body weight of Dutch type 2 diabetes patients is investigated.

Methods

Dutch type 2 diabetes (T2D) patients selected from the GfK Panel received an on-line questionnaire with 37 questions about the impact of the diagnosis of T2D on their lifestyle and behavior.

Results

The response rate was 63% (n = 578). At baseline 85% of T2D patients is overweight; 39% has obesity. Four percent was diagnosed in the last year and 40% had diabetes for more than 10 years. After diagnosis one third of the patients experienced no changes to their life at all. Half of them did not actively seek additional information. A vast majority of the patients experience the lifestyle health advises as difficult to adhere to. More than half of the patients indicated that they (almost) always follow the advises and there exists an inverse relationship with BMI and following advises. After diagnosis 60% of T2D patients lost body weight, 17% gained body weight. 36% of the respondents with a BMI ≥ 35 indicated that their weight increased.

Conclusion

A large group of patients appears not to experience significant impact of the disease on their life. Lack of intrinsic motivation might explain why the success rate of lifestyle interventions in T2D patients has limited effect.

Obes Facts. 2018 May 26;11(Suppl 1):264.

T4P73 Impact of a healthy weight intervention embedded within a national home visiting program on the home food environment

RG Tabak 1, A B Morshed 2, CD Schwarz 1, D Haire-Joshu 1

Introduction

Obesity is a worldwide public health problem that is associated with multiple chronic diseases, including diabetes. Home environment modifications may serve as important and feasible strategies for achieving healthy weight among mothers of young children. This study examines an intervention that embedded healthy weight information within Parents as Teachers (PAT), a U.S. national home visiting program, in order to determine whether this intervention helped families make food-related home environment changes.

Methods

This stratified randomized pragmatic trial included women with overweight or obesity and at least one preschool child at risk for overweight, participating in PAT programs located in St. Louis, Missouri. The intervention embedded elements of the Diabetes Prevention Program within the standard PAT curriculum. Home food availability and accessibility and eating distractions were assessed using a survey. Generalized estimating equations were used to test differences between the intervention and usual care in changes in home environment over time.

Results

The sole difference in baseline characteristics between usual care and intervention participants was that the intervention group was less educated than the usual care group (p < 0.05). There was a difference in the pattern of change over time between usual care and intervention groups in the soda availability and accessibility item (p = 0.013), while there were no significant differences in the snack foods item and distraction items. Among usual care group participants at baseline, 28% indicated soda in their home was easily accessible and in plain sight, 50% indicated soda was accessible but out of sight, and 23% indicated the soda in their home was hidden and out of reach. These responses remained similar over the two time periods in the usual care group (Figure 1). Among intervention participants at baseline, 35%, 42%, and 23% reported soda in their home was easily accessible and in plain sight, accessible but out of sight, and hidden and out of reach, respectively; this had improved to 13%, 36%, and 52% at 12 months, and to 14%, 44%, and 42% at 24 months (Figure 1).

Conclusion

This healthy weight intervention, embedded in an existing national parenting program, successfully reduced availability and accessibility of sugar sweetened beverages in the home, which is a low cost, easily modifiable factor for preventing weight gain.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):264–265.

T4P74 The Effectiveness of Group versus Individual Lifestyle Interventions for Overweight and Obese Adults: A Systematic Review and Meta-analysis of Randomised Controlled Trials

S Abbott 1, E Bryant 2, D Lycett 3, B Tighe 3, AA Tahrani 4

Introduction

Multi-component lifestyle interventions are recommended for weight management of adults who are overweight or obese. It is not clear, however, whether delivery to an individual patient or to a group of patients influences the efficacy of the lifestyle intervention. The objective of this research was to systematically review the effectiveness of group compared to individual lifestyle interventions among overweight and obese adults.

Methods

The databases MEDLINE, EMBASE, CINAHL, CENTRAL and ISRCTN were searched for published and on-going randomised controlled trials (RCTs) from inception to February 2017. The reference lists of included studies were also searched. Eligible studies were RCTs comparing group against individual lifestyle interventions for weight loss among overweight and obese adults (BMI >25kg/m2). Risk of Bias was evaluated using the Cochrane Risk of Bias tool. Heterogeneity was investigated using Cochran's Q and I2 statistics. Meta-analysis used fixed effects methods and estimated odds ratios.

Results

Eight RCTs with 2,612 participants were identified. Group interventions were twice as likely to achieve >5% weight loss compared to individual interventions (OR 2.16, 95% CI 1.80 to 2.58, p = < 0.00001). Heterogeneity existed (I2 51%, p = 0.05) and was explained through a subgroup analysis of commercial and non-commercial group intervention programmes. Compared to individual interventions, commercial group participants were more than twice as likely (OR 2.67, 95% CI 2.15 to 3.32, p = < 0.00001) and non-commercial group participants were of equitable likelihood (OR 1.34, 95% CI 0.97 to 1.85, p = 0.08) of achieving >5% weight. The ICER for a commercial group intervention was marginally more cost-effective (£8,128 or €9,155 per QALY) than for a non-commercial group intervention (£8,439 or €9,505 per QALY).

Conclusion

Participants of non-commercial groups are as likely to lose >5% weight compared to individual intervention participants; while commercial group participants are more likely to lose >5% weight compared to individual intervention participants. Given that both commercial and non-commercial group interventions are cost-effective in relation to individual interventions, healthcare providers should not discount referral to commercial slimming groups as an effective intervention for their overweight and obese adult patients. These findings support effectiveness within a 12-month period and given that obesity is a chronic condition, longer-term research is required.

Fig. 1.

Fig. 1

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forest plot of likelihood (odds ratio) of group versus individual intervention participants achieving >5% weight loss - a sub-group analysis of commercial against non-commercial group interventions

Obes Facts. 2018 May 26;11(Suppl 1):265.

T4P75 Web-Based Educational Health as an adjuvant tool on Interdisciplinary Behavioral Therapy, Improving the Food Habits and Body Image in obese women

S O Rhein 1, PP Machado 1, MDS Lima 2, DCL Masquio 3, L Tock 4, AR Dâmaso 1

Introduction

Obesity is a chronic disease related to negative health impacts, leading to the occurrence of comorbidities and dissatisfaction with body image. The recurrent practice of restrictive diets and consequent failures in weight loss therapy are the risk factors for the development of eating disorders, impairing the quality of life. Nowadays, social media have important lifestyle influences as an adjuvant tool in the treatment of obesity.

Methods

For this study, 56 obese women (32.6 ± 6.5 years), BMI (34.3 ± 4.1 kg/m2) followed the classical interdisciplinary therapy including, endocrinologist, nutritional and exercise approach, associated to website program (12weks for, eat, fit, writeR), WhatsApp and social networks. The therapy consisted of two face-to-face consultations (initial and final), in addition to daily support through digital resources and interactive online platform. Educational and motivational content (videos and texts) were available weekly for adherence to healthy eating habits and stimulation of physical exercise. Anthropometric and body composition were measured by Bioelectrical Impedance. Body image was evaluated by the Body Shape Questionnaire (BSQ) and categorized in absence of dissatisfaction (< 110 points), mild dissatisfaction (111 to 138 points) moderate (139 to 167 points) and severe dissatisfaction (≥ 168 points). 3-day Food Registry (basal and final) analyzed the food consumption. Statistical analysis was performed using STATISTICA software, considering a significance level of p < 0.05. The Ethics Committee (No. 2.034.742) approved this work.

Results

After the intervention, there was a significant reduction of anthropometric variables, such as weight (p < 0.01), BMI (p < 0.01), percentage of body fat (p < 0.01), waist circumference, (p < 0.01), abdomen (p < 0.01) and neck (p < 0.01). At the start of therapy, 10.7% of the women had morbid obesity (grade III), which reduced to 7.1% at the end of the intervention. The average of energy consumption decrease from beginning to the end of therapy (from 1750 to 1200 Kcal, respectively), improving the energy balance. The body image dissatisfaction score also decreased significantly (from 734.9 ± 28.3 to 109.4 ± 33.2, p < 0.01).

Conclusion

The interdisciplinary intervention associated to the use of electronic means had a positive effect on weight loss, body composition, and on the reduction of symptoms related to body image dissatisfaction, being a supporting strategy in the treatment of obesity in women. Financial Support: FAPESP 2017/07372–1; CNPq 409943/2016 -9 and 307342/2017–1.

Obes Facts. 2018 May 26;11(Suppl 1):265.

T4P76 Frequent follow up in an obesity medical clinic is associated with improved weight loss; type 2 diabetes is a negative prognostic factor

T Kolokytha 1, E Athanasopoulou 1, S Liatis 1, DG Eliopoulos 1, KN Tzirogiannis 1, M Karaolia 1, N Tentolouris 1, A Kokkinos 1

Introduction

Stricter follow up has been associated with better results in patients following lifestyle weight loss interventions, while the presence of diabetes has been found to hamper weight loss efforts. The aim of the present study was to assess whether the frequency of patients’ attendance at an obesity clinic affects weight loss, as well as whether diabetes may interfere with weight outcomes.

Methods

We consecutively and retrospectively collected data on 150 obese patients who completed 1 year of follow up in an outpatient medical obesity clinic, where they underwent a lifestyle modification intervention (hypocaloric diet and physical activity counseling). Anthropometric measurements (weight, height, BMI), number of visits to the clinic during the index year, and diabetic or nondiabetic status were recorded. We divided the subjects into a frequent (FA) and infrequent attendance (IFA) group, using the median number of visits (7.0) as a cutoff, and compared their respective weight loss at 1, 3, 6, and 12 months, expressed as ΔBMI%. We further assessed the percentage of patients achieving the clinically relevant weight loss goals of 5% and 10%, and investigated possible predictors.

Results

The FA group had a higher initial BMI than the IFA (40.0 ± 8.1 vs 37.3 ± 7.8 kg/m2, mean ± SD, p = 0.04). ΔBMI% was higher in the former group at 6 and 12 months (6 months: 10.3 ± 5.9% vs 8.3 ± 4.9%, p = 0.03, and 12 months: 12.3 ± 7.0% vs 8.3 ± 6.7%, mean ± SD, p < 0.001, respectively). These differences remained significant even after adjustment for initial BMI. Furthermore, the clinically significant goal of 5% weight loss was achieved by a higher percentage of FA patients (89.3% vs 63.6%, p < 0.001). The same was true for the 10% goal (57.1% vs 33.3%, p = 0.004). In multivariable linear regression analysis, FA status was significantly associated with a higher ΔBMI% at 12 months (standardized β-coefficient: 0.252, p = 0.002), whilst the presence of diabetes was a negative predictor of ΔΒMI% (standardized β-coefficient: −0.156, p = 0.05), independently of BMI at baseline and other possible confounders. In addition, in multivariable binary regression analysis, frequent attendance was associated with a higher probability of achieving 10% weight loss (OR: 2.61 [1.30–5.22], p = 0.007), whilst the presence of diabetes with a lower one (OR: 0.29 [0.10–0.89], p = 0.03).

Conclusion

An increased frequency of clinic attendance is associated with better outcomes in obese patients following a lifestyle weight loss intervention. Diabetes seems to play a detrimental role in the achievement of weight loss goals.

Obes Facts. 2018 May 26;11(Suppl 1):265–266.

T4P77 Food Label Reading Behaviour in Young Adults

M Gezmen Karadag 1, MS Karacil Ermumcu 1, H Yıldıran 1, F Ayyıldız 1

Introduction

Food label reading plays an important role in adequate and balanced nutrition of individuals. Food label reading helps making healthy choices about nutrition. The study was planned to evaluate the food label reading skills of young adults.

Methods

A total of 397 individuals aged 19–24 years (71.8% women and 28.2% men) participated in this study. Questionnaire including the demographic and general characteristics and about label reading behaviours questions including fourteen items were recorded with face to face interview.

Results

The mean age of individuals was a 21.2 ± 1.21 years. According to label reading behavior 85.6% of participants reported that they were label reader but only 14.4% of them (10.7% men; 15.8% women) always peruse label before buying the product and 9.0% (14.7% men; 6.5% women) of them never peruse. It was stated that individuals who examine label before buying the product always look at the price of the product (45.1%), expiration date (25.4%) but only 7.6% of them examine nutritional content and 4.5% of them examine the percentage of meet the nutrient requirements. 51.6% individuals (63.4% men; 47.0% women) reported that they care about price of the product as a first factor when buying a product.

Conclusion

The behaviour and frequency of food label reading is not expected level. So nutrition education is necessary to increase food label reading. Because nutrition information on food labels could be a cost-effective method of giving nutrition information to consumers.

Obes Facts. 2018 May 26;11(Suppl 1):266.

T4P78 Monitoring total body fat mass, trunk, and abdominal fat mass changes with DXA and morphologic markers

T L Branco 1, A Silva 2, F Baptista 2, S Martins 3, A Palmeira 4, P Rocha 2, C Minderico 2, P Teixeira 2, L Sardinha 2

Introduction

The purpose of this study was to verify if trunk fat mass (TFM), including abdominal fat mass (AFM), is more susceptible to weight change, and if abdominal circumference (ABDC) is a better predictor of fat mass changes than waist circumference (WC) and if ABDC is a better predictor of fat mass changes. Additionally, our study intended to identify the best simple pre-treatment anthropometric body composition predictors of short-term total loss of body fat mass (TBFM), trunk fat mass (TRFM), internal abdominal fat mass (IABDFM), waist circumference (WC), abdominal circumference (ABDC) and hip circumference (HC) in a short-term weight loss program in overweight and obese women.

Methods

We considered 126 healthy overweight and obese women (age, 38.3 ± 5.8 yrs; BMI, 30.3 ± 3.8 kg/m2) who participated in a 4-month lifestyle weight-loss program, which consisted in a group-based behaviour therapy to improve diet and increase physical activity. Anthropometric variables (sagital diameter (SD), body weight (BW), BMI, WC, ABDC and HC) were evaluated at baseline. Changes in body composition variables (TBFM, TRFM, and IABDFM) were estimated using DXA. A T test was used to compare differences between variables. Multiple regression analysis was performed to assess the relationship between the initial values of the predictor variables (SD, BW, BMI, WC, ABDC and HC) and the outcome variables, WC, ABDC, HC, TBFM, TRFM, and IABDFM changes, controlling for PA and CI changes, as well as age.

Results

After the intervention program, TBFM and BW changes were -2.78 ± 3.5 kg and -3.04 ± 3.1 kg, respectively. WC change was -3.08 ± 8.8 cm and ABDC changes was -10.44 ± 6.0 cm. When controlling for PA, CI, and age, changes in TBFM appear to be inversely related (p < 0.05) with the initial BW (b = −0.069), BMI (b = −0.194), HC (b = −0.100), ABDC (b = −0.064) and SD (b = −0.243). Changes observed in WC, TRFM and IABDFM were not significantly associated with any of the independent variables (p > 0.05). ABDCC was inversely related (p < 0.05) with initial BMI (b = −0.327), HC (b = −0.294) and ABDC (b = −1.139). HCC was inversely related (p < 0.05) with initial HC (b = −0.101).

Conclusion

ABDC is more susceptible to body fat mass loss than WC, and is a better predictor of body fat mass loss. Changes in lifestyle may provide a stimulus to loose TRFM (among which essentially abdominal fat mass) during weight loss. Baseline values of BW, BMI, SD, ABDC and HC are good predictors of TBFM changes. Our findings suggest that BMI, ABDC and HC may predict abdominal circumference changes. Baseline anthropometric measures could not predict changes in more specific areas of body fat estimated by DXA.

Obes Facts. 2018 May 26;11(Suppl 1):266.

T4P79 Identification of factors that limit the ability of exercise to produce the expected amount of weight loss: Can these factors be modified to maximize weight loss from exercise?

C K Martin 1, JW Apolzan 2, CA Myers 2, D Zhang 2, SN Fearnbach 2, D Thomas 3, N Johannsen 4, TS Church 2

Introduction

Exercise frequently fails to produce the expected amount of weight loss based on exercise-induced increases in energy expenditure. This is called weight compensation.

Methods

In a randomized controlled six-month supervised exercise trial, 198 healthy adult participants with overweight or obesity were randomized to: 1) a no-exercise control group, 2) aerobic exercise at a dose of 8 kcal/kg of body weight per week (8 KKW), or 3) an exercise dose of 20 KKW. At month 0 and 6, energy intake was measured with doubly labeled water (DLW), and appetite and other constructs were measured with self-report questionnaires. Participants in the exercise groups were classified as non-compensators (n = 55; i.e., those who lost the expected amount of weight from exercise) and compensators (n = 55; i.e., those who did not lose the expected amount of weight from exercise) via a median split. Differences on outcome variables between compensators and non-compensators were examined with ANCOVAs (age and sex were covariates). Regression analyses were used to examine associations among the variables. Alpha was 0.05.

Results

The per protocol sample (n = 171) was 72.5% female with mean+SD BMI and age of 31.5+4.7 kg/m2 and 48.9+11.4 years, respectively. Weight loss in the 8 and 20 KKW groups was only 36.2% (mean+SD: −0.4+0.4 kg) and 40.8% (−1.6+0.4 kg) of predicted weight loss, respectively. At baseline, proportionally more (p = 0.02) compensators met criteria for the metabolic syndrome than non-compensators (31% vs. 11%, respectively). Over six months, compared to non-compensators, compensators had significantly greater increases in energy intake by DLW (60.4+30.1 vs. 149.3+29.4 kcal/day, respectively), compensatory health beliefs (−2.1+1.0 vs. 1.2+1.0), and appetite ratings, such as cravings for sweets (−0.2+0.1 vs. 0.3+0.1) and hunger assessed with Visual Analogue Scales (−2.3+2.6 vs. 5.1+2.5). Among non-compensators, decreased dietary restraint over six months, measured with the Eating Inventory, was associated with larger increases in energy intake measured with DLW (R2 = 0.07, p = 0.05).

Conclusion

Compensators have poorer markers of health before exercise and compensation is driven largely by increased energy intake and appetite. Behavioral, dietary, and pharmacological interventions are available to address the correlates of compensation, and research is needed to determine if they will result in larger weight loss from exercise and confer other benefits such as better retention to exercise programs. However, change in dietary restraint was inversely associated with change in energy intake only among non-compensators; therefore, it is unclear if treatment to increase dietary restraint would be an effective strategy to reduce compensation.

Obes Facts. 2018 May 26;11(Suppl 1):266–267.

T4P80 Influence of 12 weeks controlling lifestyle modification program on the bioimpedance analysis dynamic

N Dynnyk 1, S Rozhko 1

Introduction

Obesity is spreading worldwide faster then any another disease of nowadays. It is harmful for humans because of causing a lot of diseases due to pathogenesis of developing insulin resistance, metabolic problems, liver steatosis, cardiovascular complications. Also it has big psychological influence on human being and a lot of patients with overweight suffer from depression during years. and there is a big deal how to achieve better results in losing weigh in patients and fix it for long time.

Methods

Our controlling lifestyle changing program consists of 12 group sessions of 20 persons with dietitian, 7 group training with sports trainer and supporting them online in social media chat during 12 weeks. At the begining of the weigh loss program and after 3 months we analyse patients results of bioimpedance analysis by Tanita BC-730.

Results

During our program 28 patients (20 women and 8 men) have significant weight reduction (minus 11,19kg +−3,6), fat percentage (minus 10,8%+−4,1), visceral adiposity percentage (minus 3,2+−1,7) and «biological age» (minus 15,5+−9,2). While muscular weight (plus 3,7+−0,9) and water balance (plus 4,1+−1,1) have been gaining due to correction of fluid intake and sports training.

Conclusion

Using bioimpedance analysis is good for patients’ motivation for weight loss and for controlling their results during it. As a result, we have good findings with a strong correlation between weight loss, visceral adiposity and biological age, which is not only good for aesthetic improvement of weight loss, but also has a great benefit for the health status of patients. Also, the absence of muscle mass loss and even gaining muscle weight during our program has a strong benefit from combining dieting with sports training.

Also we see that women are more likely to come for group weight loss program then men maybe due to psychological differences.

Obes Facts. 2018 May 26;11(Suppl 1):267.

T4P81 The effectiveness of cognitive behavioral strategies to increase adherence to exercise on long-term weight loss maintenance by women with overweight or obesity: A randomized controlled trial

T Nozaki 1, R Sawamoto 1, T Nishihara 1, T Hata 1, S Takakura 1, G Komaki 2, N Sudo 1

Introduction

Post-treatment weight regain is a crucial issue in the treatment of obesity. We hypothesized that participants in the program to increase adherence to exercise would show greater long-term maintenance of weight loss relative to an active control group. Therefore, in the present study, we examined the effectiveness of a cognitive behavioral program to increase adherence to exercise on preventing weight regain at two years after the end of weight loss intervention in randomized controlled trial.

Methods

Women with overweight or obesity participated in a 7-month weight loss intervention followed by a 3-month program of weight maintenance. Participants were randomized to one of two weight maintenance interventions: CBT including or not including a program to increase adherence to exercise, CBTe+ or CBTe-. The primary outcome measure was change in weight from randomization to two years after treatment.

Results

Ninety of 119 participants completed the weight loss intervention, with a final outcome weight available for 86. In the primary analysis, there was no significant difference in weight change between CBTe+ and CBTe- at the end of the two-year follow-up. The secondary analysis revealed that CBTe+ participants who discontinued logging their daily steps during follow-up gained more weight than those who did not. Higher emotional eating scores at randomization were associated with discontinuation of the log.

Conclusion

We were not able to show that the program to increase adherence to exercise was effective in preventing long-term weight gain. Importantly, emotional eating at the end of weight loss intervention was found to be related to adherence to daily physical activity.

Obes Facts. 2018 May 26;11(Suppl 1):267.

T4P82 Obesity Related Nutritional Habits of University Students in Ankara

N Acar Tek 1, B Deniz Güneş 1, G Akbulut 1, D Agagunduz 2, R Bozbulut 2

Introduction

It is known that young people may have a risk group for chronic diseases due to inadequate and unbalanced feeding during the transitional period of adulthood. Determination of student's nutritional tendencies is important in terms of prevention of possible disorders that may be caused by improper nutrition and regulation of eating habits in adulthood. This research was conducted to determine the nutritional habits of students studying at university.

Methods

The study was a cross-sectional study conducted on total 394 university students including 121 male (30.7%) and 273 female (69.3%) students studying at different universities and departments in Ankara. The questionnaire was applied with volunteer attendance, face to face interview method. The body weight, height of Individuals participating in the study were measured and food consumption for one-day were recorded. The data were analyzed using the SPSS 22.0 package program.

Results

The mean age of the students participating in the survey was 21.5 ± 1.62 years. In this study, 44.9% of the students were in the student's dormitory, 27.7% were with their family members and 27.2% were in the student's house with their friends. When dietary habits were questioned, it was determined that 46.4% were “sometimes” and 20.8% were “always” the main meal and the most skipped meal was morning meal. In addition, it was determined that the students staying in the dormitory had skipped the most main meal and most of the students who did not skip meals (37.2%) were in a health-related department. When the students were classified according to body mass index (BMI), 83.5% were found to be normal, 9.4% were overweight, 5.6% were underweight and 1.5% were obese. There was no relationship between BMI and eating habits. The daily average energy, protein, carbohydrate and fat intake of the individuals calculated by food consumption record were 1702.2 ± 539.65 kcal, 57.5 ± 23.34 g, 190.1 ± 71.00 g, 75.2 ± 24.55 g, respectively. The average daily energy and carbohydrate intake of students staying at the student's house their friends were high but no statistically significant difference was found.

Conclusion

As a result of the research; it was determined that university students had frequent skipped meals, and the most skipped meals were morning meals. Skipping breakfast in the morning is a major nutritional problem for university students. This young population should be encouraged for healthy lifestyle behaviors and a healthy diet.

Obes Facts. 2018 May 26;11(Suppl 1):267–268.

T4P83 Perceptions of the importance of weight and dietary factors as causal factors for cancer and for preventing recurrence in patients with breast, colorectal and prostate cancer

H Croker 1, P Lally 1, A Roberts 1, A Fisher 1, R Beeken 2

Introduction

Lifestyle factors, including diet and weight, influence cancer outcomes (AICF, 2007). However, awareness of diet as a causal factor is typically low (e.g. Willcox et al, 11) and less is known about awareness of the potential role of lifestyle in preventing recurrence. This analysis explored whether patients’ weight status and diet were associated with perceived importance of lifestyle in causing their cancer and preventing future recurrence.

Methods

Participants were patients with breast, colorectal and prostate cancer diagnosed in 2012/2013 taking part in the ASCOT (Advancing Survivorship Cancer Outcomes Trial) Study. Dietary data included fruit and vegetable (FV) and fat intake. Self-reported weight and height were used to calculate BMI. Fat, FV and BMI scores were dichotomised to indicate whether recommendations were met. Participants were asked to rate how important they considered an unhealthy diet (low FV, high fat) and overweight in causing cancer and a healthy diet (abundant FV, low fat) and healthy weight in preventing recurrence, scores were dichotomised. Logistic regressions tested whether meeting recommendations for FV, fat and weight was associated with perceived importance of these factors in causing cancer and preventing recurrence. Age, gender and education were included as covariates.

Results

This analysis used data from wave 1 (n = 2035); 22% of the sample were obese, 53.6% met dietary recommendations for fat and 27% for FV. Proportions perceiving lifestyle as important in causing cancer were 12.8% for fat, 9.9% for FV and 15.3% for weight. For preventing recurrence, the proportions were 39.0% for fat, 61.4% for FV and 65.9% for weight. Meeting lifestyle recommendations was associated with greater perceived importance of that lifestyle factor in preventing recurrence: dietary fat (OR = 1.76, 95% CI 1.42, 2.19); FV (OR 3.82, 95% CI 2.81, 5.19); weight (OR 1.46, 95% CI 1.12, 1.90). For causing cancer, only weight was significant, with meeting weight recommendations inversely associated with perceived importance (OR 0.39, 95% CI 0.29, 0.51).

Conclusion

Lifestyle factors were perceived as more important in preventing recurrence than causing cancer. Patients not meeting dietary and weight recommendations were less likely to perceive lifestyle as important for preventing recurrence. This supports the role for education about the importance of lifestyle for long term health after cancer. Encouragingly, patients with obesity were more likely to perceive overweight as an important causal factor.

Obes Facts. 2018 May 26;11(Suppl 1):268.

T4P84 Evaluation of the impact of a music-cultural approach linked to a physical activity program in obese teenagers: a clinical trial

NA Boa-Sorte 1, A Mattos 1, R Lorenzo 1, CF Dos Santos 1, F Orrico 1, H Ribeiro Jr 1

Introduction

It is known that this obese young population has a very low compliance to engagement to sports or other conventional form of physical exercises. Their low self-esteem allied to their poor sport performance end up promoting a reduced interest in their activities leading to an early interruption of the physical exercise. By integrating music, cultural values and physical activity we might give a potential alternative for an effective weight control and prevention program of obesity. The aim this intervention was to evaluate the efficacy of a program of physical activities with a music-cultural emphasis by comparing clinical, laboratory, nutritional and psychological aspects.

Methods

An open single-group clinical trial was conducted included thirty obese children and teenager (BMI/age > 95th), aged 8 to 16 years old, attending public schools from two poor communities of Salvador, Bahia, Brazil. Patients will be referred to the Outpatient clinics of the Pediatric Nutrition Service of the University Hospital of the Federal University of Bahia and screened by anthropometrical evaluation. They were included if no being in use of medications, having no cardiac, respiratory and orthopedic diseases and agree to sign the written informed consent. They received a physical exercises program adapted to the music-cultural program (percussive music) for three months (three times for week, one hour by day). The session was divided into warming up for 10 min followed by percussive activity for 30 to 40 min and 10 minutes to return to physiological status. Blood pressure, cardiac frequency and finger oximetry will be measured before and after each session. All patients were follow up monthly by the University health service for clinical, laboratory, nutritional and psychological evaluation. Body composition, cholesterol, triglycerides, resistance to insulin and ergospirometry test were performed. Wilcoxon test was performed to data analyse.

Results

Protocol adherence exceeded 86.75%. Four adolescents give up the program due to external motivations (conflict with school schedules and impossibility of monitoring by parent). A significant mean (SD) increase in height [147.63 (10.57) versus 149.77 (10.45) cm; p < 0.001] and decrease in BMI [27,11 (3.92)versus 26.41 (3.74) kg/m2; p = 0.004] and the BMI/age z-score indicator [2.75 (0.56) versus 2.55 (0.58); p < 0.001] were observed after intervention. The lean mass (in kg) and the predicted lung volume increased significantly, respectively, from 32.70 (7.92) to 33.67 (2.57) kg (p = 0.014) and 2.44 (0.39) to 2.56 (0.41) L (p < 0.001). With regard to the laboratorial parameters, a significant reduction in total cholesterol [167.52 (28.83) to 159.63 (27.19) mg/dl; p = 0.014) was demonstrated. This reduction was no observed to LDL-c, glycaemia, insulin and triglycerides levels. Paradoxically, HDL-c decreased significantly after the end of protocol [41.48 (12.06) to 36.74 (15.71) mg/dl; p = 0.001). Eighteen adolescents reported improved self-esteem. Reduced consumption of industrialized foods rich in saturated fat and simple carbohydrates was reported by 75% of participants.

Conclusion

Percussive music and cultural approach linked to physical activity may be a potential strategy to improve obesity treatment goals in adolescents.

Obes Facts. 2018 May 26;11(Suppl 1):268.

T4P85 Protocol of a randomized clinical trial to test the efficacy of an online platform for weight loss in adults with overweight and obesity: POEmaS Project

AM Beleigoli 1, AQ Andrade 2, MDF Diniz 2, RSR Alvares 2, MH Ferreira 2, LA Silva 2, A L Ribeiro 1

Introduction

In Brazil, weight excess affects 50% of the adult population with 19% having obesity. Moreover, only 35% of the population has a regular intake of fruit and vegetables, whereas 17% consume sweetened beverage regularly. Access to healthcare particularly in remote areas is a major challenge in our country due to the large area and population, as well as to costs. Internet-based programs have the potential to be accessible and cost-effective. Our aim is to investigate the efficacy of a web-based platform (POEmaS) to promote weight loss and diet and physical activity habits change in a Brazilian adult population.

Methods

We designed a three-arm parallel randomized controlled trial in which 18–60 years university students or employees with a minimum BMI of 25 kg/m2 were selected and allocated to one of three groups: (1) wait list with minimal intervention, (2) web-based platform, (3) web-based platform plus online nutrition specialist assistance. Pregnancy, conditions with specific dietary requirements and participation in other weight loss programs are exclusion criteria. Weight and BMI loss are the primary outcomes. Diet and physical activity behaviours, health perception and online activity features are secondary outcomes. The intervention comprises recommendations on diet and physical activity habits tailored to the Brazilian population and principles of behaviour change, such as goals setting, self-monitoring, handling outcomes expectations, modelling and social support. The web-based platform has been adapted from a commercial product (Cybergia®). It comprises an online social network and gamification features. Analysis will be on an intention-to-treat basis at 12 and 24 weeks after baseline. Analysis of covariance will be used to test for differences in weight loss between groups at each time point and linear regression will be performed to assess whether treatment group allocation is an independent predictor of weight loss. The study was approved by the Federal University of Minas Gerais (UFMG) Ethics Research Committee. All participants will sign an informed consent form prior to recruitment.

Results

We have been recruiting participants since September, 2017 via the website www.poemasufmg.com.br. First results on weight, diet and physical activity habits changes are expected by April 2018.

Conclusion

We have been performing a RCT to investigate the efficacy of a 24-week program based on an online platform for promotion of weight loss and change of diet and physical activity in a population of Brazilian overweight and obese adults. Our hypothesis is that the use of the platform leads to greater weight loss than the minimal intervention.

Obes Facts. 2018 May 26;11(Suppl 1):269.

T4P86 A cross-sectional study of motivators and barriers of weight management among Finnish adult population

F Halali 1, A Lapveteläinen 2, L Karhunen 2, A Saarela 3, R Lappalainen 4, T Kantanen 5

Introduction

Weight management (WM) has become a common practice. In 2014 population survey in Finland, 35% of working-age women and 24% of working-age men had tried to lose weight during the previous year. However, success rates are low especially in the long term and most individuals regain 33 to 100% of the lost weight within five years. Therefore, it is essential to gain a better understanding of the factors associated with WM, especially in real-life conditions. In previous studies, improved health and better appearance, feeling better and improved self-confidence have been reported as motivators of WM. On the other hand, enjoying eating food, not enough self-discipline to control appetite and poor medical conditions have been shown as barriers to successful WM. In the present study, we aimed to analyze motivators and barriers of WM among Finnish adult population.

Methods

Data was collected in the ‘KULUMA’ (Consumers at the weight management market) project through a survey targeted to 2000 free-living Finnish adults in Eastern and Central Finland. The self-reported questionnaire collected background information (such as age and weight satisfaction) and responses to items on motivators (e.g. health and ability to work) and barriers of WM (e.g. stress and not enough motivation). Principal Component Analysis (PCA) was used to extract components of motivators and barriers. Multivariate analysis of variance (MANOVA) was performed to examine the differences between the participants’ socio-demographic and weight-related characteristics regarding the PCA components.

Results

The final population of this study is 667 participants. About 67% of the respondents were dissatisfied with their current weight. More than half of the respondents (54.5%) declared that they were aiming to lose weight. There was a positive association between number of lifetime attempts to lose weight and Body Mass Index (BMI). PCA resulted in a 3-component model for motivators of WM (functional aspects, sociological aspects and psychosocial aspects) and a 4-component model for barriers of WM (life situations, food environment, personal issues and resources). Most often, socio-demographic characteristics such as age and education level were associated with the motivators and barriers of WM. For example, the barrier component ‘resources’ consisting of the items ‘poor health condition’, ‘poor economic status’, ‘not enough knowledge’ and ‘not enough support’ was scored higher among older people, those with lower education and those with higher BMI.

Conclusion

Weight management is common among Finnish adults and individuals report several motivators and barriers of WM. Health professionals should focus more on applying the knowledge on motivators and barriers of WM in implementing weight control programs, in order to support individuals’ efforts.

Obes Facts. 2018 May 26;11(Suppl 1):269.

T4P87 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):269.

T4P88 The relationships among various physique, psychological, lifestyle related factors and sleep apnea syndrome in Japanese postmenopausal women

Y Somekawa 1

Introduction

Sleep Apnea Syndrome (SAS) causing hypoxia and hypercapnia during sleep are reported to be associated with obesity, menopause, lifestyle, and complicated with hypertension, stroke, angina pectoris, myocardial infarction, and diabetes mellitus. In postmenopausal indefinite complaints such as sleeping disorder, feeling of fatigue, frequent urination, suggesting SAS are also included. The purpose of this study was to examine the relationships among these factors and SAS, and evaluate the necessity of Polysomnography (PSG)

Methods

The subjects were 80 postmenopausal Japanese women aged 48 to 86 years (mean age 64.6 ± 8.5 yr). Ages, height, weight, and Body Mass Index (BMI) were measured. Carotid artery Intima-Media Thickness (IMT) was measured by the ultrasonography. Simple PSG was performed on women suspected of SAS, and this was compared with Epworth sleepiness scale (ESS), Japanese Climacteric Symptom Checklists (CSC), Cornel Medical Index (CMI), Self-rating Depression Scale (SDS), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI). Levels of serum Total Cholesterol (TC), Triglyceride (TG), Low-Density Lipoprotein cholesterol (LDL-C), High-Density Lipoprotein cholesterol (HDL-C), Blood Glucose (BG), HbA1c, Brain Natriuretic Peptide (BNP), and Blood Pressure (BP) were measured. The relationships among the results of PSG, these physique, psychological, and lifestyle-related factors were analyzed

Results

Apnea Hypopnea Index (AHI) were significantly correlated with age, weight, height, BMI, serum BNP, and BP. Significant correlations were found among AHI and CSC's “chest pounded”, “have difficulty to sleep at night”, symptoms of the urogenital system and respiratory symptoms of CMI. Lowest values of SaO2 were significantly correlated with weight and BMI. Significant correlations were found among lowest values of SaO2 and CSC's “chest pounds”, “depressive mood”, “headaches”, “numbness of limbs or fingers”, cardiovascular system, symptoms of mental items anxiety, symptoms of tension of CMI, total point of SDS, and “use of sleeping pills” of PSQI. HADS and ESS were not significantly correlated with AHI and lowest values of SaO2.

Conclusion

High BMI is higher risk of SAS in these women. Definite symptoms could not be specified as the risk factors of SAS. But palpitations, frequent urination, and headache are considered to appear in the autonomic nervous system response to SAS caused hypoxia and hypercapnia. Also, in anxiety related sleepiness of SAS patients, use of sleeping medications may easily lowering oxygen saturation, resulting in burdening the heart. When these symptoms are complained especially in obese postmenopausal women, positive examination of PSG is essential regardless of the value of ESS.

Obes Facts. 2018 May 26;11(Suppl 1):270.

T4P89 The impact of body mass index on health-related quality of life and comorbidity in cancer survivors: A nationally representative cross-sectional survey in Korea

JE Park 1, SY Kim 2, J Park 3

Introduction

Cancer is one of the major causes of morbidity and mortality worldwide, and is the leading cause of death of Koreans in 2014. Obesity is a well-established risk factor for many cancers and is an important determinant for good health. Many cancer survivors are overweight or obese at the time of diagnosis. Therefore, weight management are important to prevent second primary cancers or other chronic diseases and promote overall health and quality of life for cancer survivors. Evidence about the association of overweight/obesity with health-related quality of life (HRQoL) and comorbidity within the Korean cancer survivors is insufficient. The purpose of this study was to assess the effects of BMI on HRQoL and comorbidity among cancer survivors.

Methods

We examined the association in a study of 1030 cancer survivors who live at least 5 years after being diagnosed with cancer, which participated in the fourth, fifth, and sixth Korean National Health and Nutrition Examination Survey (KNHANES, 2007–2015). Participants aged 19–86 years were classified into four groups based on their BMI as follows: < 20 kg/m2 (thin), 20–22.9 kg/m2 (healthy weight), 23–24.9 kg/m2 (overweight), ≥25 kg/m2 (obese). HRQoL was assessed using the Korean version of the EuroQoL 5-dimensions 3-level (EQ-5D-3L) scale. Multiple logistic regression analysis was used to identify the impact of degree of BMI on the prevalence of impaired HRQoL and several chronic diseases, or comorbidity.

Results

For severity levels of each EQ-5D dimension, cancer survivors who had a BMI of < 20 kg/m2 or ≥25 kg/m2 were more likely to report moderate or extreme problems than other BMI groups. The association between BMI and overall HRQoL scores was inverse U-shaped with EQ-5D index value high point at a BMI of 20–22.9 kg/m2 (P for trend = 0.017). In the multivariate logistic regression model, participants with a BMI of < 20 kg/m2 or ≥25 kg/m2 were associated with higher odds of impaired HRQoL after adjustment for history of comorbidity and other covariates: compared to BMI of 20–22.9 kg/m2, ORs (95% CIs) were 2.02 (1.17 - 3.47) for BMI of < 20 kg/m2 and 2.97 (1.91 - 4.61) for BMI of ≥25 kg/m2 (P for trend = 0.002). Obese cancer survivors were more likely to have a history of chronic disease. Moreover, current prevalence of chronic disease and comorbidity were higher in those with a BMI of ≥25 kg/m2 (all P for trend < 0.001). For the prevalence of hypertension, we found an OR of 3.11 (95% CI 2.18 - 4.44) for those who had a BMI of ≥25 kg/m2. Cancer survivors with a BMI of ≥25 kg/m2 had a 3.4 times higher odds for two or three comorbid conditions (hypertension, dyslipidemia, and diabetes) than compared to cancer survivors with a BMI of 20–22.9 kg/m2.

Conclusion

Deviations from normal BMI affected HRQoL among Korean cancer survivors, even after controlling for important sociodemographic characteristics, health risk behaviors, and prior history of diseases. Cancer survivors with obesity were associated with a greater prevalence of comorbidity than those without obesity. Thus, the importance of healthy weight management should be highlighted for cancer survivors. More research is needed to elucidate the mechanisms for the bidirectional relationship between BMI and HRQoL.

Fig. 1.

Fig. 1

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Tab. 1.

ORs and 95% CIs of impaired HRQoL and chronic conditions by BMI degree in cancer survivors

BMI < 20 (n = 142)
 20 ≤ BMI < 23 (n = 338)
 23 ≤ BMI < 25 (n = 237)
 BMI ≥ 25 (n = 313)
 P for trend
OR (95% CI)
Impaired health related quality of lifea
No. of cases 42 61 56 113
Model 1b 1.89 (1.14–3.14) 1.00 1.68 (1.08–2.61) 3.00 (2.00–4.49) <0.001
Model 2c 2.02 (1.17–3.47) 1.00 1.60 (0.99–2.58) 2.97 (1.91–4.61) 0.002
History of physician-diagnosed chronic diseases
History of hypertension diagnosis
No. of cases 30 97 78 151
Model 1b 0.57 (0.35–0. 94) 1.00 1.39 (0.95–2.05) 2.66 (1.86–3.78) <0.001
Model 2d 0.54 (0.33–0.89) 1.00 1.36 (0.92–2.01) 2.64 (1.84–3.77) <0.001
History of dyslipidemia diagnosis
No. of cases 8 49 46 75
Model 1b 0.36 (0.16–0.78) 1.00 1.48 (0.94–2.31) 1.77 (1.18–2.65) <0.001
Model 2d 0.34 (0.15–0.74) 1.00 1.51 (0.96–2.39) 1.80 (1.19–2.73) <0.001
History of diabetes diagnosis
No. of cases 18 41 26 79
Model 1b 0.96 (0.53–1.76) 1.00 0.97 (0.57–1.64) 2.71 (1.77–4.17) <0.001
Model 2d 0.97 (0.52–1.78) 1.00 0.97 (0.57–1.66) 2.79 (1.80–4.32) <0.001
History of cardiovascular disease diagnosise
No. of cases 5 29 28 40
Model 1b 0.32 (0.12–0.85) 1.00 1.72 (0.97–3.03) 1.90 (1.12–3.24) <0.001
Model 2d 0.32 (0.12–0.87) 1.00 1.77 (0.98–3.19) 2.00 (1.15–3.46) <0.001
History of comorbidityf
No. of cases 9 58 46 111
Model 1b 0.29 (0.14–0.60) 1.00 1.30 (0.83–2.02) 2.91 (1.98–4.29) <0.001
Model 2d 0.28 (0.13–0.60) 1.00 1.34 0.85–2.11) 3.00 2.02–4.45) <0.001
Current prevalence of chronic diseases
Hypertensiong
No. of cases 39 113 90 176
Model 1b 0.65 (0.41–1.04) 1.00 1.40 0.97–2.04) 3.07 2.16–4.35) <0.001
Model 2d 0.65 (0.40–1.04) 1.00 1.43 0.98–2.08) 3.11 2.18–4.44) <0.001
Dyslipidemiah
No. of cases 22 104 103 151
Model 1b 0.40 (0.24–0.67) 1.00 1.74 1.23–2.46) 2.11 1.53–2.92) <0.001
Model 2d 0.39 (0.24–0.66) 1.00 1.79 1.26–2.55) 2.19 1.57–3.04) <0.001
Diabetesi
No. of cases 16 42 31 85
Model 1b 0.83 (0.45–1.55) 1.00 1.14 0.69–1.88) 2.85 1.87–4.33) <0.001
Model 2d 0.80 (0.43–1.51) 1.00 1.13 0.68–1.89) 2.85 1.85–4.38) <0.001
Presence of comorbidityj
No. of cases 16 66 55 134
Model 1b 0.48 (0.26–0.87) 1.00 1.34 0.89–2.03) 3.30 2.29–4.75) <0.001
Model 2d 0.45 (0.25–0.83) 1.00 1.38 0.90–2.10) 3.40 2.34–4.94) <0.001
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Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; EQ-5D, EuroQol comprising five dimensions

a

The lowest 25% level in EQ-5D index value was cut-off points for determining impaired health related quality of life.

b

Model 1: adjusted for survey phase, age and sex

c

Model 2: adjusted for survey phase, age, sex, marital status, educational attainment, household income, smoking status, alcohol consumption status, physical activity, perceived stress status, period of time after cancer diagnosis, and history of comorbidity

d

History of comorbidity was excluded in Model2

e

Stroke, myocardial infarction, or angina pectoris were included

f

Indicates two or more comorbid conditions including prior physician-diagnosed hypertension, dyslipidemia, diabetes and cardiovascular disease

g

Systolic Blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or medication treatment for hypertension were included

h

Total cholesterol levels of ≥240 mg/dL or triglyceride levels of ≥200 mg/dL or HDL cholesterol levels of < 40 mg/dL, or use of a lipid-lowering drug were included

i

Fasting blood glucose levels of ≥126 mg/dL or use of insulin/oral medication for diabetes were included

j

Indicates two or more comorbid conditions including clinically defined hypertension, dyslipidemia, or diabetes

Obes Facts. 2018 May 26;11(Suppl 1):271–272.

T4P90 Association between serum uric acid level, metabolic syndrome and insulin resistance in obese patients – can uric acid be considered a new metabolic marker?

M M Barbosa 1, I Barros 1, V Fernandes 1, S Paredes 1, C Matta-Coelho 1, AM Monteiro 1, M Alves 1, M Noronha 2, A Fernandes 2, R Oliveira 2, ML Pereira 1, O Marques 1, SB Souto 1

Introduction

Hyperuricaemia has been associated with several factors that contribute to the development of Metabolic Syndrome (MS). The aim of this study was to determine the association between serum uric acid (UA) levels and the presence of MS, as well as the number of components of MS present, in a population of obese patients. We also sought to evaluate the association between serum UA levels and Insulin Resistance (IR) in the same sample.

Methods

This was a retrospective study of obese patients followed in clinical appointments specialized in obesity from Hospital de Braga (a project defined as Non surgical Treatment of Obesity – TObe). We excluded patients under uric acid lowering medication, patients without serum uric acid laboratorial measurements and patients with no clinical information that allowed us to establish the presence or absence of MS. The final sample included 239 subjects. MS was defined according to the NCEP ATP III criteria. We collected data regarding antropometric measures, clinical information and blood sample parameters. The statistical analysis was performed using SPSSv22®, and significance was defined as p < 0.05.

Results

Of the 239 patients included in our sample, 78.7% were female. The mean age was 45.1 ± 12.6 years and the mean body mass index was 40.0 ± 5.2 Kg/m2. In this population, 46.9% had MS. The mean serum UA level was 4.84 ± 1.28mg/dl. A significant difference in mean UA level was observed between males and females (males: 5.99 ± 1.31 vs. females: 4.52 ± 1.08mg/dl, p < 0.001). Also, patients with MS presented higher UA levels when compared with patients without MS (5.07 ± 1.21 vs. 4.63 ± 1.31mg/dl, p = 0.007). Mean serum UA levels increased as the number of MS components increased (0: 4.40 ± 1.21 vs. 1: 4.41 ± 1.18 vs. 2: 4.83 ± 1.40 vs. 3: 4.98 ± 1.31 vs. ≥4: 5.22 ± 1.05mg/dl, p = 0.024). In non diabetic patients, we found a positive correlation between UA levels and HOMA-IR (r = 0.171, p = 0.021).

Conclusion

Obese patients with MS present higher UA levels when compared with obese patients without MS. Serum UA level was significantly elevated as the number of MS components increased. A positive correlation with HOMA-IR was also found. This supports the data that suggests uric acid as a possible new metabolic marker of MS and IR.

Obes Facts. 2018 May 26;11(Suppl 1):272.

T4P91 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):272.

T4P92 Predictors of remission of type 2 diabetes with an intensive weight management programme: post hoc analysis of the Diabetes Remission Clinical Trial (DiRECT)

M E Lean 1, R Taylor 2, WS Leslie 1, AC Barnes 2, G Thom 1, N Brosnahan 1, L McCombie 1, N Sattar 3, I Ford 4, A McConnachie 4

Introduction

The DiRECT intervention, an intensive weight management programme in routine primary care, showed striking effects on remission of type 2 diabetes (T2D diagnosis < 6 years): 46% remissions at 12 months overall, 86% with weight loss >15kg. We now seek baseline predictors of remission in the intervention group (n = 149).

Methods

Logistic regression models were used to assess associations between baseline characteristics (age, sex, socioeconomic deprivation, duration of diabetes, HbA1c, weight/BMI, smoking, alcohol intake, medication use, blood pressure) and the two primary outcomes: weight loss ≥15kg, and T2D remission (HbA1c < 48mmol/mol off all anti-diabetes medications) at 12 months. All models were adjusted for age, sex, HbA1c, and GP practice as a random effect.

Results

Age was not associated with achieving ≥15kg weight loss (p = 0.36), but older patients had more remissions (17% aged < 50 years; 61% aged 60–65 years; trend p = 0.050). More men achieved ≥15kg weight loss than women (33% vs 14%, p = 0.008), but remissions were similar (p = 0.33). Baseline HbA1c was not associated with weight loss (p = 0.49), but those with lower HbA1c were more likely to achieve remission (OR 28% lower per % point increase in HbA1c, p = 0.038). Those with longer diabetes duration were more likely to achieve ≥15kg weight loss, (OR 31% greater per year (p = 0.032), but duration was not associated with diabetes remission. Neither outcome was associated with socioeconomic deprivation, smoking or alcohol intake. Loss of ≥15kg was more likely with greater baseline weight (< 90kg: 8%; ≥110kg: 40%; trend p = 0.024) or BMI (< 30kg/m2: 9%; ≥40kg/m2: 31%; p = 0.027). However, neither weight (p = 0.93) or BMI (p = 0.26) was associated with diabetes remission. Prior use of oral anti-diabetic and anti-hypertensive drugs (stopped on commencing the intervention) were not associated weight loss, but diabetes remission was less likely with more oral anti-diabetic drugs (OR 0.43 per additional drug, p < 0.001), particularly sulfonylureas, and more likely with anti-hypertensives (OR 1.37 per drug, p = 0.045). There was weak evidence that antidepressants may impair ≥15kg weight loss (p = 0.085) and remission (p = 0.064). Blood pressure was not associated with weight loss, but diabetes remission more likely with higher systolic (p = 0.017) and diastolic (p = 0.013) BP.

Conclusion

Predictors differed for weight loss with the DiRECT intervention, and diabetes remission. Male sex, diabetes duration and greater weight were associated with achieving ≥15kg weight loss. Older age, lower HbA1c, fewer anti-diabetic, more antihypertensive drugs, or higher baseline blood pressure, predicted diabetes remission. Submitted on behalf of the DiRECT Team.

Conflicts of Interest

The study was funded by Diabetes UK with support-in-kind from Cambridge Weight Plan and from Counterweight Ltd. Professor Lean provides medical consultancy to Counterweight Ltd and Naomi Brosnahan is an employee of Counterweight Ltd.

Obes Facts. 2018 May 26;11(Suppl 1):272.

T4P93 Nutritional status and endothelial dysfunction markers in young women with and without polycystic ovary syndrome (PCOS)

K Wyskida 1, G Franik 2, W Gruszka 3, A Owczarek 4, A Brzozowska 1, I Szczerbowska 3, P Kocelak 3, P Madej 2, J Chudek 5, M Olszanecka-Glinianowicz 3

Introduction

One of the consequence of PCOS is increased risk of the development of early cardiovascular disturbances. The known markers of endothelial dysfunction are nitric oxide (NO), endothelin-1. Pentraxin-3 (PTX-3) is the recently described marker of endothelial dysfunction. The aim of the study was to assess the markers of endothelial dysfunction in PCOS and non-PCOS women in relation to nutritional status.

Methods

Study enrolled 99 stable body mass PCOS women (17 normal weight, 21 overweight and 61 obese) and 61 non-PCOS women (23 normal weight, 19 overweight and 18 obese). Anthropometric measurements and plasma PTX-3, NO, endothelin-1 concentrations were obtained.

Results

There were no differences in plasma PTX-3, NO, endothelin-1, levels in non-PCOS groups (1728 vs. 1427 vs. 1027 pg/mL; 12.6 vs. 21.2 vs. 16,7 umol/L; and 2.4 vs. 1.7 vs. 2.0 pg/mL, respectively). While, in PCOS women PTX-3, NO and endothelin-1 levels were significantly higher in obese than in normal weight PCOS groups (4303 vs. 1643 pg/mL; p < 0.001; 30 vs. 21 umol/L; p < 0.01 and 2.1 vs. 1.0; p < 0.01, respectively). In addition, only PTX-3 levels were significantly higher in both overweigh and obese PCOS than corresponding non-PCOS groups (2291 vs. 1437; p < 0.01 and 4303 vs. 1027 pg/mL; p < 0.001; respectively).

Conclusion

Circulating pentraxin-3 level seems to be sensitive marker related to nutritional status and endothelial dysfunction in PCOS women.

Obes Facts. 2018 May 26;11(Suppl 1):272.

T4P94 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):272–273.

T4P95 The Liver Fat is an Independently Risk for Metabolic Disarrangement in Addition to Insulin Resistance and Obesity: a Qualitative Ultrasound Measurement Method

KC Yang 1, YY Liao 2, KC Huang 3

Introduction

Non-alcoholic liver disease(NAFLD) is an emerging chronic hepatitis in the obese epidemics. It is related with cardiovascular disease(CVD) and metabolic syndrome(MetS). Notably, more hepatic fat is associated with a higher risk CVD. It implies that noninvasive techniques with accurate measurements might be useful tools for assessing CVD risk and MetS. This study assessed the relationship of NAFLD with insulin resistance and obesity in metabolic syndrome by a novel qualitative ultrasongraphic score.

Methods

This is a cross-sectional study. A total of 394 participants were recruited from the community. NAFLD was evaluated by the quantitative measurement of Shannon Entropy. Our previous study has shown the higher value of Shannon Entropy implies the more quantity of liver fat. The association between the liver fat and the severity of MetS(metabolic sore) was assessed by linear regression model. The ability to distinguish MetS was shown by the areas under the receiver operating characteristic curve(AUCs).

Results

MetS was present in 19.3% of the participant. Participants with the higher quantity of liver fat had worst metabolic profiles, such as higher fasting sugar, higher triglycerides, higher low density lipoprotein, lower high density lipoprotein, higher body mass index (BMI) and larger waist circumference (P for trend < 0.0001 from low to high tertiles of Shannon Entropy). After adjusting for the age, sex, smoking, alcohol, sleeping hours, coffee intake, exercise time per week, menopause, BMI and insulin resistance, the participants with more liver fat (the third tertile and the second of Shannon Entropy vs. the first tertile) had higher metabolic score (β = 0.42 and β = 1.12, P < 0.0001 respectively for 2nd and 3rd tertile). The AUC(95%CI) for MetS in HOMA-IR was 0.78(0.72–0.84). The combination of HOMA-IR and quantity of liver fat significantly improved the ability to distinguish MetS(AUC = 0.85, 95% CI: 0.8–0.89, P = 0.0049) compared to HOMA-IR alone.

Conclusion

The novel liver fat quantitative ultrasound score, Shannon Entropy is significantly with MetS independently with HOMA-IR and obesity. Moreover, the liver fat also increases the distinction of MetS in addition to HOMA-IR. It is important to take the effects of NAFLD for the metabolic disarrangement.

Tab. 1.

The area under the receiver operating characteristic (ROC) curve for MetS

Model AUC 95% CI P-value
HOMA-IR+Shanon Entropy 0.84 (0.8–0.89) 0.0049
HOMA-IR 0.78 0.72–0.84 Ref
Shanaon Entropy 0.78 0.73–0.82 0.9087
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Obes Facts. 2018 May 26;11(Suppl 1):273.

T4P96 A Cohort Study in Obese Population - Ambulatory Blood Pressure Monitoring Profile as a Useful Tool

L S Da Costa 1, SR De Souza 2

Introduction

The alarming epidemic of obesity in the world is increasing. There is an epidemiological correlation between body weight and blood pressure in obese populations. The majority of new hypertensive cases in the Framingham Study is correlated to excess body fat or body mass index (BMI), at least 70% of them. The use of ambulatory blood pressute monitoring (ABPM) is expanding in clinical practice as it provides a closer correlation to prognosis than clinic blood pressure (BP) measures. Studies have supported direct and independent associations of cardiovascular risk with ABPM. The objective was to evaluate systolic (SBP) and diastolic (DBP) patient's blood pressure (BP) on 24-hour, daytime and night time periods, pulse pressure (PP), systolic and diastolic nocturnal drop and their correlation wih the BMI, in a population of hypertensive elderly subjects.

Methods

Cross-sectional study in which subjects aged 60 years and older with hypertensive treatment were included in the study. The study population consisted of 826 outpatient subjects (53% men, mean age 61.8 years) who undergo their 24-hour ABPM as a routine procedure from January 2016 until March 2017 and were treated with antihypertensive medication but were not taking other drugs. Among the participants, 3% had type 2 diabetes and were excluded from our analyses. The BMI, calculated as weight (kg)/height (m2) was checked ate the same day they undergo to the ABMP. All patients gave their written consent to participate in the study.

Results

The SPSS 10.0 (SPSS Inc) statistical package was used to analyze the data. Standard descriptive statistics, 2-tailed Student t test, bivariate and multivariate linear regression analysis were used when appropriate. P < 0.05 was considered statistically significant. From our 826 subjects, 33.8% used one or two drugs and 6.6% used three or more drugs. Parameters of 24-hour ABPM were significantly correlated with BMI: mean 24-hour, daytime and nighttime systolic BP; 24-hour, daytime and nighttime pulse pressure and, daytime diastolic BP (p < 0.05). In obese subjects, there is a higher percentage of white coat effect, compared to overweigth patients, 28% and 34% respectively (p < 0.05).

Conclusion

In our study, we have shown the association among ABPM parameters and obesity. Data from multiple population studies suggest that excess weight gain is a consistent predictor for subsequent development of essential hypertension and some cardiovascular complications usually occur associated with metabolic disorders, specailly related to excess weight gain. The percentage diagnosis of obesity in our hypertensive population is similar to the reported papers in the literature. The pattern of the presented ABPM results may help the identification of target organ damages and help in determination of therapeutic adjustments, corroborating literature data, which emphasize the use of ABPM study in the diagnostic and therapeutic evaluation in obese population.

Obes Facts. 2018 May 26;11(Suppl 1):273.

T4P97 Fasting plasma glucose levels and coronary artery calcification in subjects with impaired fasting glucose

S Kang 1

Introduction

Prediabetes is associated with an increased risk of cardiovascular disease (CVD). While the association of impaired glucose tolerance with CVD has been shown in many studies, the relationship between impaired fasting glucose (IFG) and CVD remains unclear. The purpose of this study was to compare the coronary artery calcium (CAC) scores of participants with normal fasting glucose versus those with IFG, according to fasting plasma glucose (FPG) levels, and to assess whether differences in CAC scores were independent of important confounders.

Methods

Participants were enrolled from the general population who visited for a medical check-up. CAC was assessed in asymptomatic individuals by multidetector computed tomography. Anthropometric parameters and metabolic profiles were also recorded. Subjects were divided into four fasting glucose groups. Participants with a history of CVD or diabetes mellitus were excluded.

Results

Of 1112 participants, 346 (34.2%) had a CAC score >0. FPG values in the IFG patients were positively but weakly correlated with CAC scores (r = 0.099, P = 0.001). The incidence of CAC differed according to FPG level (P < 0.001) and in Kruskal-Wallis test the mean CAC score differed by FPG group (P < 0.001). After adjustment for other factors in a multiple logistic regression analysis, those subjects with FPG ≥110 mg/dL had a significantly higher risk of CAC than did subjects with normal fasting glucose (110≤FPG [mg/dL] < 120, OR = 2.507, P = 0.002; 120≤FPG [mg/dL] < 126, OR = 3.568, P = 0.001 vs. < 100 mg/dL)

Conclusion

IFG (especially FPG ≥ 110 mg/dL) could be an independent risk factor for CAC. These associations were not altered after adjustment for other possible confounders.

Obes Facts. 2018 May 26;11(Suppl 1):274.

T4P98 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):274.

T4P99 High urinary cortisol excretion in patients with morbid obesity is associated with a less favourable metabolic profile

J Brix 1, E Krzizek 1, H Kopp 1, B Ludvik 1

Introduction

Cortisol levels might be increased in obesity leading to enhanced gluconeogenesis and inhibited glucose utilisation. Subsequent release of katecholamines might additionally promote obesity. The association of cortisol levels to metabolic parameters is not well characterized in morbid obesity.

Methods

We included 1225 patients with MO (76.8% women, mean BMI 45.6 ± 6.2 kg/m2, mean age 40 ± 12 years). Anthropometric data, cardiovascular risk factors were assessed and a glucose tolerance test (oGTT) was performed. All patients collected 24h hour urine specimen to assess cortisol on two consecutive days. Regarding cortisol excretion, patients were divided in tertiles

Results

Patients in the first tertile exhibit cortisol levels < 336.3 nmol/24h, in the second tertile: > 336.3 < 1160.8 nmol/24h and in the third tertile >1160.8 nmol/24h.a higher weight (p < 0.001) and BMI (p = 0.042), as well as HbA1c (p < 0.001). OGTT revealed non-significant trend for impaired glucose tolerance: fasting glucose (p = 0.082), 1hour postprandial glucose (p = 0.071), 2 hour postprandial glucose (p = 0.068). We did not find any differences regarding age, blood pressure, lipids, CRP or insulin levels between the groups.

Conclusion

Patients with higher cortisol excretion are more obese and present with a less favourable metabolic profile compared to those with lower cortisol excretion.

Obes Facts. 2018 May 26;11(Suppl 1):274.

T4P100 Severe hypoalbuminaemia following a Roux-en-Y gastric bypass in a patient with type 1 diabetes mellitus

E Krzizek 1, J Brix 1, B Ludvik 1

Introduction

Albuminuria in the context of diabetic nephropathy is a known side effect of poorly controlled diabetes. Data of the SOS study showed a reduction of albuminuria after bariatric surgery. On the other hand, Roux-en-Y gastric bypass carries the risk of protein malabsorption due to changes in the gut anatomy and physiology. In this case report we describe the results of a patient with both, diabetes mellitus and bariatric surgery.

Methods

A 49-year old woman (height 157 cm, weight 95kg, BMI 38.5 kg/m2) with Type 1 diabetes since 1983 underwent Roux-en-Y gastric bypass in 2005. She was admitted to our hospital due to generalized edemas. Routine check-up for bariatric patients was performed including blood tests after an overnight fasting and a urine sample. Amongst others HbA1c, creatinine, albumin and albumin-creatinine-ratio were evaluated. Yearly check-ups of these parameters were evaluated retrospectively since 1999.

Results

As expected, there was a significant weight loss after bariatric surgery (2005: 122 kg, BMI 49.4 kg/m2; 2007: 80 kg, BMI 32.4 kg/m2). Diabetes control has always been poor (HbA1c 8.9% (1999), 8.7% (2005), 10.3% (2007), 10.8% (2017)). Diabetic nephropathy and retinopathy have been known since 1999. Albuminuria was present before bariatric surgery and got worse over the years (ACR 32.6 mg/g (1999), 158 mg/g (2005), 2246,4 mg/g (2014), 1336.1 mg/g (2017). Furthermore, hypalbuminemia has been present before surgery and deteriorated subsequently (albumin 29.0% (1999), 60.6% (2005), 32.2% (2012), 21.6 (2017)).

Conclusion

In this patient, albuminuria unexpectedly worsened after Roux-en-Y gastric bypass despite weight loss, most likely due to insufficient metabolic control. Following surgery, decreased protein absorption contributed to the severe hypoalbuminemia resulting in generalized edemas. Thus, patients at high risk for hypoalbuminemia, especially those with diabetic nephropathy, need to be carefully evaluated preoperatively and be offered non-malabsorptive bariatric procedures such as sleeve gastrectomy, if indicated.

Obes Facts. 2018 May 26;11(Suppl 1):274.

T4P101 Occupational Physical Activity, Uric Acid and Cardiovascular Risk in workers affected by obesity

L Vigna 1, F Natrella 1, F Bamonti 1, F Gori 1, L Riboldi 1

Introduction

Classify the work activities with respect of the Occupational Physical Activity (OPA) required by the type of work Evaluate the possible effects of the OPA on cardiovascular risk (CV) calculated according to the Framingham Score (FS) Evaluate the possible role of serum Uric Acid (SEU) levels in relation to various CV and OPA risk factors

Methods

Our study examined 1767 (482 M/1285 F) workers affected by obesity with sedentary, mild or moderate work activity divided according to OPA and METS, admitted tho “Obesity and Work” clinic

Results

ANOVA shows a clear correlation between FS and OPA (p < 0.001) and an increase in systolic BP in relation to the OPA (p = 0.067) in Females Linear Regression analysis of SEU versus CV risk (according to FS) shows that: if SEU increases by 1 mg / dl FS increases by 0.591% (R2 = 0.017). SEU vs OPA and gender shows a slight increase of SEU in Females

Conclusion

Our study pointed out the importance between physical commitment to work and CV risk in female with obesity.. Prevention campaign for cardiometabolic risks are mandatories in Occupational settings.

Obes Facts. 2018 May 26;11(Suppl 1):274.

T4P102 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):274–275.

T4P103 External validation of equations to estimate resting energy expenditure in 14952 adults with overweight and obesity and 1498 adults with normal weight from Italy

A Sartorio 1, G Bedogni 2, S Bertoli 3, A Leone 3, R De Amicis 3, E Lucchetti 1, F Agosti 1, N Marazzi 1, A Battezzati 3

Introduction

We cross-validated 28 equations to estimate resting energy expenditure (REE) in a very large sample of adults with overweight or obesity.

Methods

14952 Caucasian men and women with overweight or obesity and 1498 with normal weight were studied. REE was measured using indirect calorimetry and estimated using two meta-regression equations and 26 other equations. The correct classification fraction (CCF) was defined as the fraction of subjects whose estimated REE was within 10% of measured REE.

Results

The highest CCF was 79%, 80%, 72%, 64%, and 63% in subjects with normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. The Henry weight and height and Mifflin equations performed equally well with CCFs of 77% vs. 77% for subjects with normal weight, 80% vs. 80% for those with overweight, 72% vs. 72% for those with class 1 obesity, 64% vs. 63% for those with class 2 obesity, and 61% vs. 60% for those with class 3 obesity. The Sabounchi meta-regression equations offered an improvement over the above equations only for class 3 obesity (63%).

Conclusion

The accuracy of REE equations decreases with increasing values of body mass index. The Henry weight & height and Mifflin equations are similarly accurate and the Sabounchi equations offer an improvement only in subjects with class 3 obesity.

Funding

The study was supported by internal grants from the International Center for the Assessment of Nutritional Status and the Italian Institute of Auxology (Progetti di Ricerca Corrente).

Obes Facts. 2018 May 26;11(Suppl 1):275.

T4P104 Gender features of accumulation of epicardial fat in patients with metabolic syndrome

D Deev 1, T Matsiyevskaya 2, B Pinkhasov 1, E Novikova 1, V Selyatitskaya 1

Introduction

Recently special attention is paid to the study of the pathogenetic role of epicardial fat in the development of cardiovascular diseases. There are not enough information relative to the epicardial adipose, despite the available evidence of gender features of the accumulation of subcutaneous and visceral adipose tissue.

Methods

The study included 70 men and 40 women. The average age of the patients was 50.6 ± 9.8 in men and 59.2 ± 8.5 years in women. Clinical, anthropometric and biochemical screening was taken. Metabolic syndrome (MS) was diagnosed according to the criteria NCEP-ATP III. The thickness of the epicardial fat (TEF) was measured with a standard echocardiographic study. results are presented as M ± SD.

Results

MS was revealed in 68,2% of cases in the general group of patients. In patients with MS, the TEF was significantly greater than in patients without MS 4,4 ± 2,2 and 2,9 ± 1,6 mm (p < 0,05) respectively. In women and men without MS TEF significantly did not differ between groups: 3.2 ± 1.7 and 2.6 ± 1.5 mm (p = 0.31) respectively, while in women with MS TEF was significantly greater than in women men 5.5 ± 2.4 mm and 4.0 ± 1.9 mm (p < 0.05), respectively. Women with MS were significantly older than men (p < 0.05), so it is impossible to exclude that the age factor has exerted impacts on increase in TEF in women. It was also confirmed by the carried-out correlation analysis. In women direct correlation of the TEF with age and systolic blood pressure level rs = 0.35 и rs = 0.32 (p < 0.05) respectively was revealed, while in men, the TEF had a direct correlation with the level of triglycerides and the inverse - with the level of high-density lipoproteins: rs = 0.28 and rs = −0.24 (p < 0.05) respectively. In men and women with MS increase in TEF was associated with a change in the structural and functional characteristics of the heart. The end-diastolic volume and the end-diastolic size of the left ventricle had significant inverse correlation with the TEF rs = −0.27 и rs = −0.26 (p < 0.05) respectively. Analogous connections was not found in patients without MS. TEF had direct correlation connections with the thickness of the posterior wall of the left ventricle and interventricular septum rs = 0.20 и rs = 0.28 (p < 0.05) respectively.

Conclusion

MS is associated with the accumulation of epicardial fat and changes in the structural and functional characteristics of the myocardium. The increase in TEF in women with MS is determined not only by gender, but also by the age factor.

Obes Facts. 2018 May 26;11(Suppl 1):275.

T4P105 Validation of genetic risk score for obesity combining six single-nucleotide polymorphisms in two independent Iberian samples

D Albuquerque 1, L Gonzalez 2, F Gimeno-Ferrer 2, G Marcaida 2, R Rodríguez-López 2, L Manco 1

Introduction

A genetic risk score (GRS) comprising six single-nucleotide polymorphisms (SNPs), located in genes SH2B1, ETV5, SEC16B, TFAP2B and FTO, was previously validated predicting individuals with high susceptibility to childhood obesity among Spanish population [1]. In this study, we aimed to replicate the association study of the GRS previously reported [1], in two independent Iberian samples. This GRS could be helpful for preventive health care.

Methods

Two population-based samples comprising 346 unrelated Portuguese children aged between 6–12 years old (191 controls and 155 obese; mean body mass index [BMI] Z-score = −0.17 ± 1.5 and 1.97 ± 0.25 respectively), and another sample comprising 332 unrelated Spanish adults aged between 18–60 years old (217 controls and 115 obese; mean BMI = 21.9 ± 1.7 and 43.8 ± 13.3 respectively) were used. SNPs were genotyped by allelic discrimination TaqMan assays. Multiple logistic regression under an additive genetic model were performed. Models were adjusted for age and gender.

Results

Regarding the sample of Portuguese children we found nominal association of the FTO rs17817449 SNP with BMI (p = 0.023), BMI Z-score (p = 0.009), weight (p = 0.020) and waist circumference (p = 0.022). In the sample of Spanish adults, marginal nominal association was also found for the FTO rs17817449 SNP with BMI (p = 0.050). Statistically significant predictor of obesity was found for the FTO rs17817449 SNP (odds ratio [OR] = 1.4, 95% confidence interval [95%CI] = 1.03–1.91, p = 0.027) on Portuguese children, and ETV5 rs7634510 (OR = 1.5, 95%CI = 1.12–1.99, p = 0.011) and FTO rs17817449 (OR = 1.7, 95%CI = 1.36–2.21, p = 0.0005) SNPs on Spanish adults. Any further associations were observed for the SH2B1 and TFAP2B SNPs.

Conclusion

The results obtained in this study failed to replicate a previously proposed GRS to predict high susceptibility to develop an obese phenotype. Nonetheless, we highlight the role of the rs17817449 FTO SNP on obesity in both Portuguese and Spanish samples. Association of the rs7634510 ETV5 SNP in adults but not in children may be due to potential differential relative effects of this SNP for obesity between children and adults.

Funding

David Albuquerque have a post-doc fellow from FCT (SFRH/BPD/109043/2015).

Reference

  • 1.González JR, et al. Genetic risk profiles for a childhood with severely overweight. Pediatr Obes. (2013);9((4)):272–280. doi: 10.1111/j.2047-6310.2013.00166.x. [DOI] [PubMed] [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):275–276.

T4P106 Overview of underlying genetic causes of pediatric obesity in a tertiary pediatric obesity center

L Kleinendorst 1, O Abawi 2, A Brandsma 3, M Jongejan 4, EF Van Rossum 5, B Van Der Zwaag 6, M Van Haelst 1, EL Van Den Akker 2

Introduction

Obesity is a multifactorial disorder. In rare cases, an underlying genetic diagnosis can be established. These patients present with early-onset severe obesity. Patients with this clinical phenotype are referred to our tertiary Erasmus MC pediatric obesity center CGG for diagnostics of underlying causes. Establishing a genetic diagnosis can lead to personalized treatment and may support reproductive decision-making. This study aims to provide an overview of obesity associated mutations and copy number variations found in this population.

Methods

Genetic testing was performed in 174 obese children who were referred between 2012 and 2017. An obesity gene panel, involving next generation sequencing of 52 genes, a SNP-array and, on clinical suspicion, specific additional diagnostics (e.g. maternal UPD14 test, whole exome sequencing) were performed.

Results

The median age at intake was 10.3 years (min 0.7 - max 18 years); 69 patients were male (39.7%) and 105 were female (60.3%). In 28 patients (16.1%), an underlying genetic cause was established (Table 1). In 22 patients (12.6%), an unknown copy number variation or variant of unknown significance was found in obesity associated genes, for which the role in the obesity phenotype of the patients has yet to be established.

Conclusion

An obesity-associated genetic diagnosis was made in 28 (16.1%) of 174 patients with early onset obesity. This diagnostic yield is relatively high compared to similar studies reported in literature, and shows that genetic testing in obesity can be highly relevant in selected patient groups.

Tab. 1.

Underlying genetic causes found in our pediatric obesity patient cohort listed by frequency

Underlying cause or gene No. of patients Characteristics
Melanocortin-4 receptor (MC4R) 5 Heterozygous mutation
1 Compound heterozygous mutations
1 Homozygous mutation
Leptin receptor deficiency 3 Compound heterozygous mutations
2 Homozygous mutation
16p11.2 deletion syndrome 3 Typical 16p11.2 deletion
Melanocortin 2 receptor accessory protein 2 (MRAP2) 2 2 sibs with heterozygous mutation
Pseudohypoparathyroidism type 1A 2 Heterozygous GNAS mutation
Central hypothyroidism 1 Heterozygous IGSF1 mutation
Cohen syndrome 1 Homozygous VPS13B mutation
Mental retardation, autosomal dominant 39 1 Heterozygous MYT1L mutation
Maternal UPD 14 1 mUPD14
Proprotein convertase subtilisin/kexin type 1 (PCSK1) 1 Heterozygous mutation
Proopiomelanocortin (POMC) 1 Deletion 2p, including POMC gene
Pseudohypoparathyroidism type 1B 1 Heterozygous STX16 mutation
Single-minded homology 1 (SIM1) 1 Deletion 6q, including SIM1 gene
Spastic paraplegia type 11 1 Compound heterozygous SPG11 mutations
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Obes Facts. 2018 May 26;11(Suppl 1):276.

T4P107 A comprehensive diagnostic approach to detect underlying causes of obesity in adults

E S Van Der Valk 1, EL Van Den Akker 2, M Savas 3, JA Visser 4, M Van Haelst 5, EF Van Rossum 4

Introduction

When encountered with obesity, many physicians focus on treatment of the (consequences of) adiposity. We plead for an individualized treatment after adequate diagnostics.

Methods

We provide experience-based and evidence-based practical advices illustrated by clinical examples, about adequate diagnostics in patients with obesity, to detect potential underlying diseases and/or contributing factors.

Results

Adult patients consulting a doctor for weight gain or obesity should be assessed for underlying diseases, such as monogenetic or syndromic obesity, hypothyroidism, (cyclic) Cushing syndrome, PCOS, hypogonadism, growth hormone deficiency, and hypothalamic obesity. The most important alarm symptoms for genetic obesity are early onset obesity, dysmorphic features/congenital malformations with or without intellectual deficit, behavioral problems, hyperphagia and/or striking family history.

Furthermore contributing causes should be investigated, including lifestyle factors, medication (mainly psychiatric drugs, (local) corticosteroids, insulin, and specific β-adrenergic receptor blockers), sleeping habits and quality, shift work, crash diets and yoyo-effect, pregnancy or menopause, smoking cessation and alcoholism. Other conditions associated with obesity include mental factors such as chronic stress or binge-eating disorder and depression.

Conclusion

Identifying and optimizing the underlying diseases, contributing factors, and other associated conditions may not only result in more effective and personalized treatment, but could also reduce the social stigma for patients with obesity.

Obes Facts. 2018 May 26;11(Suppl 1):276–277.

T4P108 The relationship between circulating neutrophil gelatinaseassociated lipocalin and early alteration of metabolic parameters is associated with dietary saturated fat intake in non-diabetic Korean women

S Han 1, OY Kim 2, JS Choi 3

Introduction

Circulating neutrophil gelatinase-associated lipocalin (NGAL) is associated with obesity-related metabolic disorders. This study investigated the relationship between serum NGAL and early alteration of metabolic parameters in non-diabetic Korean women, particularly with respect to saturated fat (SFA) intake.

Methods

Anthropometric parameters, fasting glycemic status, and levels of lipids, oxidative stress/inflammatory markers, and NGAL were measured in 82 non-diabetic Korean women [Super-healthy group (n = 57) with 0 metabolic syndrome risk factor (MetS RF) and MetS-risk group (n = 25) with MetS RF ≥ 1]. Age, weight, waist circumference, blood pressure, fasting glucose, HbA1C, triglyceride, LDL and total-cholesterol, and NGAL levels were higher, and HDL-cholesterol was lower in the MetS-risk group than in the Super-healthy group.

Results

Age-adjusted serum NGAL levels were higher in the MetS-risk group than in the Super-healthy group. NGAL increased proportionally with increase in MetS RFs (p = 0.038) and correlated positively with BMI, triglycerides, LDL- and total-cholesterol, interleukin-6, white blood cell count, and neutrophil%, and negatively with HDL-cholesterol and superoxide dismutase activity. Serum NGAL levels positively correlated with SFA intake before and after adjustment (age and BMI). Serum NGAL levels were higher in high-SFA consumers [≥7g/day, ≥7% of total calorie intake (TCI)] than in low-SFA consumers (< 7g/day, < 7% of TCI). Serum NGAL levels were highest in the MetS-risk group consuming higher SFA and lowest in the Super-healthy group consuming lower SFA. However, serum NGAL did not significantly differ between the low-SFA consuming MetS-risk and Super-healthy groups.

Conclusion

The relationship between circulating NGAL and early alteration of metabolic parameters is associated with dietary SFA intake in non-diabetic Korean women.

Obes Facts. 2018 May 26;11(Suppl 1):277.

T4P109 Relation of serum 25(OH)-vitamin D to insulin resistance in overweight and obesity

M G Nikolova 1, A Penkov 2, M Boyanov 3

Introduction

Vitamin D is recognized to serve a wide range of biological functions. The presence of vitamin D receptors on different tissues explains it's diversity of actions. Some studies have shown a relationship between vitamin D deficiency and insulin resistance, and other have shown, that vitamin D may play a functional role on glucose tolerance through its effects on insulin secretion and insulin sensitivity. The aim of this study is to investigate the relationship between serum vitamin D and insulin resistance in men and woman with overweight and obesity without diabetes mellitus.

Methods

A total 264 subjects were included – 109 men and 155 women aged 20–60 years. Participants were assessed for weight and height, waist circumference, systolic and diastolic blood pressure. Body composition was assessed by bioelectrical impedance. Fasting Plasma Glucose (FPG) was measured. Serum 25(OH)D Total and Insulin were measured by electro-hemi-luminescence, and HOMA - IR was calculated. High-sensitivity C-reactive protein was measured by an immune turbo-dimetrical method together with total, HDL-cholesterol and triglycerides. Oral glucose tolerance tests (OGTTs) were conducted to 30 subjects (11 men and 19 women) with BMI > 25 kg/m2.

Results

From all the participants, 27.2% of the participants had normal weight, 24.6% - overweight, 29.2% -class I obesity, and 18.9% – class II or III. 33.3% had vitamin D deficiency, 40.2% - insufficiency. Vitamin D was inversely correlated to FPG, Insulin, HOMA - IR and hs - CRP in the group as a whole and according to sex (tabl.1). Splitting the subjects according to BMI led to loss of significance. Vitamin D predict only blood sugar at 120 minutes from OGTT, but not at 0 minute of OGTTs and has no connection with stimulated insulin levels.

Conclusion

Serum 25(OH)D is weakly correlated to metabolic parameters related to insulin resistance in men and woman with overweight and obesity without diabetes mellitus. Adequate vitamin D supplementation may improve multiple metabolic disturbances.

Tab. 1.

The Spearman's correlation coefficients between serum 25(OH)D and FPG, Insulin, HOMA - IR and hs - CRP are shown according to sex

Independent variable Total group (N = 264) Men (n = 109) Women (n = 155)
FPG (mmol/l) –0.149* –0.296** –0.089
Insulin (mUI/l) –0.281** –0.282* –0.286*
HOMA – IR –0.328*** –0.433** –0.269*
hs CRP (mg/l) –0.293** –0.230 –0.300*
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*

- p < 0.05

**

- p < 0.01

***

- p < 0.00’

Obes Facts. 2018 May 26;11(Suppl 1):277–278.

T4P111 Association of platelet count with sarcopenic obesity in postmenopausal women: A nationwide population-based study

Y Kwon 1, D Jung 1, MJ Kim 2

Introduction

Low muscle mass with excess adipose tissue is defined as sarcopenic obesity. Sarcopenic obesity can lead to increased metabolic risk due to two different pathologic conditions. Emerging evidence indicates that sarcopenic obesity contributes to a wide range of health problems, including cardiovascular disease, metabolic syndrome, insulin resistance, and mortality. The pathophysiology of sarcopenic obesity is complex and interrelated with other factors. Some studies have concluded that women tend to have significant muscle weakness around the time of menopause. Chronic inflammation and insulin resistance have been also proposed as important risk factors for sarcopenic obesity. Recently, platelets have been shown to have a role in inflammation in addition to their classic role in hemostasis. The aim of this study was to examine the relationship between platelet count and sarcopenic obesity in postmenopausal women.

Methods

This cross-sectional study was conducted using nationally representative data. A total of 2810 postmenopausal women who participated in the 2008–2011 Korea National Health and Nutritional Survey were included in this study. Sarcopenic obesity was defined by a sarcopenia criterion and an obesity criterion. Platelet counts were divided into quartiles as follows: Q1, 150–222; Q2, 223–257; Q3, 258–294, and Q4, 295–450 (103/$$). Multiple logistic regression analysis was performed to examine the association between platelet count quartile and sarcopenic obesity after adjusting for confounding factors.

Results

In total, 2810 postmenopausal women (mean age, 62.0 ± 0.3 years) were included in this study. The mean ASM (kg) and total body fat percentage (%) were 24.1 ± 0.1 (kg) and 34.5 ± 0.2 (%), respectively. The prevalence of sarcopenic obesity in postmenopausal women was 14.8%. The prevalence of sarcopenic obesity increased significantly as platelet count quartile increased: 11.2% for Q1, 13.6% for Q2, 14.3% for Q3, and 20.0% for Q4 (p-value = 0.003). Compared to the lowest platelet quartile, the odds ratios and 95% confidence intervals for sarcopenic obesity in the highest quartile were 1.98 (1.36–2.89) in the unadjusted model; 1.93 (1.31–2.83) after adjusting for age; and 1.65 (1.23–2.65) after adjusting for age, systolic blood pressure, homeostatic model assessment insulin resistance (HOMA-IR), triglyceride, total cholesterol, total calorie intake, regular exercise, current smoking status, and education level.

Conclusion

Elevated platelet count (i.e. towards the upper end of the normal range) was significantly associated with sarcopenic obesity in postmenopausal women.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):278.

T4P112 Clinical validation of a new Visceral Adipose Tissue estimation algorithm for DXA. Preliminary Results

S Di Gregorio 1, L Horcsh 2, C Costamagna 3, LM Del Rio 1, R Villavicencio 2

Introduction

Obesity is an individual clinical condition that has become a serious public health problem that is increasing. It is an endemic disease with a high growth rate. The risks associated with overweight and obesity are due, predominantly, to its distribution. The excess of visceral fat is an independent component of cardio-metabolic syndrome; it is directly related to the prognosis of the disease. The objective is the use of a new algorithm by DXA versus the GE-CoreScan software for the estimation of abdominal fat in a cohort of patients suffering metabolic syndrome.

Methods

Eighty subjects (19 men, 61 women), derivatives for endocrinological assessment in an Argentine clinic (Rosario city). Total body composition scans using GE-iDXA model device was used. Analysis of the whole-body DXA scans was performed using specific CoreScan software (Version 14.1) and the new DENSIGRAS prototype. This new algorithm uses a variable abdominal geometry assumption to perform the VAT and SAT volumetric estimation. We excluded 7 patients in whom the abdominal analysis could not be performed due to technical reasons. Clinical parameters of the participants were evaluated as systolic blood pressure biochemical parameters such as glycemia; insulinemia; Homa index; total cholesterol; HDL; LDL; Triglycerides. Statistics: regression tests were applied to evaluate the correlations, with a value of p < 0.05 as significant.

Results

 

Conclusion

The new algorithm for VAT estimation in which the assumption of variable abdominal geometry is applied has similar capacity for the identification of subjects with metabolic syndrome that the CoreScan software y a slightly better correlation with some specific bio clinical parameters.

Conflicts of Interest

Two of the authors (Luis del Rio and Silvana Di Gregorio) are participants in the developer group of the new software that is evaluated in the study. Although they have no direct business interests.

Tab. 1.

Method TG Glycemia Insulinemia HOMA Col. Tot LDL HDL TG
Waist p. r 0.493 0.239 0.425 0.460 0.228 0.154 0.117 0.273
p 0.002 0.090 0.007 0.004 0.101 0.196 0.258 0.062
Fat mass Androyd ROI r 0.253 0.379 0.513 0.562 0.253 0.158 0.103 0.900
p 0.078 0.015 0.001 0.001 0.078 0.191 0.284 0.310
VAT CoreScan r 0.341 0.325 0.72 0.449 0.475 0.428 0.005 0.271
p 0.026 0.030 0.016 0.004 0.003 0.006 0.489 0.063
VAT DENSIGRAS r 0.345 0.340 0.434 0.501 0.316 0.283 0.05 0.169
p 0.025 0.027 0.006 0.001 0.037 0.05 0.489 0.173
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Obes Facts. 2018 May 26;11(Suppl 1):278.

T4P113 Visceral fat reference data using dual-energy x-ray absorptiometry in a healthy Spanish population cohort from 20–90 years

LM Del Rio 1, S Di Gregorio 1, E Bonel 2

Introduction

The excess of visceral adipose tissue (VAT) is deeply associated with the development of metabolic disorders that result in cardiovascular diseases, hypertension and malignancies. Visceral obesity can be estimated using surrogate methods based on anthropometric measures or calculating it, by sophisticate and expensive image techniques as CT or MRI. The anthropometric methods are simple to obtain but do not allow distinguishing between VAT and subcutaneous abdominal fat. Dual energy X-ray absorptiometry (DXA) is an established technique used in clinical and research settings to evaluate total and regional fat. There are different approaches to use this body composition method to quantify VAT. Currently, there are few reference database available for VAT. The aim of this study was to develop reference values for VAT in healthy Spanish adults of both sexes.

Methods

We used the VAT results from total body scans performed with a GE Healthcare DXA system, model iDXA with CoreScanÒ software application (version 14.1). Study population: Healthy Spanish volunteers aged 20–90 years (332 women and 236 men). The exclusion criteria that have been used to select the participants was: no history of diseases or pathological conditions, abdominal surgeries or presence of artifacts. Body mass index had to be greater than 18 and less than or equal to 25. Anthropometric measures, such as waist and hip diameters were recorded as well as body composition parameters, including bone mineral content, lean mass, total body fat mass, and android and gynoid fat. All scans were acquired and analyzed by a single trained technician applying the manufacturer's rules. VAT results were stratified by sex and by decade offering the average values and standard deviations.

Results

In women, VAT increases from 20 years to the 70s, to decrease significantly (−40%) in the 80s. This evolution is somewhat different in men, where the VAT increases from 30 to 60 years, stabilizing beyond this period. Men have a higher VAT than women, with a ratio of 1.7. This difference is maintained despite the adjustment for the size of the subjects, with a ratio of 1.4. In contrast, there are no significant differences in subcutaneous tissue (SAT) in the region of abdominal interest. VAT showed a stronger positive correlation with waist diameter (r:0.9).

Conclusion

We provide reference values for VAT obtained from healthy adults live period in a south Europe country using the GE Healthcare DXA. These values may different from other reference data now available and could be useful in the diagnosis of visceral obesity, for identifying subjects with high obesity-related risks.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):279.

T4P114 DENSIGRAS a new algorithm for the estimation of visceral fat in DXA based on variable abdomen 3D geometry

L M Del Rio 1, G Chary 1, JA Romero 1, E Bonel 1, S Di Gregorio 1

Introduction

The excess of visceral intra-abdominal adipose tissue (VAT) seems to be a key characteristic of abdominal obesity that contributes to the development of the metabolic syndrome, coronary heart disease, arterial hypertension and is related to different cancers. The objective of this study is to compare the results of VAT analysis using a new algorithm based on DXA technique, with CT VAT estimation. The comparison has also been made with GE CoreScan application.

Methods

Abdominal CT scans (GE CT Discovery 128 CT) and full body DXA (GE iDXA) were performed on 60 volunteers of both sexes. The CT images and data of 40 subjects (30 women and 10 men) have been used for the creation of a database of volumetric abdominal fat distribution and shape models. The remaining 20 volunteer scans have been used for validation. VAT estimation: We have developed an algorithm which allows the estimation of volumetric VAT and SAT in DXA scans, based in a 3D CT-to-2D DXA database. The CT scans database was obtained by multi-slice and semi-authomatic segmentation in 40 subjects and subcutaneous fat and intraperitoneal space were quantified. The images and profiles of the cross sections of the CT scans allow identification of different geometry models that have been registered and are used for the selection of the optimal geometric approach in each subject. Statistics: Means were compared by Student's test and differences between the three methods of measurement by Bland Altman test. Correlations and the coefficient of determination were evaluated using regression equations.

Results

The average difference between the VAT results of DENSIGRAS and CT with absolute values (Test of Bland Altman) is: −278,66 g SD: 198,40 g. Although, when comparing the distribution ratio between VAT/SAT as a percentage in each of the voluntary subjects and comparing them with the CT, the average difference is: −0.65%; SD: 2.21%. These findings contrast with differences between CT and VAT results with the Corescan application: −636.33 g SD: 434, 91 g. The average difference in the percentage of VAT is -10.59% SD: 12.12%, much higher than the prototype. The correlation with the TAC and DENSIGRAS is r: 0.931. The correlation between Corescan and CT is r: 0.837. The coefficient of determination (r2) between the size-adjusted VAT measurement with DENSIGRAS and the TAC is r2: 0.871. The coefficient of determination with Corescan and the TAC is r2: 0.688.

Conclusion

The performance of the DENSIGRAS prototype is superior to the GE Corescan application. The measurements of VAT with DENSIGRAS, allows to avoid CT scans for the assessment of volumetric VAT and have a huge potential in the prediction of cardiovascular and metabolic risk.

Conflicts of Interest

The authors belong to the developer group of the new software that is evaluated in the study. Although they have no direct business interests.

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Obes Facts. 2018 May 26;11(Suppl 1):279.

T4P115 Psychiatric-related safety of naltrexone/bupropion in a large randomized double-blind trial

K Gilder 1, L Acevedo 1, A Halseth 1, J Buse 2, S Kahan 3

Introduction

Prolonged-release naltrexone 32 mg/bupropion 360 mg (NB) is approved for chronic weight management as an adjunct to diet and physical activity. A large, multicenter, randomized, double-blind, placebo-controlled trial assessed the effect of NB on cardiovascular (CV) events in participants with overweight and obesity at elevated CV risk. The current analyses focused on treatment-emergent (TE) AEs that are psychiatric in nature.

Methods

Randomized participants (NB or placebo [PBO]) were required to lose ≥2% body weight at 16 Weeks, without a sustained increase in blood pressure, to continue study drug. Serious adverse events (SAE) and AEs leading to discontinuation of study drug (AELDSD) were collected.

Results

The trial was terminated early after second interim analysis, corresponding to collection of 50% of the primary endpoint data. The intent-to-treat population (NB N = 4455, PBO N = 4450) was 54.5% female, 83.5% white, mean age of 61 years, mean BMI of 37 kg/m2, 22.8% with a history of depression, 23.1% on antidepressant medication at baseline, and 121 weeks median follow-up. Incidence of psychiatric-related TE SAEs was very low (0.2% NB, < 0.1% PBO), and there were no reported suicide attempts or completed suicides. Reported events included major depression (0.1% NB); bipolar disorder, delirium, hallucination (each < 0.1% NB); and depression, and suicidal ideation (each < 0.1% PBO). Incidence of psychiatric-related AELDSDs was also very low, but slightly higher in the NB group. The most frequently reported events included insomnia (0.8% NB, 0.4% PBO), anxiety (0.6% NB, 0.2% PBO), depression (0.1% NB, 0.2% PBO), and hallucination (0.2% NB). Depression, anxiety, and sleep disorder-related AEs were generally mild/moderate. Anxiety and sleep-related AEs tended to occur early, while depression-related events occurred later.

Conclusion

Data from this large randomized trial, which includes older participants and participants using antidepressants, provides reassurance that psychiatric SAEs with NB are infrequent, while tolerability-related psychiatric AELDSDs occur at a slightly higher rate with NB. These results are consistent with the results of the Phase 3 program.

Conflicts of Interest

K. Gilder, L. Acevedo, and A. Halseth are employees and stockholders of Orexigen Therapeutics. J. Buse and S. Kahan are consultants for Orexigen Therapeutics.

Obes Facts. 2018 May 26;11(Suppl 1):279–280.

T4P116 Prediction of sibutramine therapy Results and genotyping of GNB3, SERT, NET and TPH2 genes polymorphisms

N Mazurina 1, M Galieva 1, E Troshina 1, A Volynkina 2, A Artyushin 3, A Pavlova 3, M Aksionova 3

Introduction

Obese individuals demonstrate variable response to sibutramine therapy. The aim of the study was to evaluate the influence of GNB3, SERT, NET, TPH2 genes polymorphisms on the results of obesity treatment with sibutramine.

Methods

Over 90.000 obese patients were enrolled in the All-Russia Non-interventional Program of Reduxine Safety Monitoring for Weight Reduction in Patients with Alimentary Obesity in Routine Clinical Practice (PRIMAVERA). According to the results of 3 months of therapy we formed two groups of patients: 1) < 5% of body weight reduction – non-responders (n = 52, mean age 43.6 years) 2) clinically significant weight loss ≥ 5% - responders (n = 66, mean age 43.7 years). The second group was elected by paired comparison method. Also GNB3, SERT, NET, TPH2 genes polymorphisms were assessed.

Results

We did not find significant correlations between SERT, NET and TPH2 genes polymorphism and body weight loss. GNB3 TT genotype was more frequent in significant weight loss group (responders) (p = 0.022).

We evaluated body weight loss and BMI change in patients with different genotypes of GNB3 C825T polymorphism in the whole group (n = 118). Sibutramine treatment resulted in significantly greater weight loss in patients with TT genotype than in subjects with CC/CT genotype (−9.35% vs -6.45%, p = 0.03).

Conclusion

1) Weight loss during Sibutramine treatment was not effected by SERT, NET and TPH2 genes polymorphisms; 2) GBN3 gene TT genotype was associated with more effective treatment. Conflict of interest None disclosed Funding Research related to this abstract was funded by Promomed

Tab. 1.

Alleles and genotypes frequency of GNB3 C825T polymorphism in “responders” and “non-responders”

„Responders” „Non-responders” Χ2 P
Allele C 0.534 0.590 0.520 0.471
Allele T 0.466 0.410 0.520 0.471
Genotype CC 0.379 0.385 0.004 0.948
Genotype CT 0.333 0.500 3.348 0.067
Genotype TT 0.288 0.115 5J83 0.022
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Obes Facts. 2018 May 26;11(Suppl 1):280.

T4P117 Effectiveness of liraglutide 3.0 mg treatment on weight regain after bariatric surgery in severely obese patients

F Muratori 1, G Di Sacco 1, D Pellegrino 2, F Vignati 1

Introduction

Bariatric surgery for obesity is considered when other treatments have failed. Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions, regardless of the type of procedure used. Outcomes were similar between Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG), and both of these procedures had better outcomes than laparoscopic adjustable gastric banding (LAGB). Weight regain (WR) is an important issue after bariatric surgery and might be considered as a long-term complication, because it can lead to re-emergence of obesity related comorbidities and impaired quality of life. We here report our experience on pharmacological treatment in patients who regained weight after bariatric surgery.

Methods

Twenty female patients (aged 24–57 years, 41,3+10,7) who had been undergone elsewhere to bariatric surgery (11 LAGB, 2 RYGB, 7 LSG: mean BMI before surgery 44,7 + 11 kg/m2 (range 36,1 - 53,9); minimum BMI after surgery 31,4 + 8,8 kg/m2 (range 23,62 - 40,62), came to our observation 54+30 months (range 12–775 months) after surgery because of WR. After surgery the patients were following dietary and behavior counseling. Ten out of twenty patients were treated in the past years, and after bariatric surgery, with sibutramine or orlistat because of WR. At the time of our observation (last observation of weight regains) mean BMI was 36,3 + 9,3 kg/m2 (range 27,6 -43,01). The patients were treated as follow: liraglutide was administered once-daily subcutaneously, starting at a dose of 0.6 mg with weekly 0.6-mg increments to 3.0 mg. The mean liraglutide follow-up was 10,9 + 4,6 months (range 6–18).

Results

At the beginning of liraglutide treatment the patients showed a mean BMI of 36,3 + 9,3 kg/m2 (range 27,65 - 43,01) and on drug therapy, restart losing weight reaching a mean BMI of 31,1 + 4,4 kg/m2 (range: 24,82 - 37,5). Eventually the BMI reached on pharmacological treatment was lower than the mean minimum BMI achieved after surgery. The treatment with liraglutide was well tolerated and no adverse reactions were recorded.

Conclusion

Our data demonstrate the usefulness of pharmacological approach in obese subjects who showed weight regain after initially successful bariatric surgery and dietary and behavior counseling. In conclusion addressing post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors.

Conflicts of Interest

I'm member of the italian advisory board of Novo Nordisk for Liraglutide.

Obes Facts. 2018 May 26;11(Suppl 1):280–281.

T4P118 High Number of Responders With Pharmacotherapy-Induced Weight Loss of at Least 15% in a Placebo-Controlled, Dose-Ranging Study of Semaglutide in Subjects With Obesity

J Wilding 1, AL Birkenfeld 2, B McGowan 3, O Mosenzon 4, SD Pedersen 5, S Wharton 6, L Endahl 7, CH Jepsen 7, PM O'Neil 8

Introduction

Semaglutide is a glucagon-like peptide 1 receptor agonist that was recently approved for the treatment of type 2 diabetes in the US at doses up to 1.0 mg/week, and is currently under investigation for weight management. results from a recent Phase 2 weight management trial (NCT02453711) showed significant, dose-dependent weight loss for semaglutide doses between 0.05 and 0.4 mg/day compared to placebo. In this post hoc analysis, the proportions of subjects achieving at least 15% or 20% weight loss in this trial were assessed by assigned treatment and by whether treatment was completed.

Methods

This was a randomised, double-blinded, placebo-controlled Phase 2 trial of semaglutide with monthly dietary and exercise counselling in adults with obesity without diabetes. Semaglutide (0.05, 0.1, 0.2, 0.3 or 0.4 mg) or matching placebo was given by once-daily subcutaneous self-injection; titration started at 0.05 mg, and increased to the next dose level every 4 weeks until the target dose was reached. Total treatment duration (including the escalation phase of up to 16 weeks) was 52 weeks. Subjects who discontinued their assigned treatment for any reason ceased subsequent study and counselling visits but were encouraged to return at week 52 for off-treatment assessment. The proportions of subjects with weight loss of at least 15% or 20% of their baseline weight were assessed for those with week 52 data on- or off treatment with semaglutide or placebo.

Results

649 subjects (35% male) were randomised on the above schedule. Mean age ranged from 44–48 years across dosing groups (overall range 18–77); mean weight was 111–114 kg (73–244), and mean body mass index 39–40 kg/m2 (30–80). Week 52 data were available for 600 subjects (92%): 525 on treatment and 75 off treatment. Response was dose-related and the proportion of responders in both weight-loss categories was high at the three highest doses of 0.2–0.4 mg/day; overall 32–42% of subjects lost ≥15% of baseline weight and 14–29% lost ≥20%, versus 6% and 2%, respectively, on placebo (Table). Almost all responders at these doses were still on treatment at week 52 (Table). Among subjects who completed the full 52 week treatment period, 33–50% receiving 0.2–0.4 mg/day semaglutide achieved a ≥15% weight loss, and 15–35% a ≥20% loss (Figure).

Conclusion

A high proportion of subjects in this Phase 2 study who completed semaglutide treatment at final escalated doses of 0.2–0.4 mg/day over a period of 52 weeks achieved a weight loss of 15% or more. For those who completed 0.4 mg/day, half lost at least 15% and 35% lost at least 20% of their baseline weight.

Conflicts of Interest

Cecilie Heerdegen Jepsen is a full time employee of Novo Nordisk A/S.

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Tab. 1.

Overall response by semaglutide dose and the proportion of those responding who were still on treatment at week 52

Observed data 0.0 mg (Placebo; N = 123) 0.05 mg (N = 92) 0.1 mg (N = 96) 0.2 mg (N = 94) 0.3 mg (N = 95) 0.4 mg (N = 100)
Responders at week 52, n (%)
≥15% response 7 (6) 8 (9) 19 (20) 35 (37) 30 (32) 42 (42)
≥20% response 3 (2) 5 (5) 10 (10) 21 (22) 13 (14) 29 (29)
Proportion of responders still on treatment at week 52, y/n (%)
≥15% response 4/7 (57) 7/8 (88) 19/19 (100) 35/35 (100) 29/30 (97) 41/42 (98)
≥20% response 2/3 (67) 4/5 (80) 10/10 (100) 21/21 (100) 13/13 (100) 29/29 (100)
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Obes Facts. 2018 May 26;11(Suppl 1):281.

T4P119 Effectiveness of the swallowable gastric balloon for the treatment of obesity

LA Borda 1, S R Pérez 1, RT Arau 1, J Espinós Perez 1, S Andrés Valero 1, R E Alegre 1

Introduction

The Elipse device is a procedureless gastric balloon that is swallowed, resides in the stomach for 4 months, and is then expelled. This Balloon does not require endoscopy, surgery or anaesthesia. The objectives of this study were to assess the effectivity of Elipse and to measure its effects on weight loss after 4 month with the balloon and 6 months with multidisciplinary follow up.

Methods

Each participant swallowed one Elipse device, which was filled with 550mL of filling fluid through a thin delivery catheter that was then removed. Weight was measured every 2–3 weeks. The percentage of excess weight loss (%EWL) is a common metric for reporting weight loss, for that reason, it was examined the effect of variations of this value. In the course of the treatment, the professionals ensure the patient a special diet with two main objectives: to lose weight and to acquire a healthy lifestyle including healthful nutritional habits and performs sports practice.

Results

17 patients swallowed Elipse balloon in radiology unit. All adverse events were either self-limiting or resolved with medication. All balloons were safely excreted. There have been no complications about the removal of this device in any patient to date. The results (n = 10) were 59.06% of excess weight loss in 4-month. The evidence show that the quality of life measures had improved with the swallowed balloon.

Conclusion

This research demonstrate clinically significant weight loss with Elipse baloon. Furthermore, Elipse therapy led to improvements several metabolic parameters and global quality of life. The weight loss was similar with previous studies of endoscopically placed balloons. In addition, Elipse therapy led to improvements in nutritional habits, several metabolic parameters, and overall quality of life. It's an alternative for obese patients not responding to dietetic treatment and it is useful for different clinicians (e.g. physicians, nutritionists and dietitians) who do not have possibility to use endoscopic or surgical weight loss devices.

Conflicts of Interest

We work placing allurion swallowed balloons and doing the follow up of the patients.

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Obes Facts. 2018 May 26;11(Suppl 1):281.

T4P120 Effects of a very low-calorie ketogenic diet (VLCKD) in the treatment of severe obesity or overweight with comorbidities: a pilot study

A Tantucci 1, G Perriello 1, A Timi 1, V Ragusa 1

Introduction

A low sugar diet (50–100 g/day of carbohydrates), reduces insulin levels, glycolysis and lipogenesis, and increases glucagon, gluconeogenesis and lipolysis. From the catabolism of triglycerides, glycerol and free fatty acids are produced, of which for 60% are used by the muscle and for 40% by the liver as ketones. Ketones provide the 80% of energy to the central nervous system, give more satiety and can be used by the heart. The normo-proteic intake keeps the muscle tropism and high biological value proteins provide substrates for gluconeogenesis. You get a slight reduction of insulin that counterbalances the excessive accumulation of ketones. This mechanism provides a controlled ketogenesis and reduces the risk of ketoacidosis. The aim of this study is the evaluation of the VLCKD effects in subjects (aged 45, 55, 57) with severe obesity or overweight with comorbidities.

Methods

Anthropometric assessment, renal and liver function, hematological, electrolyte and lipid profile and a planning treatment in 3 women with comorbidities (BMI 33–54, T2DM normoglycemic with oral hypoglycemic, hypertension, dyslipidemia, OSAS, familiarity for T2DM and obesity) subjected to 3 visits in 4 months.

Results

VLCKD improves anthropometry, lipid profile and blood glucose; no change in liver and renal parameters. The weight loss occurred with a slight ketonuria and ketonemia. Side effects observed: headache, muscle weakness, halitosis and dry mouth.

Conclusion

The VLCKD is a potential pre-operative support to bariatric surgery but it's essential the evaluation of ketosis risk elderly with cardiovascular disease.

Obes Facts. 2018 May 26;11(Suppl 1):282.

T4P121 Treating Binge Eating Disorder and Obesity with Eye Movement Desensitisation Reprocessing

K Richard 1

Introduction

Binge Eating Disorder (BED) is often associated with obesity. In addition, BED and obesity is also positively associated with trauma. Based on the evidence that BED and obesity is unlikely to be successfully treated with exercise and diet advice alone, and that eating pathology is a trauma reaction, a study was designed to see how well a trauma treament could address these issues. Because Eye Movement Desensitisation Reprocessing (EMDR) has proven to be an effective and - in some cases - a more efficient treatment for trauma, a newly developed EMDR protocol specifically for BED (in the form of a ten 1-hour session treatment) was evaluated in a randomised controlled trial (compared pre-and post treatment) to a waitlist control group at the University of Sydney.

Methods

The research was approved by and complied with the University of Sydney Human Research Ethics (Approval 2014/025 on 29/10/2014) registered with Australian New Zealand Clinical Trials Registry (ANZCTR, ACTRN12614000894695 on 05/08/2014). Participants were recruited by advertisements in the newspaper. Once assessed for eligibility, all participants were weighed and assessed with the Eating Disorder Examination, Binge Eating Scale, Eating Beliefs Questionnaire, the Rosenberg Self-Esteem scale, DASS21, Trauma Symptom Checklist-40, Invalidating Childhood Exeriences Scale. Of those screened, 38 met eligibility criteria and were invited for assessment, then randomly allocated by an independent researcher using a computer generated randomisation into either the waitlist group or the ten 1-hour individual EMDR treatment with the therapist of choice (of which all 3 were qualified, experienced psychologists with EMDR certification

Results

Although the sample size was small, this preliminary study showed EMDR: binging and binge episodes per month reduced, ranging from 33–100%. Regarding binge days per month, the mean improvement was 83% (SD = 22); regarding binge episodes per month, the mean improvement was 85% (SD = 21). Large effect sizes were seen also in regards to cognitions including body shape significantly. Engagement in exercise and weight reduction was marginally significant.

Conclusion

Treatment is likely to be improved with assessment of the presence of personality disorders, presence and severity of interpersonal difficulties/presence of negative social influences/lack of social support, poor self-efficacy, poor motivation, use of alcohol, presence of ADHD or other mental health disorder, use of medications which may be (partly) contributing to eating, appetite or weight disturbance, gastrointestinal pathology, metabolic syndrome, health problems e.g., blood pressure, cholesterol, glucose tolerance, Vitamin D, menopause and knowledge of nutrition. Assessment accuracy could also be improved with the use of a scale that measures body fat, muscle mass and water mass and a tape measure to measure shape improvements.

Obes Facts. 2018 May 26;11(Suppl 1):282.

T4P122 Liraglutide efficacy and tolerability in obese patients affected by severe psychiatric disorders

C Maccora 1, C Ciuoli 1, A Goracci 2, N Benenati 1, V Verdino 2, O Neri 1, A Fagiolini 2, C Formichi 3, F Dotta 4

Introduction

Obesity and metabolic syndrome are major clinical problems among patients with severe psychiatric disorders such as psychosis, bipolar disorder and depression, caused by interaction between lifestyle, unhealthy eating and adverse side effects of psycotropic medications. The aim of this study was to evaluate tolerability, adherence and efficacy of liraglutide treatment in psychiatric patients.

Methods

27 patients affected by severe psichiatric disorsers (21 females and 6 males, aged 32–74 years, mean BMI 41,7 kg/m2, range 31–68) such as schizophrenia, bipolar disorder type 1 and major depressive disorder, 19 patients (4 males and 15 females, aged 19–73 years, mean BMI 37,8 kg/m2, range 31–48), affected by binge eating disorder (BED), 48 patients without any psichiatric disorders (33 females and 15 males, aged 19–75 years, mean BMI 37,6 kg/m2, range 29–52) were treated with liraglutide titred up to 3 mg per day. These patients suffered also of hypertension, dyslipidemia, impaired glucose tolerance, type 2 diabetes. All patients had previously failed multiple lifestyle interventions like diet and physical activity. The weight was recordered before starting liraglutide, after 1 month, 3 months (94 patients), after 6 months (52 patients) and 12 months (n = 22).

Results

In psychiatric group 37% and 57% of patients had lost more than 5% of their body weight at 3 and 6 months respectively. The adherence to the psychiatric therapy was the same for all the patients (atypical antipsychotics, mood stabilizers, SSRIs antidepressant) and the dosage did not need an increase. In BED group 47% and 50% of patients had lost more than 5% of their body weight at 3 and 6 months respectively. In the group of patients without psychiatric disorders the weight lost > 5% was reached in 44% of patients at 3 months and 63% at 6 months. The most frequently reported adverse events with liraglutide were mild or moderate nausea, diarrhea and also amylase and lipase increase.

Conclusion

Our preliminary data didn't show any significant difference in efficacy and tolerability of liraglutide treatment in patients with severe psychiatric disorders compared to other patients. A larger sample is necessary to identify the specific typology of patient, who can have real benefit by liraglutide.

Obes Facts. 2018 May 26;11(Suppl 1):282–283.

T4P123 Juçara (Euterpe edulis Mart.) supplementation improves cytokines profile in monocyte of obese subjects without dietary intervention

A B Santamarina 1, G Jamar 1, LV Mennitti 1, HDC Cesar 1, LM Oyama 2, LP Pisani 1

Introduction

Monocytes are immune system cells and precursors of macrophages. In the pathophysiology of obesity, these cells are responsible for the imbalance in the production of pro-inflammatory cytokines. The management and treatment of obesity using foods which are rich in bioactive compounds has gained clinical and scientific relevance. The fruit of juçara palm tree (Euterpe edulis Mart.) shows potential health benefits, it has nutritional composition rich in dietary fiber (28.3 g / 100 g), monounsaturated fatty acids (MUFA) (38.57%) and polyunsaturated fatty acids (PUFA) (20.09%). It is also remarked for having high levels of flavonoids, such as anthocyanins (239.16 mg / 100g). Considering this, we evaluated the ability of the juçara fruit to modulate the cytokine profile produced from monocytes of obese individuals without dietary intervention.

Methods

It's a double-blind, controlled, and randomized trial. 27 subjects of both genders with obesity (BMI between 30.0 and 39.9 kg / m2) and insufficiently active lifestyle aged 31 to 59 years, were divided into 2 supplementation groups of 5g juçara freeze-dried pulp (approximately 170mg of anthocyanin) or 5g of placebo (maltodextrin) during 6 weeks. Before and after supplementation, blood sample was collected for isolation of monocytes cells. The cells obtained were cultured and stimulated with lipopolysaccharides (LPS) as proinflammatory stimuli. After 24h of incubation, the cells supernatants were collected for elisa assay of Interleukin 10 (IL-10), Interleukin 6 (IL-6), Tumor necrosis factor-α (TNF-α), and Monocyte chemoattractant protein-1 (MCP-1).

Results

IL-6 production by monocytes at baseline and after the supplementation was higher in the LPS-stimulated placebo group compared to the non-stimulated placebo group (p = 0.019; p = 0.034). After supplementation IL-6 was reduced in juçara group plus LPS compared to the placebo plus LPS (p = 0.006). After supplementation TNF-α reduced in juçara with LPS group (p = 0.049). After supplementation, MCP-1 was reduced in juçara group without LPS versus the pre-treatment levels (p = 0.041) and juçara with LPS after treatment (p = 0.047). After the supplementation there was an increase in IL-10 in the juçara group with LPS versus juçara group without LPS (p = 0.001) and with LPS pretreatment (p = 0.001).

Conclusion

Our results demonstrate a classic proinflammatory state before treatment, and this profile was improved by juçara pulp consumption. Our results suggest that juçara pulp is a potential tool against proinflammatory status related to obesity.

Conflicts of Interest

Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2015/13875-0 and 2016/1413-0).

Obes Facts. 2018 May 26;11(Suppl 1):284.

T4P124 Obesity with lower comorbidity burden is associated with substantial survival improvement in patients hospitalized with pneumonia

S Chang 1

Introduction

Obesity prevalence is increasing steadily throughout the world's population in most countries and pneumonia is one of the most common infectious diseases; however, there is uncertainty about an inverse relationship between obesity and pneumonia mortality. One meta-analysis suggests that an ‘obesity survival paradox’ exists for pneumonia, but high heterogeneity were existed among these studies. This study aimed to determine the impact of being overweight and obese on pneumonia patients, by conducting a population-based 1:1:1 propensity score (PS) matched cohort study.

Methods

Using the Nationwide Readmission database of the US from 2013 to 2014, we identified patients hospitalized with pneumonia. A pneumonia- associated hospitalization was defined as one in which the discharge record listed a principal diagnosis of pneumonia or a secondary diagnosis of pneumonia if the principal diagnosis was respiratory failure or sepsis. Use of mechanical ventilation was used to stratify pneumonia of different severity. Hospitalized pneumonia patients were categorized into normal, overweight (BMI ≥25 & < 30), and obese (BMI ≥30). To minimize baseline imbalance between patients with different body weight, we carried out PS-matched analysis, using 1:1:1 PS matching technique. PS contains 41 variables including demographics, social economic status, chronic comorbidities, and severity of pneumonia. We assess the association between body weight and 30-day in-hospital mortality by univariate Cox proportional hazard model stratified on the PS-matched pairs.

Results

A total of 1,690,760 pneumonia hospitalization episode fulfilled the inclusion criteria, of which 17,992 were overweight, 195,889 were obese, and 1,476,879 were normal weight. Compared with normal weight patients without use of ventilator, overweight (hazard ratio [HR], 0.77; 95%CI, 0.62–0.95) and obese (HR, 0.71; 95%CI, 0.64–0.79) patients were associated with an improved survival in the 1:1:1 PS-matched cohort. Similar results were obtained in the cohort requiring the use of ventilator (Table 1). To investigate whether there was a differential risk of 30-day mortality among different obese populations, we stratified patients into different subgroups and adjust the risk for mortality using PS score (Figure 1). Although the survival benefit of obesity is consistent in all subgroups, patients with lower comorbidity burden/severity is associated with substantially better survival. For example, patients with lowest co-morbidity quartile is associated with 53% improvement in survival (HR, 0.47; 95% CI, 0.37–0.60) and patients with lowest severity is associated with 67% improvement in survival (HR, 0.33; 95% CI, 0.12–0.94).

Conclusion

Using a large and nationally representative sample of over 1,000 hospitals in the US, we found that increase in BMI was significantly associated with improved survival in obese patients. We also found that severity and comorbidity burden had a modifying effect on survival.

Fig. 1.

Fig. 1

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Risk of 30-day mortality in different patient subgroups in obesity vs. normal weight patients. HR refers to hazard ratio, LCL refers to lower confidence interval and UCL refers to upper confidence interval.

Obes Facts. 2018 May 26;11(Suppl 1):284–285.

T4P125 Bifidobacterium spp. reshaping in gut microbiota by low dose of juçara (Euterpe edulis Mart.) supplementation and hypothalamic insulin resistance

G Jamar 1, AB Santamarina 1, LM Oyama 2, LV Mennitti 1, HDC Cesar 1, VV Rosso 1, L P Pisani 1

Introduction

High-fat diet (HFD) alters microbial diversity in the gut and drives a rapid development of hypothalamic inflammation, which impairs hypothalamic insulin sensitivity. The addition of the berry juçara (Euterpe edulis Mart.), in the diet may promote beneficial effects in the host. We aimed to investigate the potential of juçara with different doses on the reshaping of the gut microbiota and improvement in the hypothalamic insulin resistance induced by HDF in an acute treatment.

Methods

Male Wistar rats at 90 days old were distributed into the following groups: high-fat diet control (HFC) or HFC supplemented with 0.5% (HFJ0.5) or 0.25% freeze-dried juçara powder (HFJ0.25) to acute treatment for seven days. The serum glucose, insulin and lipopolysaccharides were measured. HOMA was calculated. TNF-α, IL-6, and IL-10 protein level were determined by ELISA on colon and IRα, AKt and pAKt protein level were determined by Western blotting on hypothalamus. TLR-4, TNF-α, IL-10 and ZO-1 gene expression, and relative levels of Bifidobacterium spp. DNA were quantified by RT-PCR.

Results

Juçara supplementation restored the fecal content of Bifidobacterium spp., reduced inflammatory response with reduction of TLR-4 in the colon and minimized hypothalamic insulin resistance. It also down-regulated the insulin receptor and up-regulated the phosphorylated protein kinase B (pAkt) and increased pAkt/Akt ratio.

Conclusion

We hypothesized that juçara supplementation was protective against the adverse effects of excessive fat consumption, by enhancing insulin receptor efficiency in the hypothalamus. Interestingly, all of our results were more significant with the lower dose. To our knowledge, this is the first study to elucidate the role of juçara in the hypothalamic insulin resistance. However, due to juçara's high antioxidant capacity, further studies are needed to verify the benefits and the health risks within a safe dosage of this promising fruit.

Obes Facts. 2018 May 26;11(Suppl 1):284.

T4P126 Physical health problems in adult patients with Prader-Willi syndrome

G Grugni 1, M Delvecchio 2, L Grugni 3, S Tamini 1, A Sartorio 1

Introduction

Prader-Willi syndrome (PWS) represents the most frequent cause of syndromic obesity, occurring in 1 in 25 000 live births. A mortality rate of about 7% a year in subjects over 30 years of age has been reported in people with PWS. However, the lifespan of PWS patients has increased significantly in the recent years. In order to get a better understanding of the onset and type of age-related problems in these individuals, we report the prevalence of medical concerns in an Italian cohort of young adults with PWS.

Methods

Data were obtained by two medical centers of the Italian Network for Rare Diseases. For each center, information was collected by reviewing all medical charts of subjects older than 18 years diagnosed with PWS. In total 110 subjects were included in this cross-sectional study, 69 females, aged 29.4+8.8 yrs (mean+SD) (range 18.1–56.8 yrs). Seventy-seven patients had a deletion of the paternally-derived chromosome 15, 23 had uniparental maternal disomy for chromosome 15, and one had a translocation involving chromosome 15. A positive methylation test was demonstrated in the remaining 9 subjects.

Results

Eighty-one subjects were obese (73.6%), 12 were overweight (10.9%) and 17 had normal BMI (15.5%). Mean BMI was 38.0+11.2 (range 17.2–66). Amenorrhea was present in 79.7% of subjects (primary = 42; secondary = 12; menopause = 1). All males but three had hypogonadism (92.7%). Forty-six patients (41 females) were undergoing sex steroids replacement. Central adrenal insufficiency was detected in 9 individuals (8.2%), while 10 patients suffered from hypothyroidism (9.1%). Thirty subjects had T2DM (27.3%), while IGT was detected in 15 individuals (13.6%). Spinal and/or femoral DXA were obtained in 95 subjects, of whom 41 had osteopenia (43.1%) and 18 had osteoporosis (18.9%). Twenty-six patients had hypertension (23.6%). Cardiovascular diseases were present in 34 cases (30.9%) (left ventricular hypertrophy = 20, pulmonary hypertension = 6, arrhythmia = 3, impaired left ventricular ejection fraction = 7, mitral valvulopathy = 4). Seven subjects (6 females) suffered from deep vein thrombosis (6.4%). Nineteen patients (17.3%) were undergoing nocturnal ventilator support, while excessive daytime sleepiness was present in 45.5% of individuals. All PWS were reported to have behavioral problems, and 46 patients were treated with neuroleptics (41.8%). Self-injurious behavior was present in 78 subjects (70.9%).

Conclusion

As more individuals with PWS attain older age, it is mandatory to recognize the presence and consequences of various morbidities. In this light, our investigation underlines the need for a multidisciplinary approach to the numerous chronic health problems for PWS, in order to allow for a better quality of life for the future.

Obes Facts. 2018 May 26;11(Suppl 1):284–285.

T4P127 Long-term effects of low energy diet combined with CBT-based group treatment of patients with obesity on weight, quality of life and eating behavior: a 2-year intervention study

M Galavazi 1, S Jansson 2, J Jendle 3, J Karlsson 2

Introduction

The primary aim of the study was to evaluate the effect on weight of a 2-year group treatment using a 12-week low energy diet (LED) followed by 12 weeks of reintroduction to ordinary food combined with cognitive behavioral therapy (CBT). Secondary aims comprised changes in health-related quality of life (HRQoL) and eating behavior and furthermore to describe patients’ satisfaction with treatment and experienced side effects during LED treatment.

Methods

Participants Inclusion criteria were individuals >18 years with BMI ≥35 kg/m2. Intervention A 2-year treatment program was delivered at the Obesity Unit, Örebro University Hospital, Örebro, Sweden. Twenty 2.5-hour group sessions took place during the first year and nine during the second year. Major themes included nutrition, eating behavior, physical activity, sleep, setting realistic goals and dealing with stress and setbacks. All participants were instructed to follow a strictly liquid-based LED (800–880 kcal/d) during 12 weeks. Thereafter, LED was phased out in three steps of 4 weeks each. Subsequently, an individualized, energy-reduced diet of 1400–1600 kcal/d was recommended. Individual advice on diet and physical activity was given before and 3 months after start of the treatment. Measurements At baseline and at 6, 12, and 24 months, body weight was measured and questionnaire data was collected. HRQoL was measured with Short-Form-36 (SF-36) and Obesity-related Problems scale (OP) and Three-Factor Eating Questionnaire-Revised 21 items (TFEQ-R21) was used to measure eating behavior. Patient Reported Experience Measures (PREM) were used to evaluate the patients’ experiences and satisfaction with treatment after 3, 6, and 12 months.

Results

Fifty-five participants in 4 groups started treatment, 40 women (73%) and 15 men (27%) with an average (SD) age of 43.2 (12.4) years (range 19–72) and average BMI of 42.0 (6.0) kg/m2 (range 35–60). Mean percentages of weight change at 6, 12, and 24 months were -18.9% (p = 0.000), -13.7% (p = 0.000) and -7.2% (p = 0.000) with follow-up of 47, 42, and 36 participants, respectively (figure 1). A weight loss of ≥5% and ≥10% after 2 years was achieved by 50% (n = 18) and 28% (n = 10) of the participants. At 1-year, improvements in 5 of 8 SF-36 domains were observed (p < 0.05) (table 1) and OP showed improvements in both psychosocial distress and avoidance (p = 0.000). TFEQ-R21 showed an increase in cognitive restraint (p = 0.001) and decreased uncontrolled eating (p = 0.008). A total of 72% (n = 34 of 47) perceived that it was quite easy or very easy to follow the 12-week LED treatment and 87% managed to strictly follow LED. Gastrointestinal side effects during LED were experienced as not present or insignificant by 22 participants (46.8%), mild by 19 participants (40.4%) and severe by 6 participants (12.8%).

Conclusion

LED in combination with group-based CBT treatment can be used to achieve substantial rapid short-term and significant long-term weight loss. HRQoL and eating behavior improved after 1 year of treatment. The vast majority of participants considered 12 weeks LED as easy to follow and experienced few side-effects.

Fig. 1./Tab. 1.

Fig. 1./Tab. 1

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Obes Facts. 2018 May 26;11(Suppl 1):285.

T4P128 Pretreatment predictors of weight control among overweight women

R Jorge 1, I Santos 1, R Tomás 2, VH Teixeira 3, PJ Teixeira 1

Introduction

Even in very effective weight control programs, many individuals fail to achieve meaningful weight loss and some regain the weight lost close to pretreatment levels. This is mostly due to behavioral and psychological factors which undermine their chances. This study aims to identify 12- and 36-month pretreatment predictors of weight control in overweight women involved in a behavioural weight management intervention.

Methods

A total of 221 overweight women participated in a 12-month randomized control trial on weight management with a 24-month follow-up period with no intervention (n = 156). Eating behaviour, general and exercise motivation, psychological well-being and quality of life, and weight related variables at baseline were assessed and tested as weight loss predictors in a completers-only analysis and using a Baseline Observation Carried Forward (BOCF) approach. Significant weight loss predictors (CI 95%) for both intervention and control groups were included in multiple linear regressions (stepwise) in order to achieve the most efficient weight loss predictive models.

Results

Fewer weight loss attempts in the last year positively predicted weight loss at 12 months in the intervention group. At 36 months, lower eating disinhibition, lower levels of perceived hunger, higher perception of weight impact in quality of life, lower levels of social physique anxiety, higher self-esteem levels, lower intervention results evaluation and lower weight loss expectations positively predicted weight loss in this group. In the control group, higher exercise self-efficacy levels, less exercise perceived barriers, higher general self-determination, higher exercise intrinsic motivation and a more internal causality locus of control for weight positively predicted weight loss at 36-month. No significant predictors were found at 12-month. The multiple linear regression model showed that weight loss attempts in the last year explained 6.2% and 6.0% of the weight loss variance in the intervention group at 12 months completers-only and BOCF linear regressions, respectively. The model intended to predict weight change at 36 months completers-only was able to explain 20.2% of the weight change variance at 36 months in the intervention group, while the BOCF explain 9.8%. The control group completers-only model was able to explain 13.9% of the weight change variance at 36 months, while the BOCF explain 4.8%.

Conclusion

Previous weight loss attempts were identified as the most efficient pretreatment predictor of 12-month weight control, which is consistent with previous studies. Other variables here identified as predictors of 36-month weight control were also identified in previous studies, although with mixed evidence. Further research on pretreatment predictors of weight loss is needed in order to improve intervention efficacy and clinical practice by helping practitioners to better tailor their patients’ intervention since the very beginning.

Obes Facts. 2018 May 26;11(Suppl 1):285.

T4P129 Cost-effectiveness and quality of life of a diet intervention postpartum: 2-year results from a randomized controlled trial

L Hagberg 1, A Winkvist 2, HK Brekke 2, F Bertz 2, EH Johansson 3, E Huseinovic 2

Introduction

We have shown that a diet intervention postpartum produced a weight loss of 12% after 1 year and 8% after 2 years. Here, we present the impact of the diet intervention on cost-effectiveness and explore changes in quality of life (QOL).

Methods

A total of 110 postpartum women with overweight and obesity were randomly assigned to diet (D-group) or control (C-group). D-group received a 12-week diet intervention within primary health care followed by monthly e-mails up to the 1-year follow-up. C-group received a brochure. Changes in QOL were measured using SF-36 divided in 8 dimensions, SF-6D, EQ-5D-3L, and EQ-VAS. The analysis of cost-effectiveness was a cost-utility analysis with a health care perspective and included costs for stakeholder of intervention, gained quality-adjusted life-years (QALYs) and savings in health care. Likelihood of cost-effectiveness was examined using the Net Monetary Benefit method.

Results

D-group increased their QOL more than did C-group at 12 week and 1 year, with pronounced differences for the dimensions general health and mental health, and the mental component summary score (all p < 0.05). Cost per gained QALY was 1,704–7,889 USD. The likelihood for cost-effectiveness, based on a willingness to pay 50 000 USD per QALY, was 0.77–1.00.

Conclusion

The diet intervention increased QOL and was highly cost-effective.

Obes Facts. 2018 May 26;11(Suppl 1):286.

T4P130 Lack of Uniform Definition of Success, Failure and Weight Regain After Primary Roux-en-Y Gastric Bypass and Gastric Sleeve

DS Bonouvrie 1, M Uittenbogaart 1, A APM Luijten 1, F MH Van Dielen 1, W Kg Leclercq 1

Introduction

Increases in availability of long-term follow-up data have led to more knowledge about the proportion of patients with 1) insufficient weight loss and 2) weight regain after bariatric surgery. However, the definitions of these outcomes lack consensus which makes it impossible to compare the literature. For this study, we intended to obtain knowledge about all the different definitions used in the literature.

Methods

The online database MEDLINE was searched for literature with a publication date between 01–07–2014 and 01–07–2017 concerning 1) adult patients who received a primary Roux-en-Y Gastric Bypass or a primary Gastric Sleeve and 2) the outcomes weight loss success, weight loss failure and/or weight regain. Articles were screened on title and abstract before inclusion.

Results

The search identified 650 articles of which 113 articles met the inclusion criteria. 47 out of 113 articles mentioned weight loss success of which 40 described a clear definition. Percentage excess weight loss > 50% was the most frequent described definition. 67 out of the 133 articles mentioned weight loss failure of which 40 described a definition, in total 27 different definitions. Weight regain was mentioned in 78 articles, but only twenty authors gave a definition. Striking is that in only 6.2% of the definitions resolution of comorbidities is included. There was no difference in definitions between RYGB and SG and also not between different nationalities. Another notable finding was that weight loss failure was often combined with the terminology of weight regain as an indication for revisional bariatric surgery.

Conclusion

This study shows that the recent literature regarding definitions of weight loss success, weight loss failure and weight regain remains highly inconsistent; only in 50% of the articles a definition is given and the dissimilarity between the definitions is wide. To address this problem and to be able to compare the literature international consensus is required, which our research team intend to produce in the following months using the Delphi method.

Obes Facts. 2018 May 26;11(Suppl 1):286.

T4P131 Sarcopenia and Bone Structure Predictors in Patients with Obesity

F Akbas 1

Introduction

Sarcopenia is defined as loss of muscle mass or strength. Although it has been accepted as a health issue for the elderly, now it is known that it can occur at any age in patients with obesity. Skeletal muscle tissue supports the bone mobility and contributes to bone strength. Bone metabolism is influenced through mechanical, hormonal, and inflammatory factors in obesity. In this study, it was aimed to search for sarcopenia and its relationship with bone metabolism predictors in patients with obesity.

Methods

All patients between 18–65 years old that were seen in our obesity out-patient clinic for the first time in a month were included in the study. Geriatric patients, patients with joint -muscle disorders/malignancy/severe organ failure or on Ca-Vitamin D-osteoporosis medication were excluded. BMI, WC, HC, body fat percentage were measured. Gait speed (6-m course), lower extremity strength (repeated chair stands test) and hand grip strength tests were applied. Serum Ca, vitamin D and PTH levels were measured. results were evaluated using SPSS.

Results

The results of parameters tested in the study are summarized in table 1. All patients had obesity as BMI, WC, HC and body fat percentage. Average gait speed, lower extremity strength and hand grip strength values were lower than the standards. 9 patients had normal gait speed (< 0.8m/s), 21 patients had normal lower extremity strength (< 13 s) and 4 patients had normal hand grip strength (within normative range adjusted for age). Only 4 patients had all 3 in normal range. Average Ca and PTH levels were in normal range although 5 patients had elevated PTH and 1 patient had decreased Ca. Average vitamin D level was low and only 1 patient had vitamin D level within the normal range. 27 patients were accepted to have sarcopenia according to common literature data (as there is still no consensus results/guidelines suggested for sarcopenia in non-geriatric patient groups). Vitamin D level was statistically significantly low in sarcopenia patients.

Conclusion

As seen in our study, sarcopenia is a common consequence of obesity. Oxidative distress, insulin resistance and inflammation play a role in its pathophysiology. Age and physical inactivity are common risk factors. As well as decreasing quality of life with impaired mobility, risk for falls and fractures, it is also found to be related to cardiometabolic diseases and increased mortality. The diagnosis is simple with non-invasive methods and considering its contribution to several negative health outcomes, it is worth screening every patient with obesity for sarcopenia and bone structure predictors and take the necessary precautions to prevent adverse outcomes and improve quality of life.

Tab. 1.

results of parameters tested in the study.

Parameter Mean value Standard deviation (±)
Age (years) 50 11.10
BMI (kg/m2) 38.95 5.34
Body fat percentage (%) 45.41 4.66
WC (cm) 120.16 10.83
HC (cm) 130.83 11.93
Gait speed (seconds) 5.71 1.16
Lower extremity strength (sec) 12.30 3.17
Hand grip test (kg) 19.65 7.14
Serum Ca level (mg/dl) 9.44 0.41
Serum PTH level (pg/ml) 61.79 25.07
Serum Vitamin D level (ng/ml) 17.50 8.02
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(BMI: Body mass index, WC: Waist circumference, HC: Hip circumference, Ca: Calcium, PTH: Parathyroid hormone)

Obes Facts. 2018 May 26;11(Suppl 1):286–287.

T4P132 Impaired renal function and cardiovascular risk in metabolically healthy patients with obesity

F Akbas 1, H Usta Atmaca 1

Introduction

Obesity is a risk factor for renal failure and pathologies leading to renal failure, independent of related diseases. Microalbuminuria (MAU) and hyperfiltration (GFR$$120 ml/dk) are the first stage of those pathologies and have been shown to reflect higher probability of cardiovascular disease. In this study, we aimed to search for impaired renal function and its relation to predicted cardiovascular disease risk in metabolically healthy patients with obesity.

Methods

100 patients with obesity without accompanying diseases, present medication or smoking history were included in the study. They were screened for any signs of acute/chronic inflammation and those having any were excluded. Blood glucose, HbA1c, urea, creatinine, total cholesterol, LDL, HDL, triglyceride and 24-hour-urine microalbuminuria levels (30–300 mg/24 hours) and GFR levels were studied. 10-years-cardiovas-cular disease risk was calculated using Framingham Risk Score Calculator and echocardiography was performed. Data was statistically analyzed using SPSS Windows 11.5.

Results

93 female and 7 male, totally 100 patients were included in the study. Mean age was 39.74 ± 11.15 years and mean BMI was 39.22 ± 5.71 kg/m2. None of the patients had metabolic syndrome according to ADA 2005 criteria. All patients had normal urea and creatinine levels. 14% (n = 14) of the patients had MAU (146 mg/24 hours mean excretion) and 47 (47%) patients had hyperfiltration (154 ml/dk mean GFR). 25% (12 = n) of patients who had hyperfiltration and 42% (6 = n) of patients who had MAU had increased cardiovascular disease risk prediction and 29% (14 = n) of patients who had hyperfiltration and 42% (6 = n) of patients who had MAU had diastolic dysfunction in ECHO evaluation.

Conclusion

Obesity has a strong relationship with microalbuminuria and hyperfiltration as early signs of impaired renal function. Impaired renal function found in patients with obesity but without metabolic syndrome components can be related with subclinical cardiac damage. Thus, it would be possible to predict cardiovascular risk of patients with obesity with a simple and non-invasive method in advance and prevent/delay further cardiovascular damage by taking the necessary precautions.

Obes Facts. 2018 May 26;11(Suppl 1):287.

T4P133 Tracking obesity from two until fifteen years of age – a cohort approach

V Halsteinli 1, R Ødegård 2, IJ Bakken 3

Introduction

Obesity is one of the most frequent disorders in paediatrics. WHO has outlined a wide spectrum of potential interventions that can reduce childhood obesity, but evidence of effect seems in general scarce. A shortcoming with randomized controlled trials (RCT) is that they usually include one or two two-year follow-up only – despite a basic interest in long-term effects. One solution is to use a mathematical simulation model as tool to extrapolate the effect of an intervention beyond the end of RCT follow-up, but so far such models have lacked longitudinal observational data as input to the model reference cohort. The aim of this paper is to utilize two Norwegian longitudinal data sets to estimate transition probabilities between BMI categories from two until fifteen years of age. We establish a tracking-obesity model that in a next step can be used to assess to what extent an observed short-term reduction in childhood obesity can be expected to persist into adulthood.

Methods

A mathematical simulation model will be established where a cohort of individuals is distributed into health states covering four BMI categories: normal, overweight, obese grade I and obese grade II, according to gender. Transition probabilities represent the chance of moving between BMI-categories within one year. Longitudinal data from two Norwegian data sets with attendance rates between 80 and 90 per cent will serve as basis for calculation of transition probabilities. (1) The Child Growth Study (CGS) provided by Norwegian Institute of Public Health. CGS-data is a representative sample of children born in 2002 with repeated measurements until 2010 (N = 3185). (2) The primary health center register of Trondheim Municipality which covers children registered in the period 2003 until 2015 with repeated measurements according to the Norwegian guidelines. Both datasets are unbalanced in the sense that number of observations per individual and the time distance between observations per individual vary, and statistical methods will be applied to predict transition probabilities per year from two until fifteen years of age.

Results

Transition probabilities between BMI categories will be graphically presented and specific attention will be given to the development of obesity grade I and II as well as gender differences.

Conclusion

The tracking obesity analysis is a first step toward building a more comprehensive model to be used in research projects – a model that will include assessment of obesity and in the next step costs. The model can be used for evaluation of both prevention and treatment initiatives.

Obes Facts. 2018 May 26;11(Suppl 1):287.

T4P134 The Dilemma of Weight Cycling in Obesity: Really represents a health risk factor?

M El Ghoch 1, S Calugi 1, R Dalle Grave 1

Introduction

Weight cycling is a common phenomenon in patients with obesity however its consequences on health have not yet been clarified. For this reason we aimed to investigate the effect of one cycle of intentional weight loss and regain on resting energy expenditure, metabolic adaptation, body composition patterns, cardiovascular risk factors and psychosocial variables in patients with severe obesity.

Methods

Clinical variables were measured in 38 adult patients with severe obesity (body mass index (BMI): 43.5 ± 7.2 kg/m2) consecutively readmitted to residential treatment (T1) for severe obesity after a cycle of weight loss (16.7 ± 7.7 kg) and regain (15.1 ± 11.3 kg), and compared with those recorded at a prior admission (T0).

Results

No significant differences were found between T0 and T1 values for weight, BMI, waist circumference, total body fat and lean percentages, resting energy expenditure, metabolic adaptation, cardiovascular risk factors or psychosocial variables. However, younger patients (r = −0.38, P = 0.023) and those with higher historical weight (r = 0.43, P = 0.010) tended to regain more weight.

Conclusion

The absence of adverse effects of weight cycling on health indicates that the risk of weight regain should not be a barrier to encouraging weight loss efforts in patients with severe obesity.

Obes Facts. 2018 May 26;11(Suppl 1):287–288.

T4P135 Body adiposity indicators and cardiometabolic risk: cross-sectional analysis in participants from the PREDIMED-PLUS trial

J Konieczna 1, I Abete 2, A Galmes 1, A Colom 3, N Babio 4, Z Vázquez 5, M Fiol 3, J Salas-Salvadó 4, P Buil-Cosiales 6, JA Martínez 2, D Romaguera 3

Introduction

Excess adiposity is associated with poor cardiometabolic (CM) health. To date, several techniques and adiposity indicators have been developed to determine adiposity. This study compared the ability of traditional anthropometric, as well as standard and novel DXA-derived parameters related to overall and regional adiposity, to predict CM risk.

Methods

Using the cross-sectional design in the context of the PRED-IMED-PLUS trial, 959 Caucasian older men and women with overweight/obesity and metabolic syndrome were assessed. At baseline, anthropometric and DXA-derived parameters of central, visceral, peripheral and central-to-peripheral adiposity together with comprehensive set of CM risk factors were obtained. Partial correlations and areas under the ROC curve (AUC) were estimated to compare each adiposity measure with CM risk, separately for men, women and in the overall sample.

Results

DXA-derived indicators, other than percentage of total body fat, showed stronger correlation (rho 0.126–0.234, p < 0.001) with CM risk than anthropometric indicators, after controlling for age, diabetes and medication use. In both sexes, DXA-derived visceral adipose tissue measures (VAT, VAT/Total fat, visceral-to-subcutaneous fat) together with lipodystrophy indicators (Trunk/Legs fat and Android/Gynoid fat) were strongly and positively correlated (p < 0.001) with glycated hemoglobin (HbA1c) and the triglyceride-to-glucose index (TyG), as well as with triglycerides (TG) and the ratio TG/HDL-cholesterol (TG/HDL-C). Additionally, Trunk/Legs fat and Android/Gynoid fat were inversely related to HDL-C levels (p < 0.001). Furthermore, in AUC with ROC analyses for both sexes, VAT/Total fat showed the highest predictive ability for abnormal HbA1c levels (AUC = 0.631), VAT for TyG (AUC = 0.620), Trunk/Legs fat for HDL-C (AUC = 0.550), Android/Gynoid fat for TG (AUC = 0.579) and TG/HDL-C (AUC = 0.605).

Conclusion

DXA regional adiposity measures offer advantages beyond traditional anthropometric and DXA overall adiposity indicators for CM risk assessment in older overweight/obese subjects with metabolic syndrome. In particular, in both sexes, visceral adiposity better stratifies individuals at risk for insulin resistance and diabetes and indicators of lipodystrophy better predict makers of dyslipidemia.

Obes Facts. 2018 May 26;11(Suppl 1):288.

T4P136 How effective is weight loss in reducing cardiometabolic risk?

E Morris 1, SA Jebb 1, A Nickless 1, J Oke 1, P Aveyard 1

Introduction

Guidelines recommend clinicians identify people at high cardiovascular or metabolic risk and promote weight loss to people who are overweight. However, the main method of intervention offered is pharmacotherapy and clinicians lack belief that losing weight will lead to clinically important changes in cardiometabolic risk. Accordingly, we examined how change in weight changes cardiometabolic risk factors using data from two trials of behavioural weight loss interventions.1,2

Methods

Using multilevel mixed effects regression models, we examined the association between weight change and change in systolic and diastolic blood pressure, fasting glucose, HbA1c, total-, HDL- and LDL-cholesterol, total cholesterol: HDL ratio, and triglycerides at baseline and at 2, 3, 4, 6, 9, 12 and 24 months for patients in both intervention and comparator groups. Pre-specified subgroup analyses examined these changes in people who had hypertension and diabetes at baseline. All analyses were adjusted for baseline values, time, gender, age, ethnicity, trial and treatment group.

Results

The final dataset comprised 2041 participants with a mean age of 50 ± 13.5 years, weight of 90.6 ± 14.8 kg and BMI of 34.5 ± 5.1kg/m2 at baseline. Mean weight change was -4.3 ± 6.0kg (range -51.2 to 21.5kg). There was a statistically significant improvement in all outcome measures. The effect on plasma lipids was small with a change of -0.02, -0.01 and 0. 003mmol/l in total-, LDL- and HDL-cholesterol, and -0.02mmol/l in triglycerides for every 1kg of weight lost. Each kilogram of weight loss was associated with a 0.4mmHg reduction in systolic and 0.3mmHg reduction in diastolic blood pressure. For people with hypertension, greater reductions of 0.5mmHg and 0.4mmHg per kilogram were seen in systolic and diastolic BP respectively. Each 1kg reduction in weight was associated with a 0.2mol/mol reduction in HbA1c. In people with diabetes, each kilogram of weight loss was associated with a 0.6mmol/mol reduction in HbA1c.

Conclusion

Weight loss in typical behavioural weight loss programmes leads to clinically relevant reductions in blood pressure and HbA1c (especially in those at highest risk), but not in lipids. Weight loss of 10 kg could confer benefits in BP and HbA1c equivalent to approximately half that of commencing drug monotherapy with antihypertensive agents or metformin. This knowledge of the health benefits of weight loss may encourage clinicians to better support patients who are overweight to lose weight and help set realistic clinical targets.

References

  • 1.Ahern AL, Wheeler GM, Aveyard P, Boyland EJ, Halford JCG, Mander AP, et al. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. The Lancet. 2017;389((10085)):2214–2225. doi: 10.1016/S0140-6736(17)30647-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Jebb SA, Ahern AL, Olson AD, Aston LM, Holzapfel C, Stoll J, et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. The Lancet. 2011;378((9801)):1485–1492. doi: 10.1016/S0140-6736(11)61344-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
Obes Facts. 2018 May 26;11(Suppl 1):288–289.

T4P137 Early predictors of incipient metabolic syndrome in an Arab population

WH Samsam 1, V Mohamed-Ali 2, S Al Sowaidi 3, A Seyam 4, A Bashraheel 4, M Alsayrafi 4, P Vito 4, N Al Rasheid 4

Introduction

Background. Metabolic syndrome is defined by a constellation of abnormal metabolic factors that directly increase the risk for type 2 diabetes and cardiovascular disorders. In the Gulf Cooperation Council region the prevalence of metabolic syndrome in the population is higher than in most developed countries, with generally greater rates for women, often higher than 40%. Thus, early clinical identification of patients is important to adequately implement treatments to reduce their risk of subsequent metabolic disease.

Aims/Hypothesis: Therefore the aims of this study were to investigate the hypothesis that in sedentary subjects, post-prandial hyperinsulinemia, despite normal levels of glucose, is an indicator of incipient diabetes. Further this lesion is associated with markers of adipose and hepatic dysfunction.

Methods

Forty two apparently clinically healthy residents of Qatar were studied. After a 10-hour overnight fast, subjects underwent a detailed clinical assessment, including body composition by bioimpedance, anthropometry measurements (height, weight and BMI), and blood pressure. A liquid mixed meal was administered (200 ml of 18g proteins, 17.4g fats and 40g carbohydrates: total energetic value of 400 kcal) and blood sampling carried out prior to and 30 and 120 minutes after the meal. The study was approved by the Institutional Research Ethics Committee and all subjects provided written informed consent prior to participation. Fasting serum levels of lipids {high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides}, and liver function markers [gamma-glutamyltransferase(GGT), Alkaline phosphatase(ALP), Alanine aminotransferase(ALT), Aspartate aminotransferase (AST), total bilirubin(TB), direct bilirubin(DB), albumin(ALB)]. Plasma glucose, insulin and proinsulin were also determined. HOMA-IR (homeostasis model of assessment-insulin resistance) was calculated using the following formula: (fasting insulin in mIU/L * fasting glucose in mmol/L)/22.5. Serum levels of leptin and adiponectin were measured using human 2-site ELISAs. All inter- and intra-assay CVs were less than 10%.

Results

There were no difference in age, blood pressure and body composition between the two groups. However, 48% of this population showed hyperinsulinemia in the fasting state, as well as relative hyperglycaemia, hyperinsulinemia and hyperproinsulinemia 2 hour after the meal challenge. Systemic lipids and markers of liver function were comparable between the groups. While leptin was elevated in the hyperinsulinemia group (26.1 ng/ml versus 20.9 ng/ml), this did not reach significance. However adiponectin was significantly lower in this cohort (5.8 mcg/ml versus 8.5 mcg/ml, P = 0.002). Significant correlations were apparent between fasting insulin concentration and height, measures of body fat as well as muscle mass. In addition fasting insulin also correlated significant with SBP, as well as all measures of glucose and HOMA-IR. Interestingly fasting insulin also correlated positively and significantly with liver enzymes. Inverse, but significant, association was found between insulin with HDL-C and adiponectin. Most of these relationships were lost in the postprandial state.

Conclusion

Thus, these data indicate that post prandial hyperinsulinemia and decreased adiponectin levels should be considered in the plethora of the altered biochemical parameters that define the metabolic syndrome. More importantly, since these biochemical alterations occur in seemingly healthy residents, they may well be considered early biomarkers of incipient metabolic syndrome. The reasons for this lesion in a young and healthy population is likely to be the consequence of a sedentary lifestyle. Exercise and training can improve both insulin resistance and increase adiponectin and should be actively advocated for this population.

Obes Facts. 2018 May 26;11(Suppl 1):289.

T4P138 Metabolic phenotypes of obesity and risk of all- causes and CVD mortality, incident cardio metabolic disease: Does the type of metabolic health matter?

S Shab-Bidar 1, K Djafarian 1

Introduction

The obesity paradox is often attributed to fat acting as a buffer to protect individuals in fragile metabolic states. If this was the case, one would predict that the reverse epidemiology would be apparent across all causes of mortality including that of the particular disease state. We performed a meta-analysis to assess the impact of body mass index (BMI) and metabolic status on risk of all-causes mortality, CVD mortality and incident cardio metabolic diseases (diabetes type2, heart disease, and hypertension).

Methods

Data from relevant studies were identified systematically by searching PubMed, Scopus databases up to 5 December 2016 and were analyzed using a random-effects model. Heterogenity was identified by Cochrane Q test. If necessary, sub-froup analysis was done.

Results

30 prospective studies were archived in the analyses with metabolically healthy normal weight as the reference. Studies of all-causes mortality and CVD mortality, T2D, heart disease, hypertension were analyzed separately. Overall, of 130029 study participants with diabetes, risk of T2D in MUHO was 2.47 fold MHO phenotype (OR = 5.77 vs OR = 2.33) and also, risk of T2D in MUHOW was 3.09 fold MHOW (OR = 4.99, CI = 3–8.28 vs OR = 1.61, CI = 1.14–2.27). 33385 participant in study of hypertension indicated the MHO and MUHO phenotypes were associated with a higher risk of incident hypertension (OR = 1.53, and OR = 1.88). Of 91044 study participants with CVD, demonstrate that risk of CVD event in MUHO was 1.46 fold MHO and 1.07 fold MUHOW group, respectively (OR = 2.12, CI = 1.71–2.63, OR = 1.45, CI = 1.12–1.87, OR = 1.97, CI = 1.59–2.44). Moreover, in study of MI a significant positive association between MUHNW phenotype and MI incidence (OR = 1.75, CI = 1.35–2.25) was observed. Risk of HF event in MUHO phenotype was associated with a 78% increased risk of HF compared with the MHNW phenotype (OR = 1.78, 95%CI = 1.45–2.18). The risk for CVD mortality in MUHO phenotype was higher than that of for all mortality studies(OR = 1.80, CI = 1.42–2.45, OR = 1.60, CI = 1.28–2.01), respectively. Interestingly, when subgroup analysis did by duration of follow up, studies with longer follow-up had increased risk of total mortality in MHO phenotype(OR = 1.35, CI = 1.08–1.67).

Conclusion

This meta-analysis revealed that individuals with metabolic abnormality, have a higher risk for cardio-metabolic diseases and also suggest that MHOW/ MHO are not a benign condition. We are refuting the notion that overweight and obesity without metabolic abnormalities are benign conditions in all population.

Obes Facts. 2018 May 26;11(Suppl 1):289.

T4P139 Gut microbiota change after group weight reduction program among obese adults

W Lin 1, BY Lin 2, W Lin 3, C Huang 4

Introduction

The number of obese individuals has doubled globally since 1980. Obesity increases the risk of life-threatening diseases including type 2 diabetes, hypertension, coronary heart disease, and cancer. Gut microbiota is closely related to obesity and insulin resistance.

Methods

Thirteen obese subjects (body mass index, BMI ≥30 kg/m2), aged 20 to 64 years, underwent group calorie restriction weight reduction program were recruited from a weight management outpatient clinic in a tertiary hospital. Gut microbiota compositions were determined by metagenomics using next generation sequencing before and after treatment to determine if microbiota concentrations, including Firmicutes to Bacteroidetes ratio and Akkermansia muciniphila abundance, correlated with weight reduction.

Results

Over the course of three months, anthropometric assessments and laboratory assays found significant decreases in weight, BMI, waist circumference, insulin, total cholesterol, and triglycerides. The metagenomic analysis revealed only one significant change in gut microbial population. Genus Akkermansia abundance increased after one month, but not after three months. Based on the percentages of change in Firmicutes to Bacteroidetes ratio after one and three months on treatment and upon further analysis using a paired t test, the percentage of change in Firmicutes to Bacteroidetes ratio was found to positively correlate with the percentage of change in BMI (p = 0.039) and weight (p = 0.20).

Conclusion

Weight reduction is closely related to gut microbiota change among obese adults.

Obes Facts. 2018 May 26;11(Suppl 1):289–290.

T4P140 Effects of omega-3 and omega-6 fatty acids on lipoprotein subclasses in abdominally obese people: a randomized double-blind crossover trial

E Grytten 1, J Laupsa-Borge 2, S Dankel 3, G Mellgren 3, E Rostrup 4

Introduction

Current nutritional guidelines encourage increased intake of polyunsaturated fatty acids (PUFAs) for cardiovascular disease (CVD) reduction. However, studies investigating health effects of omega-3 fatty acid (n-3 PUFA) and omega-6 fatty acid (n-6 PUFA) have demonstrated conflicting results. An atherogenic lipid profile associates with CVD risk, in particular high levels of triacylglycerols (TAGs), total cholesterol (TC), low-density lipoprotein (LDL) cholesterol and apolipoprotein B, and a low level of high-density lipoprotein (HDL) cholesterol. More recently, increased risk has been associated with elevated concentration of total and small LDL particles, as well as TAG-rich very-low-density lipoproteins (VLDL) and chylomicrons. The effects of dietary PUFAs on lipoprotein particle patterns are not fully understood. The aim of this study was to examine effects of n-3 PUFA and n-6 PUFA supplementation on circulating lipids and lipoprotein particle numbers and sizes in healthy, inactive individuals with abdominal obesity.

Methods

38 inactive people (12 women and 22 men aged 30–70) with increased waistline (≥94 cm in men and ≥80 cm in women) were included in a randomized double-blind crossover study. They received 3 g/day (women) or 4 g/day (men) n-3 PUFA (TAG fish oil) and 20 g/day (women) or 27 g/day (men) n-6 PUFA (safflower oil) for 8 weeks, separated by a wash-out period of 8 weeks. Before and after the two intervention periods, we measured fasting levels of lipids enzymatically and lipoproteins by nuclear magnetic resonance spectroscopy. Within- and between-group differences were analyzed by linear mixed-effects models adjusted for age, gender and BMI.

Results

The pooled analysis showed that the absolute mean changes in TAG levels differed between groups (n-3 vs n-6: –0.19; 95% CI (–0.37, –0.02); p = 0.033), and was significantly reduced after 8 weeks with the n-3 intervention, but not with n-6. We also found differential responses in the levels of TC (0.27 (0.02, 0.52); p = 0.035), LDL cholesterol (0.22 (0.01, 0.44); p = 0.043) and apolipoprotein B (0.08 (0.03, 0.12); p = 0.002) after significant reductions in the n-6 group only. Moreover, the groups differed in mean changes over time for total levels of TAG-rich lipoproteins (–18.8 (–28.7, –9.03); p < 0.001; decreased in the n-3 group only), LDL particles (131 (42.8, 221); p = 0.004; increased in n-3, decreased in n-6) and HDL particles (–3.09 (–4.50, –1.67); p < 0.001; decreased in n-3, increased in n-6). Among lipoprotein subclasses, we found differential responses in the levels of small VLDL (–14.3 (–22.1, –6.56); p < 0.001; decreased in n-3 only), large LDL (92.8 (19.3, 166); p = 0.014; increased in n-3 only), large HDL (0.83 (0.08, 1.57); p = 0.031; increased in n-3 only) and small HDL (–1.43 (–2.79, –0.07); p = 0.040; decreased in n-3, increased in n-6). However, no significant group differences were shown for VLDL, LDL or HDL particle sizes.

Conclusion

We found in both groups changes in lipids or lipoproteins that have been associated with reduced CVD risk, but in differential ways. Only the n-3 group showed reduced levels of TAGs and TAG-rich lipoproteins, while decreased levels of total and LDL cholesterol, and total LDL particles, were shown only in the n-6 group.

Obes Facts. 2018 May 26;11(Suppl 1):290.

T4P141 The importance of 1-hour plasma glucose in relation to prediabetes and metabolic syndrome in an obese population

L Haverals 1, K Van Dessel 1, A Verrijken 1, E Dirinck 1, F Peiffer 1, C De Block 1, L Van Gaal 1

Introduction

Worldwide prevalence of type 2 diabetes mellitus (T2DM) is alarming and associated with an increase in morbidity and mortality. The aim of this study is to investigate in a Caucasian obese population a possible link between 1-hour plasma glucose (1HrPG) on the one hand and prediabetes and the metabolic syndrome on the other hand.

Methods

Overweight and obese patients were consecutively included after visiting the obesity clinic. None of them were involved in a weight reduction program at enrolment. Every patient underwent a standard metabolic work-up. ROC-curves were used to compare the diagnostic sensitivity and specificity of 1HrPG versus fasting plasma glucose (FPG), 2HrPG, and HbA1c to diagnose prediabetes. Prediabetes was diagnosed using American Diabetes Association criteria.

Results

2439 patients (72.1% female) were included [mean age 43 ± 13 years, median BMI 37.3 (33.7–41.3) kg/m2] of which 1262 (51,7%) had a 1HrPG > = 155 mg/dL. Prediabetes was diagnosed in 33.8% and diabetes in 9.8% of subjects. Subjects with 1HrPG > = 155 mg/dL were more insulin-resistant (HOMA-IR 3.64 vs. 2.56, p < 0.001), had a higher waist (p < 0.001), higher visceral adipose tissue (218 ± 92 vs. 162 ± 78 cm2, p < 0.001), higher systolic blood pressure (p < 0.001), higher total cholesterol (p < 0.001), higher triglycerides (p < 0.001), lower HDL-cholesterol (p = 0.002), higher LDL-cholesterol (p = 0.003) and had higher plasminogen activator inhibitor-1 (PAI-1) [2.2 (1.0–4.0) vs. 1.4 (0.5–2.7) ng/ml, p < 0.001], compared with subjects with 1HrPG < 155mg/dL. 64,1% of the subjects with a 1HrPG > = 155 mg/dL showed the metabolic syndrome against 42.5% of subjects with a 1HrPG < 155 mg/dL (p < 0.001). In the group with 1HrPG > = 155 mg/dL only 32.6% had a normal glucose tolerance (NGT), while 48.9% was diagnosed with prediabetes and 18.5% had T2DM, compared to the group with a 1HrPG < 155 mg/dL in which 81.7% showed a NGT, 17.7% had prediabetes and 0.6% had T2DM (p < 0.001). For prediabetes, the ROC area under the curve for Hba1c was 0.677, which was greater than that of 1HrPG (0.498), FPG (0.483) and 2HrPG (0.459).

Conclusion

In line with earlier studies, this study supports the need for detection of subjects with higher 1HrPG values being at risk for development of T2DM (in 18.5%) and metabolic syndrome (in 64.1%). Our study stresses the need for routine measurement of 1HrPG, aiming at early identification of at-risk subjects.

Obes Facts. 2018 May 26;11(Suppl 1):290.

T4P142 Visceral adipose tissue independent of body mass index is related with markers of glucose and lipid metabolism in long-term renal transplant recipients

K SDS Pontes 1, MI Barreto Silva 1, KT Carvalho 1, MS Costa 1, AP Menna Barreto 1, MDL G Rodrigues 1, D CT Valença 1, S Giannini 1, R Bregman 1, M RST Klein 1

Introduction

Renal transplant recipients (RTR) compared with the general population present a higher risk of cardiovascular disease (CVD). Conventional CVD risk factors such as diabetes mellitus and dyslipidemia are highly prevalent in RTR due to several reasons, especially the use of immunosuppressive drugs. Although post-transplant (post-tx) obesity is very common, to date the association of visceral adipose tissue (VAT), a marker of dysfunctional adipose tissue, with glucose and lipid metabolism in long-term RTR is not known. The aim of the present study was to evaluate in long-term RTR the association of VAT with markers of glucose and lipid metabolism. A secondary aim was to evaluate the relation between VAT and anthropometric measures of central adiposity.

Methods

Cross-sectional study with RTR at least 6 months post-tx, aged 18–65 y. RTR undergoing dialysis, presenting AIDS, cancer, autoimmune diseases or acute illness were excluded. VAT was evaluated by dual energy x-ray absorptiometry (DXA). Anthropometry: weight, height, body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WthR). Laboratory markers evaluated after 12h fasting: adiponectin, resistin, high-sensitivity C-reactive protein (hs-CRP), glucose, insulin, HO-MA-IR, total cholesterol and fractions and triglycerides (TG). Glomerular filtration rate was estimated (eGFR) by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Individuals using antidiabetic drugs and/or insulin were excluded from the analysis involving glucose, insulin, HOMA-IR and resistin. Patients using hypolipidemic drugs were excluded from the analysis of lipid profile. Pearson's correlation was performed to determine the existence of a relationship between variables of interest. Partial correlations controlled for different confounders were also used. Skewed data were log transformed to improve normality. The study was approved by local Committee on Ethics and Research and all patients signed informed consent. All statistical analyses were performed using STATA12.0 software

Results

Were evaluated 186 RTR: 106 men (57%), 47.5 ± 11.2 years old, 115.1 ± 90.6 months post-tx, eGFR = 55.1 ± 20.5 ml/min, BMI = 26.4 ± 5.0 kg/m2 and WC = 92.4 ± 12.9 cm. In partial correlations controlled for gender, age, eGFR and time from transplant VAT presented significant correlation (p < 0.05) with adiponectin (r = −0.47), resistin (r = 0.30), hs-CRP (r = 0.29), glucose (r = 0.18), insulin (r = 0.26), HOMA-IR (r = 0.29), HDL cholesterol (r = −0.35), LDL cholesterol (r = 0.24) and TG (r = 0.41). In correlation additionally controlled for BMI, VAT remained significantly (p < 0.05) correlated with adiponectin (r = −0.24), insulin (r = 0.18), HOMA-IR (r = 0.19) and TG (r = 0.33). VAT presented a strong correlation (p < 0.0001) with WC (r = 0.81) and WthR (r = 0.71).

Conclusion

In long-term RTR, VAT is associated with markers of glucose and lipid metabolism even after controlling for BMI. Simple anthropometric measures of central adiposity present a high correlation with VAT in these patients and may be useful in clinical practice.

Obes Facts. 2018 May 26;11(Suppl 1):291.

T4P143 Effect of sodium-glucose cotransporter-2 inhibitor in type 2 diabetes with non-alcoholic fatty liver disease

B Kim 1

Introduction

Sodium-glucose cotransporter-2 inhibitors are expected to improve liver function of patients with non-alcoholic fatty liver disease combined type 2 diabetes by its characteristic mechanism. This study was designed to investigate the effect of dapagliflozin, one of the sodium-glucose cotransporter-2 inhibitors, on the liver function of type 2 diabetes patients with non-alcoholic fatty liver disease.

Methods

Patients who received dual oral hypoglycemic agents within the 3 month of diagnosing NAFLD were selected and only those who maintained the combination therapy without treatment regimen change for at least 6 months were included in the study. Patients were divided into two groups: metformin + dapagliflozin group and metformin + dipeptidyl peptidase-4 inhibitors group. Demographic data, biochemical data and the clinical and treatment histories of all patients were reviewed.

Results

Aspartate aminotransferase and alanine aminotransferase had decreased in both groups but were more decreased in the dapagliflozin group than in the dipeptidyl peptidase-4 inhibitors group, and the difference in the alanine aminotransferase reduction between the two groups was statistically significant (−21.1 U/L vs. -9.5 U/L, P = 0.008). The effect of dapagliflozin with metformin on alanine aminotransferase normalization remained significant after adjustment for confounding variables including body weight loss (odds ratio = 3.489, P = 0.046).

Conclusion

Alanine aminotransferase improvement was statistically significant in the dapagliflozin group than in the dipeptidyl peptidase-4 inhibitors group and the result was consistent after adjustment for confounding variables including body weight loss.

Obes Facts. 2018 May 26;11(Suppl 1):291.

T4P145 Improvement of metabolism and body composition beyond the normal state following gastric bypass surgery

D P Andersson 1, I Dahlman 2, DJ Eriksson Hogling 1, J Bäckdahl 1, E Toft 1, V Qvisth 1, E Näslund 3, A Thorell 4, M Rydén 1, P Arner 1

Introduction

Improvements in cardiometabolic risk profile following bariatric surgery are not fully characterized. The aim of this study was to compare cardiometabolic, inflammatory and anthropometric status between post-obese Roux-en-Y gastric by-pass (RYGB) operated patients and weight stable controls subjects.

Methods

A longitudinal controlled study was performed on 188 patients subjected to RYGB. The subjects were examined before the operation and two years post-operatively. One hundred forty-seven patients reached a post-obese state (BMI < 30 kg/m2). For sixty-nine of these post-obese patients a weight stable control subject matched for age, sex and BMI was selected. Metabolic outcome measures such as insulin sensitivity, lipid profile, blood pressure, inflammatory markers, body composition and adipose tissue cellularity (fat cell size and number) were then compared between post-obese subjects and weight stable control subjects.

Results

All measures of the risk profile associated with obesity were significantly improved in post-obese (p < 0.01 for all vs. before surgery). Insulin sensitivity, blood pressure, inflammatory status (CRP, interleukin 6, CCL18 and MCP1) and fasting blood glucose/triglycerides/HDL cholesterol were normalized. Moreover, in post-obese subjects insulin clearance (0.38 ± 0.08 vs 0.34 ± 0.08 ml/m2/min), fasting circulating levels of insulin (4.8 ± 1.9 vs 5.2 ± 2.4 mU/l), total cholesterol (4.1 ± 0.7 vs 4.8 ± 0.7 mmol/l), LDL cholesterol (2.1 ± 0.6 vs 2.9 ± 0.8 mmol/l) and Apo B/Apo A1 ratio (0.56 ± 0.20 vs 0.68 ± 0.21) were improved beyond the level of the control subjects (p < 0.01 for all). In addition, post-obese patients had a higher lean body mass compared to control subjects (48.4 ± 9.1 vs. 44.0 ± 8.1 kg, p < 0.01) and their adipose cellularity had a significantly more benign profile (i.e. hyperplasia with many small fat cells, 358 ± 163 vs 472 ± 148 pl p < 0.0001).

Conclusion

RYGB induces a supernormal cardiometabolic state in post-obese characterized by better body composition, lower insulin and atherogenic lipid/lipoprotein levels, higher insulin clearance and a more benign adipocyte morphology compared to matched weight stable controls. This may in part explain why RYGB patients are long term protected against type 2 diabetes and other cardio-metabolic complications to obesity.

Obes Facts. 2018 May 26;11(Suppl 1):291.

T4P146 The effect of orlistat, metformin and diet on insulin-like growth factor-1 in obese female population with and without insulin resistance

M Kujawska-Łuczak 1, M Szulińska 2, D Skrypnik 2, K Musialik 2, E Swora-Cwynar 3, M Kręgielska-Narożna 2, K Skrypnik 4, D Pupek-Musialik 1, M Grzymisławski 3, P Bogdański 2

Introduction

Data on the relationship between obesity and circulating insulin-like growth factor -1 (IGF-1) are confusing. The aim of this study was to compare the influence of orlistat (IO), metformin (IM), and calorie-restricted diet (LC) on IGF-1 serum concentration in obese women, with special respect to insulin-resistance status.

Methods

114 obese female subjects were enrolled in open label trial and randomized into insulin sensitive (IS) and insulin resistant (IR) group and received a low-calorie diet (LC), or an isocaloric diet and 500 mg metformin twice daily (IM), or isocaloric diet with 120 mg orlistat three times daily (IO). Before and after the intervention weight, height, body mass index (BMI), serum lipid profile, alanine aminotransferase, aspartate aminotransferase, insulin, glucose, HOMA-IR (homeostatic model assessment), IGF-1, visceral adiposity index (VAI) were estimated and changes of these parameters (Δ) were calculated.

Results

The reductions in BMI and body fat were significant and comparable in both IS and IR groups. Women with IR showed a significant increase in serum IGF-1 concentration. A greater decrease in HOMA-IR in the LC, a greater reduction in body weight in the IM, and a greater drop in body weight, body fat, and HOMA-IR in the IO were registered. HOMA-IR reduction was significantly greater in IR women. Significant positive correlations between ΔIGF-1 and initial HOMA-IR and ΔHOMA-IR; initial triglyceride/high-density lipoprotein (TG/HDL) ratio and ΔTG/HDL ratio; and initial VAI and ΔVAI were registered.

Conclusion

IR premenopausal women show a significant increase in circulating IGF-1 serum concentration after low-calorie diet, isocaloric diet with metformin and isocaloric diet with orlistat. The increase in serum IGF-1 concentration is parallel to the improvement of insulin resistance parameters.

Obes Facts. 2018 May 26;11(Suppl 1):292.

T4P147 Associations between Carbohydrate Counting and Insulin Pump Usage with Depression and Eating Disorders in Type 1 Diabetes Mellitus

N Sanlıer 1, Y Ertaş Öztürk 2, D Agagunduz 2, M S Karacil Ermumcu 2, R Bozbulut 2

Introduction

The incidence of type 1 DM in children is increasing. Providing glycemic control is the prevalent treatment of this disease. However, insulin dependency would increase anxiety, depression and disordered eating behavior in young children. This study investigates depression and eating disorders in children with type 1 diabetes mellitus (DM).

Methods

We included 149 children (81 male, 68 female) with type 1 DM aged 10–17 years in this cross-sectional study. The Children's Depression Inventory (CDI) and Diabetes Eating Problem Survey-Revised (DEPS-R) were administered, anthropometric measurements were taken and certain biochemical results were evaluated. Carbohydrate counting and using insulin pump was questioned.

Results

The mean age of the children was 13.42 ± 2.31 years and they were diagnosed with DM at a mean of 8.52 ± 2.96 years. Eating disorder scores were significantly different in children who used or did not use carbohydrate counting (respectively; 18.94 ± 11.84, 26.34 ± 10.27) and who used or did not use insulin pumps (respectively; 16.16 ± 13.76, 22.56 ± 11.19). The children who did not use carbohydrate counting (13.63 ± 7.14) had higher depression scores than those who did (10.28 ± 6.40). Similarly, depression scores were lower in children who used insulin pumps than in those who did not (respectively; 8.58 ± 5.59, 12.00 ± 6.93). The HbA1c levels of the children had significant effects on eating disorder and depression scores and a one unit increase in the children's HbA1c levels caused a three unit increase in eating disorder scores and 1.3 times greater risk of depression.

Conclusion

Our study shows that children with type 1 DM are at risk of depression. The depression and eating disorder scores were higher in those children who did not use carbohydrate counting and insulin pumps. For this reason, carbohydrate counting and insulin pump are not only biochemically but also psychologically useful treatments.

Obes Facts. 2018 May 26;11(Suppl 1):292.

T4P148 Maternal High Folic Acid Supplement and Relationship with Glucose Intolerance and Insulin Resistance in Offspring

MS Karacil Ermumcu 1, N Acar Tek 1

Introduction

Folic acid is known as vitamin folate, is a form of synthetically produced water soluble vitamin found in fortified food and supplements. Humans are not able to synthesize folate de novo and, therefore, the daily requirements of folate are met with consumption of food rich in this vitamin and supplements. Biologically active folic acid is essential in meeting the requirements of the function of the human body. Folic acid is used to synthesize, repair and methylate deoxyribonucleic acid (DNA) therefore it is especially important in pregnancy and childhood for continuous cell division and growth. Folate deficiency can cause many health problems such as macrocytic anemia, weakness and confusion, memory deficits, shortness of breath, peripheral neuropathy, pregnancy complications, depression, hyperhomocysteinemia and cancer.

Methods

This review aims to evaluate maternal high folic acid supplement and relationship with glucose ıntolerance and ınsulin resistance in offspring

Results

Especially folic acid have preventive effect in pregnancy for neural tube and birth defects. Folic acid supplement recommendations in preconception and during pregnancy have been well established many countries of the world and especially many populations are encouraged periconceptional folic acid supplement. Folic acid plays a fundamental role in the epigenetic pathway and maternal folic acid supplement influences normal DNA methylation in offspring. Detrimental effect of maternal folic acid supplement involving altered epigenetic regulation of related genes as possible mechanism on glucose regulation in offspring. High maternal folate concentration is associated with an increased risk of insulin resistance in children. In an animal model has reported that maternal high folic acid supplement promotes glucose intolerance and insulin resistance in male mouse offspring fed a high-fat diet. The first possible mechanism may be an imbalance between vitamin B12 and folate. High folate status could exaggerate the metabolic effects of vitamin B12 deficiency and it worse insulin resistance. The second one may be the harmful effects of unmetabolized plasma folic acid related to decreased natural killer cell cytoactivity involved in the pathogenesis of gestational diabetes mellitus.

Conclusion

Further larger cohort studies are warranted to examine this adverse effect.

Obes Facts. 2018 May 26;11(Suppl 1):292.

T4P149 Synchronous Distance Diabetes Prevention Program, Dose Response: Preliminary results

C Dunn 1, C Thomas 2

Introduction

More than half of Americans age 20 or older have either diabetes or prediabetes. Without weight loss and moderate physical activity, 15–30% of people with prediabetes will develop type 2 diabetes within 5 years. Individuals who participate in lifestyle interventions and who achieve a 5–7% decrease in body weight have shown a 58% decrease in their risk to develop type 2 diabetes. Diabetes prevention programs are often delivered via an in-person, onsite format. There has been an expansion of online and telehealth formats in recent years to expand the reach of prevention programs. There is limited evidence documenting the effectiveness of offering diabetes prevention programs in this format.

Methods

Eat Smart, Move More, Prevent Diabetes (ESMMPD) is a synchronous distance education diabetes prevention program approved by the Centers for Disease Control and Prevention. ESMMPD is a yearlong program that includes healthy eating, physical activity, and mindfulness strategies. Participants attend 16 classes in the first 5 months of the program (Phase 1) and 8 additional classes over the next 7 months (Phase 2). Classes are taught by a live instructor and include weekly communication through an online tracking portal. Participants enter their weight, A1c, weekly goals, and physical activity as well as questions to their instructor through the portal.

Results

Program completion is defined as attending at least 9 classes in Phase 1 and 3 classes in Phase 2. Preliminary results of the first year's cohorts (n = 179) found no significant difference in weight loss between those who completed Phase I (n = 148) and those who completed the entire program (n = 101) with percentages being 3.32% v. 4.09% (p = 0.105). An average weight loss percentages of 5.1% was shown among participants who completed at least 20 of 24 classes (n = 45) and those who completed 23 of 24 classes (n = 16) showed an average weight loss percentage of 6.1% (p = 0.01).

Conclusion

A synchronous distance education diabetes prevention program has the potential to successfully enhance diabetes prevention efforts. Preliminary findings suggest that sustained attendance is a key component in a participant's weight loss.

Obes Facts. 2018 May 26;11(Suppl 1):293.

T4P150 Improvement of prediabetic condition after 4 and 12 weeks intervention by the ACOORH concept – subanalysis of a multicenter RCT

W Banzer 1, A Berg 2, K Braumann 3, D Führer-Sakel 4, M Halle 5, S Martin 6, D McCarthy 7, GH Predel 8, J Scholze 9, C Seyller 10, H Toplak 11

Introduction

The Almased Concept against Overweight and Obesity and Related Health Risk, ACOORH, has investigated weight control and body composition in obesity. However, it is unknown whether this intervention may convert a prediabetic state into normal glucose regulation. This aspect is of clear clinical importance as large intervention trials have demonstrated that the risk for developing T2DM is significantly lower for subjects who had returned to normal glucose regulation versus those who had maintained in a prediabetic state.

Methods

To objectify the possible effect of ACOORH, a 1-year-multi-center RCT (centers established in Berlin, Düsseldorf, Essen, Frankfurt, Freiburg, Graz, Hamburg, Cologne, London, Munich, Strasbourg) for overweight and obese patients, a subgroup of prediabetic participants of the ACOORH study with an HbA1c between 5.70–6.49% (n = 141; n♀ = 101, n♂ = 40; BMI 32.2 ± 2.23kg/m2) was analyzed separately. The intervention regimen was the same as for all 463 ACOORH participants (BMI 27–35 kg/m2, 21–65 yrs), who had been randomized 1:2 to a telemedically controlled lifestyle (LS) intervention consisting of a fat restricted low calorie diet and increased physical activity versus a telemedically controlled meal replacement (MR) regimen (low-calorie, low-glycemic, soy-protein-rich product; Almased®; regimen: 1st week substituting 3 main meals/day, 2nd-4th week 2 main meals/day, and 5th-12th week 1 main meal/day).

Results

Baseline values for HbA1c were comparable between MR-group (n = 96; baseline HbA1c 5.90 ± 0.22%) and LS-group (n = 45; baseline HbA1c 5.89 ± 0.21%). results after 4 weeks intervention revealed that HbA1c decreased significantly more in the MR-group (−0.21 ± 0.20%) than in the LS-group (−0.13 ± 0.18%). These results were persistent over 12 weeks of intervention (MR-group: −0.19 ± 0.24% vs. LS-group -0.12 ± 0.22%) and were related to more significant weight control and body composition changes induced by the MR regimen.

Conclusion

These data demonstrate significant benefits of meal replacement strategy on glucose regulation already after 4 weeks of intervention, so that 50% of the prediabetic participants lost their baseline prediabetic state. In this respect meal replacement was more effective than lifestyle intervention.

Conflicts of Interest

This study was supported by Almased Company, Germany.

Obes Facts. 2018 May 26;11(Suppl 1):293.

T4P151 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):293.

T4P152 Olive Leaf: Potential Benefits of Lipid Profile and Glycemic Control

N Acar Tek 1, D Agagunduz 2, B Deniz Güneş 1

Introduction

Olive tree leaves have been widely used traditional herbal in order to prevent and treatment of various diseases. They contain several potentially bioactive compounds that may have hypoglycaemic and hypolipidemic properties.

Methods

To examine effects of olive leaf on potential benefits of lipid profile and glycemic control, database of Cochrane Library, PUBMED, Science Direct, Google Scholar were searched and summarized related evidence.

Results

The latest literature is attempting to define the relationship between olive leaf polyphenols and cardiovascular disease, diabetes and cancer prevention. However, the number of scientific studies is limited concerning on olive leaf and health benefits and potential role in the management of hyperglycemia and hyperlipidemia. Oleuropein, the basic phenolic compound of olive leaf extract, is responsible for the characteristic bitter taste of olive fruits. Oleuropein has many beneficial effects on human health. It was reported that the olive leaf extract could prevent complications in type 2 diabetes. Elevated levels of advanced glycation end products (AGEs) in the body in type 2 diabetes, contribute to diabetic complications and age related disease by directly causing the cross-linking of long lived proteins such as collagen, leading to vascular stiffness and affecting vascular structure and function. A recent study indicate that methanolic olive leaf extract to be a successful inhibitor of protein glycation (3 weeks incubation), inhibiting fluorescent of advanced glycation end products (AGE) formation. Olive leaf extracts have potential effect for prevention of diabetic complications and management and treatment of type 2 diabetes mellitus. A systematic review and meta-analysis research on the effects of olive leaf extract on glucose levels in diabetes-induced rats reported that olive leaf extract is beneficial for both the lipid profile and glycaemic control in diabetes-induced rats and also may be as effective among humans. The other study showed that olive leaves extract was able to correct glucose metabolism disorder by minimizing oxidative stress induced by radio frequency in rat tissues. There are even fewer human-based studies on the olive leaf extracts. A double-blinded placebo controlled human-based study report that eight-week 20 mL olive leaf extracts consumption support in health benefits through influencing the expression of genes in inflammatory and metabolic pathways. The effects of drug (atorvastatin at dose of 20 mg/kg) and olive leaf extracts (doses of 50 or 100 mg/kg/day) were compared in rats with high total cholesterol and LDL cholesterol levels. This study showed that olive extracts (at both doses) and drug significantly reduced total cholesterol and LDL cholesterol levels.

Conclusion

As a result, the olive leaf extract may have beneficial effects on atherosclerosis. The health effects of olive leaf have drawn attention to today's researchers. As a result, although human studies are limited, all studies report positive effects. Olive leaf extract is effective in the correction of lipid profile and hyperglycemia. The new studies are needed to evaluate the interactions between olive leaf extract, oral antidiabetics and lipid-lowering drugs.

Obes Facts. 2018 May 26;11(Suppl 1):294.

T4P153 Relationship between bone mineral density and body mass composition in morbidly obese patients

E Sava 1, A Sirbu 1, B Leca 1, M Mitrache 1, S Martin 1, C Copaescu 2, S Fica 1

Introduction

The relationship between obesity and bone metabolism is highly debatable. While increased body weight has been considered a protective factor against osteoporosis for many years, recent studies suggest that the accumulation of fat mass may have a negative impact, determining loss of bone mass and increasing the risk of fracture. The aim of this study was to assess the consequences of obesity on bone metabolism by evaluating bone mineral density (BMD) and phospho-calcium metabolism in a group of morbidly obese patients.

Methods

60 patients (34 women and 26 men) with mean age 39.96 ± 11.20 years and mean BMI 41.02 ± 6.43 kg/m2 were assessed. Physical examination, biochemical tests and body composition measured by Dual-energy X-ray absorptiometry (DXA) were performed and the following parameters were analyzed: RSMI (relative skeletal muscle index), TFM (total fat mass), TLM (total lean mass), BMC (bone mineral content) and VAT (visceral adipose tissue). TFM% and corrected TLM (g) were determined based on formulas: TFM% = TFM(g)/weight*10, corrected TLM (g) = TLM(g)-BMC(g).

Results

The patients were divided into two groups based on the presence or absence of metabolic syndrome (MetS), as defined by the NCEP ATPIII criteria: 29 patients (48%) with MetS (MetS-) and 31 patients (52%) without MetS (MetS+). Significant difference was found on BMD (1.24 ± 0.09 g/cm2 vs 1.30 ± 0.14 g/cm2, p = 0.04), BMC (2699.48 ± 362.65g vs 3015.87 ± 560.75g, p = 0.013) and VAT (1996.96 ± 1019.37 g vs 3496.35 ± 1247.35 g, p < 0.001). Mean calcium level was 8.76 ± 0.42 mg/dl in MetS- group vs 8.87 ± 0.55mg/dl in MetS+ group, showing no significant difference between the two groups. Also, there was no difference in PTH levels (28.74 ± 12.60 pg/dl MetS- vs 26.27 ± 13.53 pg/ml MetS+). BMD was positively correlated with BMI (r = 0.321, p = 0.012), waist circumference (r = 0.433, p = 0.003), waist-hip ratio (r = 0.325, p = 0.029), uric acid levels (r = 0.352, p = 0.006), triglycerides levels (r = 0.295, p = 0.022), TFM% (r = −0.298, p = 0.021), corrected TLM (r = 0.664, p < 0.001), VAT (r = 0.329, p = 0.013) and RSMI (r = 0.573, p < 0.001). The correlations between BMD and biological parameters where maintained when results were adjusted through linear regression based on sex in the following way: BMI (β = 0.756, p = 0.001), TFM% (β = −0.220, p < 0.001), corrected TLM (β = 2.185, p < 0.001) and VAT (β = −0.866, p = 0.054)

Conclusion

The measurements indicate that BMI, waist circumference, visceral adipose tissue, lean mass and relative skeletal muscle index are associated with BMD. The interactions between adipose tissue and bone are complex and further studies are necessary to establish the relationship between obesity, metabolic syndrome and bone metabolism.

Obes Facts. 2018 May 26;11(Suppl 1):294.

T4P154 Obesity is dominating factor in asymptomatic urine infection in type 2 diabetic patients

S Svacina 1, I Karen 2, J Hendl 3

Introduction

Asymptomatic urine infection is a common complication in obese type 2 diabetic patients. We have analyzed what is the role of obesity in this complication.

Methods

We have investigated 99 type 2 patients (57 women and 42 men) coming to diabetes centre without subjective clinical signs of infection. Documented was age, gender, BMI, leukocyte count in urine, CRP, HbA1c and fasting glucose. As the cut point for urine infection 25 leucocytes per ml was used.

Results

Mean duration of diabetes was 8.7 years, mean blood glucose was 8.8 mmol/l, HbA1c 56.1 mmol/mol, BMI 30.02 kg/m2, age 61 years, CRP 11.4 mg/l and leukocytes in urine 79.7 elem. per ml. Leukocytes above the level had 25 patients. Multiple linear regression was calculated to analyze the relation of leucocytes count in urine to age, BMI, gender, blood glucose and HbA1c. Significant relation of leukocyte count in urine was found to age, glucose and BMI. BMI explains 88% of the regression. Adding the other two parameters increases the R2 by 1% only. There was not any significant relation to HbA1c and gender. The regression line of HbA1c to blood glucose is significantly shifted in the subgroup with infection

Conclusion

BMI is the main factor influencing the presence of asymptomatic urine infection in type 2 diabetic patients. There is also a significant relation to age and actual fasting blood glucose level. Chronic compensation of diabetes (HbA1c) and gender are not related to the urine infection. Blood glucose is significantly elevated secondary to infection. Asymptomatic urine infection in obese diabetic patients should be perhaps treated according to the influence on blood glucose level,

Obes Facts. 2018 May 26;11(Suppl 1):294.

T4P155 Plasma myostatin levels and metabolic complications in obese patients

J Goralska 1, U Razny 1, A Gruca 1, A Zdzienicka 1, J Baran 1, B Solnica 1, M Malczewska-Malec 1

Introduction

Myokines, such as myostatin, released by skeletal muscles, affect the energy balance of the body by modulating the differentiation and phenotype of not only muscles but also other tissues. Recent data suggest that myostatin may influence circulating glucose levels via direct affects on glucose uptake independent of its effects on muscle growth. Therefore, research on the association of myostatin with the development of obesity and insulin resistance are needed. The aim was to determine myostatin plasma levels in obese patients in relation to the metabolic health and to study if the 12-week low calorie diet could influence plasma myostatin level.

Methods

The study included 88 obese patients, assigned to a low calorie or control diet. Plasma glucose, insulin and lipids levels were determined by standard diagnostic tests. Plasma myostatin concentration was determined by ELISA before and after 12-week diet.

Results

Positive correlations between myostatin plasma level and body weight and insulin resistance were found, although no relationships with age, body fat or plasma lipids were observed. Fasting glucose, insulin and HOMA-IR were elevated in patients with higher (>50pctl) myostatin levels. Low calorie diet induced weight loss but did not influence plasma myostatin levels (22,4 ng/ml vs 22,3 ng/ml).

Conclusion

Increased myostatin plasma levels may contribute to the development of insulin resistance but not lipid complications in obese patients. The weight loss as a result of 12-week low calorie diet without changes in physical activity does not significantly alter plasma myostatin levels.

Supported by the EU FP7 BIOCLAMS (Grant agreement no. 244995)and CMUJ grant K/ZDS/007157

Obes Facts. 2018 May 26;11(Suppl 1):295.

T4P156 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):295.

T4P157 Is There a Relationship Between Milk Fat Globule Membrane and Cancer?

B Deniz Güneş 1, G Özata Uyar 2, G Akbulut 1, N Acar Tek 1

Introduction

The milk fat globule membrane (MFGM) has gained a lot of attention recently, due to the growing interest in its nutritional and technological properties. The fat globules in milk consist of a triglyceride core, surrounded by a thin membrane, called MFGM.

Methods

As viewed from the lipid core outwards, the MFGM consists of an inner monolayer of polar lipids and proteins surrounding the intracellular fat droplet, an electron dense proteinaceous coat located on the inner face of the bilayer membrane and finally a true bilayer membrane of polar lipids and proteins.

Results

The lipids of the MFGM are primarily polar lipids, although neutral lipids can also occur. The polar lipids of the MFGM consist of phospho- and sphingolipids. The major types of polar lipids present in the membrane are phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine. It is known that 25–70% of MFGM is composed of proteins. Major MFGM proteins such as mucin-1, xanthine dehydrogenase/oxidase, CD36, PAS 6/7, adidophilin and butyrophilin have been characterized. Among the health-beneficial components of the MFGM are cholesterolemia-lowering factor, inhibitors of cancer cell growth, vitamin binders, inhibitor of Helicobacter pylori, inhibitor of beta-glucuronidase of the intestinal Escherichia coli, xanthine oxidase as a bactericidal agent, butyrophilin as a possible suppressor of multiple sclerosis, and phospholipids as agents against colon cancer, gastrointestinal pathogens, Alzheimer's disease, depression, and stress. Many studies have demonstrated that phospholipids and sphingolipids of MFGM possess cancer risk-reducing properties. Several reports attribute its chemo preventive activity to products of sphingomyelin hydrolysis, which affect multiple cellular targets that control cell growth, differentiation and apoptosis. There is experimental evidence that dietary sphingomyelin has reduced the risk of colon cancer and may prevent malignant tumor growth; sphingosine and ceramide have induced apoptosis in a human adenocarcinoma cell line. One of the isolated proteins of bovine MFGM, namely fatty acid binding protein, has been found to inhibit the growth of some breast cancer cell lines in vitro at extremely low concentrations. The BRCA proteins, which are breast cancer inhibitors, are involved in DNA repair processes, although they have an additional function as one of the direct regulators of cytokinesis.

Conclusion

During the last decade, the study of the health benefits provided by MFGM has been mainly focused on its individual components. Immunomodulatory and antimicrobial activity as well as anticarcinogenic potential have been reported, though the specific mechanisms behind those effects is lacking. There is a need for further work on the MFGM on cancer and its impact on human health.

Obes Facts. 2018 May 26;11(Suppl 1):295.

T4P158 Evolution of non-alcoholic fatty liver disease in morbidly obese patients who underwent Roux-en-Y gastric bypass: comparison between fibrosis score and histopathological findings

FHM Chaim 1, E Cazzo 1, FDM Chaim 1, EC Cândido 1, AM Neder 1, JE Poletto 1, L Baltieri 1, DAO Modena 2, MA Gestic 1, M Utrini 1, ÉA Chaim 1

Introduction

Since non-alcoholic fatty liver disease (NAFLD) has become a public health concern over recent decades, its detection and monitoring through non-invasive methods have become relevant topics. Objective: To compare the course of the main features of NAFLD among obese individuals who undergo bariatric surgery, by means of paired liver biopsies and non-invasive fibrosis score.

Methods

This is a historic cohort study that assessed data from a prospectively collected database, which enrolled 32 individuals who underwent Roux-en-Y gastric bypass (RYGB) from January 2013 to December 2016 and then another surgical procedure after at least three months. The features of NAFLD (steatosis, steatohepatitis and fibrosis) were assessed by histological examination of liver biopsies collected during the surgical procedures; the histological level of fibrosis was correlated with values obtained by means of the NAFLD fibrosis score. The project was approved by the local Ethics Review Board.

NAFLD Score = −1.675 + (0.037*age [years]) + (0.094*BMI [kg/m2]) + (1.13*IFG/diabetes [yes = 1, no = 0]) + (0.99*AST7ALT ratio) – (0.013*platelet count [xl09/L]) – (0.66*albumin[g/dl])

Results

Of 507 patients underwent RYGB, 32 (6.3%) underwent another surgical intervention after at least three months. The new interventions were: 18 incisional hernias (56.2%), 10 cholecystectomies (31.2%), three band removals due to slippage (9.3%) and one laparotomy due to internal hernia (3.1%). The mean age at the time of RYGB was 41.7 years and 84.3% of the patients were female. The mean interval between procedures was 22.6 months (5–74). The mean BMI of patients at the time of gastric bypass was 36.5 kg /m2. The steatosis, fibrosis and steatohepatitis reversion rates were respectively 70.5%, 62.5% and 66.6%, according to the histopathological examination (p < 0.05). The mean fibrosis score ranged from –0.348 to –1.585 between the two periods (p < 0.05); there was reversal of significant fibrosis according to the score in 77.7% of the cases.

Conclusion

RYGB has been shown to be an effective procedure to control NAFLD, leading to significant resolution rates of its presentations. The noninvasive fibrosis score showed an appropriate correlation with the histological examination of liver biopsies, and thus can be considered for use in large scale in clinical practice and population studies.

Tab. 1.

Comparison between evaluated periods

Gastric bypass Second surgery p Reversal
Steatosis 17 (53,12%) 5 (15,6%) 0,001588 70,5%
Fibrosis 14 (43,7%) 5 (15,6%) 0,013803 62,5%
Steatohepatitis 18 (56,2%) 6 (18,7%) 0,001946 66,6%
NAFLD Score 9 (28,1%) 1 (3,1%) 0,005885 77,7%
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Obes Facts. 2018 May 26;11(Suppl 1):296.

T4P159 Biomarkers of antioxidant activity in obese patients before and after weight loss

M Sumarac Dumanovic 1, D Stamenkovic-Pejkovic 2, S Polovina 2, D Jeremic 1, J Dumanovic 3, T Simic 4, D Micic 5

Introduction

It has shown the association between obesity and oxidative stress and its improvement after the weight loss. Possible reasons for obesity-associated oxidative stress might be a high metabolic load that exposes cells to an overload of nutrients with excessive mitochondrial oxidation and enhanced ROS generation, inflammatory states associated with obesity as well as insulin resistance. The main objective of the study was to demonstrate that the weight loss in obese subject correlates with the increased expression and activity of extracellular glutathione peroxidase and enhanced protection against oxidative damage to proteins and lipids.

Methods

In 18 healthy nonobese person (BMI 24.5 ± 3.3kg/m2, age 34.1 ± 2.5yrs) and 21 obese (BMI 49.34 ± 2.7kg/m2, age 36.12 ± 2.27 yrs.) activities of antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured before and after 3 months reduced caloric intake. In 11 of 20 BMI was reduced for more than 10%. In this subgroup of patients, we also analyzed changes in activity of these enzymes after 1 and 4 week of diet. Fasting plasma glucose and insulin were measured before and after 3 months (HOMA-IR was calculated) in all patients. Liver enzymes (ALT and GGT) and CRP were also determined.

Results

No difference was found in SOD in obese vs. nonobese (369.7 ± 15.75 vs. 342.42 ± 19.87, p > 0.05 but GSH-Px in obese was lower vs nonobese (746.77 ± 34.25 vs. 915.25 ± 32.64, p < 0.05). SOD in subgroup with reduction in BW vs. no responder (757.32 ± 54.02 vs. 735.17 ± 43.36, p > 0.05) and GSH-Px in same subgroups 377.23 ± 21.82, vs. 362.8 ± 23.36, p >0.05) were similar. No difference in SOD and GSH-Px in subgroup with BW loss before, after one week, 4 weeks and 3 month (362.8 ± 23.36 vs 376.58 ± 23.79 vs. 373.71 ± 20.3, p > 0.05) and (757.32 ± 54.02 vs. 637.70 ± 49.30 vs. 775.01 ± 74.98 vs 602.84 ± 52.12, p > 0.05, respectively. There was no correlation between SOD and GSH-Px and BMI, HOMA-IR, CRP but was significant correlation with GGT (−0.705, p < 0.05 and -0.608, p < 0,05), respectively.

Conclusion

Our data confirmed higher activities of antioxidant enzymes in nonobese healthy persons. In extreme obese patients, after more than 10% body weight loss, down-regulated activities of antioxidant enzymes e.g. superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) are still present. Still the question of whether and when the expression and activity of extracellular glutathione peroxidase and other antioxidant enzymes are recovered after weight loss has to be addressed.

Obes Facts. 2018 May 26;11(Suppl 1):296.

T4P160 Impact of Obesity on the Metabolic Control of Type 2 Diabetes: results of Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Study)

A Sönmez 1, V Yumuk 2, C Haymana 3, I Demirci 1, C Barcin 3, S Kıyıcı 4, S Güldiken 5, G Örük 6, S Yener 7, S Baldane 8, F Kutlutürk 9, F Küçükler 10, O Deyneli 11, B Çetinarslan 12, T Sabuncu 13, F Bayram 14, I Satman 15

Introduction

Obesity is not only the major factor in the pathogenesis of type 2 diabetes mellitus, but also the major obstacle for the good metabolic control of patients with diabetes. So far, no nationwide survey has been performed to search for the impact of obesity on the glycemic and other metabolic parameters of type 2 diabetes in Turkey. We analyzed the results of the TEMD study, a recent survey on the glycemic and other metabolic parameters of patients with diabetes in order to find out role of obesity on metabolic control.

Methods

A retrospective survey was performed among patients who were under follow-up in the same center for at least a year, in 68 tertiary endocrine units, 37 cities and 12 NUTS regions of Turkey. Lactation or being pregnant, younger than 18 years, decompensated liver disease or renal replacement therapy, psychiatric disorders interfering cognition or compliance, or previous history of bariatric surgery were the exclusion criteria. The demographic, anthropometric, clinical and biochemical data, including medications were recorded for each patient. Blood Pressures were measured by standardized electronic sphygmomanometers.

Results

A total of 4640 patients with type 2 diabetes were enrolled. Only 9.9% (n = 460) were in normal weight, while 31% (n = 1439) were overweight, 48% (n = 2225) were obese and 11.1%(n = 516) were morbidly obese (Table-1). The prevalence of obesity and morbid obesity in women (49.6% and 15.1% respectively) were significantly higher than in men (37.6% and 3.1% respectively)(p < 0,001 for both)(Figure-1). The parameters of metabolic control including HbA1c, Arterial Blood Pressures, LDL Cholesterol, triglycerides and HDL Cholesterol levels worsen in the higher body mass index categories (p < 0,001 for all). Also, the level of education (p < 0,001) and monthly income (p = 0,03) are significantly lower in the higher body weight categories. The prevalence of microvascular complications including retinopathy, nephropathy (p = 0.01 for both) and neuropathy (p < 0.001) were significantly higher in the higher body weight categories. According to the binominal logistic regression analysis, obesity was the significant predictor of poor metabolic control along with the longer diabetes duration, higher age, lower monthly income and lower education status.

Conclusion

Analysis of the TEMD survey indicates that obesity is the major determinant of the poor metabolic control of the type 2 diabetes patients living in Turkey. These results implies that, a significant improvement in the diabetes health care can only be achieved by the prevention and management of obesity.

Obes Facts. 2018 May 26;11(Suppl 1):297.

T4P161 The effect of Decoction Xiang-sha Six Jun-zi on weight reduction in subjects with simple obesity- A pilot study

Y Yang 1, H Wu 2, Y Chang 2, J Wu 2, F Lu 2, C Chang 2

Introduction

The prevalence of obesity has increased dramatically, and it raises the risk of developing metabolic syndrome. Decoction Xiang-sha Six Jun-zi (DXSJ) is a traditional Chinese medicine prescription with high frequency used in the outpatient clinic of Chinese medicine, and it had an improvement effect on fatty liver, and some of the ingredients had been confirmed for the improvement of obesity, hyperlipidemia, and diabetes in both cell and animal models, but clinical studies were scarce. Therefore, the aim of this study was to investigate the effect of DXSJ on weight reduction in simple obesity subjects with double-blind placebo- controlled study design.

Methods

A total of 41 subjects with simple obesity aged 20–70 year-old were enrolled. Using a double-blind placebo-controlled study design, 34 subjects with simple obesity were randomized to receive placebo or DXSJ (3 g. Tid) for 12-week to investigate the effects of DXSJ on simple obesity. In addition, the metabolic parameters, lipid profile, kidney and liver functions were evaluated.

Results

There were no significant differences in the baseline characteristics between placebo and DXSJ group, including the age, gender, metabolic parameters, lipid profile, kidney and liver functions. DXSJ significantly decreased body weight and body mass index in simple obese patients, but not in placebo group. There were no significant differences between DXSJ group and placebo group in fasting plasma glucose, insulin, homeostasis model assessment-insulin resistance, and lipid profile. However, there were no significant adverse events observed during the trial.

Conclusion

DXSJ reduced body weight and body mass index in simple obese subjects and it exerted an anti-obesity effect of simple obesity without significant side effects.

Obes Facts. 2018 May 26;11(Suppl 1):297.

T4P162 The effects of a community-based education, counseling, and exercise camp program on health behaviors in patients with metabolic syndrome

SY Lee 1

Introduction

The purpose of this study was to evaluate the effects of a two-day community-based education, counseling, and exercise camp program on health behaviors in patients with metabolic syndrome and to ascertain whether changes in health indicators are observed. In addition, we examined whether the camp have long-term effects on patients’ medical knowledge and also improve depression and life satisfaction.

Methods

Twenty-nine patients with metabolic syndrome over the age of 45 participated in a two-day camp. They has been teaching and practicing medical, nutrition, diet and exercise together with doctors, nurses, dietitians, exercise specialists, social workers, and administrators and has had time for personal medical consultation. At 1, 2, 3, and 6 months after the camp, they visited the public health center, conducted physical examination, blood tests, and questionnaires.

Results

Twenty-two patients were analyzed for 6-month follow-up data. The waist circumference decreased significantly after 1 month (P < 0.01) but then gradually increased again for 5 months. Physical activity was also increased at 1 month (P < 0.05), but decreased again at 3 months. Satisfaction with life was constantly increased and remained significant until 2 months and remained until 6 months. Depression was also better than before 3 months and 6 months. (P < 0.05 for both) High density lipid-cholesterol was significantly increased after 6 months in the blood test (p < 0.05), but calculated low density lipid-cholesterol was decreased but not significant. Triglyceride and fasting blood glucose increased (P < 0.05). Medical knowledge tby education lasted for a long time (P < 0.05).

Conclusion

The participants showed an improvement in life satisfaction and depression after a two-day community-based education, counseling, and exercise camp program and this effect lasted for a long time. Medical knowledge was maintained for a long time even by one education. However, the indicators of behavioral changes such as exercise were only sustained for a short time.

Obes Facts. 2018 May 26;11(Suppl 1):297.

T4P163 Three and twelve month weight outcomes after attendance at a community based weight management programme in North West England

DR Broom 1, O Flannery 2, N Colledge 2

Introduction

There are limited weight management services avaialble in primary care. Research suggests commercial weight management services are effective in helping people manage their weight but they typically only include advice on physical activity. The objective of this analysis was to assess 3 and 12 month weight loss after attendance at a community-based weight management programme which included physical activity sessions delivered by a local leisure trust and a commercial slimming group between January 2009 and November 2014.

Methods

After institutional ethical approval and consent from participants during triage, a retrospective analysis of a 12 week multi-component intervention, tier 2 community weight management service for adults in Wigan, North West England, UK was conducted. Participants (n = 8514) mean ± SD age was 47.4 ± 14.3 years and starting body mass was 86.7 ± 14.3 kg. Differences in body mass from baseline to three and twelve months were examined using repeated measures ANOVA. Because some follow-up observations were missing, the Last Observation Carried Forward approach was also used. The alpha level of statistical significance was set at P < 0.05 and effect sizes were quantified using the partial eta squared.

Results

Repeated measures ANOVA revealed there was an effect of time (P < 0.01, ES = 0.36) with a significant reduction in body mass from baseline (86.7 ± 14.3 kg) to 3 months (81.2 ± 13.6 kg) to 12 months (79.7 ± 14.0 kg). Last Observation Carried Forward confirmed an effect of time (P < 0.01, ES = 0.42).

Conclusion

Significant reductions in body mass were reported at 3 and 12 months highlighting the effectiveness of the community weight management programme that included tailored physical activity opportunities for participants.

Obes Facts. 2018 May 26;11(Suppl 1):297–298.

T4P164 Impact of bariatric surgery on working productivity in patients with morbid obesity

D Romero 1, SG Fidel Kinori 2, MS Cepeda 2, G Parramon 2, M Velasquez 1, M Comas 1, JM Fort 3, C Hernandez 4, R Simo 4, J Mesa 1, A Ciudin 1

Introduction

Morbid obesity (MO) is a major global public health problem, associated with a significant economic burden, both due to its high prevalence and the number and severity of its comorbidities. MO is associated with a high degree of difficulty to lead a normal social and working life. Weight loss is effective in decreasing these risks and to reduce disease severity. Bariatric surgery (BS) is an effective therapy for sustained weight loss and for the improvement of the quality of life of these patients. Nevertheless, data in literature is scarce regarding the impact of BS on the working productivity (WP) of the MO patients. On these bases, the objective of the present study is to evaluate the relationship between BS and WP in MO patients.

Methods

We performed a retrospective revision of the medical records of the consecutive patients that attended the MO Unit of our center between February-October 2017 and had a complete psychological evaluation. The specific psychological exam in the MO Unit was performed using the ZKPQ, STAI, BDI-II, BITE and Rosenberg SS questionnaires as part of the pre-BS evaluation as per protocol. On the day of the visit to our center, the WPAI-GH questionnaire was administered to all the patients.

Results

138 patients were recluted, aging 48.21 ± 10.81 years, 73% women, and 85.4% Caucasian. A total of 56.2% were not employed. 61.03% of the cases underwent BS, with a follow-up of 36.45 ± 27.82 months and a satisfactory evolution (previous BMI 44.12 ± 6.8 kg/m2 versus post-BS BMI 33.4 ± 5 kg/m2, p < 0.001). In the group of BS patients, 83.0% were not previously employed and 3.03% have been reinserted into the labor market after the BS. No significant correlations were found between the WP and the age, gender, ethnicity, any BMI, MO related comorbidities, follow-up time after the BS, surgical technique or socio-economic status. We found significant correlations between the WP and the education level, the presence of depression, anxiety and lack of activity as well as self-esteem evaluated by the psychological tests previous BS.

Conclusion

A significant percentage of patients with MO that underwent BS were not employed, despite the satisfactory evolution in terms of BMI. A significant correlation exists between the WP and the pre-BS psychological profile of the MO patients.

Obes Facts. 2018 May 26;11(Suppl 1):298.

T4P165 Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): results of a randomised controlled trial

NM Astbury 1, P Aveyard 1, A Nickless 1, K Hood 1, K Corfield 1, R Lowe 1, S A Jebb 1

Introduction

Low energy total diet replacement programmes (TDR) lead to successful weight loss but are not recommended for routine treatment of obesity because of concerns about safety and weight regain.

Methods

In this parallel-group, randomised trial we recruited 278 adults (61% female) who were obese from primary care registers in 10 GP practices (mean ± SD) BMI 37.2 ± 5.4 kg/m2, age 47.8 ± 12.1 years. Participants were allocated to either a low-energy TDR programme offered by a commercial provider, which involved replacing all conventional foods with products comprising 810kcal/day for 8 weeks, followed by 4 weeks gradual food re-introduction and behavioural support for 24 weeks, or usual care (UC) for weight loss provided by a healthcare professional at the GP practice. The primary outcome was weight change at 12 months analysed as intention-to-treat with mixed effects models. Secondary outcomes included biomarkers of cardiovascular risk. We also measured quality of life and recorded any adverse events.

Results

Participants in the TDR group lost more weight (−10.7kg) than usual care (−3.1kg) at 12 months; adjusted mean difference of -7.2 kg (95% CI: −9.4, -4.9). Weight losses ≥5% occurred in 73% and 32%, and ≥10% in 45% and 15% of participants in TDR and UC groups respectively. Changes in biomarkers of cardiovascular risk reflected the changes in weight. There was a significantly greater improvement in 10 year risk of a cardiovascular event in participants in the TDR group (−1.0%; 95% CI: −1.7, -0.3). There appeared to be a greater improvement in quality of life in the TDR group. Adverse events classed as moderate or greater occurred in 11% and 12% of participants in TDR and UC respectively.

Conclusion

A low-energy TDR programme is acceptable to patients, safe and more effective than usual weight loss programmes offered in primary care and could be used to treat obesity in generalist healthcare settings.

Conflicts of Interest

This study was funded by a research grant from Cambridge Weight Plan UK Ltd to the University of Oxford and supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust. NMA, PA and SAJ are supported by NIHR Biomedical Research Centre, Oxford.

Obes Facts. 2018 May 26;11(Suppl 1):298–299.

T4P166 Access to Tier 3 Obesity services within the UK – A postcode lottery?

E Scott 1, R Cassidy 2, KL Johnston 3, M Capehorn 4

Introduction

The prevalence of obesity has tripled in many European countries since the 1980s and according to recent figures, 27% of the UK population is obese; the sixth highest figure in OECD countries and the highest in Western Europe1. It is estimated that the NHS in England spent £6.1 billion on overweight and obesity-related ill-health in 2014 to 2015 and that UK-wide costs are projected to reach £9.7 billion per annum by 20502.

In April 2014, responsibility for commissioning tier 3 obesity services was passed to local Clinical Commissioning Groups (CCGs) and this action was intended to improve services as local commissioning allows greater tailoring of services to meet the needs of the local community. However, nearly four years on, provision is variable with many areas experiencing inadequate services. Attempts by Public Health England to map tier 3 services in 2015 were met with a poor response.

Methods

In September 2016, Freedom of Information (FOI) requests were sent to all registered CCGs in England, Health Boards in Scotland and Wales, and Health and Social Care Trusts in Northern Ireland, requesting information about their Tier 3 Obesity Service provision. The following questions were asked:

  • – 1. Who is the named person / commissioner responsible for commissioning tier 3 obesity services within your organisation?

  • – 2. In the most recent year where figures are available, how many patients were referred to tier 3 services?

  • – 3. Who currently provides your tier 3 services?

Results

201 of the 208 CCGs in England responded, including 11 who believed that tier 3 was still the responsibility of NHS England. At the time of the request, 135 (68.2%) CCGs were commissioning a tier 3 service, six were in the process of commissioning a new service and three were decommissioning their services. 39 (19.7%) CCGs reported having no tier 3 services. Of those with a tier 3 service, most used an NHS provider (97/135; 71.9%), followed by private providers (37/135; 27.74%) or the local council (1/135; 0.7%). Between CCGs, referral rates ranged from 1.1 to 503.8 patients per 100,000 population. Referral rate was not correlated with local obesity rate nor was there any difference in referral rate by service provider.

Responses from the Scottish Health Boards revealed that tier 3 services are centrally commissioned by the Scottish Government as part of a more comprehensive ‘prevention bundle’. No responses were received from Wales or Northern Ireland.

Conclusion

Provision of and referral to tier 3 services across England is variable and does not appear to be based on local clinical need. Access to appropriate services is key for patients to manage a condition like obesity. The absence of tier 3 services in some areas as well as the wide variation in referral rates by CCG, deprives patients of this opportunity which risks widening the health inequalities experienced by those who can't afford to self-fund private treatment.

Conflicts of Interest

Kelly Johnston and Richard Cassidy are employed by LighterLife UK Ltd.

References

Obes Facts. 2018 May 26;11(Suppl 1):299.

T4P167 The change of adipose tissue using by CryoElsa (Huons, Korea)

KR Lee 1, D Lee 1, K Ko 1, I Hwang 1, K Kim 1, H Suh 1

Introduction

Since cryolipolysis was approved as an adjuvant method for fat reduction, an open clinical interventional study was investigated to reduce abdominal fat using by new device named CryoElsa (Huons, Korea) for healthy volunteers.

Methods

Their height, weight, and waist girths ((27.83 +/− 2.6 kg/m2, 7 Females) were measured at initial, 8th week. In addition the cross-sectional areas of visceral/subcutaneous adipose tissues were compared by C-T for 8 weeks. The Wilcoxon signed-rank test was performed through SPSS program (version 18, Illinois, USA), probability less than 0.05 was considered as significant at both sided. All subjects were submitted to a 60 minute cooling application on abdominal fat through vacuum.

Results

The subcutaneous adipose tissue and visceral adipose tissue were lost 11%, 9.07%, respectively. Visual improvements were noted without statistical decrease on abdomen, waist circumferences and V/S ratios. Some adverse events such as pain, bruise were noted.

Conclusion

In conclusion cryolipolysis through Elsa (Huons) promotes to reduce abdominal fat for 8 weeks in thirteen apparently healthy Koreans.

Conflicts of Interest

Cryo-Elsa device was provided by Humedix company (Korea). In addition, half of participating subjects were provided and financial interest was partly funded by Huons global company in Korea.

Tab. 1.

Demographic Comparative data for 8 weeks

0th Week 8th Week p-value
Weight (Kg) 76.6(15.1) 76.9(14.7) 0.438
BMI(Kg/m2) 27.8(2.6) 28(2.6) 0.286
Visceral Adipose Tissue(cm2) 134.9(50.1) 122.6(41.9) 0.087
Subcutaneous Adipose Tissue (cm2) 246.9(27.1) 244.2(44.1) 0.382
Waist Circumference (cm) 96.8(7.2) 93.4(7.0) 0.074
V/S Ratio 0.56(.22) 0.53(.23) 0.279
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Obes Facts. 2018 May 26;11(Suppl 1):299.

T4P168 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):299.

T4P169 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):299.

T4P170 Impact of specialized pediatric and transitional care on endocrine, anthropometric, and metabolic parameters of adults with Prader-Willi Syndrome

A Paepegaey 1, M Coupaye 1, A Jaziri 1, F Menesguen 1, B Dubern 2, J Oppert 1, M Tauber 3, G Pinto 4, C Poitou 1

Introduction

The transition of patients with Prader-Willi syndrome (PWS) to adult life is challenging because of multiple comorbidities, including hormone deficiencies, obesity, and cognitive and behavioral disabilities. Objective: To evaluate endocrine management, anthropometric, and metabolic parameters of PWS adults who received, or not, transitional care, defined as specialized pediatric care followed by an organized care pathway to a multidisciplinary adult team.

Methods

Hormonal and metabolic parameters were recorded for 95 adults with PWS (mean age 29.4 ± 8.8 years, Body Mass Index (BMI): 39.8 kg/m2) referred to the French Reference Center and compared according to transition status.

Results

Among the entire cohort, 35.8% received GH treatment during childhood and 16.8% a GH stimulation test after completing growth. In adulthood, 14.7% were treated with GH, 56.8% received sex-hormone-therapy, 90.0% were hypogonadic, and 37.9% had valid screening of the corticotropic axis. The main reason for suboptimal endocrine management was marked behavioral disorders. Patients receiving transitional care were more likely to have a GH stimulation test and GH and sex-hormone substitution in childhood. They also had a lower BMI and percentage of fat mass (32.5 ± 7.8 vs 43.4 ± 12.3 kg/m2, p < 1.10–3 and 47.3 ± 6.8 vs 51.0 ± 6.0%, p = 0.01, respectively), better metabolic parameters, and less antidepressant treatments. In multivariate analysis, transitional care remained significantly associated with BMI, percentage of fat mass, fat mass index, and antidepressant treatment.

Conclusion

A coordinated care pathway with specialized pediatric care and transition to a multidisciplinary team accustomed to managing complex disability improves the health status of adults with PWS

Obes Facts. 2018 May 26;11(Suppl 1):299–300.

T4P171 Effects of a Very Low Calorie Diet (VLCKD) integrated in a multidisciplinary rehabilitation program for hospitalized obese subjects: a case-control study

SL Budui 1, F Giordano 1, S Leoni 1, E Sartori 1, M Berteotti 1, L Franceschini 1, M Taddei 1, F Gilli 2, S Salvetti 1, M Lovisi 1, F Castiglioni 1, S Skafidas 2, F Schena 2, ML Petroni 1, L Busetto 3

Introduction

Very Low Calorie Ketogenic Diets (VLCKDs) achieve rapid weight loss, and it is one of the therapeutic approaches in patients with severe obesity. However, the effect of a VLCKD associated with regular physical activity have not been rigorously evaluated. The aim of the study is to evaluate the results of a VLCKD in an intensive therapeutic intervention consists in a multi-disciplinary approach that included 2hours daily exercises program under the supervision of a kinetotherapist.

Methods

A case-control study was conducted in patients with severe obesity and obesity-associated morbidities that underwent a 3 weeks residential rehabilitation program (RN), in groups of 12–14 patients. At admission and at discharge all patients are evaluated by anthropometric assessment (weight, body mass index (BMI), waist and neck circumferences), laboratory tests (glycaemia, HbA1c, lipid profile), physical performance assessment (VO2 peak by incremental cycle ergometer test, six minutes walking test (6MWT), chair stand test CST), body mass composition assessment.

Results

We analyzed 35 patients with obesity that underwent a VLCKD during the 3wk RN (VLCKDp) and 54 controls subjects (CTRL) that underwent a RN with balanced ipocaloric diet. Subjects were matched by sex (males VLCKDp 62,9% vs CTRLS 53,7%), age (VLCKDp 48,6y vs CTRL 50,1y), BMI (VLCKDp 49,2 kg/m2 vs CTRL 46,1 kg/m2) and comorbidities (diabetes and OSAS) submitted to the rehabilitation program from 13/4/15 to 30/1/2017. When analyzing anthropometric changes, we observed statistically significant weight reduction in VLCKDp when compared to CTRL (−5.4% vs -4.4%, p < 0.05), and a reduction of 4.8% and 3.7% in waist and neck circumference in VLCKDp similar to the results in CTRL (−4.0% and -3.3% respectively). Body mass composition variations were similar in the two groups (FFM VLCKDp -4.2% vs CTRL -2.4%, FM VLCKDp -7.4% vs CTRL -7.1%). Both groups presented an improved glicaemic and lipid profile, with no statistical significant differences. However, the most interesting result was obtain by comparing the physical performance, as both groups presented an improvement in VO2 peak (VLCKDp +11.6% vs CTRL +9,9%), with longer distances in 6MWT (VLCKDp +46.7m vs CTRL +20.0m) and a higher number of standings at the CST (VLCKDp +23.3 vs CTRL +32.0).

Conclusion

Our preliminary study shows that the association of a VLCKD and regular aerobic physical activity is possible, safe, and could enhance the weight loss result, but more important, prepares the subject for weight loss maintenance, by changing the life style habits.

Obes Facts. 2018 May 26;11(Suppl 1):300–301.

T4P172 The 5As Team Program: Improving person-centered obesity assessment and management in primary care

D L Campbell-Scherer 1, T Luig 2, J Asselin 3, R Anderson 4, S Fielding 4, M Heatherington 2, M Borowitz 5, J Torti 1, A Cave 1, JA Johnson 6, AM Sharma 7

Introduction

Primary care providers encounter patients living with obesity in their daily practice, however, there is a gap in empirical and theoretical understanding for the development of an effective and practical approach to supporting patients to improve health. The 5As Team Program (5AsT) has worked with interdisciplinary primary care teams as well as people living with obesity in order to: 1) change the quality and quantity of obesity management by creating resources and tools to support collaborative deliberation, 2) understand what people want from their healthcare team, and 3) understand the key elements, impacts and outcomes of personalized consultations on everyday self-management.

Methods

A randomized control trial (RCT) with mixed methods evaluation was used to assess a training intervention, co-created by providers, to improve the quality and quantity of obesity management in primary care. Qualitative assessment of patients’ perspectives of the role of primary care in their obesity management and of personalized consultations from interviews, videos, and diaries were analyzed with thematic analysis.

Results

Individual providers had widely varied impacts of the intervention from 17% decrease to more than 100% increase in the number of visits conducted (intervention phase RR 1.30, 95% CI 0.83–2.03; 9-months post-intervention RR 1.38, 95% CI 0.87–2.19). Mixed-Methods analysis revealed increased provider confidence and high functioning teams were key factors that increased frequency of obesity visits. Findings from qualitative analysis of personalized consultations suggest that interpersonal processes occurring during collaborative, personalized obesity assessment and care planning are key in supporting patient activation and self-care as well as for coordinating optimal interdisciplinary clinical care to improve health outcomes.

Conclusion

The 5AsT intervention resulted in positive change in obesity assessment and management in primary care. Qualitative results illuminate processes that support tailored obesity care planning and meaningful changes in patients’ efforts to improve health. These inform the development of an approach and tools for use by interdisciplinary primary care providers.

Conflicts of Interest

AM Sharma is a member of an Advisory Board with a commercial organization [Novo Nordisk: Advisory Board for anti-obesity drug]; AM Sharma was a member of the Data Safety Monitoring Board for an anti-obesity trial [Takeda]. DL Campbell-Scherer has an unrestricted educational grant from Novo Nordisk via the Canadian Obesity Network to support training of physicians and teams in obesity prevention and management.

Obes Facts. 2018 May 26;11(Suppl 1):301.

T4P173 Changes in hepatokines and insulin resistance indices after 8 weeks of intervention (diet and physical activity) in obese otherwise healthy subjects

A Penesová 1, B Bajer 1, A Havranova 1, Z Radikova 1, R Imrich 1, M Vlcek 1

Introduction

Hepatokines are proteins secreted from liver with potential to influence glucose regulation and other metabolic parameters. Fetuin A is elevated in obesity and related disorders and is also associated with insulin resistance, where fetuin A causes impaired glycemic control. Fibroblast growth factor (FGF) 21 is involved in regulation of glucose and lipid metabolism. The aim of the study was to analyze the effect of life style intervention on hepatic parameters (alanine aminotransferase (ALT), aspartate aminotransferase (AST)), insulin sensitivity and physical fitness.

Methods

A group of 43 obese patients (13M/30F; 43.0 ± 12.4 years; BMI 31.2 ± 6.3 kg/m2) participated in a weight loss interventional program (NCT02325804) following an 8-week program consisting of hypocaloric diet (−30% energy intake) and physical activity 150 minutes/week. Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices according Matsuda and Cederholm were calculated (ISIMat and ISICed). Plasma ALT, AST, Fetuin A, FGF 21, and physical fitness were measured.

Results

The average reduction of body weight was 6.8 ± 4.9 kg (0–15 kg; p = 0.0006), accompanied with significant reduction of body fat mass (p = 0.03), and waist circumference (p = 0.02). Insulin sensitivity improved (IR HOMA 2.71 ± 3.90 vs. 1.24 ± 0.83; p = 0.01; ISIMat 6.64 ± 4.38 vs. 8.93 ± 5.36 p ≤ 0.001; ISICed 59.1 ± 21.4 vs. 64.7 ± 22.2 p = 0.03). Total and LDL cholesterol, as well as triglycerides decreased (p = 0.02, p = 0.02, p = 0.05 resp.), Physical fitness significantly improved after intervention (as measured by VO2 max: 25.1 ± 5.9 vs. 28.0 ± 6.0 ml.kg−1.min−1, p ≤ 0.001). ALT decreased significantly (0.44 ± 0.26 vs. post 0.33 ± 0.18 ukat/l, p = 0.004), however AST not (0.40 ± 0.15 vs. 0.35 ± 0.09 ukat/l, p = 0.07). Hepatokine Fetuin A significantly decreased after intervention (43.1 ± 10.8 vs 32.6 ± 8.6 ng/ml, p < 0.001), while FGF 21 levels tended to decrease (146 ± 152 vs. 830 ± 164 pg/ml, p = 0.07).

Conclusion

Eight weeks of diet and physical activity intervention program in obese otherwise healthy subjects leaded to improvement of insulin sensitivity, liver marker profiles, as well as physical fitness.

Funding

Supported by grants APVV 15–0228; VEGA 2/0161/16

Obes Facts. 2018 May 26;11(Suppl 1):301.

T4P174 Diet quality index was an independent predictor to explain changes in α-MSH in obese adults after interdisciplinary therapy

V FS Poli 1, S MA Domeney 1, RB Sanches 1, J PN Fidalgo 1, MA Nascimento 1, S G Andrade-Silva 1, A DS Moraes 1, VZ Dourado 1, LM Oyama 1, A R Dâmaso 1, D A Caranti 1

Introduction

The development and maintenance of obesity may involve pathophysiological mechanisms such as neuroendocrine control of food intake dysfunction and chronic low-grade inflammation status. This condition also increases the risk for developing other chronic diseases. Interdisciplinary therapy focus on changes in lifestyle has been researched as a promising alternative for managing obesity and associated diseases. This study was conducted to (1) evaluate the effects of interdisciplinary lifestyle modification therapy in obese adults and (2) assess the association between changes in diet-quality score and in serum concentration inflammation and neuroendocrine control of food intake markers.

Methods

The study evaluated dietary data, inflammatory markers and neuropeptides levels of forty obese individuals before and after 32 weeks of an interdisciplinary therapy. Diet Quality Index associated with the Digital Food Guide (DQI-DFG) scores were calculated based on data derived from a three-day food record estimating usual food intake. Leptin, IL-6, TNF-α, resistin, adiponectin, NPY and α-MSH were analyzed. Anthropometric measures and body composition were also assessed. Student's t test and Wilcoxon test were used for comparisons among categories. Correlation and multiple linear regression analysis were used to verify associations between neuropeptides, inflammatory markers and food intake. P < 0.05 was considered significant.

Results

The assessment of dietary intake showed a significant increase in the score of DQI-DFG by almost 10 points and a significant reduction in total energy intake of obese adults after therapy (P < 0.001). The therapy was effective in improving the inflammatory profile of these individuals, by reducing IL-6, leptin and TNF-α concentrations. The therapy promoted an increase in the anorexigenic factor α-MSH (P = 0.041). However, no significant changes in the NPY concentration was observed. Significant correlation coefficients were found between DQI-DFG and α-MSH concentration (r = 0.45, P = 0.008); and between DQI-DFG and NPY concentration (r = −0.42, P = 0.009). Total energy intake was not correlated with neuropeptides nor inflammatory markers. Multiple linear regression analysis showed that α-MSH was independently associated with diet quality index (β = 0.015, P = 0.008), and NPY inversely associated with diet quality index (β = −0.005, P = 0.039), after adjustment for potential confounders.

Conclusion

The proposed interdisciplinary therapy improved the dietary pattern of obese adults, as it increased the DQI-DFG score. The therapy positively changed the inflammatory profile, neuropeptides secretion, anthropometric measurements and body composition of this population. Our study suggests that an increase in diet quality score may help to appetite control, decreasing orexigenic and increasing anorexigenic factors, favouring the obesity control.

Conflict of interest: None disclosed.

Funding

CAPES, FAPESP (#11/51723–7), CNPQ (#471108/2011–1) and UNIFESP supported the Research performed in Santos, Brazil by GEO – UNIFESP.

Obes Facts. 2018 May 26;11(Suppl 1):301.

T4P175 Patients compliance of controlling weight loss during preoperative 6 month before bariatric surgery

N Dynnyk 1, O Potapov 2, O Baka 2, S Kosiukhno 2, O Perehrestenko 2, I Todurov 3, A Komorowski 4

Introduction

Obesity is a huge problem of medicine nowadays because of targeting multiple pathogenesis, with establishing mostly insulin resistance, fatty liver disease and cardiovascular complications. The main question consists of how to deal with patients adherence to weight loss recommendations.

Methods

We have investigated in multicentric study retrospectively 47 patients with morbid obesity, who came to dietitian consulting during 6 months. Everybody have been measured by anthropometric methods, bioimpedance analysis. Also they have complex lab diagnostic and ultrasonography of the abdomen. Then dietitian have explained the principles of weight loss and recommend to write nutrition diaries and come to dietitian and psychologist for controlling programm during 6 months. After 6 months we check number of controlling visits of patients and percentage of positive weight loss.

Results

As a result we observed significant decreasing in weight loss (minus 15,2 +−2.1) (p<0,01), Visceral adiposity index (p<0,01) and Fat contain (p<0,01) measured by bioelectric impedancemetry in 15 (31,9%) patients that were followed up by controlling dietitian and psychologist sessions during 6 months. While 8 (17,7%) were missed after first two visiting and didn't answer on calls. 24 patients (51,06%) were keeping touch with dietitian by electronic devices and achieve a little bit less significant weight loss reduction (minus 10,4+−1,8) (p<0,01) than in group of patients with visiting dietitian and psychologist.

Conclusion

During our invastigation we conclude, that better patients compliance in weight loss in morbid patients before bariatric surgery is with following up controlling sessions with dietitian and psychologist during 6 month. But due to our results big percentage of people are more likely to be following up with dietitian by electronic devices. It's good deal of choice to be recommended patients with morbid obesity to schieve weight loss before bariatric surgery.

Obes Facts. 2018 May 26;11(Suppl 1):301–302.

T4P176 Individual adaptive thermogenesis and body composition changes after weight loss process

CB Messias 1, VFS Poli 2, RJ 2Gomes 1, CLS Teixeira 2, A 2Moraes 1, S Rossi 1, MG Cuesta 1, LH Affonso 1, SDS Gil 2, LA 1Cerrone 1, GM Dos Santos 1, DA Caranti 2

Introduction

A compensatory downregulation in resting energy expenditure (REE) has been noted in weight loss processes induced by exercise and dietary restriction. It has been shown that there is a protection factor working to maintain body energy storage. This process is called adaptive thermogenesis (AT), which means the difference between predicted and measured REE. Researches have noted AT as causing a greater-than-expected change in energy expenditure in response to changes in energy balance.

Methods

Forty obese women (body mass index - BMI = 35.1 ± 2.7 kg/m2) completed 16 weeks clinical intervention. They were divided into 2 groups. 19 subjects participated in an exercise intervention (EX) and 21 were under an interdisciplinary intervention (INT). Body composition, REE and BMI were measured at baseline and post- intervention. Using a regression equation in a reference population with 104 obese women (BMI = 34,81 ± 2.91 kg/m2) based on fat mass (FM) and free fat mass (FFM) we calculated the predicted REE. In addition, the AT was calculated post-intervention.

Results

The results support the received view that interdisciplinary intervention is more beneficial than exercise alone. We observed a significant decrease in body weight (p = 0.011), BMI (p = 0.009) and fat free mass (p = 0.001) in INT group. The means of EX group remained unchanged. Although there were no significant changes in predicted and measured REE in both groups, 68% of EX group and 58% of INT group experienced a greater-than-expected decline in REE (−153.7 ± 127/ -164,7 ± 65.5 kcal per day, respectively). Pending further research, AT seems to be an individual process that influences energy expenditure and can make a difference in body weight loss.

Conclusion

Interdisciplinary intervention showed greater changes in body composition, even though fat free mass was diminished. There were, in both interventions, individual changes and a greater-than-expected decline in REE.

Conflicts of Interest

Funding: CAPES, FAPESP (2015/06630-1) and UNIFESP supported the Research perfomed in Santos, Brazil by GEO – UNIFESP.

Obes Facts. 2018 May 26;11(Suppl 1):302.

T4P177 Body mass index variation in patients on warfarin - educational outpatient intervention in patients with rheumatic valvular disease

LDCG Rocha 1, LS Da Costa 1, SR De Souza 2, ACL Francz 1, LC Sampaio 1, ACSM Cavadas 1

Introduction

The prevalence of valvular disease is up to 50% of all cardiopathies and the use of warfarin, oral anticoagulant (ACO), is indicated when they progress to atrial fibrillation and/or metal prosthesis implantation is needed. Warfarin metabolism is affected by multiple factors, including diet, medications, and individual patient characteristics, but few studies have investigated how body mass index (BMI) affects warfarin dosing. It is known that variations in vitamin K intake and important variations in BMI may interfere with ACO absorption and consequently with the effectiveness of the expected anticoagulation. Despite the lack of an optimum dosing strategy in obese patients, warfarin remains the most commonly used anticoagulant. The BMI >30 kg/m2 has been linked to increased time to obtain a therapeutic international normalized ratio on initiation of warfarin as well as higher maintenance dose. Mueller JA et al have reported that BMI is positively correlated with the total weekly warfarin dose, for each 1-point increase in BMI, the weekly warfarin dose increased by 0.69 mg.

Methods

The University Extension (US) is a model of empowerment of the population by acting outside the medical school of undergraduate students. With the identification of problems related to the use of ACO, an analogy is created with the Problem Based Learning (PBL) method where the patient proposes the difficulty and the student, in the presence of a teacher / mediator, identifies and develops a solution, applying it. All patients gave their consent to participate in the study. The main purpose of our study was to demonstrate the use of active teaching methods favoring the education of the students of a medical school, participants in a US project in collaboration with the nutrition team. The other objectives were to demonstrate the indirect acquisitions to the treatment through the application of pre and post test, about the ACO use, its control, possible affected situations and possible complications. After the application of a “knowledge pre-test” on 76 patients using ACO from our cardiology institution, the students teach them a lecture on this subject.

Results

In the evaluation of prior knowledge of the analyzed sample, we observed that 63% of the patients have known that the international normalized ratio (INR) test evaluates the efficacy of the drug and 82.9% of them have known that there is a need for monthly control. The comparisons of the pre- and post-test immediately showed a significant improvement in all parameters, after the lecture interactions. There was an increase of 43.4% vs. 56.6% over the time of drug intake in relation to meals, 57.9% vs. 82.9% in knowledge of the ideal individual INR value to be reached monthly and 46% vs. 54% of correct assertions about INR elevation vs. high doses of anticoagulant.

Conclusion

The best post-test performance already highlights the importance of continuous education of patients and students, keeping them in a learning cycle based on solutions of individual problems to be presented in daily clinical practice and the relevant approach of factors such as consumption of certain nutrients, nutritional health assessment and monitoring of body mass index.

Obes Facts. 2018 May 26;11(Suppl 1):302.

T4P178 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):302.

T4P179 Circadian rhythm influence on management of type 2 diabetes mellitus clinical manifestation

E Grišin 1, E Gavelienė 1

Introduction

Type 2 diabetes mellitus – multifactorial disorder, affecting more than one human body system. It is more often diagnosed in older people having risk factors such as: obesity, dyslipidemia, lack of physical activity, concomitant cardiovascular diseases. According to the recommendations of Ministry of Health, diabetes treatment should include lifestyle modification and pharmacological therapy. Despite the success of pharmacotherapy it has been noticed, that very close beneficial effects could be reached implementing tactical nutrition therapy regulating circadian rhythm controlled metabolic processes.

Methods

During 4 months of study, 9 female patients with type 2 diabetes mellitus were presented with 3 different hypocaloric meal plans. M1 (morning) meal plan with high calorie breakfast; M2 (equal) meal plan with equal calories distribution during the day. M3 (evening) meal plan with calorie dense evening meals. Every end of the month, patients were given different meal plan and had to take body composition tests to access the amount of lost total weight, body fat and muscle mass. We are presenting an example of treatment using synchronized with human daily activity meal planning in order to treat type 2 diabetes mellitus clinical symptoms.

Results

All clinical trial patients successfully reduced weight(p < 0.05; Using M1 meal plan patients lost: 4,38 ± 4,65kg, M2: 6,28 ± 3,45kg, M3: 2,44 ± 1,57kg) while losing minimal amount of muscle tissue and increased their sense of well-being. Night shift workers reached their best results in weight reduction using M3 meal plan (−4.6% weight reduction) comparing to M1(−3.9% weight reduction) and M2(−2.6% weight reduction), while concentrating the biggest amount of their daily calories before going to work. Comparing lost amount of body fat(%) and muscle mass(kg) while eating according to different plans, the most physiologically suitable for patients was M1 meal plan (lost amount of body fat: 1,2 ± 1,36%, lost amount of muscle mass: 0,4kg ± 2,1; M2: lost amount of body fat: 1 ± 1,37%, lost amount of muscle mass: 2,7 kg ± 1,63; M3: %, lost amount of muscle mass: 0,6 kg ± 1,1, lost amount of body fat 0,6 ± 0,82%.)

Conclusion

To the best of our knowledge, this is one of few studies analyzing effectiveness of circadian rhythm on disease management. Nevertheless, we would like to highlight such possibilities and show its successful outcomes on treating chronic diseases.

Obes Facts. 2018 May 26;11(Suppl 1):303.

T4P180 Low calorie diet and the levels of plasma and food minerals

M C Posea 1, A Dragomir 2, G Radulian 3

Introduction

According to the World Health Organisation, obesity is the public health challenge of the 21st century. In Romania, the prevalence of the overweight and obesity is 31.3% and 21.3% respectively (The ORO study). There is a need of knowing the benefit or the risk of a low caloric diet to plasma and food’ minerals.

Methods

We evaluated the intake's energy, vitamins and minerals in a sample of 238 overweight and obese subjects before and after a nutritional intervention using a software based on more than 8000 foods. We also performed anthropometric’ measurements, paraclinic and laboratory’ tests.

Results

As we expected, all the antropometric and paraclinic's data improved after the hypocaloric diet. As for laboratory ‘test, only the plasma cholesterol had a significant improvement in the end, from 209.23 to 194.04 mg/dl (p = 0.0098). The frequency of subjects with total cholesterol over normally decreased from 56.36% to 36.36% of patients and significantly increased the frequency of cases with total cholesterol in normal range, from 43.64% to 63.64% of patients after intervention (χ2 = 4.42, p = 0.035). The mean values of the plasma glucose, calcium, magnesium, iron, HDL cholesterol and TSH didn't change significantly. Regarding the mean intake of vitamins, after the intervention we found that: - vitamin B1 decreased significantly from 152.67% to 129.61% of the recommended daily intake (RDI), p = 0.016; - vitamin B9 decreased from 94.07% to 79.54% of RDI, p = 0.05; - vitamin C intake increased significantly from 184.64% to 231.889% of RDI, p = 0.017; We found that the frequency of cases with vitamin B1 over normal intake, significantly decreased from 75.64% to 50% of subjects after the intervention and significantly increased the incidence of below normal, from 11, 54% to 34.62% of cases (x2 = 13.26, p = 0.001). For the other vitamins, the frequency of cases did not change statistically significantly after the intervention. Regarding the intake of minerals, we found that: -for Calcium, the frequency of normal intake decreased significantly from 25% to 10.53% of patients, and significantly increased the incidence of below normal intake, from 63.16% to 81.58% of cases, in the end (x2 = 6.86, p = 0.03); - for Magnesium, the frequency of normal intake decreased significantly from 44.74% prior to intervention to 26.32% of subjects and significantly increased the incidence of intakes under normal, from 53.95% to 68.42% of patients (x2 = 6.73, p = 0.03); -for Manganese, the frequency of over normal intake decreased significantly from 71.05% to 57.89% of cases and significantly increased the incidence of below normal intake, from 14.17% to 31.58% of patients after intervention (χ2 = 6.32, p = 0.04).

Conclusion

The nutritional intervention to the improvement of all anthropometrics’ and paraclinic ‘s data. Assessing the effect of nutritional intervention on dietary intake of vitamins and minerals in overweight and obese patients showed significantly decreasing in calcium, magnesium and manganese from food but not a significantly change in plasma levels of these minerals. The research results support the need for balanced nutritional recommendations as to maintain normal plasma test in the long term.

Obes Facts. 2018 May 26;11(Suppl 1):303.

T4P181 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):303.

T4P182 Attitudes and approaches to the use of meal replacement products among health professionals working in the management of obesity

G Maston 1, J Franklin 2, A Sainsbury 3, A Gibson 3, E Manson 2, TP Markovic 2

Introduction

Formula meal replacement products (MRPs) have been used extensively in the management of overweight and obesity for more than 40 years. However, health professionals remain concerned about the safety of meal replacement diets (MRDs). There is a negative association between MRDs and weight regain, and a philosophical preference for using ‘real’ food rather than a formula based product. This study explored the attitudes of a targeted set of health professionals regarding the use of MRDs and their experience with patient compliance, weight loss durability and program safety.

Methods

The survey was specifically created utilising a mixed method design to capture perceptions, concerns and experiences using MRDs. The survey was directed to all healthcare professionals who worked in weight management in Australia. The online survey was distributed by establishing contact with professional associations, private businesses with professional membership, direct email and online via social media platforms.

Results

A total of 288 health professionals began the survey with some questions left incomplete. Of this, 257 responders identified as: dietitian/nutritionist 80.9%, other allied health 24.9%, medical 5.4% and other 6.2%. 43 had more than one profession. Only 72.3% of the 231 reported they have used MRDs in practice. A majority of participants had a clear understanding of how MRDs result in weight loss with 57.9% of 77 stating it was due to a decreased energy intake and 18.4% reported that appetite suppression from ketosis was the main mechanism. Non-compliance Of the 62 responders, all experienced patient non-compliance. Of these 37.1% believed non-compliance was attributed to boredom with program taste and/or texture or lack of variety. A further 29% listed persisting hunger or hunger arising from a liquid only diet as the cause. Long term weight loss 42.3% of 194 responders stated that weight loss was not achieved long term, 9.8% felt that weight loss was achievable short and long term, 23.7% stated that weight loss is only achievable under certain program conditions and 10.3% believed they were only successful short term. Of the combined groups (52.6%) who believed MRDs did not produce long term weight loss, 39.2% believed it was due to lack of behaviour change, 2.1% believed individual motivation affected weight loss, 5.7% reported the program as too restrictive and unsustainable, 2.1% reported long term weight loss was dependant on the individual and 2.6% reported that lack of support hampered long term success. Safety 36.2% of 191 agreed that MRDs were safe, 31.4% said safety was conditional on medical support provided and 12.6% said they were not safe.

Conclusion

The survey highlighted there are varied attitudes regarding the use of MRDs among healthcare professionals working in weight management. There is a discrepancy between overweight and obesity clinical practice guidelines and dietary treatments that are practiced amongst some health professionals. It has been documented in previous investigations that MRDs are an underutilised tool and this phenomenon persists. This investigation suggests it may be due to a lack of resources and strategies to mitigate dietary non-compliance and the misconceptions held regarding weight loss durability and program safety.

Obes Facts. 2018 May 26;11(Suppl 1):304.

T4P183 Vitamin D deficiency and secondary hyperparathyroidism in severe obesity: an observational study of patients undergoing bariatric surgery in Singapore

AC Maung 1, ZH Liew 1, S Ganguly 1, PC Lee 1, KW Tham 1

Introduction

Vitamin D deficiency and secondary hyperparathyroidism are highly prevalent among patients with severe obesity and associated with increased risk of bone loss and fractures after metabolic bariatric surgery (MBS). The aim of this study is to assess the prevalence of vitamin D status and secondary hyperparathyroidism in MBS candidates in a multi-ethnic population in Singapore.

Methods

In this observational study, we extracted data from a prospective MBS database in a tertiary hospital in Singapore using REDCapTM. The study cohort consisted of patients with severe obesity who were scheduled to undergo primary sleeve gastrectomy or gastric bypass. These patients’ demographics, laboratory parameters including serum calcium, albumin, phosphate, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP) and 25-hydroxyvitamin D (25(OH)D) were systematically collected prior to bariatric surgery and analyzed using SPSS version 20.

Results

There were 487 patients with a mean BMI of 42.8 ± 8.58 kg/m2. Mean age was 40.7 ± 10.30 years with 61.6% female (Table 1). Ethnic breakdown of the patients is as follows: 39.4% Chinese, 30.8% Malays and 24.0% Indians. Nearly all (93.6%) MBS candidates had vitamin D insufficiency (25(OH)D < 30 mcg/L) with majority of them (68.8%) having deficiency (25(OH)D < 20 mcg/L) and 10.3% with severe deficiency (25(OH) D < 10 mcg/L) preoperatively. 25(OH)D levels were lower among Indian and Malay patients as compared to Chinese counterparts (p = 0.001 and p = 0.002 respectively using Tukey's B test). Serum iPTH was elevated in 34.7% and started to increase with decreasing 25(OH)D levels when 25(OH)D falls below 20 mcg/L (Figure 1). Serum ALP level did not correlate with 25(OH)D level or BMI but was positively correlated with iPTH (r = 0.177, p = 0.002), even after adjustment for 25(OH)D and BMI.

Conclusion

High prevalence of vitamin D deficiency associated with secondary hyperparathyroidism was observed in our multi-ethnic Asian cohort presenting for MBS. There are ethnic differences in vitamin D levels; 25(OH)D levels are lower in Malays and Indians, compared with Chinese patients. iPTH levels were negatively correlated with vitamin D at 25(OH) D levels < 20mcg/L for which 25(OH)D repletion should be aggressively undertaken to reduce risk of bone loss post-operatively.

Fig. 1.

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Tab. 1.

Baseline characteristics of patients and 25(OH)D status (n = 487)

Age (years) 40.66 ± 10.30
BMI (kg/m2) 42.84 ± 8.58
Gender Female Male 300 (61.6%) 187 (38.4%)
Race Chinese Malay Indian Others 190 (39%) 143 (29.4%) 128 (26.3%) 26 (5.3%)
25(OH)D level Severe Deficiency (≤10 mcg/L) Deficiency (≤20 mcg/L) Insufficiency (≤30 mcg/L) Optimal (> 30 mcg/L) Number of patients in each 25(OH)D status
50 (10.3%) 285 (58.5%) 121(24.8%) 31(6.4%)
Race Chinese
Malay Indian		 Mean 25(OH)D
20.37 mcg/L 17.00 mcg/L 16.65 mcg/L		 Chinese vs Malay
P = 0.002		 Chinese vs Indian
P = 0.001		 Malay vs Indian
P = 0.943
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Obes Facts. 2018 May 26;11(Suppl 1):304–305.

T4P184 Dietary alpha-lactalbumin influences energy balance in association with altered gut microbiota composition and intestinal nutrient transporters without affecting body weight in high-fat diet fed mice

S Boscaini 1, R Cabrera Rubio 1, PD Cotter 1, JR Speakman 2, JF Cryan 3, KN Nilaweera 1

Introduction

Obesity has become one of the most prevalent health issues over the last 20–25 years. Whey proteins, a by-product of cheese manufacture, are increasing being considered as dietary solution to the obesity problem, albeit the underlying mechanisms remain poorly understood. To this end, we explored the impact of alpha-lactalbumin (LAB, a specific whey protein) on enteric microbial populations, on intestinal nutrient transporters and on energy balance.

Methods

C57BL/6J mice were singly housed and were provided with 45% energy high fat diet containing 20% energy alpha-lactalbumin (HFD-LAB) (n = 8) or casein (HFD-CAS) (n = 8). The controls received 10% energy low fat diet containing CAS (LFD-CAS) (n = 8). During the 10 week trial, body weight and energy intake were measured weekly and energy expenditure was measured at week 8 and 9. At the end of the trial, samples were collected to carry out 16S rRNA gene sequence analysis (on colon contents) and gene expression using qPCR (in the small intestine, hypothalamus and adipose tissue).

Results

The HFD-LAB group showed a higher energy intake (439.160 ± 7.552 KJ) compared to HFD-CAS group (409.166 ± 10.462 KJ) (P < 0.005). The energy surplus was not stored in the body as there were no differences in body weight gain, or adipose tissue weight between HFD-LAB and HFD-CAS fed mice. In addition, there were no differences in tissue metabolic activity as energy expenditure did not change. In the ileum, we observed a decrease in the gene expression for glucose transporter 2 (glut2) and fatty acids transporter cluster of differentiation 36 (cd36) (both P < 0.001) in the HFD-LAB fed mice compared to the control groups. Bioinformatics analysis on the faecal gut microbiota revealed a significant difference in the β-diversity (P = 0.002) between HFD-LAB and HFD-CAS groups, without showing any changes in the α-diversity. In addition, significant differences in some genera and families abundance (Table 1) were detected in the HFD-LAB fed mice compared to HFD-CAS fed mice. Interestingly, correlations analysis showed that the genus Parabacteroides has a positive correlation with glut2 and a negative correlation with cd36 (both P < 0.001) in the HFD-LAB group.

Conclusion

These results showed that the changes in gut microbiota populations abundance in mice fed with whey protein LAB could be linked to the differential regulation of intestinal nutrient transporters and energy intake. Indeed, the correlations analysis suggest a potential functional relationship between LAB, gut microbiota, intestinal nutrient transporters and energy balance, without affecting weight gain or adiposity.

Conflicts of Interest

Support from the School of Medicine, University College Cork (Ireland) is gratefully acknowledged.

Tab. 1.

P values relative to the genera and families in which their abundance is significantly higher either in the HFD-CAS group or in the HFD-LAB group. Statistical differences across multiple samples were estimated by the bioinformatics methods “False discovery rate” control based on the “Benjamini-Hochberg” procedure

Family HFD-LAB vs HFD-CAS
Streptococcaceae P = 0.029 ↑ HFD-CAS
Lactobacillaceae P = 0.015 ↑ HFD-LAB
Genus
Lactococcus P = 0.001 ↑ HFD-CAS
Parabacteroides P = 0.026 ↑ HFD-LAB
Streptococcus P = 0.001 ↑ HFD-LAB
Parvibacter P = 0.039 ↑ HFD-LAB
Lactobacillus P = 0.011 ↑ HFD-LAB
Turicibacter P = 0.024 ↑ HFD-CAS
Bifidobacterium P = 0.05 ↑ HFD-LAB
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Obes Facts. 2018 May 26;11(Suppl 1):305.

T4P185 The effect of Adiposano™ in obesity-derived cardiovascular risk factors: an open-label prospective clinical trial

R Megna 1, D Martinez-Puig 2, E Costa Larrión 3

Introduction

Obesity has reached epidemic proportions globally and continues to grow. It is well known that obesity, or specifically the excess of white adipose tissue, is frequently associated to dysregulated production of adipokines and inflammatory mediators, hyperlipidemia, insulin resistance and oxidative stress. A patented formulation of glycosaminoglycans (GAGs) has been shown to regulate adipogenesis and consequently to control adiposity, leptinemia and glucose metabolism in animal models of diet-induced obesity. The aim of this study is to evaluate the effect of formulation containing the GAG's composition (Adiposano™) in overweight humans.

Methods

This is a prospective open-label intervention study. 32 overweight to obese patients received daily 2 capsules of Adiposano™ (Diem Labs LLC, Michigan) for a period of 6 months. Adiposano™ is a commercial formulation containing 280 mg of citrus bioflavanoid complex and 80 mg of a patented formulation of glycosaminoglycans. The patients were advised not to change their dietary and exercise patterns during the study period. Before and during the intervention, body weight and composition as well as analytical parameters (adipokines, biomarkers of inflammation, basic biochemical profile) were recorded. All patients followed the protocol for 3 months and 20 of them followed it for 6 months. A repeated measures analysis, with time as an inter-individual factor was performed using the Statgraphics software (Graphic Software System, Rockville, MD, USA). All statistical tests used α = 0.05 two-sided significance level.

Results

The results obtained show a numerical reduction of body mass index associated to a change in body composition: lean body mass increased numerically (842 vs. 135 lbs at 0 and 6 months; P > 0.05) while body fat mass tended to decrease (119 vs.104 lbs; P = 0.07). The decrease in body fat has been parallel to a significant decrease in plasma leptin concentration (69.41 vs. 53.74 ng/mL at 0 and 6 months; P = 0.0010) and consequently to a decrease in the leptin/adiponectin ratio (7.19 vs. 5.23; P = 0.00120) (figure 1).

Conclusion

The overall results show that Adiposano™ administration for 6 months has an impact on body fat mass, associated to a reduction in plasmatic leptin concentration. This effect tends to repercut on insulin sensitivity and specially on normalization of dyslipidemia.

Conflicts of Interest

DM and EC are employees at Bioiberica S.A.U

Fig. 1.

Fig. 1

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Evolution of Leptin, adiponectin and L/A ratio during the treatment period. In addition, a significant decrease on total cholesterol has been detected at 6 months of treatment as compared to baseline (P = 0.0163), accompanied with a trend towards a reduction in plasmatic triglyceride levels (P = 0.0899). Besides this, insulin and HOMA-IR score have been reduced numerically although differences didn't reach statistical significance.

Obes Facts. 2018 May 26;11(Suppl 1):305–306.

T4P186 Dietary Intake after Weight Loss and the Risk of Weight Regain: Macronutrient Composition and Inflammatory Properties of the Diet

HFL Muhammad 1, RG Vink 2, NJT Roumans 2, LAJ Arkenbosch 2, EC Mariman 2, MAV Baak 2

Introduction

Weight regain after successful weight loss is a big problem in obesity management. Several studies have been conducted to evaluate whether dietary factors are associated with weight regain. Several studies found that higher dietary protein content after weight loss was associated with less weight regain. However, not all studies support this notion. The role of other macronutrients in the prevention of weight regain has been less well studied. Dietary intake not only has a direct impact on body weight, but may also have indirect effects that are important for body weight regulation. We have previously shown that weight regain after weight loss was correlated with the expression of genes related to adipose tissue stress and inflammation. Because inflammation is also influenced by the dietary pattern, the inflammatory properties of the diet might play role in weight regain. This study aimed to investigate whether weight regain after a weight loss period is correlated with the macronutrient composition and/or the inflammatory index of the diet during that period.

Methods

Sixty one overweight and obese adults participated in this experimental study. Subjects lost approximately 10% of their initial weight by means of very low-calorie diet for five weeks, or a low calorie diet for 12 weeks. After that, subjects in both groups followed a strict weight maintenance diet based on individual needs for four weeks, which was followed by a nine-month weight maintenance period without dietary counseling. Anthropometrics and dietary intake data were recorded before weight loss (baseline) and during the weight maintenance period.

Results

On average, participants regained approximately half of their lost weight. We found no evidence that macronutrient composition during the weight maintenance period was associated with weight regain. The dietary inflammatory index (r = 0.304, p = 0.032) was positively correlated with weight regain and remained significant after correction for physical activity (r = 0.287, p = 0.045).

Conclusion

In summary, we found no evidence for a role of macronutrient composition of diet after a weight loss intervention for the prevention of weight regain in this study. On the other hand, the inflammatory properties of the diet during the weight maintenance period may play a role in weight regain after a diet-induced weight loss program in overweight and obese adults. Further research should investigate whether tailoring diet with the aim to reduce the dietary inflammatory index is a potential approach to improve weight maintenance.

Obes Facts. 2018 May 26;11(Suppl 1):306.

T4P187 Modulation of plasma metabolites following a low-glycemic index diet

P Hernández-Alonso 1, S Giardina 1, D Cañueto 2, J Salas-Salvadó 1, N Cañellas 2, M Bulló 1

Introduction

Low glycemic index (LGI) diets consistently exert beneficial metabolic effects reducing glucose levels. However, their potential modulatory effect on other plasma metabolites has not been fully addressed in the medium term. We therefore examined whether a LGI diet improves a set of plasma metabolites related with different metabolic diseases.

Methods

We conducted a parallel randomized clinical trial with three intervention arms: a LGI, a high glycemic index (HGI) and a low fat (LF) diet. A total of 104 overweight/obese subjects were enrolled in the GLYNDIET study for 6 months. Blood samples were collected at baseline and at the end of the intervention. Plasma metabolomic profile, which mostly comprised lipid species and amino acids, was analyzed with three different approaches: GC/Q-TOF, LC/Q-TOF and Nuclear Magnetic Resonance (NMR).

Results

Among the amino acids analyzed, serine levels were significantly increased following the LGI diet compared to both HGI and LF diets (q = 0.002), whereas leucine and valine were reduced in the LGI versus LF diet (q = 0.015 and q = 0.024, respectively). A set of two sphingomyelins, two lysophosphatidylcholines and six phosphatidylcholines were significantly modulated in LGI diet compared to HGI or LF diet (q < 0.05). We reported significant correlations between plasma amino acids and lipid species with parameters such as body weight, glucose, insulin and inflammatory markers. Even though multivariate analysis did not show a clear separation of the intervention periods, we reported a modulation of specific metabolites.

Conclusion

Our results suggest that a LGI diet may modulate a set of metabolites associated to derangements that take part in different metabolic diseases such as obesity, type 2 diabetes and hypertension. Further studies are needed to extrapolate our results to other populations.

Obes Facts. 2018 May 26;11(Suppl 1):306.

T4P188 Weight reduction following low-carbohydrate diets compared to low-fat diets: a systematic review and quality assessment of systematic reviews with meta-analyses

C Churuangsuk 1, M Kherouf 1, M EJ Lean 1, E J 1

Introduction

Low-carbohydrate diets (LCD) have become popular for weight management. Randomised controlled trials (RCT) and meta-analyses have been conducted to assess the effectiveness of LCD compared to conventional low-fat diets (LFD), but vary in terms of methodology (e.g. definition of LCD and trial inclusion), quality and Conclusions.

Methods

We conducted a systematic search in MEDLINE, Embase, Web of Science and Cochrane Database of Systematic Reviews (September 2017). Systematic review with meta-analyses of RCTs of LCD vs LFD in overweight/obese adults reporting mean differences in weight loss outcome were included. A modified version of AMSTAR-2 was used to assess methodological quality.

Results

We retrieved 201 records after duplicate exclusion. A total of ten meta-analyses were included; methodological quality was low for five of the meta-analyses, moderate for three and high for only two meta-analyses. Low quality was due to lack of assessment of the risk of bias (RoB) and impact of RoB on the pooled Results, and lack of appraisal of the drivers of heterogeneity. The definition of LCD varied among meta-analyses: four included LCD with Carbohydrates (CHO) < 60g or contributing toward < 20% energy per day, while another five included LCD with CHO < 120 g/day or up to 45% energy per day. One meta-analysis did not define LCD other than as defined by the RCTs’ authors. Five meta-analyses synthesized pooled effects at 6 and 12 months, one at 12 months, and four synthesized their results regardless of duration of intervention (2–24 months). At 6 months, three out of five meta-analyses (two of low; one of moderate quality) reported significant greater weight loss in LCD than LFD by 1.4 to 4.0 kg with significantly high heterogeneities (I2 = 65–91%). At 12 months, three out of six meta-analyses (two of low; one of high quality) reported a greater weight loss in LCD, by 0.77–1.0 kg compared to LFD (I2 = 0–48%). Overall, meta-analyses with significant results favouring LCDs included RCTs with CHO < 60g/day, whereas three out of five meta-analyses with CHO contributing toward up to 45% energy showed no difference in weight loss between the two diets. Low quality meta-analyses (n = 4/5) showed superiority of LCD for weight loss at all time points (0.7 to 4.0 kg), while moderate quality showed inconsistent Results. One high quality meta-analysis reported a greater weight loss of 0.9 kg at 12 months with ketogenic LCD < 50g CHO/day vs LFD, while another high quality meta-analysis (LCD vs. isoenergetic ‘balanced’ diets) reported no difference. Potential sources of heterogeneity included gender, duration, RoB and type of outcome assessment (intention to treat/per protocol). Only one of these meta-analyses reported adverse effects of LCD including constipation, headache, halitosis, muscle cramp and general weakness.

Conclusion

Published meta-analyses have substantial variation in methods and quality. Most meta-analyses are of rather low methodological quality and reporting of adverse effects is scarce. To aid decision making, better quality reviews with reporting of the adverse effects and other potential harms such on as micronutrient status are needed.

Obes Facts. 2018 May 26;11(Suppl 1):306–307.

T4P189 Green tea and green tea extracts for body weight and body composition: fact or fiction?

S Shab-Bidar 1, K S 1

Introduction

Although several randomized clinical trials (RCTs) have investigated the effect of green tea on body weight and body composition, results are inconsistent. The aim of this meta-analysis was to summarize the published evidence from RCTs regarding the effects of green tea consumption on body weight and body composition in adults.

Methods

A comprehensive searches of PubMed and SCOPUS for publications in English were conducted up to January 2017. Mean differences of eligible trials were pooled using random-effects models (the Der Simonian-Laird estimator). Subgroup analysis and meta-regression analysis were conducted to assess potential source of heterogeneity.

Results

Of 4599, 19 and 18 eligible RCTs were met inclusion criteria and had enough data on body weight and body composition, respectively. Meta-analysis on 19 eligible studies for body weight, on a total of 1342 adults aged 21–75 years, showed that, the pooled estimated difference was -0.99 kg (95% CI: −2.40, 0.43, p = 0.171) and a significant heterogeneity was found between (p = 0.056, I2 = 36.6%). When we considered data on body composition, we observed that among a total of 1211 subjects, the pooled standard difference in means was -0.66% (95% CI, -2.00, 0.25, p = 0.12) with a significant between-study heterogeneity (p < 0.001, I2 = 81.9%).

Conclusion

The results provide an evidence that increasing green tea consumption might not lead to a significant change in weight loss, where as it would result in a reduction of body fat.

Obes Facts. 2018 May 26;11(Suppl 1):307.

T4P190 Vitamin D and Body Fat Mass: Is there any relationship?

S Shab-Bidar 1, M S 1

Introduction

Studies have indicated that 25-hydroxyvitamin D (25(OH) D) level in obese is lower than normal weight subjects; however, results of studies have investigated relationship between 25(OH)D and fat mass are inconsistent. In addition, several randomized clinical trials (RCTs) have studied the influence of cholecalciferol supplement on percentage fat mass but their results are conflicting. The objectives were to investigate the association between vitamin D3 and percentage fat mass (PFM) pooling together observational studies and RCTs.

Methods

PubMed/MEDLINE, Cochrane and Scopus were comprehensively searched from inception to September 2016. The Fisher's Z (SE) correlation coefficient and mean (SD) of changes in PFM from baseline were used to perform meta-analysis in observational studies and RCTs, respectively. To determine potential source of heterogeneity, subgroup and meta-regression analyses were conducted.

Results

Pooling correlation coefficients showed an inverse association between PFM (Fisher's Z:-0.24, 95%CI: −0.30 to -0.18) and FM (Fisher's Z:-0.32, 95%CI: −0.43 to -0.22) and 25(OH)D. Subgroup analysis revealed continent but not gender influence on the effect size. Meta-regression analysis indicated that age, latitude and longitude are not sources of heterogeneity. Combining trials showed vitamin D3 supplementation had a mild but insignificant effect on PFM (−0.31%, 95%CI: −1.07 to 0.44). Subgroup analyses indicated that type of cholecalciferol and treatment regimens explain source of heterogeneity. Age, baseline body mass index, dose of cholecalciferol, length of study, female (%) and baseline 25(OH)D are not source of heterogeneity.

Conclusion

In conclusion, our results state that 25(OH)D level is inversely correlated with PFM but cholecalciferol supplementation had no effect on PFM.

Obes Facts. 2018 May 26;11(Suppl 1):307.

T4P191 The Effect of Intermittent Energy Restriction Using Meal Replacements in Overweight Chinese Subjects: A Pilot Randomized Control Trial

BCC Lam 1, JSY Han 1, CY Ho 1, H Teoh 2, MPS Yum 3, MTK Wong 1, GCH Koh 4

Introduction

The “5:2” diet is a form of intermittent energy restriction, where adherence to this dietary intervention consists of fasting (70–75% energy restriction) for two consecutive days and consuming enough to meet energy requirements for the remaining five days. Although there is some evidence supporting this approach, there have been no studies done in the Asian population. Hence, a pilot study was conducted to investigate the effectiveness of the “5:2” diet in an overweight Chinese sample in Singapore. Additionally, the feasibility of using a proprietary meal replacement product (Optifast®) during the two fasting days was also examined.

Methods

This was a single centre, randomized controlled trial, comparing the “5:2” diet (n = 9) with a control of “advice only” (n = 10) for an intervention period of 12 weeks. While all subjects were given standard dietary and physical activity advice, subjects in the “5:2” diet group took three packets of Optifast®, supplemented with two scoops of protein powder (Propass®) and one tablet of multivitamin (540–570 kcal, 54g protein, 60g carbohydrates) during each fasting day. Weight loss was the main outcome, and secondary outcomes included metabolic outcomes such as change in fasting insulin, insulin resistance and markers of fatty liver, and Quality of Life (QOL) outcomes (36-Item Short Form Health Survey).

Results

Baseline characteristics of the subjects are shown in Table 1. The “5:2 diet” group lost a mean of 3.9 kg (4.4%) compared to the control group which lost a mean of only 0.5 kg (0.6%) (P < 0.05). This was significant even after adjusting for initial body weight (P = 0.02). When the amount of weight loss was analysed based on the first, second and third month, majority of the weight loss occurred in the first two months (Figure 1). At the end of the study, the “5:2” diet group had a smaller waist circumference (P = 0.02) and hip circumference (P = 0.03), and significantly lower Alanine Aminotransferase and Gamma Glutamyl Transpeptidase levels (P < 0.05), compared with at the start of the study. The rest of the metabolic markers remained statistically similar for both groups. As for QOL measurement, all parameters improved after three months in the “5:2” diet group, but only “General Health” was significant (P = 0.03). There were no major adverse outcomes in the “5:2 diet” group, and the subjects generally tolerated the intervention, with only one drop-out in the intervention group, due to the subject's inability to keep to the study schedule.

Conclusion

This pilot study shows that the “5:2” diet, compared to control, can be effective in reducing weight in an overweight Chinese sample in Singapore. Additionally, the use of Optifast® is feasible during the two fasting days.

Fig. 1.

Fig. 1

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Mean (Standard Deviation)

Table 1.

Baseline Characteristics

Control (n = 10) Intervention (n = 9) P Value
Male 4 (40%) 6 (66.7%) 0.37
Female 6 (60%) 3 (33.3%)
Age 38.8 (10) 40.6 (5.9) 0.65
Weight (kg) 78.2 (10.8) 88.6 (8.6) 0.03
BMI 29.8 (2.7) 31.1 (2.9) 0.31
Waist (cm) 95.8 (9) 103 (7.1) 0.07
Hip (cm) 106.6 (5.4) 108.2 (5.9) 0.50
%Body Fat 38.2 (7.3) 36.5 (7.5) 0.63
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Obes Facts. 2018 May 26;11(Suppl 1):308.

T4P192 Macronutrient manipulations of cheese resulted in lower energy content without compromising its satiating capacity

T T Hansen 1, A Sjödin 1, C Ritz 2, SK Korndal 1

Introduction

Manipulation of food product's macronutrient composition in order to reduce energy content without compromising satiating capacity may be helpful in body weight control. For cheeses, substituting fat with protein may provide such opportunity. We aimed at examining acute effect of cheeses with different macronutrient composition on accumulated energy intake and subjective appetite sensation.

Methods

Thirty nine normal weight (average BMI 24.4 kg/m2) men and women completed the partly double-blind, randomized crossover study with high protein/low fat (HP/LF, 696 kJ), high protein/high fat (HP/HF, 976 kJ) and low protein/high fat (LP/HF, 771 kJ) cheeses. After overnight fast, 80 g cheese was served with 70 g bread, 849 g juice and 125 g coffee/tea/water. Ad libitum spaghetti bolognaise was served after three hours and energy intake assessed. Subjective appetite ratings were assessed using visual analog scales. Composite appetite scores were calculated and evaluated relatively to energy intake.

Results

Total accumulated energy intake (± SE) was 188.3 (± 97.4) kJ lower when consuming the HP/LF compared to the HP/HF (P≤0.05). However, compared to the LP/HF cheese, the difference failed to reach significance (177.0 (± 100.4) kJ lower, P = 0.08). In relation to energy intake from the cheese containing breakfasts, the composite appetite score was lower after consuming the HP/LF compared to the HP/HF (P = 0.003) and the LP/HF (P = 0.007) cheeses.

Conclusion

There was no compensatory energy intake following consumption of the HP/LF resulting in a lower total energy intake. The HP/LF cheese also resulted in an increased feeling of satiety in relation to its lower energy content compared to both HP/HF and LP/HF cheese.

Obes Facts. 2018 May 26;11(Suppl 1):308.

T4P193 Effects of prebiotics on affect and cognition: Lessons from intervention studies in humans

O Luminet 1, O Desmedt 1, N Delzenne 2, B Pachikian 2, V Broers 1, G Zamariola 1

Introduction

Studies conducted in rodents have highlighted that neurobiological processes underlying cognition and affect are modulated by the gut microbiota. Some specific dietary fibers are able to modulate the composition of the gut microbiota and are thus considered as prebiotics.

Methods

We conducted a review of the impact of the available prebiotic intervention studies in humans on cognition and affect, addressing the question of the potential mediating role of microbiota. PubMed, Scopus and PsycInfo as well as additional articles and books focusing on the topic were selected as sources. Fourteen articles were eligible for a narrative synthesis. Outcome variables were affective (affect, psychological well-being, anxiety, and depression) and cognitive (memory, attention, perception and executive functions). There was no restriction regarding the design and treatment comparison. Data extraction was performed by one author with characteristics established a priori. A quality assessment was independently performed by three authors.

Results

Prebiotic interventions lasting several weeks significantly improved affect and verbal episodic memory compared to a placebo. In irritable bowel syndrome patients, anxiety significantly decreased after prebiotic intake compared to a placebo. Acute prebiotic interventions (< 24 hours) were more efficient in improving cognitive variables such as verbal episodic memory and working memory than affective variables. Limitations include the absence of pre-registration of the review and no standardized procedure for the extraction of data.

Conclusion

We recommend that future research testing the effects of prebiotics on affect and cognition: a) measure microbiota using adequate methodologies, b) include objective measures of affect, c) correct for multiple tests, and d) recruit patients with dysbiosis, inflammation or psycho-pathological disorders. Future research is needed to unravel the type of prebiotic, the dose, and the duration of administration required to obtain significant effects on affect and cognition.

Obes Facts. 2018 May 26;11(Suppl 1):308.

T4P194 The impact of a high-protein diet on energy expenditure and substrate oxidation: preliminary findings of a randomized, controlled, cross-over trial

C Oliveira 1, N Boulé 2, AM Sharma 3, S Elliott 4, S Ghosh 5, M Siervo 6, C Prado 1

Introduction

Differences in macronutrients’ energy content can elicit different responses in energy metabolism. Energy expended through digestion, absorption and storage of dietary protein is higher than for carbohydrate and fat. Therefore, high-protein (HP) diets may confer a metabolic advantage by positively impacting energy metabolism; and may therefore benefit weight regulation. However, the exact role of HP diets in the regulation of energy expenditure and fat oxidation is unknown. The aim of this study was to compare the impact of a HP diet versus a control diet on energy expenditure and substrate oxidation in healthy women.

Methods

The acute intervention was a randomized, controlled, cross-over design with participants allocated to two isocaloric arms: a) Control diet: 55% carbohydrate, 15% protein, and 30% fat; b) HP diet: 35% of carbohydrate, 40% protein, and 25% fat achieved through a nutritional supplement (Almased®). Participants received the prescribed diets for 32 hours while inside the whole-body calorimetry unit (WBCU). Diets were designed to ensure participants were in energy balance. The following components of energy metabolism were assessed: resting metabolic rate (RMR), exercise energy expenditure, sleeping metabolic rate (SMR), basal metabolic rate (BMR), postprandial energy expenditure (PEE), 24-hour energy expenditure, and respiratory exchange ratio (RER). Differences between diets were assessed by paired sample T-test or Wilcoxon matched pairs test, as appropriate, considering a critical significance value of p < 0.05.

Results

Twelve healthy, normal-weight women (age: 24.4 ± 3.12 years, body mass index: 22.22 ± 1.39 kg/m2) were assessed. Compared to the control diet, the HP diet produced higher SMR (3.78 ± 2.81 kcal/hour; p < 0.001), PEE (4.25 ± 4.99 kcal/hour; p = 0.01) and 24-hour energy expenditure (60.27 ± 89.37 kcal/d; p = 0.03). Moreover, the HP diet resulted in a lower RER during measurements of RMR (–0.03 ± 0.02; p = 0.004), SMR (–0.03 ± 0.02; p < 0.001), BMR (–0.04 ± 0.02; p < 0.001), PEE (–0.03 ± 0.02; p < 0.001) and 24-hour energy expenditure (–0.02 ± 0.01; p = 0.002). No differences were observed in the remaining variables between the HP and control diets.

Conclusion

Compared to the control diet, the HP diet increased selected components of energy expenditure and decreased RER in healthy women. This preliminary data suggests a diet higher in protein may provide a metabolic advantage compared to a North American macronutrient distribution diet. Future analysis of net macronutrient oxidation rates will be calculated at the completion of the study to explore the physiological meaningfulness of these findings.

Conflicts of Interest

The research reported was supported by Almased Wellness GmbH®. The company did not interfered or reviewed data analysis and interpretation.

Obes Facts. 2018 May 26;11(Suppl 1):309.

T4P195 Relationships between prevalence of obesity and consumption of foods containing added sugars, fats and salt among adults in Bulgaria

L S Rangelova 1, VL Duleva 1, SP Petrova 1, P Dimitrov 2

Introduction

The results obtained by the national surveys of dietary intake and nutritional status of Bulgarian population show some negative characteristics and trends associated with chronic non-communicable diseases as obesity. The last national survey on risk factor nutrition in adults was conducted under the National program for prevention of chronic non-communicable diseases 2014–2020. The aim was to evaluate the overweight and obesity prevalence among adults and to examine the relationship of their BMI with intake of foods containing added sugars, fats and salt.

Methods

A cross-sectional study of a representative sample of 2745 adults aged 19–74 years was carried out in 2014. The study included direct face-to-face interviews. Overweight and obesity of adults were assessed by Body Mass Index (BMI). The data of food consumption were obtained by Food Frequency Questionnaire (FFQ). Relationships of food frequency consumption of adults with their BMI were investigated.

Results

The method FFQ gives values for the usual frequency with which separate foods or groups of foods, witch are consumed in the last year before the study, and the pattern of nutrition of different age groups of the population in Bulgaria can be estimated. Daily and more than once a day chocolates (chocolate and desserts) consume 13.9% of adults at 19–29 years, 30–59 years - 9.4%; 60–74 years - 4.8%. As age progressed, there was a decrease in the frequency of use of this group of products, but at the age of 60–74 there was an increase in the consumption of two other food groups -„Waffles, candies „and” Marmalade, jam, honey„. The group of 19–29 year olds mostly consume soft drinks with sugar from the adult population - daily - 19%. In adults there is a decrease in the frequency of use of foods high in fat, as snacks and fried potatoes / chips. At 19 - 29 years 5 and more times a week use 10.8%, daily - 3.8%, while at 60–74 years the daily consumption is only 1–2%. The rate of adults with overweight was between 23.8 – 40.7%; obesity was 8.9 – 35.3% as it was highest among females aged 60–74 years (35.3%). Statistically significant relationship between BMI and frequency of consumption of a wide range of energy rich foods was established in the survey.

Conclusion

The regular intake of foods containing added sugars, fats, salt may lead to the risk of adverse effects such as weight excess and high blood pressure. Therefore, consumption of these foods should be done with caution in Bulgarian adults.

Obes Facts. 2018 May 26;11(Suppl 1):309.

T4P196 The effect of Glucomanan on the metabolic health in obese adults

T Handjieva-Darlenska 1, S Shekerdjiiska 2, N Georgiev 2, R Shekerdjiiski 2, S Handjiev 3

Introduction

Obesity has reached an epidemic proportion in the Bulgarian population. The aim of our study was to investigate the effect of a food supplement with Glucomanan on the metabolic parameters in obese adults.

Methods

A total of 22 subjects (19 women and 3 men) have participated in the study. The following parameters were studied: mean age was 46.8 years, mean body mass index (BMI) – 33.9 kg/m2, mean fat mass (FM) – 42.09%, and mean visceral fat mass (VFM) – 11.4. All subjects received 3 gr of the food supplement with Glucomanan, dissolved in 200 ml water before each meal, and 200 ml water after the meal three times/ daily for a 60-day period. At different time intervals the enrolled subjects underwent anthropometric and bio-impedance measurements with Tanita 420. They didn't receive any other dietary and physical activity advices.

Results

The food supplement was very well tolerated except in four patients who suffered from flatulence, and mild diarrhea. At the end of the 60-day period a reduction of all studied parameters were demonstrated as follows: mean BMI with 7.3%, mean FM with 4.9%, and mean VFM with 5.3%.

Conclusion

The use of a food supplement with Glucomanan has a beneficial effect on the metabolic health in obese adults.

Obes Facts. 2018 May 26;11(Suppl 1):309.

T4P197 The alginates in the treatment of obesity (clinical and experimental studies)

T Handjieva-Darlenska 1, S Shekerdjiiska 2, N Georgiev 2, R Shekerdjiiski 2, S Handjiev 3

Introduction

The effect of alginates containing food supplement is based on the property of the compounds of alginic acid (organic acid originating from kelp) to produce gel in an acid medium (the gastric juice) which is insoluble and hard to be assimilated in to the organism. The aim of the studies was to examine the effect of alginates on the weight loss and body mass index (BMI) in obesity subjects and in obese animals.

Methods

First (clinical) study: A total of 120 obese patients (105 given alginates and 15 placebo control group) with mean age 37,8 years, BMI – 33,7 were followed up for the period of 45 days. Anthropometric indexes were measured as follows: body weight (kg), BMI (kg/m2), waist to hip ratio, fat mass, cholesterol and triglycerides. Second (experimental) study: 18 male rats Wistar with mean age 4 year were randomized in 2 groups – control group and experimental group receiving alginates. After 3 weeks the body weight, cholesterol, triglycerides, blood sugar and ghrelin were measured.

Results

First study: We found statistically significant reduction of BMI and waist circumference in the group. Total cholesterol, LDL-cholesterol and triglycerides were also statistically significantly reduced in the experimental group. Second study: The data showed reduction of body weight with 32.5% more compared to the controls. A suppression of ghrelin production was demonstrated.

Conclusion

Our studies suggest that alginates exert beneficial effects on the metabolic parameters in both animal and human obesity.

Obes Facts. 2018 May 26;11(Suppl 1):309–310.

T4P198 The relationship between dietary glycaemic, dietary glycemic load and the osteoporotic fracture risk in an elderly Mediterranean population

JF García Gavilan 1, M Bulló 1, L Camacho-Barcia 2, N Rosique-Esteban 1, P Hernández-Alonso 3, J Basora Gallisà 4, MA Martínez-González 5, R Estruch 6, M Fitó 7, J Salas-Salvadó 8

Introduction

Osteoporosis is a bone condition characterised by loss of bone mass that increases the risk of serious fractures and is influenced by factors such as endocrine diseases and diet. In this sense, high glucose and insulin levels seem to have a negative impact on bone health. The relation between the dietary glycaemic index (DGI) and the dietary glycaemic load (DGL), which has proved to be effective at modulating blood glucose levels after carbohydrate consumption, has yet to be explored in relation to bone health. We aimed to assess the effect of DGI and DGL on the risk of osteoporotic-related fractures in an elderly Mediterranean population.

Methods

This is an observational cohort analysis carried out with 870 participants recruited in the PREDIMED-Reus centre (Spain). Participants were men and women, aged 55–80y with high cardiovascular risk. DGI and DGL were assessed from validated food frequency questionnaire and glucose were used as reference. Osteoporotic fractures were adjudicated from a systematic review of medical records. The association between tertiles of cumulative DGI and DGL during follow-up and fracture risk was evaluated by multivariate Cox proportional models.

Results

114 new cases of osteoporotic-related fractures were documented during a mean follow-up of 8.9 years. Participant in the highest tertile of DGI and DGL had an increased risk of osteoporotic fractures (HR: 1.80; 95% CI: 1.03–3.15; HR: 3.20; 95% CI: 1.25–8.18, respectively) compared to participants in the lowest tertile, even after adjusting for potential confounders.

Conclusion

A high DGI and DGL are associated with a higher risk of osteoporosis-related fractures in an elderly Mediterranean population at high cardiovascular risk.

Conflicts of Interest

Jordi Salas is a non-paid member of the Scientific Committee of the Nut and Dried Fruit Foundation. None of the other authors have conflicts of interest.

Obes Facts. 2018 May 26;11(Suppl 1):310.

T4P199 Implications of omega-3 fatty acids in obesity management

C Muscurel 1, L Gaman 1, I Stoian 1, V Atanasiu 1, M Petran 1, T Holban 1

Introduction

Obesity is associated with inflammation and omega 3 polyunsaturated fatty acids (ω-3PUFA) are the ability to regulate adipose tissue metabolism and adipokine production. Our purpose was to assess the impact of ω-3PUFA intake to level of adiponectin, interleukin-6 (IL6) and triglycerides.

Methods

The study included 20 obese men (body mass index > 30kg/m2). We determined the plasma concentration of adiponectin (ELISA method), IL-6 (chemiluminescence method) and triglycerides (spectrophotometric method) before and after 6 month through supplemented intake of ω-3PUFA (300 mg eicosapentaenoic acid- EPA and 200 mg docosahexaenoic acid-DHA daily from sea fish oil concentrate add to 7g EPA+ DHA weekly from dietary salmon meal).

Results

After the period of ω-3PUFA intake, plasma concentration of triglycerides and IL-6 were significantly decreased (p < 0,05) and adiponectin concentration was significantly increased (p < 0,001).

Conclusion

ω-3PUFA intake can contribute to regulate the inflammatory state associated with obesity.

Obes Facts. 2018 May 26;11(Suppl 1):310.

T4P201 Weight loss and weight loss maintenance efficacy of a novel weight loss program: The retrospective RNPC® cohort

TK Thorning 1, O Fabre 2, R Legrand 2, A Astrup 1, M F Hjorth 1

Introduction

Body weight loss is essential to lower risk factors for type 2 diabetes and cardiovascular disease in overweight patients. Therefore, we examined the effectiveness of the RNPC® program for short and long-term body weight reduction. Secondarily, possible pre-treatment determinants of successful weight loss and weight maintenance among the RNPC® participants were investigated.

Methods

The RNPC® program is a novel weight loss and maintenance program achieving weight loss by an energy-restricted 800–1000 kcal/day high-protein low-glycemic diet (weight loss phase), followed by an intensive follow-up with a step-wise increase in energy intake to reach energy balance (weight stabilization phases). The analysis included 12,179 overweight or obese patients that were treated in 54 RNPC® clinics in France.

Results

A total of 10,809 (89%) patients completed the initial weight loss phase and 2,996 (25%) completed the full program. Median weight loss percentage was 10.7% (Interquartile range [IQR]: 5.8;16.5) after a median of 105 days (IQR: 56;175) during the weight loss phase, and a median of 17.5% (IQR: 12.7;24.2) after a median of 251 days (IQR: 187; 350) at program completion. Patients with pretreatment fasting glucose above 100 mg/dL (prediabetics and diabetics) lost more weight both during the weight loss and managed to keep it during the stabilization phases compared to those with normal fasting glucose (See Table 1).

Conclusion

The RNPC® program is cost-effective and well tolerated for short-term body weight loss as well as effective in the long term among the group that completes the program. The program might be particularly effective among patient with elevated fasting glucose.

Conflicts of Interest

MFH and AA are co-inventers on a pending provisional patent application on the use of biomarkers for prediction of weight-loss responses. The work reported in this manuscript was funded by a grant from Groupe Éthique et Santé. AA is a consultant for Groupe Éthique et Santé.

Obes Facts. 2018 May 26;11(Suppl 1):310–311.

T4P202 Dietary inulin supplementation promotes weight loss and decreases liver elasticity in obese individuals

S Hiel 1, J Rodriguez 2, MA Gianfrancesco 3, D Portheault 4, G Kalala 5, M Mulders 6, B Chang 6, G Zamariola 7, AM Neyrinck 2, B Pachikian 1, S Potgëns 2, C Frenay 8, LB Bindels 1, PD Cani 9, N Lanthier 10, P Trefois 11, O Klein 6, O Luminet 7, J Bindelle 5, M Cnop 12, N Paquot 3, J Thissen 13, N Delzenne 1

Introduction

Obesity has reached epidemic proportions in Europe. Novel strategies, including nutritional approaches, are needed to prevent and control obesity and metabolic disorders. In this context, we launched the multidisciplinary project FOOD4GUT (funded by the Excellence Program of the Walloon Region, Belgium) which proposes to increase inulin intake to control obesity and related metabolic disorders. We aim to examine whether a shift in the gut microbiota composition by inulin-type prebiotic improves the obese phenotype.

Methods

We have established a placebo-controlled parallel study with the objective to include 150 obese subjects (BMI> 30 kg.m−2; 18–65 years, recruited in three university hospitals in Belgium), presenting at least one of the following criteria: (pre-)diabetes, hypertension, dyslipidemia, and/or liver steatosis. The participants were randomly assigned to receive either 16 g/day of inulin (Fibruline, Cosucra) or placebo (Maltodextrin, Cargill) with dietary advice to increase (or not) the consumption of vegetables rich in inulin type fructans for 3 months.

Results

Up to date, 60 patients have completed the study and an interim analysis has been performed concerning anthropometric measurements, blood parameters, body composition and Fibroscan analysis. Anthropometric data revealed a tendency to reduce body mass index (p = 0.06) in the inulin-treated group versus control group. Liver elasticity (measured with Fibroscan as an index of liver fibrosis) was significantly decreased by the treatment. Blood pressure, body fat mass and markers of glucose and lipid metabolism were not significantly modified by the treatment.

Conclusion

We showed that three months dietary inulin supplementation promotes body weight loss and improves markers of liver fibrosis. Further analysis on a larger number of patients is needed to confirm these trends and to highlight other potential beneficial health effects, that will be related to the change in the gut microbiota composition and activity.

Obes Facts. 2018 May 26;11(Suppl 1):311.

T4P203 The effect of diet containing yoghurt in the management of obesity

T Handjieva-Darlenska 1, S Handjiev 2

Introduction

Obesity is a big problem in Bulgaria where 20% of the adult population is obese. The aim of our study was to investigate the effect of diet containing yoghurt on the anthropometric parameters in adults with overweight/ obesity.

Methods

A total of 90 subjects with central obesity (63 women and 27 men) were enrolled in the study. Baseline mean subject characteristics were: age - 45.5 year old, body mass index (BMI) – 34.5, fat mass - 41%, visceral fat - 14, waist circumference - 115 cm, hip circumference - 125, waist-to-hip ratio – 0.7, sagittal diameter - 29 cm. All obese patients underwent a dietary regimen, included 290 g yoghurt enriched with Lactobacillus bulgaricus, Streptococcus thermophilus and Bifidus essensis for dinner for a 6-month period. The product consisted of proteins - 4.3 g, carbohydrates (lactose) - 3.9 g, fat - 0.5 g, and 37 kilocalories per 100 g product. At the beginning and at the end of the study several anthropometric parameters have been measured by bioimpedance device (Tanita 420).

Results

The study demonstrated a decrease in BMI with 10.3%, in fat mass with 9.2%, in visceral fat with 17% as well as a decrease in waist circumference - 10.9%, hip circumference - 6.8%, and sagittal diameter - 13.3%.

Conclusion

The regular consumption of yoghurt enriched with Bifidus essensis (0.5% fat) in the diet of obese patients leads to improvement of the studied anthropometric parameters as well as to significant decrease in the cardio-vascular risk.

Obes Facts. 2018 May 26;11(Suppl 1):311.

T4P204 Do anthropometric measurements change during menstruation cycle?

O Kucukerdonmez 1, Y Serin 2, B Kocaadam 2, E Koksal 2

Introduction

Several studies suggest that anthropometric measurements may change during menstrual cycle. The purpose of this study is to comparison the changes of anthropometric measurements before, during and after menstruation.

Methods

The study was executed in 37 healthy women aged between 18–26 who had natural menstruation cycle and didn't use oral contraceptive. The anthropometric measurements of the participants were measured before menstruation (1–3 days before the expected menstrual day), during menstruation (2–4. days), and after menstruation (days 1–3). At each interview, the anthropometric measurements of the individuals were taken by the researchers in accordance with measurement techniques. Friedman's Two-way Analysis of Variance was used for comparision the menstrual cycle stages.

Results

The mean age of the women was found 22.2 ± 1.22 years. Anthropometric measurements of the participants according to menstrual periods are shown in Table 1. There was no statistically significant difference in anthropometric measurements of individuals between menstrual periods (p < 0,05).

Conclusion

The menstruation period is one of the factors that affect the body composition (especially total body water) of women. However, in this study, because of the small samples we didn't find such effect. In addition, it should be take into consideration that the anthropometric measurements to be made in during menstruation may be misleading.

Tab. 1.

Comparison of anthropometric measurements of individuals before, during and after menstruation

Body weight (kg) 54.2 (51.2–63.1) 54.4 (51.7–63.6) 54.0 (50.7–63.2) 0.231
Height (cm) 162.0 (159.5–166.5) 162.0 (159.5–166.5) 162.0 (159.5–166.5) 0.251
BMI (kg / m2) 20.5 (19.3–22.9) 20.7 (19.5–22.8) 20.8 (19.2–22.9) 0.231
Waist circumference (cm) 68.5 (63.8–72.0) 68.0 (64.3–72.5) 68.0 (63.5–72.0) 0.070
Hip circumference (cm) 94.0 (92.0–101.5) 94.0 (92.0–101.5) 94.0 (92.0–101.8) 0.118
Waist / Hip ratio 0.71 (0.69–0.74) 0.71 (0.69–0.75) 0.71 (0.69–0.74) 0.084
Upper middle arm circumference (cm) 25.5 (24.0–27.5) 25.0 (23.5–27.5) 25.0 (23.5–27.5) 0.093
Triceps Skinfold thicknesses (mm) 16.0 (12.8–20.4) 16.0 (12.4–20.2) 16.4 (12.0–20.0) 0.992
Biceps Skinfold thicknesses (mm) 7.2 (5.3–9.2) 7.2 (5.3–9.4) 6.8 (5.2–8.2) 0.249
Subscapular Skinfold thicknesses (mm) 11.4 (8.8–15.1) 11.2 (9.2–14.9) 10.8 (8.8–15.2) 0.946
Suprailiyak Skinfold thicknesses (mm) 11.6 (8.9–17.7) 11.4 (9.0–15.5) 11.0 (9.2–16.8) 0.789
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Obes Facts. 2018 May 26;11(Suppl 1):312.

T4P205 Dietary protein-induced thermogenesis in young women on oral contraception: differential effects during actual pill phase versus placebo phase

MR Duhita 1, Y Schutz 1, J Montani 1, A Dulloo 1, J Miles-Chan 2

Introduction

Obesity is more prevalent in women than men worldwide, with the rising prevalence amongst young women of child-bearing age of particular concern. Whilst the underlying mechanism for this gender disparity is largely unknown, oral contraceptive pill (OCP) use may be a factor that contributes to the alteration in energy balance in young women. Given the considerable interest in the use of dietary protein for body weight maintenance, we aimed to investigate, in healthy, young women, the influence of the combined monophasic oral contraceptive pill (OCP) on the thermogenic response to a standardised high (HP) versus normal protein (NP) meal - during both the actual OCP usage phase and the placebo phase of the monthly cycle.

Methods

Resting energy expenditure (EE; by indirect calorimetry) and heart rate (HR) were measured in 10 healthy young women taking the combined, monophasic OCP (20 – 30y; BMI 18.5–25 kg/m2). Following an overnight fast, EE and HR monitoring was conducted for 30 min at rest, and continued for 3.5 hours post-ingestion of either a normal protein (NP; 11% energy from protein) or HP (24%), isocaloric meal (590 kcal). The two meal tests were conducted in a randomised order, with each meal tested twice in each participant – once during OCP usage phase (cycle day 16–21) and once during the placebo phase (cycle day 22–28).

Results

Whilst there was no effect of OCP phase on baseline (overnight fasted) EE or HR, the thermic response to dietary protein differed between the OCP usage phase and the placebo phase; with the HP meal eliciting a greater thermic effect than the NP meal during the placebo phase (p < 0.001), but no such differential response to protein load found during the actual OCP usage phase of the monthly cycle (p = 0.6).

Conclusion

This study shows that the thermic effect of dietary protein can differ acutely between the OCP and placebo phases of each OCP pill cycle. With epidemiological data indicating >80% of women of childbearing age use or have ever used the OCP (US data), coupled with the surging obesity prevalence in this group, this interaction between sex hormone status and diet-induced thermogenesis has important implications for the dietary management of body weight. Further investigation is therefore warranted to determine both the underlying mechanism and the potential to exploit hormonal status to maximise the effectiveness of obesity prevention/treatment strategies.

Obes Facts. 2018 May 26;11(Suppl 1):312.

T4P206 Açai Berry: Usage as Functional Food and Relation with Health

N Acar Tek 1, MS Karacil Ermumcu 1, M S 1

Introduction

The fruit of the açai palm (Euterpe oleracea Martius) is widely found in South America with Amazon region of Brazil and it has gained international attention as a popular functional food. Its fruits are commonly known as açai berry, it is a small, round, black-purple and also its appearance similar to a grape. Açai berry is consumed raw and as juice. The açai berry juice is used commercially in syrup, ice cream, liquors, energy drinks and a variety of other beverages, and also it can be used as a natural food colorant.

Methods

This review aims to evaluate açai berry usage as functional food and its relation with health

Results

Açai berries have high amounts of flavonoids and also they are rich in carbohydrates. The fat content of açai berry is that monounsaturated oleic acid is the primary fat (56.2%) and also it includes saturated fatty acid-palmitic acid (24.1%) and polyunsaturated acid-linoleic acid (12.5%). Açai berry includes vitamins A, C, and E, calcium, phosphorus, iron, thiamine, and polyphenols and anthocyanins. In the last decades, most of the beneficial effects of açai berry gained attention. These are losing weight, preventing aging, improving sexual performance, digestion, arthritis, and general health. And also açai berry exhibits antioxidant, antinociceptive, antiinflammatory and anticancer activities because of its high level of phytochemicals. These effects have been most frequently investigated, but the responsible constituents have not been fully resolved. In vitro and animal model studies showed that açai berry consumption slows the progression of oxidative stress and induces hypocholesterolemic, antiatherogenic, anti-inflammatory and hepatoprotective effects. Recently the açai berry has been marketed as a dietary supplement. It is considered a major botanical dietary supplement. So companies sell açai berry products in the form of tablets, juice, smoothies, and instant drinks.

Conclusion

There is limited scientific research to support the health benefits of the açai berry. Therefore, more scientific research is needed to confirm the many health benefits of the açai berry. Until the health benefits of the açai berry are scientifically proven, it seems more reasonable, cheaper, and safer to get antioxidants from other fruit and vegetable sources.

Obes Facts. 2018 May 26;11(Suppl 1):312–313.

T4P207 Evaluation of nutritional risk parameters and nutritional screening test (Nutritional Risk Screening 2002 and Subjective Global Assessment) at hospital admission

E Speranza 1, O Di Vincenzo 1, M Marra 1, R Sammarco 1, C De Caprio 2, M Naccarato 2, G Negro 2, L Santarpia 2, F Pasanisi 3, F Contaldo 1

Introduction

In several hospital clinical trials, the nutritional intervention has been proven to identify the risk of malnutrition or malnourishment in hospitalized patients and it is necessary to ensure an adequate and timely nutritional treatment. There are no standard criteria to assess nutritional status, and different methods have been used in hospitalized patients. Thus, assessing patients’ nutritional status may be useful in predicting which patients have increased morbidity and mortality risk. The first outcome of this study is to evaluate two validated nutritional screening tools in order to identify the risk of malnutrition or malnourishment in hospitalized patients: Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA), as well as BIA parameters and handgrip strength.

Methods

The prospective study was carried out at the Federico II University Hospital in Naples, since September 2016 to November 2017. Two hundred eighty-six consecutively inpatients over 18 years of age underwent a nutritional assessment within 72 h of admission to the departments of Medicine and Surgery of the University Hospital Federico II coming from the Emergency Unit, and were included in the study. SGA and NRS 2002 were consecutively administered to all patients. Other variables studied were age, sex, anthropometry (height, weight, body mass index), bioimpedance and muscle strength parameter with the use of biompedance analysis and handgrip.

Results

All sample was divided in tertiles of body mass index (tert 1 ≤23.7 kg/m2; 2: 23.7–27.5 kg/m2; 3:≥ 27.5 kg/m2). The results show that the value of phase angle and handgrip, according to current literature, increases in the second tertile (normal weight patients) while, in contrast to what we would expect, the muscle strength decreases in the last tertile of overweight patients. Our study shows a concordance between the rate scores (higher risk of malnutrition) of both questionnaires. We have observed that in group 1 there is the highest rate of the worst score NRS 2002 (45%) and the same goes for the SGA, with the smaller rate of the lowest SGA score (29%).

Conclusion

Our study confirms, that body weight is an important nutritional parameter. The assessment of nutritional risk with simple screening tests should be more widely used for early detection of malnutrition in hospitalized patients admitted from Emergency Unit.

Obes Facts. 2018 May 26;11(Suppl 1):313.

T4P208 Evaluation of BIA parameters and phase angle in different BMI groups

M Marra 1, R Sammarco 1, E Speranza 2, D Morlino 1, F Maione 2, O Di Vincenzo 1, A Caldara 2, G Stella 2, MC Pagano 2, C Bongiorno 2, F Pasanisi 2, F Contaldo 1

Introduction

The phase angle (PA) reflects the ratio between intra- and extracellular water and it may be affected by nutritional and hydration status. Although its biological interpretation is still not clear, phase angle appears to have an important prognostic role in clinical practice, as it allows identification and monitoring of patients at risk of impaired nutritional status. The aim of this study was to estimate, in a wide range of BMI, average BIA parameters: Resistance (Res), Reactance (Xc) and phase angle (PA) that can be used as reference values.

Methods

Anthropometric measurement and BIA parameters were evaluated in 4546 female patients at the Department of Clinical Medicine and Surgery of University Federico II, Naples, Italy since 2005 to 2016. Patients were divided in 6 groups in according to BMI range (Group 1 < = 15; Group 2 = 15–20; Group 3 = 20–30; Group 4 = 30–40; Group 5 = 40–50, Group 6 = > 50 kg/m2)

Results

age, weight, BMI, Res, Xc and PA are reported in table according to BMI ranges. Age was higher (p < 0.05) in group 5 and 6 compared to other groups. Res and Xc were significantly different between groups, except for reactance that was significantly different between groups 1 and 3 and inversly correlated with BMI. PA was higher (p < 0.05) in group 5 and 6 and it was directly correlated to BMI.

Conclusion

Phase angle differs across categories of BMI. These reference values of phase angle could be useful for preliminary nutritional evaluations in the clinical setting.

Tab. 1.

Group 1 < = 15 n.218 Group 2 >15 < = 20 n.1099 Group 3 >20 < = 30 n.1567 Group 4 >30 < = 40 n.753 Group 5 >40 < = 50 n.636 Group 6 > 50 n.273
Age (yrs) 25.6 ± 7.5 25.4 ± 7.6 28.3 ± 10.2 35.0 ± 13.5 34.6 ± 12.6* 36.6 ± 11.2*
Weight (kg) 35.1 ± 3.76** 45.1 ± 5.34** 62.2 ± 8.82** 90.9 ± 10.68** 116.0 ± 11.86** 144.1 ± 14.61**
BMI (kg/m2) 13.6 ± 1.18** 17.4 ± 1.37** 23.8 ± 2.85** 34.9 ± 2.92** 44.4 ± 2.86** 55.6 ± 4.68**
Res (ohm) 736±107** 674 ± 80** 594 ± 64** 508 ± 56** 454 ± 48** 400 ± 48**
Xc (ohm) 63 ± 16* 69 ± 13 65 ± 10* 57 ± 9 53 ± 8 45 ± 9
PA (degree) 4.91 ± 0.94 5.88 ± 0.88 6.33 ± 0.79 6.48 ± 0.88 6.72 ± 0.85* 6.55 ± 1.01*
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*

p < 0.05 versus others group

**

p < 0.05 between groups;63

Obes Facts. 2018 May 26;11(Suppl 1):313.

T4P209 Benefits of the ACOORH concept on weight control and metabolic regulation after 12 weeks of intervention: results of a multicenter RCT

W Banzer 1, A Berg 2, K Braumann 3, D Führer-Sakel 4, M Halle 5, S Martin 6, D McCarthy 7, GH Predel 8, J Scholze 9, C Seyller 10, H Toplak 11

Introduction

Recent studies have emphasized that meal-replacement strategies are more effective in losing weight and fat mass than usual lifestyle intervention programs. Moreover, it has been shown that a meal replacement regimen high in soy protein may be more effective in improving anthropometric and metabolic measures and associated risk factors than a low-caloric diet. Recent studies have emphasized that meal-replacement strategies are more effective in losing weight and fat mass than usual lifestyle intervention programs. Moreover, it has been shown that a meal replacement regimen high in soy protein may be more effective in improving anthropometric and metabolic measures and associated risk factors than a low-caloric diet.

Methods

To confirm this, ACOORH (Almased Concept against Overweight and Obesity and Related Health Risk) was designed as a 1-year-multicenter RCT (centers established in Berlin, Düsseldorf, Essen, Frankfurt, Freiburg, Graz, Hamburg, Cologne, London, Munich, Strasbourg) for overweight and obese patients using a low-calorie, low-glycemic, soy-protein-rich product (Almased®) according to a pretested regimen (1st week substituting three main meals/day, 2nd-4th week two main meals/day, and 5th-12th week one main meal/day) comparing this to a control group of life-style intervention. Primary target variable was total body weight (BW; BMI), secondary targets include waist circumference (WC), body fat (FM), lean body mass, fasting blood glucose and insulin levels (FBI), HbA1c, LDL-Chol, triglycerides (TG), serum leptin, measures of hemodynamometry endothelial (BP; PWV) and muscle strength.

Results

463 non-diabetic participants (BMI 27–35 kg/m2, 21–65 yrs) with at least one criterion of the metabolic syndrome were recruited and randomized (1:2) into a telemedically controlled lifestyle (LS, n = 126) intervention consisting of a fat restricted low calorie diet and increased physical activity versus a telemedically controlled meal replacement (MR, n = 270) regimen. Baseline as well as 4 and 12-weeks data are available in female (n = 298) and male (n = 165) participants (31.6 ± 2.36 kg/m2, 50.4 ± 9.6 yrs). Meal replacement strategy had a significantly higher (p < 0.001) impact on weight, BMI, WC and FM (MR: −6.3 ± 4.08kg, -2.2 ± 1.40kg/m2, -6.4 ± 5.87cm, ♂-5.7 ± 4.0kg, ♀-4.9 ± 3.35kg) than the LS group (−3.2 ± 3.69kg, -1.1 ± 1.24kg/m2, -3.6 ± 4.99cm, ♂-3.9 ± 2.83kg, ♀-2.2 ± 3.21kg). Significant benefits (p < 0.001) were also observed for HbA1c, LDL-Chol and serum leptin levels in the MR group. Considerable improvements in FBI, HOMA index, TG and BP were recognized in both intervention groups.

Conclusion

The results demonstrate significant benefits of the meal replacement strategy for body composition and weight-related risk factors after 12 weeks of intervention. Final results for the total sample and intervention (12 months of intervention) will be presented in summer 2018.

Conflicts of Interest

The ACOORH study was financially supported by the Company Almased, Germany.

Obes Facts. 2018 May 26;11(Suppl 1):314.

T4P210 Association of pro-inflammatory cytokines profile and muscle strength with body adiposity and skeletal muscle mass in patients with chronic kidney disease

MI Barreto Silva 1, APM Menna Barreto 1, JFR M 1, MRST R 1, R T 1

Introduction

Currently, obesity is a nutritional condition commonly observed in patients with chronic kidney disease (CKD). The association of high body adiposity and inflammation on muscle mass and function are scarcely studied in these patients. The main objective of the present study was to evaluate the pro-inflammatory cytokines profile and muscle strength association with body adiposity and skeletal muscle mass in patients with CKD.

Methods

This cross-sectional study followed Declaration of Helsinki guidelines and was approved by the local Ethical Human Research Committee of the University Hospital. All CKD patients signed informed consent after selection according to inclusion (age ≥18 years, estimated glomerular filtration rate (eGFR) < 60 mL/min., regular treatment at outpatient Nephrology Clinic with renal dietitian and nephrologist for >6 months) and exclusion (acute inflammatory, infectious and malignant illnesses, previous kidney transplantation, pregnancy, under experimental drug protocols and immunosuppressive therapy) criteria. Laboratory and nutritional parameters were assessed after a 12-hour fast. Tumor necrosis factor-alpha (TNFa) and interleukin-8 (IL8) were the pro-inflammatory cytokines analysed. The eGFR was calculated by CKD-EPI equation. Dual-energy X-ray absorptiometry (DXA) was used to determine percentage of total body adiposity (TBA) and skeletal muscle mass index (SMI = appendicular muscle mass /height2). Handgrip strength (HGS) was evaluated by dynamometer to measure the maximum isometric strength of the hand and forearm muscles. Statistical analyzes were performed by SPPSS 20.0.

Results

The sample population consisted of 235 CKD patients (men: 57.9%; eGFR = 28.8 ± 12.7mL/min.). Patients distribution by body mass index classes: normal (40.9%; 96), overweight (32.3%;76) and obese (26.8%;63). Patients were grouped according to high TBA% (women: ≥ 32; men ≥23) and low SMI kg/m2 (women < 5.5; men < 7.26), thus composing four groups of joint exposure. The eGFR and all routine laboratory parameters were not different among groups; triglyceride levels were higher in G4 compared to all others.

Conclusion

The joint exposure to high total body adiposity and low skeletal muscle mass was associated with a pro-inflammatory profile in CKD patients. Muscle strength was positively associated with SMI and negatively with TBA, independent of age, gender and eGFR.

Tab. 1.

Pro-inflammatory profile according to TBA and SMI

G1 adequate TBA: 23.0 ± 6.3 adequate SMI: 7.9 ± 1.3 G2 adequate TBA: 20.5 ± 5.8 low SMI: 6.3 ± 0.7 G3 high TBA: 37.8 ± 6.5 adequate SMI: 7.9 ± 1.3 G4 high TBA: 32.3 ± 4.4 low SMI: 6.6 ± 0.7 ANOVA
TNFa (pg/mL)a 14.3 (3.8–23.8) 19.3 (9.8–26.7) 21.6 (13.7–28.6) 26.8 (15.8–33.1) 0.01b
IL8 (pg/mL)a 10.4 (4.5–17.3) 17.4 (12.0–20.8) 17.0 (10.5–23.4) 21.2 (12.3–25.2) 0.01c
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Partial correlations analysis adjusted for age, eGFR and gender showed significant (p < 0.01) and inverse association between SMI with TNFa (r = −0.22) and with IL8 (r = −0.23); and direct (p < 0.05) between TBA with TNFa (r = 0.15) and with IL8 (r = 0.12). HGS was directly associated with SMI (r = 0.36) and inversely with TBA (r = −0.38) (p < 0.0001).

a

Median (interquartil interval); post-hocBoferroni:

b

G1 vs. G3 = 0.02; G1 vs. G4 = 0.01

c

G1 vs. G3 = 0.04; G1 vs. G4 = 0.01

Obes Facts. 2018 May 26;11(Suppl 1):314.

T4P211 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):314.

T4P212 The effect of improving dietary omega-3 polyunsaturated fatty acid status on uterine expression of contractile associated proteins in the term pregnant rat

F Mustikaningrum 1, S Draycott 1, SL Evans 1, B Muhlhausler 2, M Elmes 1

Introduction

The prevalence of maternal obesity is increasing worldwide and a key consequence is prolonged and dysfunctional labour and emergency caesarean section. Previous data from our established model of maternal obesity identifies that maternal obesity is associated with decreases in uterine expression of key contractile associated proteins (CAPs) and uncoordinated myometrial contractions ex-vivo and prolonged labour in-vivo. Fatty acid analysis of the labouring uterus ascertained that High-Fat, High-cholesterol (HFHC) fed rats that exhibit maternal obesity only differed significantly in their total omega-3 polyunsaturated fatty acids (PUFAs), being 50% less than lean controls. This study aims to determine whether increasing dietary omega-3 PUFA can increase expression of the CAPs connexin-43 (CX43), caveolin-1 (CAV-1) and cyclooxygenase-2 (COX-2,) in the term rat uterus.

Methods

Wistar rats were fed a diet that differed in their omega-6 and omega-3 PUFA ratio and total fat content for 4 weeks. Rats were fed either 1) high omega-6 diet (9:1 ratio, 36% fat, n = 4), 2) high omega-6 diet (9:1 ratio, 18% fat, n = 4), 3) high omega-3 diet (1:1.5 ratio, 36% fat, n = 4) or 4) high omega-3 diet (1:1.5 ratio, 18% fat, n = 5). After 4 weeks each rat was mated and maintained on their respective diets throughout pregnancy. At 20 days gestation, rat dams were euthanized and uterine horns harvested, snap frozen and stored at -80°C before western blot analysis.

Results

The fatty acid profile of plasma from rats fed the high omega-3 PUFA diet at 20 days gestation confirmed that the omega-3 PUFAs docosahexaenoic acid (DHA) and α-linolenic acid (ALA) were significantly higher than those fed the high omega-6 diet with P values of P = 0.006 and P < 0.001, respectively. Uterine expression of both CX43 and CAV-1 was increased following exposure to the high omega-3 diet (P = 0.033 and p = 0.029 respectively). COX-2 expression within the uterus was significantly increased by the high omega-3 diet (P = 0.017) with an interaction with the dietary fat level where COX-2 expression was 2 fold higher in the 36% versus 18% fat diet (P = 0.041).

Conclusion

The present study demonstrates that a high omega-3 diet increases uterine expression of CX43, CAV-1, and COX-2 and suggests that dietary intervention to increase omega-3 PUFA status during pregnancy may improve labour outcomes in obese pregnant women

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):315.

T4P213 Skeletal muscle mass can be accurately evaluated by electrical bioimpedance, anthropometry and handgrip strength in normal weight and overweight/obese renal transplant recipients

MI Barreto Silva 1, AP Menna Barreto 2, MS Costa 2, KJ Carvalho 2, KSDS Pontes 1, S Giannini 2, CCM Silva 2, H Silva 2, R Bregman 2, MRST Klein 1

Introduction

After renal transplantation commonly occurs gain weight contributing to high rates of overweight and obesity, in renal transplant recipients (RTR). Dialysis before kidney transplant and post-transplant therapy present some risk factors that may contribute to the reduction of lean body mass and its main constituent, skeletal muscle mass (SMM), in this population. Reduced SMM is associated with morbidity and mortality in RTR. Accurate evaluation of SMM may contribute to better define its association with outcomes. Among high precision techniques, dual-energy X-ray absorptiometry (DXA) is widely used and recommended as a reference method. However, other accessible, low cost and easy to use alternative for DXA still remains to be tested considering clinical and nutritional conditions, such as RTR and overweight/obese individuals. The aim of the present study was to evaluate the precision and accuracy of different methodologies used to estimate SMM in comparison to DXA in normal weight and overweight/obese RTR

Methods

Cross-sectional study performed in adult RTR submitted to kidney transplant for at least 6 months. SMM, appendicular muscle mass (ASM) and skeletal muscle mass index (SMI = ASM/height2) were evaluated by DXA and estimated by different equations using anthropometric measures (Anthro), bioelectrical impedance analysis (BIA) and handgrip strength (HGS). The SMM estimative equations evaluated based on BIA measures (Janssen et al., 2000), Anthro model 1 and 2 (Lee et al., 2000). ASM and SMI estimated by Anthro and HGS (Baumgartner et al.,1998), were also evaluated. Overweight/obesity was defined as body mass index (BMI ≥ 25 kg/m2). Lin's concordance correlation coefficients (CCC) and accuracy (C-b) (1989) were calculated, and Bland & Altman mean differences ± 1.96 standard deviation (mean ± SD) between two methods were also analysed. When CCC and C_b values were > 0.8, and mean ± SD values were < 2.0 Kg for SMM, < 1.0 Kg for ASM and < 0.5 Kg for SMI, the methods were considered recommended to be used.

Results

RTR patients (n = 201; men: 57.7%; 116) were evaluated; BMI distribution: normal (47.8%) and overweight/obese (52.2%). All equations presented high accuracy, except for Anthro equation model 1.

Conclusion

The use of BIA, anthropometry and HGS measures to estimate SMM, ASM and SMI presented high accuracy in RTR and are recommended to be used even in overweight and obese patients.

Tab. 1.

Accuracy of skeletal muscle mass parameters assessed by DXA and different recommended equations, according to gender

CCC; 95%CI* Accuracy: C_b Pearson correlation coefficients: r Bland & Altman Differences: mean ± to SD ratios
Normal BMI
SMM
DXA vs. BIA 0.852; 0.74–0.90 0.932 0.915 –1.9 ± 2.8 to –6.6
DXA vs. Anthro 1 0.876; 0.82–0.91 0.944 0.928 –1.7 ± 2.3 to –5.7
DXA vs. Anthro 2 0.729; 0.73–0.85 0.860 0.928 –2.9 ± 1.1 to –6.9
ASM
DXA vs. dynamometry 0.920; 0.88–0.95 0.981 0.938 0.60 ± 3.6 to –2.3
SMI
DXA vs. dynamometry 0.808; 0.72–0.87 0.964 0.838 0.2 ± 1.3 to –0.9
Overweight/Obese
SMM
DXA vs. BIA 0.905; 0.86–0.93 0.989 0.915 –0.7 ± 4.7 to –6.6
DXA vs. Anthro 1 0.893; 0.85–0.92 0.954 0.937 –1.9 ± 2.5 to –6.3
DXA vs. Anthro 2 0.831; 0.77–0.88 0.887 0.939 –3.1 ± 1.3 to –7.5
ASM
DXA vs. dynamometry 0.920; 0.88–0.95 0.977 0.942 1.0 ± 4.4 to –2.4
SMI
DXA vs. dynamometry 0.824; 0.75–0.88 0.946 0.872 0.4 ± 1.6 to –0.9
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Obes Facts. 2018 May 26;11(Suppl 1):316.

T4P214 A very low-calorie ketogenic diet is safe in terms of acid-base balance during the course of the treatment in obese patients

AB Crujeiras 1, D Gomez-Arbelaez 2, AI Castro 1, A Goday 3, A Bellón 4, C Tejera 5, D Bellido 5, C Galban 6, I Sajoux 7, FF Casanueva 1

Introduction

Very low-calorie ketogenic (VLCK) diets have been consistently shown to be an effective obesity treatment, but the current evidence for its acid-base safety is limited. The aim of the current work was to evaluate the acid-base status of obese patients during the course of a VLCK diet.

Methods

Twenty obese participants undertook a VLCK diet for 4 months. Anthropometric and biochemical parameters, and venous blood gases were obtained on four subsequent visits: visit C-1 (baseline); visit C-2, (1–2 months); maximum ketosis; visit C-3 (2–3 months), ketosis declining; and visit C-4 at 4 months, no ketosis. results were compared with 51 patients that had an episode of diabetic ketoacidosis as well as with a group that underwent a similar VLCK diet in real life conditions of treatment.

Results

Visit C1 blood pH (7.37 ± 0.03); plasma bicarbonate (24.7 ± 2.5 mmol/l); plasma glucose (96.0 ± 11.7 mg/l) as well as anion gap or osmolarity were not statistically modified at four months after a total weight reduction of 20.7 kg in average and were within the normal range throughout the study. Even at the point of maximum ketosis all variables measured were always far from the cut-off points established to diabetic ketoacidosis.

Conclusion

During the course of a VLCK diet there were no clinically or statistically significant changes in glucose, blood pH, anion gap and plasma bicarbonate. Hence the VLCK diet can be considered as a safe nutritional intervention for the treatment of obesity in terms of acid-base equilibrium.

Conflicts of Interest

ABC, DG-A, DB and FFC received advisory board fees and or research grants from Pronokal Protein Supplies Spain. IS is Medical Director of Pronokal Spain. The remaining authors declare no conflict of interest.

Obes Facts. 2018 May 26;11(Suppl 1):316.

T4P215 Validity of predictive equations for estimating resting energy expenditure in morbidly and complicated obese patients

R Cancello 1, D Soranna 2, A Brunani 3, M Scacchi 4, A Tagliaferri 4, S Mai 5, P Marzullo 6, A Zambon 2, C Invitti 1

Introduction

The accurate assessment of energy requirements of obese individuals is crucial to plan an appropriate dietary restriction. The resting energy expenditure (REE) is commonly estimated using predictive equations recommended by expert guidelines: Harris-Benedict (HB), WHO/FAO/ONU (FAO) and Mifflin-St Jeor (MJ). However, the validity of these equations among obese patients is controversial.

Methods

This study examined the best REE predictive equation in 4247 obese and morbidly obese patients (69% women, mean age 48 ± 19 years, mean BMI 44 ± 7 Kg/m2) admitted to the Istituto Auxologico Italiano in 1999–2014 years. Data on REE measured by indirect calorimetry, body composition, and cardiovascular, respiratory, metabolic, endocrine and psychological diseases were collected. Agreement between REE measured and predicted by HB, FAO, MJ, Muller (MU), Lazzer (LA), Muller with Body Composition parameters (MU-BC) and Lazzer with Body Composition parameters (LA-BC) equations was tested by two indices: i) accuracy (% of patients with predicted REE ± 10% of measured REE); and ii) bias (mean difference between predicted and measured REE).

Results

MJ predictive equation showed the best performance for both accuracy (MJ: 56.18%, HB: 49.28%, FAO: 47.12%, MU: 46.86%, LA: 46.019%, MU-BC: 49.12%, LA-BC: 44.69%) and bias (MJ: −25.8, HB: 111.20, FAO: 114.39, MU: 131.29, LA: 137.73, MU-BC: 103.89, LA-BC: 139.67 kcal/d). The best performance of MJ equation was confirmed also by Concordance Correlation Coefficient and Mean Squared Deviation indices. Sex and age did not affect the accuracy of MJ which increases with the increase in BMI (51.47% vs 57.93% vs 58.08%, p < 0.001 in BMI < 40, 40$$46 and >46 kg/m2 p < 0.001) and number of comorbidities (from 51.74 to 61.1% in patients with 0 and ≥ 3 comorbidities). MJ equation has the higher performance values in patients with high energy needs such as those with type 2 diabetes and sleep apnoea (69% and 66% respectively).

Conclusion

The MJ equation shows good levels of performance to estimate the energy needs of morbidly obese patients. Further studies are needed to identify factors that affect the organ-tissue metabolic rate and should be considered to develop equations with a better performance.

Obes Facts. 2018 May 26;11(Suppl 1):316–317.

T4P216 Physical, anthropometric and nutritional status in older adults by sex of the US-Mexico border

R Espinoza Gutiérrez 1, M Ortiz Ortiz 1, L M Gomez Miranda 1, J J Calleja Núñez 1, E C Guzmán Gutiérrez 1

Introduction

Obesity in older adults is associated with a high risk of cardiometabolic syndrome, physical disability, deterioration of quality of life and even dementia, assuming a decrease in health and quality of life. In Mexico, the combined prevalence of overweight and obesity in adults is 71.2%, higher in women (76%) than in men (69%). However, it is important to know how this phenomenon behaves in a region of Mexico with a high influence of the United States. The aim of this study was to identify the anthropometric, physical and nutritional status of older adults from the US-Mexico border.

Methods

The sample consisted of 86 older adults (63 women and 23 men) with an average age of 69.7 +/− 8.8 years. The characteristics of the adults were not to suffer from limiting diseases, to have functional autonomy, to be sedentary and to be able to carry out basic and instrumental activities of daily life. The upper and lower train strength, aerobic resistance and flexibility of the upper and lower train were evaluated with the battery of tests of Senior Fitness Test, as well as the nutritional status with the Mini Nutritional Assessment. For the statistical analysis, frequency distribution and descriptive statistics were performed. Also, a Student's T test to identify differences by sex.

Results

The prevalence of overweight and obesity in men was 78% and in women 81%. In the anthropometric variables of height (1.72 ± 0.11 cm and 1.57 ± 0.07 cm) and weight (85.3 ± 20.7 kg and 75.2 ± 15.7 kg) men had higher values than women, respectively (p≤0.05). Although the BMI did not show significant differences by sex, men were overweight (28.5 ± 5.4 kg / m2) and women with obesity (30.3 ± 5.9 kg / m2) according to WHO. Women showed better results in upper train flexibility than men (−5.3 ± 10.5 cm and -12.6 ± 10.1 cm respectively, p≤0.05). In the upper train force variables (18.1 ± 5.9 cm and 18.4 ± 6.1 cm) and lower (15.2 ± 5.6 cm and 15.0 ± 6.1 cm), lower train flexibility (−4.8 ± 9.6 cm and 0.3 ± 8.4 cm), aerobic endurance (13.7 ± 43.1 repetitions and 117.2 ± 36.9 repetitions) and nutritional status (23.1 ± 4.3 points and 21.9 ± 4.4 points) there were no significant differences between men and women respectively (p > 0.05).

Conclusion

The prevalence of overweight and obesity was high in both sexes, the high BMI in this population implies a large amount of body fat due to its condition of sarcopenia. The upper train force was of a population over 80 years old, which has been related to a greater risk of falling. Both sexes are at risk of malnutrition, a condition that attenuates the risk of sarcolemma.

Obes Facts. 2018 May 26;11(Suppl 1):317.

T4P217 A Coalition to Improve Physician Competencies in Obesity Prevention and Management

D L Campbell-Scherer 1, S Wicklum 2, E Cameron 3, D Klein 1, R Lafrance 4, M Heatherington 5, T Luig 5, A Connors 4, K Moniz 5, AM Sharma 6

Introduction

Family physicians play a vital role in the prevention and management of obesity. However, medical students and residents receive very little education and training in this area, leaving them poorly prepared to counsel and support patients. Despite calls from international health organizations to improve training, there are currently no widely recognized programs available. We formed an international coalition to navigate challenges involved with implementing changes to educational standards.

Methods

Coalition members (n = 29) were invited to an inaugural meeting based on their knowledge and experience with medical education and/or obesity prevention. They included medical educators, patient advocates, policy makers, interdisciplinary researchers, and healthcare professionals in the area of obesity care. The meeting consisted of short presentations on member initiatives, followed by facilitated group Discussions on 1) important core competencies for physician training and curriculum content 2) strategies to advocate for change to educational standards and build institutional capacity, and 3) strategies for implementation and evaluation that allow for comparative study.

Results

The coalition members identified the following core content and competencies for physician training: 1) a solid foundation in the basic pathophysiology of obesity, 2) proficiency in communication skills such as shared decision making, motivational interviewing, and collaborative deliberation, and 3) the ability to work within an interdisciplinary team. Advocacy with educational and professional bodies was thought to require strong evidence-based core messages that align with institutional priorities Suggested strategies for implementing comprehensive content on obesity into medical curriculum were to include obesity specific questions on medical licensing exams creating a demand for learning. In addition, identifying and integrating skills that translate to the management of other diseases and conditions, can help alleviate limitations due to space and time in the curriculum.

Conclusion

The inaugural meeting of an international coalition to improve obesity prevention and management provided a diverse group of experts with a forum to share innovative ideas, discuss challenges, and suggest potential solutions. Coalition members are now working on specific steps towards progressing the recommendations of the group, and growing the coalition through dissemination.

Conflicts of Interest

AM Sharma is a member of an Advisory Board with a commercial organization [Novo Nordisk: Advisory Board for anti-obesity drug]; AM Sharma was a member of the Data Safety Monitoring Board for an anti-obesity trial [Takeda]. DL Campbell-Scherer has an unrestricted educational grant from Novo Nordisk via the Canadian Obesity Network to support training of physicians and teams in obesity prevention and management.

Obes Facts. 2018 May 26;11(Suppl 1):317.

T4P218 Efficacy of glucose control on a combination of dapagliflozin in people with type 2 diabetes mellitus in Korea

SJ Jeong 1, CH J 1

Introduction

Dapagliflozin, sodium-glucose cotransporter-2 (SGLT-2) inhibitor, reduces hyperglycemia and body weight by inhibiting renal glucose reabsorption. However, only a few studies have shown the glycemic efficacy on a combination of dapagliflozinintype 2 diabetic patientsin Korean. We evaluated the efficacy and safety of glucose control on a combination of dapagliflozinin people with type 2 diabetes in Korea.

Methods

This is a retrospective, observational study, data from 61 patients with 12 months of dapagliflozin(10mg once-daily) therapy were analyzed, visited one medical center from January 2015 to July 2016. We had divided into three treatment groups: first group was dual combination of dapagliflozin and metformin(Group 1); second group was triple combination of dapagliflozin and metformin with sulfonylurea or dipeptidyl-peptidase IV(DPP-4) inhibitors(Group 2); third group was quadriple combination of dapagliflozin, metformin and sulfonylurea with DPP-4inhibitors(Group 3).

Results

Of 61 type 2 diabetic subjects, 32 (52.5%) were men and 29 (47.5%) were women. Mean age and duration of DM were 58.5 ± 9.6 years and 11.4 ± 5.6 years respectively; mean body weight and BMI were 72.6 ± 12.1 kg and 27.3 ± 3.6 kg/m2 respectively. Mean HbA1c and 2-hour postprandial glucoselevels were 7.6 ± 1.0% and 194.2 ± 69.8mg/dLrespectively. After 12 months, Dapagliflozin leads to improvement in HbA1, 2-hour postprandial glucose(PP2) in each group. In total, the reductions in HbA1c and PP2 levels were -0.61 ± 0.82% (P = 0.000) and –35.4 ± 62 mg/dL (P = 0.000) respectively. In group 1, the reduction rates in HbA1c and PP2 levels were 0.39 ± 0.80% (P = 0.093) and –19.2 ± 41.0 mg/dL (P = 0.152) respectively. In group 2, the reduction in HbA1c and PP2 levels were –0.93 ± 1.0% (P = 0.018) and –63.1 ± 90.6 mg/dL(P = 0.034) respectively. In group 3 the reduction in HbA1c and PP2 levels were-0.65 ± 0.71% (P = 0.002) and –37.9 ± 61.4mg/dL (P = 0.001) respectively. And also mean change from baseline body weight was –3.4 ± 2.6 kg (P < 0.001) for total, –3.4 ± 3.1 kg (P < 0.001) for group 1, –2.7 ± 2.0 kg (P = 0.008) for group 2,–4.0 ± 2.3 kg (P < 0.001) for group 3. In total, mean change from baseline SBP and DBP were –6.0 ± 14 mmHg (P = 0.001) and –3.4 ± 7.7 mmHg (P = 0.002) respectively. There were no serious adverse event including hypoglycemia in dapagliflozin group.

Conclusion

In patients with type 2 diabetes, a combination of dapagliflozin improvedglycemic control and reduced body weight reduction with safety.

Obes Facts. 2018 May 26;11(Suppl 1):317–318.

T4P219 Phase Angle in Evaluating Nutritional Status

B Deniz Güneş 1, N Acar Tek 1, G Akbulut 1

Introduction

An accurate estimate of body composition is important in nutrition assessment and monitoring. Bioelectrical impedance analysis (BIA) is the most commonly used method for assessing body composition. BIA measures body component resistance (R, pure opposition of a biological conductor to alternating electric current) and reactance (Xc, capacitive resistance of cell membranes) by recording a voltage drop in applied current. Resistance is related to the water content in the tissues, while reactance is the resistive effect produced by the tissue interfaces and cell membranes. The phase angle (PhA) is calculated directly from R and Xc. This measure has a number of advantages, such as independence from regression equations, and the fact that it can be calculated even in situations in which it is not possible to estimate the body composition.

Methods

Phase angle is more appropriate than impedance for the assessment of nutritional status, because PhA presents the degree of cellular health. In healthy persons, PhA ranges from 5° to 7°. In healthy subjects, age, sex and BMI are the major determinants of PhA. Ageing is associated with decline in tissue mass, which results in decreasing PhA. Males have higher PhA values due to higher muscle mass. Higher BMI is associated with more cells, which increases PhA until a BMI of 30 kg/m2. Interestingly, at BMI >40 kg/m2, an inverse relationship with PhA is observed. This has been attributed to increased tissue hydration or a pathological fluid overload. Low PhA indicates pathological membrane state and function. Low PhA may be due to over hydration and/or malnutrition. Accordingly, many studies find a correlation between phase angle and other measures of nutritional status and/or muscle mass.

Results

Phase angle has gained popularity over the past years since it has shown to be highly predictive of impaired clinical outcome and mortality in a variety of diseases. PhA is frequently lower than normal in disease since influences such as infection, inflammation or disease-specific parameters may impair phase angle. Phase angle (PhA) is a predictor of morbidity and mortality in HIV/AIDS, pancreatic, colorectal, breast and lung cancer, liver cirrhosis, dialysis, pulmonary disease, amyotrophic lateral sclerosis, geriatric and surgical patients. Disease-related malnutrition is characterized by an early shift of fluids from intracellular water (ICW) to extracellular water (ECW) space with increased ECW/ICW and a concomitant decrease in body cell mass, both lowering phase angle. In patients suffering from malnutrition, PhA can reflect the early water shift from intracellular to extracellular space.

Conclusion

In conclusion, together with the known biological determinants, malnutrition and inflammation have a strong impact on PhA in disease. Phase angle is a superior indicator of survival and outcome and should therefore be used as screening tool for identification of patients at risk because of impaired nutritional or functional status.

Obes Facts. 2018 May 26;11(Suppl 1):318.

T4P221 Early improvement in control of eating questionnaire items following naltrexone/bupropion treatment

D McLin 1, L Acevedo 2, K Gilder 3, A Halseth 2

Introduction

Prolonged-release naltrexone 32 mg/bupropion 360 mg (NB), approved for chronic weight management as an adjunct to diet and physical activity, is postulated to reduce hunger via sustained activation of hypothalamic POMC neurons and to reduce cravings through modulation of the mesolimbic dopaminergic reward system. The purpose of this exploratory analysis was 1) to assess the magnitude of the treatment group differences (LS mean ± SE) in an integrated analysis of the Phase 3 trials at the earliest time point measured for all 20 Control of Eating Questionnaire (CoEQ) items, and 2) assess the relationship between early changes in CoEQ items comprising the Craving Control subscale and long-term weight loss.

Methods

In four Phase 3 trials of participants with overweight and obesity (BMI ≥27 and ≤45 kg/m2), eating behavior was evaluated with the CoEQ (twenty 100mm visual analog scales) at Baseline and Weeks 8, 16, 28, and 56. The Completer populations of the 4 trials were pooled and analyzed.

Results

An integrated analysis in the Completer population showed statistically significant improvement in participants treated with NB relative to those treated with placebo on 13 of 20 CoEQ items at Week 56. Further analysis revealed that improvements at Week 8, the earliest time measured, in both eating control (Question #19) and the Craving Control subscale, may inform long-term weight loss. Seventeen of the CoEQ items were statistically improved for participants treated with NB compared to placebo at Week 8 (p < 0.05), with one item statistically favoring placebo treated participants (frequency of craving for fruit or fruit juice; p < 0.05). Week 8 scores for individual items contributing to the Craving Control subscale (Questions #1, 9, 10, 11, 12, and 19) were also correlated with long-term weight loss across treatment groups; however, there was significantly greater weight loss in the NB group. Question #19 (“Generally, how difficult has it been to control your eating?”) exhibited the strongest linear relationship (slope = 0.071, R2 = 0.065, P < 0.0001).

Conclusion

These results extend earlier data suggesting NB is associated with early improvement in multiple measures of eating control and craving that may contribute to, and be predictive of, weight loss associated with long-term treatment.

Conflicts of Interest

D. McLin, L Acevedo, K Gilder, and A. Halseth are employees of Orexigen Thereauptics.

Obes Facts. 2018 May 26;11(Suppl 1):318.

T4P222 Effect of naltrexone/bupropion on binge eating scale scores in two open-label studies

A Halseth 1, L Acevedo 1, K Gilder 2, D McLin 3

Introduction

A bidirectional association exists between obesity and depression, especially major depressive disorder (MDD). Binge eating disorder is also known to be associated with higher scores on depression indices. Prolonged-release naltrexone 32 mg/bupropion 360 mg (NB) is approved for chronic weight management as an adjunct to diet and physical activity. The purpose of this analysis was 1) to compare the effect of MDD on baseline Binge Eating Scale (BES) scores, and 2) to compare the effect of NB on BES scores in participants with overweight and obesity.

Methods

Data was pooled from two open-label studies (Study 1: 24-week single-arm study, presence of MDD required [defined as a score >26 on the Inventory of Depressive Symptomatology-Self Report], N = 25; Study 2: 26-week open-label controlled treatment period from a 78week study, acute depressive disorder was exclusionary, N = 153). All participants were required to have a BMI ≥30 (obese) or a BMI ≥27 (overweight) with at least one weight-related comorbidity. All participants received counseling on diet, exercise, and behavioral modification.

Results

Across the two studies, mean age was 46 years, mean BMI was 36 kg/m2, with all or predominantly female participants. Discontinuation rates were similar in Studies 1 (48%) and 2 (54%). Mean (SE)% weight change in study completers was 9.2 (1.8)% in Study 1 and 9.6 (0.5)% in Study 2. At baseline, mean (SD) BES score was 28.4 (8.9) in Study 1, and 15.0 (8.6) in Study 2 (≤17 reflective of little to no problem with binge eating; ≥27 reflective of a severe problem). Mean (SD) BES score in study completers was 7.8 (6.7) in Study 1 and 8.5 (7.4) in Study 2. The safety profile of NB in these studies was consistent with the Phase 3 program. Limitations of this analysis include open-label study design and use of different lifestyle intervention programs.

Conclusion

Patients with both obesity and MDD may present with more disordered eating behavior compared to those without depression, and NB may be an effective tool to reduce disordered eating even in those with higher BES scores prior to treatment.

Conflicts of Interest

A. Halseth, L. Acevedo, K. Gilder, and D. McLin are employees of Orexigen Therapeutics.

Obes Facts. 2018 May 26;11(Suppl 1):318–319.

T4P223 An initial investigation into patient attrition (and retention) in an adult weight management service using a bespoke IT platform and mobile phone text service

E M Di Battista 1, K O'Brien 1, S Quirke 1, J Everitt 2, P Thomas 3, W Fauvel 3, G Thomas 3

Introduction

Physical activity and dietary behaviour change trials targeting people with obesity demonstrate clinical benefits with modest reductions in percentage body weight (i.e., 2.5%-15%; Ryan and Yockey, 2017). Positive results have spurred health services to implement weight management programmes but participant retention has proved challenging. Attrition rates for weight management services vary between 50–80% but the reasons for such high rates are poorly understood and infrequently evaluated (Moroshko et al., 2011). One major challenge is how to actively engage former weight management participants to discuss attrition after they are disengaged from such services. Latest data from the Office for National Statistics (2017) suggests 95% of UK households own a mobile phone and short messaging services (SMS) have been applied in various weight management studies (Bardus et al., 2015). The aim of this project was to create and pilot a prototype SMS that engages with participants (and former participants) and explore reasons for retention and attrition in an NHS adult weight management service.

Methods

A collaboration between Aneurin Bevan University Health Board's Adult Weight Management Service (AWMS) and small / medium enterprise ‘Nudjed’ resulted with ‘PREMsend’ – a bespoke information technology platform and automated SMS application – which distributed a brief questionnaire to AWMS patients every 6 weeks to explore user experiences. The brief questionnaire measured service experience using simple quantitative (Likert scale: 1–5, with 5 being most positive) and qualitative measures (reasons for number chosen in Likert scale) to create an easy and intuitive data collection method of patient experience. Using thematic analysis, qualitative data was coded and triangulated with Likert measures to investigate factors of attrition and retention.

Results

To date, PREMsend has contacted 330 patients with 229 responders (a 69.4% response rate). Average overall service user score among current patients was higher (4.1 out of 5) than those who left the programme (average of 3.1). Service user satisfaction decreased over time, with an average score at 9–12 months of 3.1, compared to a score of 4 from those 0–3 months into the program. By triangulating data we identified that lower scores and attrition were associated with difficult appointment booking procedures and delays between appointments, which patients described as slow and frustrating. Higher experience scores and programme retention were associated with experiences of a safe, comfortable, and non-judgemental environment with friendly, approachable, and good listener clinicians.

Conclusion

We developed a bespoke information technology platform and automated SMS application, ‘PREMsend’ which can be implemented into NHS weight management services to engage service users regarding their experiences. Initial data suggests appointment booking procedures need to be more efficient to reduce attrition. Patient centred, non-judgemental clinicians were associated with retention and were highly valued by patients with obesity. Formative evaluation over time will provide in-depth data in order for the weight management service to design procedures that minimise participant attrition.

Conflicts of Interest

The 3 latter authors are employed or have a stake in the company Nudjed which owns the ICT platform PREMSend so therefore have financial interests in the product's commercial success.

Obes Facts. 2018 May 26;11(Suppl 1):319.

T4P224 A personalized approach to obesity consultations: patient perspective and impacts

T Luig 1, R Anderson 2, AM Sharma 3, D L Campbell-Scherer 4

Introduction

Previous research revealed people living with obesity want substantive conversations, personalized assessments and plans. Together with patients and interdisciplinary primary care providers we have created a model for personalized obesity consultations that integrates the 5As of obesity management with the collaborative deliberation model for care. To do this, we used in-depth qualitative methods to examine how people perceive the interpersonal work and content of the consultation; and how this experience impacts their ability to make changes in everyday life to improve their health.

Methods

We recruited 20 people living with obesity through purposeful sampling to ensure a diversity of patient contexts. Video-recorded one-on-one interventions with a primary care clinician, loosely structured, conversational interviews (patient and clinician) following the consultation, and documentation of intervention impact on patients’ self-management through diaries and two follow-up interviews over the course of 6–8 weeks. Thematic analysis using inductive and deductive coding managed in NVIVO11.

Results

From the patient perspective an impactful personalized obesity consultation is anchored in the patient's story and a comprehensive root cause assessment, and guided by a whole-person health approach and an orientation on patients’ strengths and resources. Using collaborative communication, the care planning focuses on strengthening the patient's capacity to engage in health promoting strategies that fit with the context and fundamental goals of their lives. Impacts that patients experienced include (1) increased confidence, hope, and self-compassion; (2) activation and increased activity levels; (3) increased insight into own barriers and improved coping.

Conclusion

We examined patient experiences of the obesity consultation and their everyday life experience of effecting change to improving health and used results to develop a model for a personalized obesity consultation approach. Findings suggest that interpersonal processes that shift the patient towards focusing on whole-person health goals and towards a strength-based, compassionate view of self, effectively support patient activation and self-efficacy for improving health outcomes.

Conflicts of Interest

AM Sharma is a member of an Advisory Board with a commercial organization [Novo Nordisk: Advisory Board for anti-obesity drug]; AM Sharma was a member of the Data Safety Monitoring Board for an anti-obesity trial [Takeda]. DL Campbell-Scherer has an unrestricted educational grant from Novo Nordisk via the Canadian Obesity Network to support training of physicians and teams in obesity prevention and management.

Obes Facts. 2018 May 26;11(Suppl 1):319–320.

T4P225 Preoperative education and informed consent in young adults undergoing bariatric surgery: patients’ perspectives on current practice

C EJM Dohmen 1, DS M 1, M Uittenbogaart 1, A APM Luijten 1, F M H Van Dielen 1, W KG Leclercq 1

Introduction

Information about the quality of the perceived education and informed consent process in bariatric surgery, especially in young adults is lacking. As part of the surgical informed consent process, pre-operative education informs patients about their bariatric procedure, the perioperative risks, the results and the lifestyle adjustments needed after bariatric surgery. Afterwards, patients should be able to make an informed decision to undergo their surgical procedure. Aim of this study was to evaluate the preoperative education and informed consent process in young adults, aged 18–25 years, undergoing bariatric surgery.

Methods

23 of the 55 young adults who underwent bariatric surgery between 2012 and 2017 at our centre were interviewed using a semi-structured interview. This interview included three sections: education of the specific informed consent domains; perioperative expectations and experiences; personal (un)certainties to undergo bariatric surgery.

Results

23 patients were interviewed. Mean age at surgery was 23.1 ± 1.6 years and mean BMI at surgery was 42.2 ± 5.3 kg/m2. All consent domains were remembered. However, 95% of the patients could not mention one or more complications. Primary success outcome for patients was not confined to weight loss, but gaining self-confidence, being able to buy clothes in a regular shop and raised fertility chances were considered more important. 37,5% of the patients had troubles dealing with their new self-image. 25% of the patients regrets the decision for the bariatric surgery.

Conclusion

The preoperative education and informed consent process is an essential step in bariatric surgery. This study provides new information on perceived education and informed consent issues in young adults. Improved preoperative education including possible scenarios after bariatric surgery to assess risks and lifetime consequences should be developed to help these patient in making a truly well informed decision.

Obes Facts. 2018 May 26;11(Suppl 1):320.

T1PLB1 Independent association of fat infiltration in thigh muscle with coronary artery diseases in 3012 Korean adults

S Lim 1, KM Kim 1, EJ Chun 2, D Lee 3, HC Jang 1

Introduction

Ectopic fat deposition is associated with cardiovascular risk factors. Recently, it is reported that fat infiltration in muscle (myosteatosis) is associated with subclinical atherosclerosis. However, studies examining the fat density in muscle and its association with coronary artery diseases are sparse. The aim of this study was to investigate the association between fat density in thigh muscle and subclinical atherosclerosis in coronary arteries.

Methods

We recruited 3012 subjects (mean age, 56.1 years; 56.2% men) from the Korean Atherosclerosis Study-2 participants who had one or more cardiometabolic risk factors. Fat area and fat density at mid-thigh level was measured by computed tomography (CT) attenuation (Hounsfield Units): 0˜30 for low density muscle (LDM); 31˜100 for normal density muscle (NDM); –250˜–50 for fat amount. Coronary artery stenosis was defined by >50% stenosis by multidetector coronary CT angiography. Plaque was classified into calcified or noncalcified components according to the proportion of the calcified lesion. Multivariable regression models were used to evaluate the association between fat density in muscle and coronary artery disease.

Results

Among the participants, 18.2% had significant stenosis and 15.4% had noncalcified plaque in the coronary arteries. Fat area at mid-thigh level was 123.45 ± 36.59 cm2. Areas of LDM and NDM were 40.44 ± 14.13 cm2 and 163.85 ± 45.18 cm2, respectively. The ratio of LDM/NDM was independently associated with coronary artery stenosis and noncalcified plaque after adjusting for conventional cardiovascular risk factors (both P < 0.05). The subjects with the highest quartile of LDM/NDM had 3.21 times greater risk of coronary artery stenosis than those with the lowest quartile (P < 0.05).

Conclusion

This study results suggest that fat infiltration in thigh muscle contributes to development of atherosclerosis among Korean adults. Future longitudinal studies are needed to confirm this finding.

Please note: By default, authors did not disclose any conflicts of interest unless explicitly stated in the abstract.

Obes Facts. 2018 May 26;11(Suppl 1):320.

TIPLB2 Role of fish oil in early life programming

L Ramalingam 1, K Menikdiwela 1, L Allen 1, S Scoggin 1, N Moustaid-Moussa 1

Introduction

Obesity is complex disease and a global epidemic. Half of American women of childbearing age have obesity or overweight. This in turn increases the prevalence of childhood obesity and comorbidity. Thus, early dietary interventions during pregnancy may help prevent both maternal and offspring obesity and its metabolic complications. Fish oil, rich in omega 3 polyunsaturated fatty acids exert various health benefits like lowering serum triglycerides, inflammation and insulin resistance. However, whether maternal consumption of fish oil protects offspring from the adverse effects of maternal obesity remains unclear. Hence, we hypothesized that fish oil (FO) supplementation during pregnancy and continuation in offspring will reduce obesity and its associated adipose tissue inflammation in the offspring.

Methods

Mice (dams) were fed a control low fat (LF), a high fat supplemented without (HF) or with fish oil (HF-FO) for 8 weeks prior to pregnancy, during pregnancy and lactation. After weaning, male and female offspring from HF or HF-FO fed dams were either randomly assigned to the same diets (HF-HF or FO-FO), or switched to the other diet (HF-FO or FO-HF), and compared to a control LF diet, for 12 weeks. Physiological outcomes included body weight, body composition, glucose and insulin tolerance tests. Serum, adipose tissue, and other tissues were collected at the end of the feeding period for further analyses.

Results: Results: Mice fed on HF had significantly higher body weight and were insulin resistant compared to LF mice. Both male and female offspring who continued on FO (FO-FO) had significantly better glucose clearance and insulin sensitivity compared to all H[MN1] [KM2] F groups. Moreover, expression of pro-inflammatory maker Tumor necrosis factor [MN3] [KM4] α was lower in both FO[MN5] [KM6] -FO and LF groups compared to HF-HF group. Moreover, Adipocyte size was, significantly reduced in fish oil groups (FO-FO, FO-HF, HF-FO), compared to HF mice indicating beneficial effects of FO supplementation on both obesity and insulin resistance. However, body weight was not significant but compared to some HF groups lower trend was there. Since it exceeds character limit 2000 I've removed body weight

Conclusion

Fish oil supplementation during pregnancy and continuous feeding to offspring reduces adverse maternal effects of high fat diet on offspring. Further mechanistic studies are ongoing to better understand the contribution of in utero high fat vs fish oil feeding on offspring metabolic health.

Obes Facts. 2018 May 26;11(Suppl 1):320–321.

T1PLB3 A body weight homeostat that regulates fat mass in rats and mice

V Palsdottir 1, DA Hägg 2, E Schéle 1, SL Dickson 1, F Anesten 1, T Bake 1, J Bellman 1, SH Windahl 2, C Ohlsson 2, J Jansson 1

Introduction

Subjects spending much time sitting have increased risk of obesity, but the mechanism for the anti-obesity effect of standing is unknown. It is known that osteocytes can sense changes in bone strain, opening for the possibility that osteocytes of the weight bearing bones could sense changes in the body weight as well. We hypothesized that there is a homeostatic regulation of body weight, which can be influenced by posture.

Methods

To test this hypothesis we implanted heavy capsules that weighed 15% of the body weight into the abdomen of adult Sprague-Dawley rats and C57BL6 mice with diet induced obesity, or subcutaneously on the back of the mice. Control animals were implanted with an empty capsule of equal size (3% of the body weight). The body weight and food intake was recorded throughout the experiment, and at the end fat pads and skeletal muscle were dissected and weighed. The glucose tolerance and leptin levels were checked in mice. We also unloaded some animals by exchanging the heavy capsule to an empty capsule a couple of weeks after the first surgery.

Results

We demonstrated that increased loading of rodents, reversibly decreases the biological body weight via reduced food intake. Importantly, loading relieved diet induced obesity and improved glucose tolerance. However, the body weight-reducing effect of increased loading was lost in mice depleted of osteocytes.

Conclusion

We propose that increased body weight activates a sensor dependent on osteocytes of the weight bearing bones. This induces an afferent signal, which decreases food intake and reduces body weight. These findings demonstrate a novel leptin-independent body weight homeostat that regulates fat mass.

Obes Facts. 2018 May 26;11(Suppl 1):321.

T1PLB4 Mechanisms underlying the efficacy of a rodent model of vertical sleeve gastrectomy – a focus on energy expenditure

BJ Oldfield 1, CC Lee 1, A C 1

Introduction

Bariatric surgery remains the only effective and durable treatment option for morbid obesity. Vertical Sleeve Gastrectomy (VSG) is currently the most widely performed of these surgeries primarily because of its proven efficacy in generating rapid onset weight loss, improved glucose regulation and reduced mortality compared with other invasive procedures. VSG is associated with reduced appetite, however, the contribution of reduced energy expenditure to VSG-induced weight loss, particularly that in brown adipose tissue (BAT), remains unclear.

Methods

Diet-induced obese male Sprague-Dawley rats (n = 35) were either sham-operated or underwent SG surgery and had ad libitum access to a high fat diet. A subset of sham-operated rats were pair-fed to the food consumed by the VSG group. Animals were also implanted with biotelemetry devices between the interscapular lobes of BAT to assess local changes in BAT temperature as a surrogate measure of thermogenic activity. Metabolic parameters including food intake, body weight and changes in body composition were assessed. To further elucidate the contribution of energy expenditure via BAT thermogenesis to VSG-induced weight loss, a separate cohort of chow-fed rats (n = 33) underwent complete excision of the interscapular BAT (iBAT lipectomy) or chemical denervation using 6-hydroxydopamine (6-OHDA). In a separate cohort (n = 20), neuronal activation, indicated by elevated Fos protein in the nucleus of the solitary tract (NTS), was assessed in response to VSG following intragastric infusion of water or a mixed meal (Ensure).

Results

VSG caused significant reductions in food intake resulting in commensurate reductions in both body weight (P < 0.0001) and fat mass (P < 0.05). VSG was associated with an increase in BAT thermogenesis, as demonstrated by an elevation in iBAT temperature (P < 0.05) and UCP1 expression (P < 0.01), as well as the beiging of white fat, as indicated by elevated Cited1 mRNA (P < .01) expression in subcutaneous (inguinal) fat. The positive effect of VSG on weight loss and fat mass was significantly reduced in animals with disrupted iBAT function whether it was induced by lipectomy or chemical denervation. Intragastric infusion of water to rats who have undergone VSG produced a significant elevation in the number of Fos-labelled neurons in the NTS compared to Sham controls. By comparison, infusion of a mixed-meal (Ensure) resulted in twice as many Fos-labelled neurons in the NTS compared to that detected after the same volume of water.

Conclusion

Collectively, these data support a role for BAT thermogenesis in VSG-mediated weight loss. In addition, both stretch and nutrients are likely to contribute to recruitment of brainstem neural relays following VSG.

Obes Facts. 2018 May 26;11(Suppl 1):321.

T1PLB5 Impact of long term supplement with artificial sweeteners on insulin dependant glucose uptake in obese.

C Malbert 1, R Young 2, M Genissel 1, A Chauvin 1, F Le Gouevec 1, J Georges 1, M Horowitz 2

Introduction

In an attempt to reduce the adverse health outcome of an excess addition of sugar in western diets, the consumption of noncaloric sweeteners such as sucralose and acesulfame K has been increased throughout the world. Unfortunately, the use of these compounds has reduced only marginally the proportion of rapidly metabolized sugars resulting ultimately in diets containing a significant amount of both caloric and noncaloric sweeteners. Surprisingly, the impact of this association has been poorly reviewed especially in the context of morbid obesity. Our work aimed to investigate comprehensively the effect of the addition of noncaloric sweeteners to an obesogenic diet on the glucose uptake rate measured both at the organ and at the whole body level using a large animal model of morbid obesity.

Methods

Twenty, three years old miniature pigs, were made massively obese by supplying them with high-fat, high sucrose diet during five months resulting in about doubling of the body weight (75.3 ± 6.01 vs. 32.7 ± 2.90 kg). Once obese their body weight was stabilized, and the corresponding daily diet intake was locked until the completion of the experiment irrespective of the experimental group. Half of the animals received the same diet supplemented with a mixture of sucralose (92 mg daily) and acesulfame-K (52 mg daily, sweetener group). This amount corresponds to the amount supplied by the daily ingestion of 1.5 L of sweetened beverage in humans. The control group received the same diet but without artificial sweeteners. Glucose uptake rates were obtained for the brain, the liver, the duodenum and the skeletal muscle using dynamic PET 18FDG scanning in the condition of hyperinsulinemia (120 mU.kg-1.h-1) in euglycemia. Clamp data were also used for calculation of whole-body glucose uptake. Regional glucose uptake rates were obtained through model analysis of PET images together with direct measurement of the arterial input function.

Results

Whole body glucose uptake was not significantly different between groups (p > 0.05) and this reflected the unchanged skeletal muscle glucose uptake (3.2 ± 0.43 vs 3.1 ± 0.32 μmoles.min-1.100g-1). On the contrary, brain, liver and duodenal glucose uptake were all increased in the sweetener compared the control group; 29, 66 and 57% for brain, liver and duodenal glucose uptake respectively. This was the consequence of an increased inward flux (K1) irrespective of the organ and also with a doubled phosphorylation rate for the duodenum only (k3).

Conclusion

In conclusion, the unaltered whole body sensitivity does not preclude the absence of change in the glucose metabolism in several organs qualitatively, if not quantitatively, essential for glucose homeostasis. While the increase glucose uptake occurring within these organs might not be critical for overall glucose status, it is likely to play a crucial role in the adverse health outcomes associated with chronic consumption of artificial sweeteners in humans.

Tab. 1.

Brain, liver, duodenal and muscle glucose metabolism during the clamp. (mean ± SD)

(µmoles.min-1.100g-1) Control diet group Sweetener diet group
Brain glucose uptake 16.1 ± 0.97 20.8 ± 0.96*
Liver glucose uptake 9.8 ± 0.53 16.3 ± 0.66*
Duodenal glucose uptake 7.9 ± 0.29 12.4 ± 1.21*
Muscle glucose uptake 3.2 ± 0.43 3.1 ± 0.32
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Obes Facts. 2018 May 26;11(Suppl 1):322.

T1PLB6 Whey protein isolate modulates fat gain and body composition of mice on high fat diet

O Nychyk 1, D Derous 2, S Boscaini 1, A Walsh 1, S Mitchell 2, JR Speakman 3, KN Nilaweera 1

Introduction

An increasing number of studies have indicated that the source of dietary protein can have an impact on energy balance during high-fat feeding in both humans and rodents. Whey protein isolate (WPI), a by-product of cheese manufacture, has gained considerable interest in relation to its health benefits, including reduction in body weight and energy intake. The present study investigates the effect of protein source (WPI vs casein) and amount (%) on energy balance and provides a comprehensive body composition analysis of adult mice fed a high-fat diet.

Methods

Male C57BL/6J mice, aged 20 weeks, were group-housed (three per home cage) and were exposed to high-fat diet (40% fat) combined with 3 different levels of protein (10, 20 and 30% balance carbohydrate), each replicated with the protein coming from either WPI or casein. In total, 6 different treatments (CAS-10, CAS-20, CAS-30; WPI-10, WPI-20, WPI-30), with 12 mice per group, were used in the study. During the 12 week trial, the energy intake and body weight were measured weekly. At the end of 12 week dietary manipulations the mice were dissected into 24 different body components to provide a complete picture of body composition. All results are expressed as means ± SE.

Results

Cumulative energy intake was not significantly affected by protein source or protein concentration throughout the study period. In contrast, both protein source and protein concentration (20 and 30% only) differentially affected body-weight gain and body composition. The mice in the high-fat (HF) WPI-20 group gained significantly more weight (9.19 ± 1.43 g) than the CAS-20 group (7.43 ± 0.92 g) (P < 0.01). Similarly, the WPI-20 group had a significantly higher percentage of lean mass and a corresponding lower percentage of fat mass than the CAS-20 group (P < 0.01 for both parameters). In contrast, 30% protein had an opposite effect on body-weight: mice from the WPI-30 group gained significantly less weight (7.28 ± 1.55g) than the CAS-30 group (11.85 ± 1.1g) (P < 0.001), whereas the percentage of fat mass and lean mass was not significantly different between these groups. The WPI-20 group had increased weight of adipose tissue compartments (subcutaneous, visceral adipose tissue), liver, organs of the gastrointestinal tract (colon, caecum) and skin relative to the HF CAS-20 group (Table 1). The WPI-30 group had reduced the weight of adipose tissue depots (brown and visceral adipose tissue), liver, organs of the gastrointestinal tract (stomach, intestine) and structural organs (carcass, skin) relative to the CAS-30 group (Table 1).

Conclusion

This study showed that metabolic effects of WPI are independent of energy intake and dependent on protein concentration in the diet. A higher concentration of WPI (30%) counteracts the effects of a high-fat diet on body-weight gain and tissue growth whereas lower concentration of WPI (20%) exacerbates the impact of energy surplus on body composition.

Table 1.

Table 1

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Effect of whey protein isolate on organ/tissue weight. The p-values are shown relative to casein; the arrows indicate the increase or decrease in organ/tissue weight. SAT: subcutaneous adipose tissue; BAT: brown adipose tissue. N/s: not significant. *Trend towards significance.

Obes Facts. 2018 May 26;11(Suppl 1):322.

T1P166 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):322–323.

T1P167 Is there any relationship between constipation and waist circumference in females?

G Akbulut 1, N Acar Tek 1, F Ayyıldız 2

Introduction

Constipation is a symptom and significant health problem affecting individuals of all ages. A lot of factors such as obesity, sedentary lifestyle and dietary intake may effect constipation risk. The studies showed that constipation affected significantly more women than men. It was aimed to evaluate relationship between constipation and waist circumference in females.

Methods

Waist circumference, which is an indicator for chronic disease risk were measured and assessed according to World Health Organization (WHO) waist circumference classification. It consists of subscales such as gender, mobility, fiber intake, fluid intake, pathophysiological conditions, and medications. Both waist circumference and constipation risk, ‘cut-off’ scores were determined for the three categories of low, moderate and high risk. Relationships between the mean scores were determined by pearson's correlation. A p value of less than 0.05 was considered statistically significant.

Results

The mean age of individuals was 27.8 ± 10.29 years (n:428). 0.9% of females who had low disease risk according to waist circumference were high constipation risk. 84.8% of females had high disease risk and low constipation risk. 90.7% of individuals had low disease risk and low constipation risk. Constipation risk assessment scale scores weren't correlated with waist circumferences (r: 0.023 p: 0.563).

Conclusion

In this study there was any relationship between waist circumference and constipation risk assessment. Further clinical studies investigating this relationship are needed.

Tab. 1.

Evaluation of a constipation risk assessment scale according to waist circumference

 Chronic disease risk according to waist circumference
Low risk (<80 cm)
 Moderate risk (80–88 cm)
 High risk (>88 cm)
n % n % n %
Low risk (≤10 points) 388 90.7 99 88.4 78 84.8
Moderate risk (11–15 points) 36 8.4 11 9.8 11 11.9
High risk (≥16 points) 4 0.9 2 1.8 3 3.3
Total 428 100.0 112 100.0 92 100.0
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Obes Facts. 2018 May 26;11(Suppl 1):323.

T1P168 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):323.

T1P169 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):323.

T1P170 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):323.

T1P171 Obesity-related adipokines and cancers – a meta-analysis of observational studies

YS Yoon 1, SW Oh 2, AR Kwon 3

Introduction

Higher amounts of body fat are associated with increased risks of cancer. One of the mechanisms that explains obesity-cancer relation is an adipokine system, which is closely connected to chronic inflammation. We performed this meta-analysis to comprehensively assess the association between various circulating adipokines (adiponectin, leptin, Interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α)) and risk of obesity-related cancers.

Methods

Pubmed and Embase were searched up to October 2017 for prospective observational studies investigating the relationship between circulating adipokines and cancers. Summary odds ratio(OR) and the corresponding 95% confidence interval (95% CI) was estimated through the meta-analysis comparing highest vs. lowest category of adipokines and dose response meta-analysis were performed using a random-effects model.

Results

A total of 93 observational studies (adiponectin = 60 studies, high molecular weight adiponectin = 9 studies, leptin = 39 studies, IL-6 = 16 studies, TNF-α = 10 studies, and resistin = 17 studies: breast cancer = 30 studies, colorectal cancer = 22 studies, endometrial cancer = 15 studies, ovarian cancer = 6 studies, kideny cancer = 7 studies, prostate cancer = 7 studies, pancreatic cancer = 8 studies, and multiple myeloma = 4 studies; 5 cohort studies, 42 case-control studies, and 46 nested case-control studies) were included. Circulating adiponectin was associated with a significantly decreased risk of cancer (pooled OR = 0.70, 95% CI (0.60–80), I2 = 71.9%, Pheterogeneity <0.01) and leptin was associated with a significantly increased risk of cancer (pooled OR = 1.26 (1.05–1.51), I2 = 65.7%, Pheterogeneity <0.01). For each 5 μg/ml increase in adiponectin and for each 5ng/ ml increase in leptin, the pooled OR was 0.88 (0.83–0.93) and 1.05 (1.01–1.09), respectively. IL-6 (pooled OR = 1.09(0.94–1.25)), TNF-α (pooled OR = 1.65(0.99–2.74)), and resistin (pooled OR = 1.28(0.78–2.11)) was not associated with cancer risk. By cancer site and type, higher adiponectin was associated with decreased risk of breast cancer (summary OR = 0.74 (0.60–0.91)), colorectal cancer (summary OR = 0.74 (0.60–0.91)), endometrial cancer (summary OR = 0.49 (0.34–0.72)), and ovarian cancer (summary OR = 0.29 (0.11–0.74)) and highest category of leptin was found to be associated with increased risk of endometrial cancer (summary OR = 1.88 (1.24–2.87)) and kideny cancer (summary OR = 2.07 (1.51–2.83)).

Conclusion

We demonstrated that lower level of circulating adiponectin and higher level of leptin was associated with the increased risk of cancers. This association was further confirmed through dose-response meta-analysis. We did not observe a significant association of IL-6, resistin, and TNF-α with cancers. In addition, our results suggested that the association between adiponectin and leptin and risk of cancer risk could be independent of adiposity. Therefore, adiponectin and leptin may be considered for promising target for cancer prevention.

Obes Facts. 2018 May 26;11(Suppl 1):323.

T1P172 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):323–324.

T1P173 Differential roles of osteopontin in the pathophysiology of metabolic syndrome-derived hepatocellular carcinoma

A D Nardo 1, NG Grün 1, M Zeyda 1, M Dumanic 2, G Oberhuber 3, TH Helbich 4, TM Stulnig 1

Introduction

Osteopontin (OPN, gene Spp1), a multifunctional protein and inflammatory cytokine, has been proposed to play a pivotal role in many pathophysiological events related to metabolic syndrome and carcinogenesis. OPN is overexpressed in adipose tissue and liver during obesity and concurs in the induction of adipose tissue inflammation and non-alcoholic fatty liver (NAFL). Studies performed in both mice and humans demonstrated a putative role for OPN in malignant transformation and tumor growth, including hepatocellular carcinoma (HCC). Metabolic syndrome is nowadays recognized as an important risk factor for HCC. In order to fully understand the role of OPN on the development of HCC in NAFL, we reproduced in our laboratories a recently published NASH-HCC mouse model called STAM on a both wild type (WT) and OPN deficient (Spp1-/-) background, and evaluated its properties in non-alcoholic steatohepatitis (NASH), fibrosis and HCC.

Methods

Two-days-old WT and Spp1-/- mice received a low-dose streptozotocin (STZ) injection in order to induce diabetes and were fed a high-fat diet (HFD) starting from week 4. Different cohorts of mice of both genotypes were sacrificed at 8, 12 and 19 weeks of age in order to evaluate the NASH, fibrosis and HCC phenotypes, respectively.

Results

Lack of osteopontin prevented HCC progression to less differentiated tumors and improved overall survival rate while enhancing the development of well-differentiated liver tumors. On the other hand, Spp1-/- mice developed a stronger fibrosis due to increased hepatocellular apoptosis. OPN-deficient mice also showed an aggravated NASH due to increased CD36-mediated lipid uptake. The worse steatotic and fibrotic phenotypes observed in Spp1-/- mice were probably a consequence of overall improved metabolic condition.

Conclusion

In a model of metabolic syndrome, the lack of OPN improved overall outcomes but worsened hepatic inflammation and fibrosis. OPN appears necessary for dedifferentiation of HCCs. This work is supported by the CCHD doctoral program of the FWF (W1205-B09), and the Federal Ministry of Economy, Family and Youth and the National Foundation for Research, Technology and Development (to T.M.S.).

Obes Facts. 2018 May 26;11(Suppl 1):324.

T1P174 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):324–3.

T2PLB1 Acute effects of non-nutritive sweetener consumption on food intake behavior and spatio-temporal brain responses to food viewing

C Crézé 1, L Candal 1, J Cros 1, J Knebel 2, K Seyssel 1, N Stefanoni 1, P Schneiter 1, L Tappy 1, U Toepel 2

Introduction

Whether non-nutritive sweetener (NNS) consumption impacts food intake behavior in humans is still unclear. Discrepant sensory and metabolic signals are proposed to mislead brain regulatory centers, in turn promoting maladaptive food choices favoring weight gain. Consistent with this hypothesis, some studies indeed showed differential brain responses to NNS vs sucrose tasting. Along the same line, we hypothesized that ingestion of sucrose- and NNS-sweetened drinks would differently alter subsequent drives towards food and spontaneous intake and modulate spatio-temporal brain dynamics to food viewing.

Methods

Eighteen normal-weight men were studied in fasting condition and after consumption of a standardized breakfast accompanied by either a NNS-sweetened (NNS), or a sucrose-sweetened (SUC) drink, or water (WAT), in a randomized crossover double-blinded design. Their brain responses to visual food cues were assessed by means of electroencephalography before and 45 min after food ingestion. Four hours after ingestion of the meal, their food intake was monitored during a buffet lunch.

Results

Total energy intake at buffet was significantly lower under SUC (mean kcal ± SEM; 791 ± 62) than under WAT (942 ± 71) and NNS (917 ± 70) (NNS vs WAT: p = NS). There were no differences between drink conditions in terms of food choices. Under SUC and WAT, neural activity significantly increased pre-to-post-prandially in brain areas linked to cognitive control and interoceptive activity (dorsal prefrontal and insula), and decreased in temporal areas linked to food categorization. These changes were correlated with a decreased hunger level pre-to-post-prandially and smaller caloric intake at buffet. Under NNS, neural activity significantly increased pre-to-post-prandially in ventrolateral prefrontal regions linked with the inhibition of reward.

Conclusion

Contrary to sucrose, NNS consumption did not have different acute effects than water on subsequent food intake. Yet, it inherently impacted brain responses to food viewing in ventrolateral prefrontal cortices, which may be a marker of longer-term consequences on impulse control when exposed to food cues.

Conflict of Interest: None disclosed.

Funding

Research related to this abstract was funded by a grant from the Swiss National Science Foundation attributed to Prof. Luc Tappy. The electroencephalographic recording equipment was provided by Prof. Micah M. Murray (Center for Biomedical Imaging of Lausanne and Geneva, Switzerland).

Obes Facts. 2018 May 26;11(Suppl 1):324.

T2PLB2 Cancer survivor's adherence to healthy lifestyle behaviors; meeting the World Cancer Research Fund (WCRF) recommendations, a systematic review and meta-analysis

DN Tollosa 1

Introduction

Lifestyle behaviors such as healthy diet, regular physical activity and maintaining a healthy weight are essential for cancer survivors to improve the quality of life and longevity. However, there is no study that synthesis cancer survivor's adherence to healthy lifestyle recommendations. The purpose of this review was to collate existing data on the prevalence of adherence to healthy behaviors and produce the pooled estimate among adult cancer survivors

Methods

Multiple databases (Embase, Medline, Scopus, Web of Science and Google Scholar) were searched for relevant articles published since 2007, reporting cancer survivors adherence to more than two lifestyle behaviors based on the WCRF/AICR recommendations. The pooled prevalence of adherence to single and multiple behaviors (operationalized as adherence to more than 75% (3/4) of health behaviors included in a particular study) was calculated using a random-effects model. Subgroup analysis adherence to multiple behaviors was undertaken corresponding to the mean survival years and year of publication.

Results

A total of 3322 articles were generated through our search strategies. Of these, 51 studies matched our inclusion criteria, which presenting data from 2,620,586 adult cancer survivors. The highest prevalence of adherence was observed for smoking (pooled estimate: 87%, 95% CI: 85%, 88%) and alcohol intake (pooled estimate 83%, 95% CI: 81%, 86%), and the lowest was for fiber intake (pooled estimate: 31%, 95% CI: 21%, 40%). Thirteen studies have reported the proportion of cancer survivors (all used a simple summative index method) to multiple healthy behaviors, whereby the prevalence of adherence was ranged from 7% to 40% (pooled estimate 23%, 95% CI: 17% to 30%). Subgroup analysis suggested that short-term survivors (<5 years survival time) had relatively a better adherence to multiple behaviors (pooled estimate: 31%, 95% CI: 27%, 35%) than long-term (>5 years survival time) cancer survivors (pooled estimate: 25%, 95% CI: 14%, 36%). Pooling of estimates according to the year of publication (since 2007) also suggests an increasing trend of adherence to multiple behaviors over time

Conclusion

Overall, the adherence to multiple lifestyle behaviors was poor (not satisfactory), and relatively, it is a major concern for long-term than short-term cancer survivor. Cancer survivors need to obey healthy lifestyle recommendations related to physical activity, fruit and vegetable, fiber, red/processed meat and sodium intake.

Obes Facts. 2018 May 26;11(Suppl 1):324.

T2PLB3 Self perception, self-esteem and food disturbances in persons with obesity or diabetes – a comparative study

A Morosanu 1, M Morosanu 1, AI Clinciu 2

Introduction

Body image self perception, body satisfaction, body image are important factors in therapeutic management and quality of life of persons with obesity and/or diabetes. In studies, body image self perception varied with BMI in women with type 2 diabetes. There was a direct relation between low body satisfaction and increased BMI in girls. Body dissatisfaction was related to low self-esteem and depression in women. Perceived overweight was linked to low self-esteem in women. Eating disorders frequently associate with overweight and obesity. Disturbed body image was related to abnormal eating behaviors or attitudes and could precede dysfunctional eating behaviors. Decreased body satisfaction was associated with increased inadequate behaviors like unhealthy diets and compulsive eating.

Methods

The study included 105 adult persons with obesity or diabetes mellitus, among which 60 women (57,14%), 45 men (42,86%), mean age 52,23 ± 14,04 years (minimum - 20 years, maximum - 80 years), 41 persons with obesity and 64 persons with diabetes. We collected anthropometric data: weight, height, waist circumference, body mass index (BMI). We applied validated questionnaires: Questionnaire for Evaluation of Eating Disturbances (Clinciu), Questionnaire of Self Perception Clinciu (SP), Questionnaire of Body Self Perception Clinciu (BSP), Rosenberg Self Esteem Questionnaire (RSE), Social Self-Esteem Inventory (SSEI) (Lawson).

Results

Body self perception (total BSP) was inversely correlated with BMI and waist, while total QEED score was directly correlated with BMI and waist for the whole group. RSE score was inversely correlated with waist. In persons with obesity, BSP was inversely correlated with BMI and waist, while total SP and SSEI score were inversely correlated only with BMI. The relations were not significant in persons with diabetes. Total QEED score was directly correlated with BMI and waist (weak intensity), and RSE score was inversely correlated with waist in persons with diabetes. The relations were not significant in persons with obesity. Analysis of parameters between obesity and diabetes showed SP values significanlty lower in persons with diabetes compared with obese persons. Persons with diabetes had higher values of total QEED and lower values of critic PS (close to significance).

Conclusion

The more increased were BMI and/or waist, the lower were BSP, SP and social self-esteem in persons with obesity, while persons with diabetes experience higher tendency toward eating disorders and lower self esteem. Self perception was diminished in persons with diabetes showing lower self-esteem possibly due to chronic disabling disease (diabetes) which may have been more damaging for self image than obesity. It is possible that persons with diabetes could be more predisposed to eating disorders than obese persons. Correlation between QEED – BMI may sustain this supposition.

Obes Facts. 2018 May 26;11(Suppl 1):324–325.

T2PLB4 Maternal body mass index and pregnancy outcomes, comparing women of Pakistani women with white British women: an analysis of data from the Born in Bradford (BiB) cohort

E Slack 1, J Rankin 1, S Rushton 2, N Heslehurst 1

Introduction

South Asian populations are at increased risk of obesity-related poor health compared with White populations. There is limited evidence relating to the implications of obesity in pregnancy for South Asian women and their offspring. This study investigated associations between early pregnancy maternal BMI and pregnancy outcomes in in Pakistani and White British women.

Methods

Analysis was carried out using data on pregnancies among Pakistani and White British women from the BiB Cohort (n = 11088; 4991 Pakistani and 4385 White). Frequencies were used to look at ethnic differences in BMI categories. Generalised linear models were used to investigate associations between maternal BMI as a continuous exposure and different pregnancy outcomes. Adjustments were made for maternal age, parity, place of birth of mother, father and their parents, gestational age at booking, smoking, family history of diabetes, previous diabetes, age mother moved to the UK, alcohol consumption environmental tobacco smoke, Index of Multiple Deprivation, parental education and employment.

Results

Following exclusion of missing data (ethnicity (n = 22) and BMI (n = 537)), subsequent pregnancies (n = 858) and other ethnic groups (n = 1595), n = 7626 women remained (4261 Pakistani and 3815 White). Using general population BMI criteria, 42% had a recommended BMI (18.5-24.9kg/m2) (41% White, 43% Pakistani), 4% were underweight (<18.5kg/m2) (2% White British, 5% Pakistani), 28% were overweight (25.0-29.9kg/m2) (27% White British, 28% Pakistani), and 21% had obesity (≥30.0kg/m2) (23% White British, 18% Pakistani). Using Asian-specific BMI criteria for Pakistani women, 29% had a recommended BMI (18.5-23.0kg/m2), 31% had an overweight BMI (23.0-27.49kg/m2), and 29% had obesity (≥27.5kg/m2). For every 1kg/m2 increase in BMI, both ethnic groups had gestational weight loss; Pakistani women lost less (adjusted coefficient -0.23 95% confidence interval (CI) -0.28 to -0.18) than White women (adjusted coefficient -0.27 95%CI -0.33 to -0.21). Pakistani women had increased odds of gestational diabetes (GDM) (AOR 1.09 95%CI 1.06-1.12) compared with White women (AOR 1.05 95%CI 1.01-1.09). Pakistani women had lower odds of hypertensive disorders of pregnancy (AOR 1.11 95%CI 1.07-1.15) than White women (AOR 1.13 95%CI 1.09-1.16). Birth weight (g) was lower in Pakistani women (adjusted coefficient 16.38 95%CI 10.62-22.14) compared with White women (adjusted coefficient 17.75 95%CI 13.09-22.41). Odds of cesarean section were lower in Pakistani women (AOR 1.04 95%CI 1.00-1.07) compared with White women (AOR 1.06 95%CI 1.04-1.10). Odds for induction were lower for Pakistani women (AOR 1.07 95%CI 1.04-1.10) compared with White women (AOR 1.08 95%CI 1.04-1.11). There was no significant associations between BMI and pre- or post-term birth, or stillbirth for either ethnic group.

Conclusion

In the BiB cohort, applying Asian-specific criteria to Pakistani women's BMI increases prevalence of overweight and obesity by 3% and 11% respectively. Pakistani women had increased odds of GDM and lower birth weight. Further research will investigate associations between maternal BMI, gestational weight gain and pregnancy outcomes using regression analysis and structural equation modelling.

Obes Facts. 2018 May 26;11(Suppl 1):325.

T2PLB5 A voluntary deal between the government and food federation for tackling obesity – a Belgian case study

C K Nikolaou 1, O Deschutter 2

Introduction

With both obesity prevalence constantly increasing, governments are trying to find solutions to contain the epidemic. The 5% calorie reduction covenant was signed in June 2016 between the Belgian Health Ministry and the food commercial groups, in Belgium. The covenant had as a primary aim to reduce the calorie intake of the Belgian population by 5% within a year and thus reduce the prevalence of obesity and other Non-Communicable Diseases (NCDs) in the country. This study presents findings on how this voluntary deal is approached by commercial groups providing and distributing food items in the Belgian market.

Methods

A review and analysis of documents and communications followed by an interview with representatives from the commercial groups carried out to gauge the approach taken from the commercial groups in order to achieve the 5% calorie reduction.

Results

Even though the agreement was signed in 2016, the calorie reduction is intended to be measured from the year 2012 when manufacturers started reformulating products to reduce salt content. Commercial groups include both manufacturers and distributors of food products. The manufacturers’ group comprises of 95% regional and 5% multinationals however multinationals, despite the small percentage, have more products in the market. To date, the main target of the manufacturers’ group is product reformulation to reduce the amount of sugar, saturated fat, fat in products and increase the amount of fibre. The products that have already been reformulated or will soon be reformulated are soft drinks, flavoured milk (cow's milk), yoghurts (cow's milk), soy products (milk, yoghurts, desserts), chocolate, ice-cream, soft drinks, and bread. Distributors of products announced that newly reformulated products will be accompanied with information to the consumers.

Conclusion

All products, except for bread, targeted by the convenant are food products that according to the nutrition guidelines of Belgium and that of most countries should only be consumed occasionally. Reaching a 5% calorie reduction at the population level by targetting only these products seems unlikely and raises the question as to whether voluntary deals should be replaced with legislation.

Obes Facts. 2018 May 26;11(Suppl 1):325–326.

T2PLB6 Does weight bias depend on educational attainment and level of income? A systematic Review

M Bernard 1, T Fankhänel 1, SG Riedel-Heller 2, C Luck-Sikorski 1

Introduction

Obesity is considered as a worldwide health issue, not only because of its health-related consequences but also because of its impact on the social level due to stigma. Aim of this study is to review the quantitative state of research on weight-related attitudes depending on people's educational attainment and level of income from a sociological perspective. Based on Bourdieu's ‘Theory of Class’ and his concept of ‘habitus’ it is assumed that people with a higher level of education and income show greater and more negative attitudes towards people with obesity.

Methods

A systematic literature review was conducted in 2017 using PubMed, PsychINFO, Web of science, and Cochrane Library. Fifteen studies that measured either educational attainment or level of income on the one hand and weight bias on the other hand, were included in the analysis.

Results

The results of studies were heterogeneous: Six of these studies were found in support of the hypothesis, whereas two of the studies contrast it. The remaining seven studies do not show any significant correlation between education or income and weight bias. In result, the work assumption can neither get verified nor falsified.

Conclusion

Controversial findings could be traced back to cultural differences, as Bourdieu's concept might be more applicable for countries, in which the idea of a Protestant work ethic is common. Furthermore, educational attainment seems to be more likely to predict weight bias than income. The review revealed a lack of research when it comes to examining the impact of socioeconomic capital (level of education and income) on obesity stigma.

Obes Facts. 2018 May 26;11(Suppl 1):326.

T2P213 Obesity as a coping strategy against Posttraumatic Stress Disorder

MT Yerli 1

Introduction

The aim of this paper is to discuss about the connection between obesity and traumatic event. The general approach about the correlation between obesity and trauma is that obesity is a side effect. But the hypothesis of this study is that obesity is a defense mechanism that protect people especially from suicide.

Methods

Data was collected from patients who came to a university clinic in order to lose weight. We used psychodrama and art-therapy techniques and qualitative methods to understand the patients past experiences and worked on trauma using active psychotherapeutic methods and “four port” concept.

Results

All patients talked about at least one traumatic experience and expressed that eating helped them to hang on to life during their fight against their trauma. And after working on trauma using “four port” approach, it was expressed that they felt themselves better.

Conclusion

Our findings show us that obesity is a kind of coping strategy. After concluding the result it can be said that well-designed studies needed to show this hypothesis

Obes Facts. 2018 May 26;11(Suppl 1):326.

T2P214 Influence of an educational media campaign on the development of pro-health shopping behavior of Poles in the context of purchasing products with a lower content of salt, sugar and fat

G Skarżyńska 1, P Cholewińska 1, M Jarosz 1, M Siuba-Strzelińska 1

Introduction

The research carried out before the media campaign among people deciding about family food purchases revealed the lack of sufficient knowledge on how to understand the information contained in the nutrition box on the labels and how to refer this information to their own diet. Therefore, the aim of the campaign was to develope the habit of comparing food products from the same categories in terms of nutrient content, so that consumers would choose those more beneficial for health. The main focus is on comparing the level of fat, sugar and salt as the main factors of chronic diseases. Main message of the campaign: Less salt, sugar, fat? I buy it!

Methods

The study was conducted using the CATI technique (computer-assisted telephone interviewing), on a representative group of Poles aged 18+, women and men (N = 854), deciding about purchases, date of pre-test: 23-30.12.2016, post-test: 17-23.02.2017

Results

The research confirmed that the campaign had a positive impact on consumer behavior: −79% of people learned through the campaign that by comparing product labels they can choose products with higher health values; -76% learned through the campaign that similar products can differ significantly in terms of composition; -70% of those who saw the campaign began to read labels and compare different products more often; -over 2/3 of people indicated that the campaign prompted them to pay attention to salt, sugar and fat content in selected food products (68%). -in the opinion of 63% of people, the campaign provided information that they had not previously had - what to look for when buying food products. This contributed to the growth of positive behaviors in the entire representative group deciding about purchases: - the percentage of Poles who declare reading labels always or often increased by 11% (from 49% before, up to 60% after the campaign). - among persons reading labels after the campaign by 8% more people declared that they compare labels of similar products with each other in order to select a product with healthier ingredients (before the campaign 66%, after the campaign 74%) - what's more - in this group the percentage of people comparing the key ingredients promoted in the campaign has increased: for fat by 3% (before the campaign 60% after the campaign 63%), for sugar by 8% (before the campaign 57% after the campaign 65%), for salt by 6% (before the campaign 33% after the campaign 39%)

Conclusion

In the case of a low level of knowledge among buyers on how to understand the information contained in the nutrition box on the label, effective education should be based on the small steps method. The promotion of simple, easy to implement recommendations effectively affects the awareness and shopping behavior of people who decide about shopping in households.

Obes Facts. 2018 May 26;11(Suppl 1):326–327.

T2P215 Efficacy of a game-based mobile application intervention in physical activity promotion and health management

Y Chang 1, S Liu 2, Y Hsu 2

Introduction

Mobile applications provide a unique platform for the delivery of health intervention to young populations. The study aims to assess the efficacy of a mHealth application incorporating a team-based exercise game and on-line support from social media for physical activity promotion and obesity prevention.

Methods

Participants were 140 undergraduate students in Taiwan (mean age = 22.5 ± 0.5 years; female = 80%). Participants were randomly assigned to one of the three intervention groups for 2 months: activity tracker group, activity tracker + on-line game group, and activity tracker + on-line game + Facebook group. Physical activity was objectively measured by wrist-worn activity trackers. Assessment of body composition was obtained through bioelectrical impedance analysis. Paired Sample T-Test and multivariate regressions were utilized to evaluate the efficacy of the game-based mHealth intervention in increasing physical activity and reducing body fat.

Results

After the 8-week intervention, participants in the “activity tracker + on-line game” group (p < 0.0001) and the “activity tracker + on-line game + Facebook” group (p < 0.0001) showed significant increase in time spent doing moderate-to-vigorous physical activity (MVPA). Similar results were found for body fat percentage, there were significant reductions in body fat percentage were found for both “activity tracker + on-line game” group (p < 0.0001) and the “activity tracker + on-line game + Facebook” group (p < 0.0001) over the 8-week intervention. As for the changes in muscle mass, only those in the “activity tracker + on-line game + Facebook” group showed increase in muscle mass at the end of the intervention. No significant changes in MVPA, body fat percentage, and muscle mass were observed for the “activity tracker” group.

Conclusion

Simply wearing activity devices may not result in promoting physical activity among young adults. Incorporating features such as online gaming and social media in the wearable technology could lead to desirable changes in activity behaviors over a 2-month period.

Obes Facts. 2018 May 26;11(Suppl 1):327.

T2P216 Effect of diet energy density and life style changes on diabetes mellitus and glycemic control

T Koçak 1, E T 1

Introduction

Type 2 Diabetes mellitus (DM) is defined as a chronic disease that is caused by lifestyle changes such as sex, age, diet, obesity, sleep problems, and rapidly increasing world prevalence [1]. By 2017, the number of diabetic patients in the world is estimated to be 424.9 million, which is expected to reach 628.6 million by 2045 with an increase of 47.9% [2]. The prevalence of DM was determined to 13.7% according to Diabetes Epidemiology Turkey (TURDEP-II) in Turkey [3]. The diet is known to play an important role in the etiology of DM [4]. There are also a number of studies that have shown negative metabolic effects that include reduced insulin sensitivity in individuals who consume dietary energy density foods [5, 6]. Wang et al showed that dietary energy density was higher in individuals with Type 2 diabetes (3.08 kJ / g) than those without diabetes (3.01 kJ / g), and there was a positive relationship between diabetes and dietary energy density [6]. In addition to diet, stress is thought to be effective in the development of diabetes [7]. Stress may cause glycemic control (GC) impairment through the effects on the neuroendocrine system, or it can indirectly affect through changes in lifestyle [8, 9]. Lloyd, et al. examined the levels of GC in people with stress conditions. It has been shown that severe stressors in daily life are associated with poor GC. It has been associated with the elimination of stressors and GC [9]. Metabolism, food consumption, meal timing and some nutrient affect circadian rhythm with feedback mechanism [10]. Circadian rhythm impairment leads to metabolic diseases. The first of these is the metabolic syndrome [11, 12]. In a study conducted by La Fleur et al. on rats, 24-hour rhythm relationship with suprachiasmatic nucleus (SCN) plasma glucose concentrations was investigated. As a result; intact circadian rhythm has played a key role in energy metabolism and insulin sensitivity. SCN has been implicated in circadian variations in glucose uptake and insulin release [12].

Methods

We searched tree electronic databases (Pubmed, Web of Science and Science Direct), using key terms such as ((Diabetes mellitus OR Diabetes Epidemiology OR insulin sensitivity OR dietary energy density OR Stress OR glycemic control OR meal timing OR Circadian rhythm)) with language (English) filter. We included human studies and animal models. The last literature search is made on March 1, 2018.

Results

The dietary energy intensity and lifestyle (physical activity, meal timing, nutrient composition, sleep pattern and stress) are associated with glycemic control.

Conclusion

Lifestyle changes (physical activity, meal timing, nutrition pattern, sleeping pattern and stress) play a key role in the prevention of obesity and related Type 2 Diabetes mellitus.

Conflicts of Interest

Type 2 Diabetes mellitus (DM) is defined as a chronic disease that is caused by lifestyle changes such as sex, age, diet, obesity, sleep problems, and rapidly increasing world prevalence. By 2017, the number of diabetic patients in the world is estimated.

Obes Facts. 2018 May 26;11(Suppl 1):327–328.

T2P217 The assesment of beverage consumption in adults in Turkey – a pilot study

F Ayyıldız 1, N Acar Tek 1, G Akbulut 2

Introduction

The prevalence of overweight/obesity has increased in recent years. A lot of factors such as age, gender, dietary, genetic and sedentary lifestyle effect on weight status. Dietary factors including beverage consumption may play a role in weight management by effect of energy balance. It was aimed to evaluated beverage consumption according to gender.

Methods

This study was conducted among 983 individuals (352 males and 631 females) aged between 18-64 years. The daily consumption of beverages was evaluated by practitioner according to a beverage intake questionnaire. The data was analysed by SPSS and statistical significance level was given within a confidence interval of 95%.

Results

 

Conclusion

Beverage intake may be affect by gender. Also beverage consumption may be affect by age, demographic and lifestyle factors. Further, long-term prospective studies investigating the relationship among beverage consumption, total energy intake are needed

Tab. 1.

The assessment of beverage consumption according to gender (mL) The most commonly reported beverage was plain water. The top three choices of beverages both of gender were water, black tea and coffee. In males the mean consumption of ayran, fresh fruit juice, fruit juice, black tea, carbonated beverages, soda, energy drinks and alcolic beverages were higher than females (p < 0.05). However the mean herbal teas consumption in females was higher than males (p = 0.00). There wasn't any significant difference in water, milk, kefir and coffee consumption among gender (p > 0.05).

 Male (n: 366)
 Female (n: 634)
Beverage consumption (mL/day) x ± SD Min Max x ± SD Min Max p
Water 1626.2 ± 692.85 30.0 3500.0 1573 ± 3±690.25 100.0 5000.0 0.25
Milk 74.4 ± 130.39 0.0 1500.0 74.9 ± 91.54 0.0 600.0 0.95
Ayran 86.6 ± 85.90 0.0 400.0 69.9 ± 91.54 0.0 400.0 0.00
Kefir 6.6 ± 27.51 0.0 200.0 7.3 ± 31.41 0.0 250.0 0.73
Fresh fruit juice 29.7 ± 50.40 0.0 250.0 22.9 ± 49.38 0.0 400.0 0.04
Fruit juice 44.9 ± 69.10 0.0 550.0 29.8 ± 58.97 0.0 600.0 0.00
Black tea 541.8 ± 452.97 0.0 2500.0 446.4 ± 397.13 0.0 2500.0 0.00
Herbal teas 37.2 ± 82.76 0.0 500.0 70.1 ± 109.65 0.0 800.0 0.00
Coffee 97.3 ± 154.15 0.0 1000.0 105.7 ± 143.17 0.0 1000.0 0.40
Carbonated bevereages 82.5 ± 122.75 0.0 1100.0 43.5 ± 88.73 0.0 1000.0 0.00
Soda 47.0 ± 69.92 0.0 600.0 38.6 ± 58.89 0.0 350.0 0.06
Energy drinks 6.9 ± 25.8 0.0 220.0 0.9 ± 10.83 0.0 250.0 0.00
Alcoholic beverages 9.9 ± 37.35 0.0 330.0 5.2 ± 23.17 0.0 200.0 0.03
Other drinks 0.4 ± 5.54 0.0 100.0 0.6 ± 6.99 0.0 100.0 0.59
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Obes Facts. 2018 May 26;11(Suppl 1):328.

T2P218 The assessment of cardiovascular disease risk and dietary intake in university Student

H Yıldıran 1, F Ayyıldız 2, I Ülker 2

Introduction

Lifestyle, dietary behaviors and anthropometric measures effect on cardiovascular disease risk. Waist-to-height ratio (WHtR) is very popular indicator as measures of adiposity and as important cardiometabolic disease risk factors. The purpose of this study was to examine association between dietary intake and WHtR in university students

Methods

This study was conducted on 300 healthy university students (92 males and 208 females) aged between 18-25 years. The dietary intake (energy, protein, carbohydrate and fat) was evaluated by a 24-hour dietary recall form. WHtR was calculated and classified into two categories. WHtR cutoff value of ≥0.5 identified people with increased risk for CVD. The data was analysed by SPSS and statistical significance level was given within a confidence interval of 95%.

Results

The mean age of students was 20.9 ± 1.75 years. In males, energy and carbohydrate intake in increased risk group according to WHtR was higher than no increased risk group. In females all of them (energy, protein, carbohydrate and fat intake) was higher in increased risk group. However these results were not statistically significant (p > 0.05).

Conclusion

Waist-to-height ratio may contribute to increase in CVD risk factors in university students. The evaluation of other CVD risk factors as physical activity and socio-economic status may be useful in further following studies.

Tab. 1.

The Assessment of Cardiovascular Disease Risk and Dietary Intake
No increased risk (<0.5)
 Increased risk (≥0.5)
x ± SD x ± SD p
Males (n: 92) Energy (kkal) 1885.8 ± 591.40 (n:70) 1946.2 ± 829.66 (n:22) 0.75
Protein (g) 62.2 ± 24.44 62.0 ± 30.73 0.97
Carbohydrate (g) 224.0 ± 81.53 244.0 ± 115.29 0.45
Fat (g) 78.6 ± 30.37 76.1 ± 31.71 0.73
Females (n:208) Energy (kkal) 1751.5 ± 584.12 1930.9 ± 671.30 0.20
Protein (g) 54.2 ± 23.67 56.9 ± 24.35 0.63
Carbohydrate (g) 214.7 ± 85.76 253.4 ± 105.15 0.12
Fat (g) 71.9 ± 25.97 72.5 ± 22.53 0.92
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Obes Facts. 2018 May 26;11(Suppl 1):328.

T2P219 Evaluation of n-3 fatty acids intake status and anthropometric measurements of female university students

I Ülker 1, H Yıldıran 2, F Ayyıldız 1

Introduction

Omega-3 fatty acids are an important fatty acids that is essential for the prevention and treatment of many diseases, from coronary heart disease to inflammation. The amount of omega-3 fatty acids consumption is affected by many factors. One of the most important factors affecting the amount of consumption is the changing eating habits depending on the student. Antropometric measurements are another factor that may affect omega 3 fatty acids intake. This study was planned to evaluate n-3 fatty acids intake status and anthropometric measurements of female university students.

Methods

This study was conducted on 208 individuals aged 18-25 years (mean age 20.6 ± 1.67 years). The data about the volunteers participating in the survey were obtained by questionnaire filled in face to face. Questionnaires and anthropometric measurements of health information, food consumption records were taken by the researcher. While BMI is 20-25 kg/m2 as normal weight, BMI is 25-30 kg/m2 as overweight.

Results

Participants’ intake of n-3 fatty acidss was found to be minimum and maximum of 0.22g and 4.87g (average 1.1 ± 0.66g), respectively. The mean body mass index (BMI) of the subjects participating in the study was 21.3 ± 2.61 kg / m2. Participants’ waist circumference measurements and waist circumference were calculated as 76.4 ± 8.54 cm and 0.7 ± 0.06, respectively. In the BMI <25, n-3 fatty acids intake was found 1.1 g, while in the 25 ≤ BMI, n-3 fatty acids intake was found 1,2. There was no correlation between anthropometric measurements and n-3 fatty acids intake.

Conclusion

This study there was no relationship between n-3 fatty acids and anthropometric measurements. Participants’ average n-3 fatty acids intake levels is the recommendations of the World Health Organization.

Obes Facts. 2018 May 26;11(Suppl 1):329.

T2P220 Screening tools used for determining disordered eating behaviour among female undergraduate students at a South African university

J E Barnard 1, F Veldman 2, S Kassier 1

Introduction

The prevalence of disordered eating behaviour among female university students at undergraduate level often go undiagnosed due to the clinical criteria used for diagnostic purposes that are not necessarily sensitive enough to enable the diagnosis of an eating disorder (ED), within this classification. Available studies render conflicting results of disordered eating and eating disorders among dietetic- and non-dietetic undergraduate female students. The aim of this study was to detemine and compare the Body Mass Index (BMI), eating behaviour and eating attitude of a sample 62 first-, third- and fourth year dietetics students versus 83 first year non-dietetic students at a South African University, using various approved screening tools.

Methods

Eating behaviour was determined by means of the ‘'sick, Control, One stone, Fat, Food’ (SCOFF) questionnaire and the behavioural questions of the Eating Attitude Test-26 (EAT-26) questionnaire to screen for the presence of an eating disorder. Eating attitude was determined by means of the Three Factor Questionnaire (TFEQ), which assessed hunger, disinhibition of eating and dietary restraint and the EatScore of the EAT-26 questionnaire. Statistical analysis were conducted by SPSS version 21, descriptive statistics, independent samples t-tests and chi-square tests.

Results

The mean BMI of first year non- dietetic students (24.2 +−5.3kg/m2) was higher than first year dietetic students (23.2 +−4.3 kg/m2). The prevalence was higher in first year non-dietetic students for SCOFF 1 (Bulimia Nervosa (BN) - self induced vomiting), SCOFF 2 (binge eating), SCOFF 3 (weight loss), SCOFF 4 (feeling fat) and EAT A (binge eating). While first year dietetic students had a higher indication for SCOFF 5 (food), EAT B (BN), EAT C (diet pills) and EAT D (treated for an ED).

Conclusion

Thus disordered eating was prevalent in both first year non-dietetic students (binge eating, BN and self-worth based on body shape and weight) and first year dietetic students (obsessive calorie counting, misusing laxatives or diuretics, BN and previously diagnosed with an existing ED). The questioinnaires used as screening tools were similiar for the results of the students, which concluded that it would be of value if one combined screening tool could be developed (ED Questionnaire) for future use. This could assist in the selection process of prospective dietetic- and non-dietetic students to determine if they suffer from a disordered eating pattern, which then could be assisted at undergraduate level.

Obes Facts. 2018 May 26;11(Suppl 1):329.

T2P221 Metabolic syndrome and the risk of Parkinson's disease – a nationwide population-based cohort study

S Kim 1, G Nam 1, NH Kim 2

Introduction

The association of metabolic syndrome with the development of Parkinson's disease is currently unclear. Once a term is abbreviated, the abbreviation should be used consistently throughout the text.

Methods

Health checkup data This phrase seems incomplete. Please check that my suggestion clarifies the meaning of the phrase.

Results

We identified 44,205 incident Parkinson's disease cases during follow up. The metabolic syndrome group showed an increased risk of Parkinson's disease development compared with the non-MetS group in all adjusted models (model 1, HR, 95% CI: 1·29, 1·27–1·32; model 2, 1·26, 1·24–1·29; model 3, 1·24, 1·21–1·27). Each metabolic syndrome component was positively associated with Parkinson's disease risk (1·13, 1·10–1·16 for abdominal obesity; 1·13, 1·10–1·15 for hypertriglyceridemia; 1·23, 1·20–1·25 for low high-density lipoprotein cholesterol; 1·05, 1·03–1·08 for high blood pressure; 1·21, 1·18–1·23 for hyperglycemia). Parkinson's disease incidence positively correlated with the number of metabolic syndrome components (log-rank P < 0·001) and we observed a Stepwise increase is not a common expression. Please consider gradual.

Conclusion

Our population-based large-scale cohort study suggests that metabolic syndrome and its components may be risk factors for Parkinson's disease development. Careful monitoring of neurological symptoms related to Parkinson's disease is imperative in metabolic syndrome patients and assessment and optimal control of metabolic syndrome is recommended when encountering a newly diagnosed parkinsonism

Obes Facts. 2018 May 26;11(Suppl 1):329.

T2P222 Cardiorespiratory fitness and health-related quality of life in adolescents – a longitudinal analysis from the LabMed Physical Activity study

O S Evaristo 1, C Moreira 2, R Santos 3, J Mota 2, S Abreu 2, J Oliveira_Santos 2, L Lopes 2, A Oliveira 2, C Agostinis-Sobrinho 2

Introduction

Background

There is an insufficient number of longitudinal studies that examine the association between cardiorespiratory fitness and health-related quality of life (HRQoL) in adolescents. Purpose: The purpose of this study was to examine the longitudinal associations between cardiorespiratory fitness and health-related quality of life (HRQoL) in a sample of adolescents, and to determine whether changes in cardiorespiratory fitness were associated with HRQoL over a 2-year follow-up.

Methods

This is a longitudinal analysis with 571 Portuguese adolescents (274 boys and 297 girls) aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire; the 20 m shuttle-run was used to estimate cardiorespiratory fitness; socioeconomic status was assessed with the Family Affluence Scale; and pubertal stage was assessed with Tanner stages. One-way repeated measures analysis of variances (ANOVAs), regression analysis, and ANCOVA were performed.

Results

HRQoL decreased more over the time for girls reporting poorer HRQoL than for boys. After adjustments for potential confounders, regression analyses showed significant cross-sectional associations between cardiorespiratory fitness and HRQoL both at baseline (B = 0.095; p = 0.023) and at follow-up (B = 0.090; p = 0.012). ANCOVA showed that adolescents whose cardiorespiratory fitness decreased over time exhibited lower scores of HRQoL at follow up, compared to those with persistent high cardiorespiratory fitness; this held after adjustments for age, sex, socioeconomic status, and pubertal stage.

Conclusion

Changes in cardiorespiratory fitness during adolescence were associated with HRQoL over a two-year period. This study suggests that improving cardiorespiratory fitness could be a particularly important strategy in improving the HRQoL of adolescents.

Obes Facts. 2018 May 26;11(Suppl 1):329.

T2P223 Associations between physical fitness and adherence to the Mediterranean diet with health-related quality of life in adolescents. Results from the LabMed Physical Activity study

O S Evaristo 1, J Oliveira-Santos 2, C Agostinis-Sobrinho 1, R Santos 3, L Lopes 4, J Mota 1, C Moreira 4, A Oliveira 1, S Abreu 1, S Póvoas 5

Introduction

Physical fitness (PF) and adherence to the Mediterranean diet are important indicators of healthy lifestyles. The purpose of this study is to analyze the combined associations between PF and adherence to Mediterranean diet with health-related quality of life (HRQoL) in adolescents.

Methods

This is a cross-sectional analysis with 956 Portuguese adolescents aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire. Physical fitness (PF) was assessed with the ALPHA health-related fitness battery. The 20-m shuttle run test was used for the estimation of cardiorespiratory fitness; handgrip strength and standing long jump tests were applied for the assessment of muscular fitness and the 4x10m shuttle run test for the assessment of motor fitness (speed and agility). The results of the PF tests (cardiorespiratory fitness, muscular fitness, and motor fitness) were transformed into standardized values (Z-scores) by age and sex. Adherence to the Mediterranean diet was assessed with the KIDMED index. Regression analysis and ANOVA were performed.

Results

PF (B = 0.228; p < 0.05) and adherence to the Mediterranean diet (B = 0.259; p < 0.05) were positively associated with HRQoL, after controlling for several variables. Participants classified as high PF and high adherence to Mediterranean diet had on average the highest HRQoL score compared to those with low PF and low adherence to Mediterranean diet (F(3,939) = 4.270; p = 0.005), after adjustments for potential confounders.

Conclusion

The combination of high PF levels and optimal adherence to Mediterranean diet is positively associated with HRQoL.

Obes Facts. 2018 May 26;11(Suppl 1):329–330.

T2P224 Leptin resistance associates with mood disorders in postmenopausal women

M F Naufel 1, V Boldarine 2, LM Oyama 3, COD Nascimento 2, GMSD Santos 4, H Hachul 5, EB Ribeiro 2

Introduction

The postmenopause is marked by several factors that have a negative impact on the quality of life, such as hot flashes, sleep disorders, obesity and mood symptoms. Although obesity and mood disorders are highly prevalent among postmenopausal women, the existence of a connection between these pathologies and, if so, which are the factors involved, have not been elucidated. The aim of the present study was to explore whether metabolic, anthropometric and hormonal parameters relate to behavioral symptoms in postmenopausal women.

Methods

57 spontaneous postmenopausal women (age 50-65, PM group) and 23 women in reproductive stage (age 40-50, control group, paired by BMI to PM groups) were studied, who were not in use of hormonal, contraceptive or antidepressant treatments. The postmenopausal women were either at early (EPM, n = 33) or late postmenopause (LPM, n = 24). After a 12-h fast, blood and saliva were collected for biochemical and hormonal determinations (leptin, adiponectin, PAI-1, prostaglandin-E2, INF-γ, TNF-α, FSH and cortisol). Anthropometric parameters were determined by bioimpedance (Inbody-230®). Depression and anxiety symptoms were assessed by Beck's depression and anxiety inventories (BDI and BAI). Data were analyzed by either Anova (and post-hoc Tukey) or Kruskall-Wallis, for p < 0.05. Pearson's correlation and linear regression models were applied.

Results

The LPM group had lower skeletal muscle mass, energy intake and basal metabolic rate values than those of the control group. BMI, percentage body fat (PBF), waist to hip ratio (WHR), and serum leptin levels were above their respective cut-off points in the three groups. HOMA-IR was higher in both EPM and LPM than in controls. Total cholesterol levels were higher in EPM while triglycerides were higher in LPM than in controls. Depression (BDI (median(min-max): CTRL = 7(1-20); EPM = 10(0-29); LPM = 13(6-29) and anxiety scores (BAI: CTRL = 5(1-14); EPM = 10(1-27); LPM = 12(3-25)) were higher in the postmenopausal than in the control groups. BDI scores were also higher in LPM than in EPM. LPM had higher levels of prostaglandin-E2 than those of the control group. BDI scores correlated positively with age, PBF, WHR, FSH, leptin and prostaglandin-E2, while it correlated negatively with energy intake. BAI scores showed positive correlation with age, BMI, PBF, WHR, insulin, FSH, and leptin. The linear regression model for BDI showed that age and leptin levels were positive predictors while energy intake was a negative predictor. Age and leptin levels were also positive predictors of BAI scores.

Conclusion

Postmenopausal women presented abdominal obesity with insulin resistance and decreased energy intake and basal metabolic rate. Depression and anxiety symptoms were increased, with leptin levels and age showing a positive influence, while energy intake showed a negative influence on depressive symptoms. These findings in obese postmenopausal women indicate a relevance of the aging process and the leptin resistance of obesity in favoring the development of mood disorders. Moreover, dieting for weight loss may be cautious in older ages and postmenopause, as caloric restriction may induce depressive symptoms.

Obes Facts. 2018 May 26;11(Suppl 1):330.

T2P225 The determination of the constipation severity scores according to BMI classification

N Acar Tek 1, G Akbulut 1, F Ayyıldız 2

Introduction

Constipation and obesity are a common health problem and results in impaired patients’ quality of life and well-being. Obesity and constipation may be affected each other. The aim of the study was to determine the constipation severity according to body weight and gender

Methods

Constipation severity instrument is developed and validated as a self-report measure of symptom severity in patients with constipation. It has 3 subscales: obstructive defecation, colonic inertia, and pain. Scores range from 0 to 73 with higher scores representing greater symptom severity. Body weight and height were measured and BMI (Body Mass Index) was calculated. Beside actual BMI measures of individuals were assessed according to World Health Organization (WHO) BMI classification. While BMI is 20-25 kg/m2 as normal weight, BMI is 25-30 kg/m2 as overweight.

Results:

This study was conducted w 820 individuals (337 males and 483 females) aged mean constipation severity scores of males with normal weight was higher than overweight 19-64 years. The males (p = 0.008). Similarly this score of females with normal weight was higher than overweight females (p = 0.004). Both gender symptom severity was grater in normal weight (p < 0.05).

Conclusion

The mechanisms underlying the relation between obesity and constipation are still unknown. The constipation severity instrument is a reliable and valid instrument for assessing constipated patients. For constipation as dietary modification (including high-fibre and fluid intake), increased activity, body weight management can be suggested.

Tab. 1.

The mean the constipation severity scores according to BMI classification

 Normal weight (20–25 kg/m2)
 Overweight (25–30 kg/m2)
x±SD Min Max x±SD Min Max p
Males (n:337) 26.1 ± 15.09 (n:174) 0.0 63.0 15.6 ± 13.05 (n:163) 0.0 56.0 0.008
Females (n:483) 22.3 ± 12.44 (n:336) 0.0 58.0 18.5 ± 13.49 (n:147) 0.0 57.0 0.004
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Obes Facts. 2018 May 26;11(Suppl 1):330.

T2P226 Human variability in the energy cost of low-level physical activity: is there a role for insulin sensitivity?

C Monnard 1, E Fares 1, J Calonne 1, I Scerri 1, EK Grasser 1, A K 1

Introduction

It is now recognized that variability in the energy expenditure (EE) associated with low-level physical activity of everyday life plays a role in human predisposition to obesity. However, little attention has been directed towards elucidating the determinants of variability in the specific energy cost (or efficiency) of performing light physical activity. Using two recently validated light exercise tests that are weight-bearing – one primarily dynamic (low power cycling using bicycle ergometry) and the other primarily isometric (intermittent leg press while seated comfortably) - we investigated the extent to which insulin sensitivity might be a determinant of the variability in the energy cost of performing these standardized low-intensity exercises.

Methods

Healthy young men (n = 40; BMI range: 18-35 kg/m2), considered as physically inactive (i.e. who habitually do not meet the guidelines for moderate-to-vigorous aerobic physical activity levels), were studied on two separate mornings in the overnight fasted state. On the first morning, an oral glucose tolerance test was performed and insulin sensitivity was assessed according to the calculated Matsuda index. Concomitantly, EE was measured by ventilated hood indirect calorimetry to assess glucose-induced thermogenesis. On the second morning (2-5 days later), subjects were randomized to perform two exercise tests (i) low power cycling at 60 rpm across 10, 20, 30, 40, 50W for 5 min each using face-mask indirect calorimetry, and (ii) intermittent leg press exercise (30s press & 30s rest per min for 8 min) at isometric loads of 5, 10, 15 & 25 kg force using ventilated-hood calorimetry. The energy cost for performing each exercise test was determined from the slope of the linear regression of EE vs power (cycling ergometry) or EE vs load (isometric leg press).

Results

All subjects were in the normal healthy range for fasting blood pressure, plasma glucose, insulin, and lipid profiles. The Matsuda index of insulin sensitivity correlated positively and significantly with glucose-induced thermogenesis (r = 0.4, p < 0.01), but not significantly with the energy cost of low power cycling, nor with that of the leg press exercise. Sensitivity analysis indicated no alterations in findings when obese subjects were omitted from the data analysis.

Conclusion

In inactive but healthy young men, insulin sensitivity is a significant determinant of the variability in thermogenesis in response to glucose, but does not explain the variability in energy cost (and hence variability in thermogenesis) in response to low intensity exercise.

Obes Facts. 2018 May 26;11(Suppl 1):331.

T2P227 Muscular fitness and cardiorespiratory fitness are associated with health-related quality of life: Results from LabMed Physical Activity study

O S Evaristo 1, C Agostinis-Sobrinho 1, C Moreira 2, R Santos 3, S Abreu 1, J Mota 1, J Oliveira-Santos 2, L Lopes 2, A Oliveira 1, S Póvoas 4

Introduction

Children's physical fitness levels are an important indicator of their lifestyle and seems to have positive consequences in health-related quality of life (HRQoL). The purpose of this study is to analyse the combined associations of cardiorespiratory fitness and muscular fitness with HRQoL in a sample of Portuguese adolescents.

Methods

This is a cross-sectional analysis with 567 Portuguese adolescents aged 12-18 years-old. HRQoL was measured using the Kidscreen-10 questionnaire. Cardiorespiratory fitness was estimated with a 20-m shuttle-run. Muscular fitness was evaluated using handgrip and standing long jump tests and a muscular fitness index was computed by means of standardized measures of both tests. Socioeconomic status was assessed using the Family Affluence Scale. Body composition (body mass and height) was measured according to standard protocols. Accelerometers were used to obtain objective physical activity time. Pubertal stage was assessed using Tanner stages. Adherence to the Mediterranean diet was assessed using the KIDMED index. Participants were divided into four groups based on low or high values of both cardiorespiratory and muscular fitness. Regression analysis and ANOVA were performed.

Results

HRQoL was positively associated with cardiorespiratory fitness (B = 0.112; p < 0.05) and muscular fitness score (B = 0.328; p < 0.05), after controlling for potential confounders. Analysis of covariance after adjusting for potential confounders showed that adolescents with high cardiorespiratory fitness/high muscular fitness exhibit better HRQoL when compared to those with low muscular fitness/low cardiorespiratory fitness and with those with low muscular fitness/high cardiorespiratory fitness.

Conclusion

In adolescents, the combination of high cardiorespiratory fitness and high muscular fitness is positively associated with a better HRQoL.

Obes Facts. 2018 May 26;11(Suppl 1):331.

T2P228 Cross-sectional associations between physical activity and internet addiction among undergraduate students in Taiwan

J Sun 1, Y Chang 1

Introduction

Internet addiction is a major public health problem, particularly among university students. Few studies have addressed modifiable behavioral factors associated with Internet addiction in the context of Taiwan. The purpose of this study was to investigate associations between physical activity and Internet addiction in undergraduate students in Taiwan.

Methods

We recruited 320 undergraduate students in northern Taiwan to participate in a cross-sectional questionnaire-based survey in 2016. The independent variable was physical activity as measured by the Taiwanese short-form version of the International Physical Activity Questionnaire (IPAQ), which evaluates an individual's weekly levels of vigorous-intensity aerobic physical activity (VPA) and moderate-intensity aerobic physical activity (MPA). The dependent variable was Internet addiction as measured by the Chen Internet Addiction Scale (CIAS), which evaluates five factors: compulsive use of the Internet, Internet addiction withdrawal symptoms, Internet addiction tolerance symptoms, interpersonal and health-related problems, and time management problems. We analyzed the data using the chi-square test, t test, one-way ANOVA, and multiple regression analyses in SAS.

Results

Among the 320 surveyed students, the average CIAS score was 53.29, and 18.13% of participants were at risk for Internet addiction (defined as CIAS score > 64). Male students were more likely to report higher CIAS score than female students. Students satisfied with the emotional support they received from their friends and family had lower CIAS scores. Results of multiple regression analysis showed that a routine of at least 150 min of MPA per week was negatively associated with risk for Internet addiction (β = −4.39, 95% CI = [-8.10,0.66]). No significant associations were observed between Internet addiction and 75 min of VPA or 150 min of total physical activity per week. Among the five categories of the CIAS scale, a routine of 150 min of MPA was negatively related to tolerance symptoms, time management problems, and interpersonal and health-related problems.

Conclusion

A routine of 150 min of MPA per week was associated with a lower risk for Internet addiction. Intervention efforts aimed at reducing undergraduate students’ problematic Internet use should promote recommended levels of MPA. After completing this study, we also recommend longitudinal research on the long-term health impacts of Internet addition.

Obes Facts. 2018 May 26;11(Suppl 1):331–332.

T2P229 Effects of time of day of physical activity on daily total physical activity, sleep, and metabolic health

Y Chang 1, Y Lin 2, Y Hsu 2

Introduction

There is a lack of studies on determining how time of exercise during the day could affect total energy expenditure and metabolic health. The study aims to examine associations between timing of physical activity, sleep time, and biomarkers.

Methods

A total of 307 adult Taiwanese (mean age = 56.9 ± 10.7 years, male = 40.7%) were recruited. Subjects wore pedometers for 24 hours and for 7 days. Based on the average percentage of accumulated steps throughout the week, subjects were categorized into four types of exercise concentration: morning, afternoon, evening, and no preference. Sleep behavior was assessed by questionnaires. Fasting glucose, insulin, and lipids were collected from blood assays.

Results

Those in the morning exercise group were older than the afternoon, evening, and no preference groups (p < 0.001). Those in the evening and morning group had a higher level of daily physical activity than those in the no preference group (p = 0.001). Individuals who exercise in the afternoon reported longer night time sleep duration and shorter nap length than those who exercise in the morning (p = 0.004). In addition, greater steps accumulated in the morning were correlated with a higher level of High-density lipoproteins (HDL) cholesterol (r = 0.14, p = 0.02) and a higher level of triglyceride ((r = 0.13, p = 0.03). Steps accumulated in the afternoon were inversely related to HDL-cholesterol (r = −0.17, p = 0.004) while positively related to waist circumference ((r = 0.13, p = 0.02) and 2-hr fasting glucose (r = 0.14, p = 0.02). After controlling for age, gender, and BMI, afternoon exercisers had a higher level of fasting glucose (p = 0.04), greater waist circumference (p = 0.03), and a lower level of triglyceride (p = 0.048) than morning exercisers.

Conclusion

Afternoon exercisers had a lower level of total physical activity and more unfavorable effects on metabolic biomarkers. Studies with larger sample sizes and longitudinal design are needed to confirm associations between time of day of physical activity and metabolic health.

Obes Facts. 2018 May 26;11(Suppl 1):332.

T2P230 Evaluation of physical activity levels with different instruments in young adults: IPAQ, pedometer, and physical activity diary

N Acar-Tek 1, H Mortaş 1, S Arslan 1, T Tatar 1, S Köse 1, M S Karacil Ermumcu 1

Introduction

Recent studies have shown that physical inactivity is common in young adults who are expected to have high physical activity. There exists no report in this field in Turkey. The aim of the present study was to determine the physical activity levels of young adults using the pedometer step counts (PSC), International Physical Activity-Short Form (IPAQ-SF), and physical activity diary (PAD).

Methods

This study was conducted in 551 individuals aged between 18 and 30 years. A questionnaire that includes socio-demographic characteristics, physical activity habits, and anthropometric measurements of the individuals was administrated. Three instruments were used: PSC, PAD, and IPAQ-SF.

Results

The three different physical activity evaluation instruments were shown positive correlation (p < 0.01). The majority of the individuals were active according to PSC (50.1%) and IPAQ-SF (59.7%). However, 61.2% of the individuals were sedentary according to the PAD. In addition, 48.5% of the individuals met the target of 10000 steps/d and 38.9% of them met the target of being active (PAL ≥ 1.7) while 13.4% of them met the target of 30 min / d moderate to vigorous intensity physical activity.

Conclusion

The percentage of individuals met daily physical activity goal is low in young adults according to the different evaluation methods. This situation is a risk factor for young adults who are expected to have high physical activity. Therefore, it is necessary to determine whether any of the changes brought about by the transition to university life are also physical inactivity.

Obes Facts. 2018 May 26;11(Suppl 1):332.

T2P231 Body mass index stratification in Italian adults with congenital heart disease in relation to diagnosis

A E Malavazos 1, G Capitanio 1, IA Matelloni 1, E Stella 1, M Chessa 2, L Morricone 1

Introduction

Adults with Congenital Heart Disease (ACHD) live longer than in the past but are now exposed to environmental and behavioral risk factors related to overweight and obesity, which are two major health problems all over the world. On the other side also underweight is associated with an increased all-cause mortality and it could be a negative prognostic factor. The awareness on Body Mass Index (BMI) in ACHD is very limited. The aim of the present study was to describe the prevalence of BMI in Italian hospitalized ACHD patients in relation to diagnosis, sex and age.

Methods

We classified 1420 ACHD hospitalized patients, aged 18-69 years, based on BMI, as recommended by WHO, and compared them to the Italian reference population of the Italian National Health Institute “Passi” surveillance system.

Results

We found a statistically higher prevalence of underweight compared to the Italian reference population (6.20% vs 3.20%) and particularly in Septal Heart defects & lesions with Left-to-Right Shunt 5.02%, in Conotruncal Heart Diseases categories 10.15% and in Univentricular Heart 12.12%. ACHD women were more underweight than ACHD men. Underweight decreased as the age increased. Overweight was significantly lower in the total ACHD population (26.90%), in Conotruncal Heart Diseases category (21.83%) and in Univentricular Heart category 12.12%, while in the Italian reference population it was 31.70%. Men were more overweight than women. Obesity resulted statistically similar between the Italian reference population (10.50%) and our ACHD population (9.93%), as in Valve defects, Atrioventricular and/or Ventriculoarterial discordance & Aortic defects (10.77%) and in Septal Heart defects & lesions with Left-to-Right Shunt (10.27%). Both overweight and obesity increased with age.

Conclusion

In our cohort of ACHD there was a doubled prevalence of underweight, compared to the Italian reference population (6.20% vs 3.20%). The prevalence of overweight was lower (26.90% vs 31.70%), but obesity was similar (9.93% vs 10.50%). Since BMI is the most widely used measure of obesity, but it does not account for the variation in body fat distribution, future objective will be to quantify the visceral component of the adipose tissue in ACHD patients (e.g. epicardial adipose tissue). A simple way to evaluate abdominal fat would be to measure the waist circumference. It will also be important to assess body composition and body fatness in all ACHD patients in order to better reflect their risk of acquired cardiovascular disease, and either to maintain or achieve adequate visceral component through targeted interventions.

Obes Facts. 2018 May 26;11(Suppl 1):332–333.

T3PLB1 Accelerated cardiovascular aging among adolescents with obesity and type 2 diabetes

J R Ryder 1, AS Kelly 1, Z Gao 2, PR Khoury 2, TR Kimball 2, LM Dolan 2, EM Urbina 2

Introduction

Cardiovascular (CV) disease begins in childhood and progresses across the lifespan. However, the normal rate of CV aging from adolescence to young adulthood has not been documented and risk factors associated with accelerated CV aging have yet to be identified. We conducted a 5-year longitudinal study of youth with either normal-weight (NW), obesity (OB), and/or type 2 diabetes (T2D) to determine rates of CV aging and risk factors for accelerated progression. A priori we hypothesized that accelerated CV aging would occur in youth with OB and T2D as compared to NW.

Methods

Four hundred and fifty-nine adolescents (NW [n = 146], OB [n = 162], T2D [151]) completed a baseline and 5-year follow-up visit with the following measures collected: height, weight, systolic blood pressure (SBP), heart rate (HR), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), c-reactive protein (CRP), and hemoglobin A1c (hbA1c). Primary metrics used for CV aging included non-invasive measures of vascular structure (carotid intima media thickness [cIMT]; common, internal, and bulb] and arterial stiffness (carotid-femoral pulse wave velocity [PWV], and augmentation index [Aix]). Longitudinal outcomes were examined using generalized estimating equation (GEE) adjusting for baseline sex, race, and age. Additional GEE models examined the association of changes with risk factors with measures of vascular structure and arterial stiffness.

Results

Youth with OB and T2D had greater changes in cIMT (common, bulb, and internal, p < 0.05 all) and PWV (p < 0.01) when compared to NW. Youth with T2D had accelerated increases in bulb cIMT (p = 0.005), Aix (p < 0.001), and PWV (p = 0.003) compared to youth with OB. Higher SBP was associated with greater change in internal and common cIMT and PWV. Higher BMI was associated with greater change in common cIMT and PWV, while higher hbA1c was associated with greater change in bulb cIMT, PWV, and Aix. No statistically significant associations were observed for HR, LDL-c, HDL-c, TG, or CRP with measures of CV aging.

Conclusion

These longitudinal data support the hypothesis that, OB and T2D in adolescents and young adults accelerates the CV aging process by exacerbating changes in intima media thickness and arterial stiffness. This effect is most pronounced in youth with T2D when compared with peers with NW or OB. Higher levels of SBP, BMI, and hbA1c are associated with greater changes in vascular structure and function. In conclusion, the presence of either OB or T2D early in life accelerates the progression of key risk factors for the development of CV morbidity and mortality.

Obes Facts. 2018 May 26;11(Suppl 1):333.

T3P142 Parent feeding practices and child appetite in early life – a discordant twin analysis

A Fildes 1, CH Llewellyn 2

Introduction

Parental feeding practices (PFP) such as pressure to eat and restriction are thought to causally influence child overweight and appetite regulation. However, recent evidence suggests parents may adopt certain feeding practices in response to characteristics of their child. Less is known about these relationships as they start to emerge in infancy. We used a powerful discordant twin design to test the hypothesis that mothers vary their use of pressure and restriction for twin pairs who differ in their appetite and weight during the earliest period of feeding, while controlling for all environmental confounders of the relationship shared completely by twin pairs.

Methods

Data were from Gemini, a population-based birth cohort of twins (n = 2402 families; n = 4804 twins). Mothers completed measures of PFP, and reported on child appetite and weight during the first 3 months of life and again when their twins were 16 months. Paired Samples T-tests were used to test if ‘pressure’ and ‘restriction’ differed between twin pairs who were discordant for weight, food responsiveness and satiety responsiveness measured using the Baby Eating Behaviour Questionnaire in infancy (3 months) and the Child Eating Behaviour Questionnaire in toddlerhood (16 months).

Results

Greater maternal pressure was exerted on the lighter twin and the twin with lower food responsiveness or higher satiety sensitivity in both infancy (3 months; p < 0.01) and toddlerhood (16 months; p < 0.01). Mothers also used more restriction of the twin who was born heavier and displayed higher food responsiveness and lower satiety sensitivity at 3 months (p < 0.05). At 16 months, mothers used greater restriction with the heavier twin and the more food responsive twin (p < 0.01).

Conclusion

From the very start of life, mothers appear to adapt their feeding practices according to their infants’ weights and appetites. These findings suggest child-responsive parent feeding practices are evident even during the earliest stages of infant feeding, calling into question the commonly-held simplistic view that parents cause their infant's appetite.

Obes Facts. 2018 May 26;11(Suppl 1):333.

T3P143 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):333.

T3P144 Eating dinner fast in Hong Kong adolescents: prevalence and correlates

HY Mok 1, SYD Ho 2, TH Lam 1

Introduction

Eating fast is linked to lower satiety, higher food intake and obesity in adults and children. We investigated the prevalence of eating dinner fast and its correlates in Hong Kong adolescents.

Methods

In the Hong Kong Student Obesity Surveillance (HKSOS) project, 34678 students (mean age 14.6 ± 2.0 years, 44.8% boys) from 42 randomly selected secondary schools completed a self-administered questionnaire. Finishing dinner in about 15 minutes was classified as fast and all longer durations as adequate. Other dinner characteristics included starting time, concurrent television (TV) watching, level of fullness, fruit and vegetable intake, and night-eating (eating between dinner and sleep). Socio-demographic characteristics included age, sex and perceived family affluence. Weight status was based on International Obesity Task Force classification using self-reported weight and height. Socio-demographic correlates were identified using Chi square tests. Poisson regression was used to calculate adjusted prevalence ratios.

Results

Over one-third (36.5%) of students finished dinner in 15 minutes, 38.2% in 30 minutes, 14.4% in 45 minutes, and 10.9% in 60+ minutes. In bivariate analyses, fast eating was significantly associated with boys (fast eating prevalence 37.8% vs 35.7% in girls); lower perceived family affluence (poor 39.2%, medium 36.0%, rich 30.4%); older age (18+: 39.6%, 14-17: 38.8%, ≤13: 32.0%); dinner starting time (7pm or earlier 41.5%, 7:30-8:30pm 31.7%, 9pm or later 35.0%); TV watching (never 48.4%, seldom or sometimes 31.8%, always 37.4); feeling very full (37.5% vs not very full 36.2%); less night-eating (none 37.8%, 1-4 days per week 36.3%, 5-7 days per week 31.8%) and weight status (underweight 34.4%, normal 37.9%, overweight 37.1%, obese 35.2%) (P from 0.034 to <0.001). In regression analyses, fast eating was significantly associated with early dinner time [adjusted prevalence ratio 1.36 (95% CI 1.23, 1.51) for 7pm or earlier vs 7:30-8:30pm]; extreme frequency of TV watching [1.75 (1.46, 2.09) for never, 1.22 (1.06, 1.40) for always vs seldom/sometimes]; and no night-eating [0.88 (0.79, 0.99) for 1-4 days per week vs none].

Conclusion

Over one-third of Hong Kong adolescents ate dinner fast (about 15 minutes). Our preliminary results showed that eating dinner fast was associated with older age, being boys, lower perceived family affluence, earlier dinner time, never or always TV watched during dinner and no night-eating. Because of the wide range in eating time for slower eaters, more in-depth analysis, accounting for the amount of food eaten, is warranted.

Obes Facts. 2018 May 26;11(Suppl 1):333.

T3P145 FTO gene rs9939609 polymorphism and selected metabolic disorders in adult obesity patients with respect to the age of obesity onset

K Wiśniewska 1, M Wrzosek 2, M Siuba-Strzelińska 3

Introduction

Due to the increasing number of obese people around the world, there is a strong and constant need to improve obesity diagnosis and treatment. Early identification of obesity patients based on their genotype could play an important role in preventing a number of obesity-related diseases. The research aimed to analyse the association between the FTO rs9939609 polymorphism and the selected anthropometric and biochemical parameters in obesity patients with respect to the age of obesity onset.

Methods

The research group was composed of 275 patients divided into two subgroups: patients with early onset obesity (<20 years old) and later onset obesity (≥20 years old). The patients’ average age was 43.8 ± 11.3 years and their average BMI was 41.6 ± 5.9 kg/m2. The patients’ weight and height were measured and their fat mass and free fat mass were determined using the DEXA scan. Blood tests were also performed, including total cholesterol and fasting glucose levels. Genomic DNA was isolated from peripheral blood leukocytes. Genotyping of the rs9939609 polymorphism was performed using ViiA™ 7 for real-time polymerase chain reaction analysis. Statistical analyses were conducted with StatSoft Statistica 10.

Results

The analysis showed that patients with AA genotype of the rs9939609 polymorphism and with earlier age of obesity onset (<20 years old) had a lower fasting glucose concentration (101.2 ± 32.8 mg/dl) than those with later age of obesity onset (≥20 years old) (121.0 ± 46.4 mg/dl; (p = 0,04)). Early onset obesity patients with TT genotype demonstrated significantly higher BMI and (p = 0.01) and higher fat mass (p = 0.0002).

Conclusion

The group of patients with earlier age of obesity onset (<20 years old) demonstrated the association of rs9939609 polymorphism with increased fat mass, BMI and lower fasting glucose concentration.

Obes Facts. 2018 May 26;11(Suppl 1):334.

T3P146 Body composition improvement in children achieving WHO physical activity recommendations

L Tomaino 1, P Ferrer 2, I Iglesia 3, M Miguel-Berges 4, P Flores-Barrantes 4, M Álvarez-Sauras 3, P Samper 5, C Agostoni 1, G Rodríguez 2

Introduction

Sedentary lifestyle and obesity might be associated, and their prevalence is increasing among children. WHO recommends, as a preventing measure in schoolchildren, the practice of 60 minutes of moderate-to-vigorous physical activity (MVPA) on a daily basis. The aim of this study is to investigate the relationship between body composition of a representative sample of 7 years old children from a Spanish region, and the level of physical activity.

Methods

A sample of 306 children belonging to a longitudinal observational study was analyzed cross-sectionally at the age of 7 years old. The following variables were assessed: body mass index (BMI), body composition (lean mass (LM), fat mass (FM) and bone mass) assessed with DXA (Dual-energy X-ray absorptiometry), and the level of MVPA (measured with accelerometer for 7 days). Associations were obtained throughout lineal regression analyses between MVPA and body composition variables.

Results

In our sample, boys have significantly higher bone mass, more LM and a lower percent of FM than girls; also, they do more daily physical activity (1 hour daily more) than girls (P < 0,001). 72% of boys and the 41% of girls meet WHO recommendations of 60 minutes of daily MVPA. Among girls there is an inverse correlation between MVPA and FM percent; nevertheless, meeting or not WHO cut-off recommendation of PA is not associated with it. In boys, there is a direct correlation between MVPA and bone mass, bone density and LM (P < 0,05), existing significant benefit in overall body composition of active boys compared to no active ones. Finally, boys and girls that fulfil WHO recommendations have almost a 5% lower body FM than their counterparts.

Conclusion

It is necessary to implement WHO recommendations on daily MVPA in schoolchildren. 60 minutes of daily MVPA improve bone health and body composition in children of 7 years old. Although not fulfilling the level recommended by WHO, percent of FM decreases with MVPA, particularly in girls.

Obes Facts. 2018 May 26;11(Suppl 1):334.

T3P147 Body composition assessed by deuterium dilution technique and anthropometry among overweight and obese children in Malaysia

SK Wu 1, MI Mohamed Noor 2, BK Poh 1, JE Wong 1

Introduction

Body composition has now been recognised as an important nutrition indicator of children. However, most studies examined body composition using either anthropometry or bioimpedance techniques; while only limited studies employed stable isotope deuterium dilution (D2O) technique among children. This study aimed to correlate different methods of assessing body composition, using D2O technique as reference, among overweight and obese schoolchildren in Malaysia.

Methods

Percentage of total body water (TBW%), fat-free-mass (FFM%) and body fat (BF%) were assessed by D2O in 68 overweight and obese children aged 7 – 10 years. Body weight, height and waist circumference (WC) were measured, while body mass index (BMI) and waist-to-height (WHtR) were calculated.

Results

Mean age, weight, height, WC, BMI and WHtR were 8.51 ± 0.77 years, 38.6 ± 8.1 kg, 133.0 ± 7.1 cm, 69.9 ± 8.1 cm, 21.6 ± 2.8 kg/m2, and 0.52 ± 0.47, respectively. Mean body composition were 45.0 ± 3.4% (TBW%), 58.4 ± 4.4% (FFM%) and 41.6 ± 4.4% (BF%). There were no statistical differences in anthropometric and body composition indices between boys and girls. There were, however, significant (p < 0.05) and strong positive correlations between BF% with weight (r = 0.616), BMI (r = 0.660), WC (r = 0.662) and WHtR (r = 0.628) in boys. Results also indicated significant (p < 0.05) though slightly weaker correlation between BF% with weight (r = 0.522), BMI (r = 0.565), WC (r = 0.576) and WHtR (r = 0.454) among girls.

Conclusion

In this sample of overweight and obese children, there were moderate-to-strong correlations between body composition assessed by deuterium dilution technique and anthropometric indicators in both boys and girls.

Tab. 1.

Correlation between BF% measured by deuterium oxide dilution with the anthropometric measures of overweight and obese participants

Anthropometric measures n Correlation coefficient p-value
Male
Weight 38 0.616** <0.01
BMI 38 0.660** <0.01
WC 38 0.662** <0.01
WHtR 38 0.628** <0.001
Female
Weight 30 0.522* 0.003
BMI 30 0.565* 0.001
WC 30 0.576* 0.001
WHtR 30 0.454* 0.012
All
Weight 68 0.538** <0.01
BMI 68 0.587** <0.01
WC 68 0.571** <0.01
WHtR 68 0.511** <0.01
Open in a new tab
*

Significant at p < 0.05 using Pearson correlation

**

Significant at p < 0.01 using Pearson correlation

Obes Facts. 2018 May 26;11(Suppl 1):334.

T3P148 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):334–335.

T4PLB1 Sleeve gastrectomy alters gut permeability in obese patients

T Kellerer 1, H Hauner 2, T Skurk 3

Introduction

Obesity and its related diseases have been associated with a systemic low-grade inflammation. Disturbance of gut barrier function may contribute to this inflammatory state, as it enables the entering of bacterial products, like LPS, into the circulation. The aim of the present study was to investigate, whether patients with obesity exhibit increased gut permeability and if excessive weight loss after sleeve gastrectomy can modulate permeability.

Methods

We analysed anthropometric data, dietary intake, metabolic and inflammatory markers, gut permeability and microbiota composition in 17 morbidly obese patients (BMI 53.0 ± 7.5 kg/m2) before and after laparoscopic sleeve gastrectomy as well as in 17 age- and gender-matched control patients (BMI 21.9 ± 2.7 kg/m2). Gut permeability was assessed by a four sugar test (lactulose, mannitol, sucrose, sucralose).

Results

Sleeve gastrectomy reduced body weight of the patients by 40.1 ± 10.0 kg during the first 6 months, which corresponded to 51.9 ± 15.4% excessive weight loss (EWL). This was accompanied by a decrease in blood glucose, insulin, HOMA-IR, NEFAs and CRP. Gut permeability did not differ significantly between lean and obese patients. However, sleeve gastrectomy led to a decrease in gastroduodenal (p < 0.05) as well as small intestinal permeability (p < 0.05), while colonic permeability increased (p < 0.01). According to the contrary changes in intestinal and colonic permeability, plasma levels of LPS binding protein remained unaltered after surgery. Regarding the microbiota, lean and obese patients could be clearly separated according to their microbial diversity and composition, and sleeve gastrectomy induced marked changes of several taxonomic groups.

Conclusion

In summary, the effects of sleeve gastrectomy on body weight, metabolic and inflammatory parameters are accompanied by specific alterations in gut permeability and microbiota composition.

Obes Facts. 2018 May 26;11(Suppl 1):335.

T4PLB2 Real-world clinical effectiveness of liraglutide 3.0 mg for weight management in Canada

S Wharton 1, A Liu 2, A Pakseresht 2, E Nørtoft 3, CL Haase 3, J Mancini 4, SG Power 4, S Vanderlelie 5, RA Christensen 5

Introduction

Real-world clinical effectiveness of liraglutide 3.0 mg, in combination with diet and exercise, was investigated at 4 and 6 months post-initiation. Changes in body weight and cardiometabolic markers were examined from baseline.

Methods

Using a database of de-identified electronic medical records from six Canadian weight management clinics, a cohort of liraglutide 3.0 mg initiators during 2015–2016 was identified. Post-initiation values at 4 and 6 months were compared to respective baseline values using a paired t-test.

Results

The full cohort consisted of 311 subjects; comprising ≥4 months (n = 210) and ≥6 months (n = 167) persistence groups. For all subjects, mean age was 49.7 years. Subjects were predominantly white (78%) and female (83%). Mean BMI and weight were 40.7 kg/m2 and 114.8 kg, respectively. At baseline, 74.9%, 19.9% and 5.1% of subjects had normoglycaemia, prediabetes, and diabetes, respectively. Mean baseline values for HbA1c and blood pressure were 5.8% and 127/77 mmHg. There was a statistically significant change in body weight 6 months after initiation of treatment in persistent subjects (≥6 months: –8.1 kg, p < 0.001). Weight loss was also statistically significant for subjects persistent on treatment for ≥4 months (–6.9 kg, p < 0.001) and in all subjects, regardless of persistence (–7.5 kg, p < 0.001). Change in body weight from baseline for the ≥6 months group was –7.1%, with 63.4% and 35.2% of subjects having lost ≥5% and ≥10% body weight, respectively. Overall change in body weight was also observed in the ≥4 months group (–6.2%) and in all subjects (–6.6%). For the ≥6 months treatment group, there was a statistically significant change in HbA1c (–0.35%, p < 0.001) and SBP (–3.0 mmHg, p < 0.01), but not DBP (0.1 mmHg, p = 0.90).

Conclusion

In a real-world setting, liraglutide 3.0 mg, when combined with diet and exercise, was associated with clinically meaningful weight loss and improvements in cardiometabolic markers.

Conflicts of Interest

Abstract preparation supported by Novo Nordisk.

Obes Facts. 2018 May 26;11(Suppl 1):335.

T4PLB3 Defining the appropriate setting for treating obese patients with SIO algorithm.

L Vigna 1, A Brunani 2, P Capodaglio 2, GM Agnelli 1, SC Tomaino 3, D Consonni 1

Introduction

Recently, the Italian Obesity Society (SIO) proposed a new algorythm based on the interaction of BMI, age and Edmonton Obesity Staging System (EOSS) for allocating patients with overweight or obesity to the appropriate treatment setting (Standard Italiani per la cura dell'obesità – SIO-ADI 2016-2017)

Methods

In the present study, we aimed at evaluating the clinical usefulness of the SIO algorithm in assessing the appropriate treatment setting for obese patients. For this purpose, we studied the distribution of the EOSS stages and the categorization provided by the “four M's Method” in two large samples of obese patients. Such data obtained from two retrospective cohorts of 288 obese out-patients (83M-205F) and 298 obese in-patients(51M-247F) age 15-75yrs were compared with the data related to the self-reported disability in activities of daily living (subscore ADL of the TSD-OC).

Results

For this study we have analyzed two retrospective groups of patients enrolled with the same criteria: obese (body mass index >30kg/m2), both sex, We fitted linear regression models to analyze the relationship between EOSS category and age, BMI, and ADL. To compare slopes across group we included a product-term in the regression models Slope (years per EOSS class) (95% CI) +5.6 (+3.8; +7.5) -3.2 (−4.9; -1.57) <0.001* Slope (BMI per EOSS class) (95% CI) +1.4 (+0.5; +2.2) +1.7 (+0.7; +2.6) 0.68* Slope (BMI per EOSS class) (95% CI) +1.4 (+0.5; +2.2) +1.7 (+0.7; +2.6) 0.68* *Out-patients vs in-patients slope Age was positively associated with EOSS class in Out-patients, while the relationship was negative among In-patients. The BMI increase with increasing EOSS category was similar in the two groups. ADL score was positively associated with EOSS in both groups, with a steeper slope among In-patients. Among both groups, there was a high frequency of subjects with metabolic (46,8% hypertension and 26.6% diabetes) and mechanical (62.3% arthritis and 24.9% obstructive sleep apnea syndrome) diseases; mental diseases were present in 22.5% of patients. There were no important differences in the distribution of co-morbidities across EOSS categories in the two groups

Conclusion

These data demonstrated that the comorbidities, when appropriately evaluated with EOSS, are present also at lower BMI levels. Therefore, a strategy based on lifestyle interventions together with pharmacological or surgical approaches is recommended at this stage. The difference found between In- and Out-patients and also the correlations found seem to justify the correct assignment of clinical setting in obesity treatment. In particular, in stage 2 of EOSS we found Out-patients that need lifestyle modification with or without pharmacological treatment or to support surgery approach, but also In-patients because the presence of high BMI and high disability index suggest that rehabilitation program is must be considered to reduce the development in the progressive stage 3 and 4 In conclusion, we present the first clinical application of SIO therapeutic alghoritm in the definition of appropriate setting of obesity treatment especially for rehabilitation intensive program, and we can suggested that the use of this instrument in association with ADL evaluation appear a sensitivity tools.

Obes Facts. 2018 May 26;11(Suppl 1):336.

T4PLB4 Perceptions of barriers to effective obesity management in Canada: results from the ACTION Study

D Macklin 1, AM Sharma 2, A Bélanger 3, V Carson 4, J Krah 5, M Langlois 6, D Lawlor 7, S Lepage 8, A Liu 4, N Mackay 9, A Pakseresht 4, SD Pedersen 10, X Ramos-Salas 11, M Vallis 12

Introduction

Obesity is a chronic disease that is often poorly recognized and managed in clinical practice. The ‘Awareness, Care, and Treatment In Obesity MaNagement’ (ACTION) study investigated perceptions, attitudes and barriers to weight management in people with obesity (PwO), healthcare providers (HCPs) and employers in Canada.

Methods

Adult PwO (self-reported BMI ≥30 kg/m2), HCPs and employers completed online surveys in 2017.

Results

Survey respondents included 2000 PwO, 395 HCPs and 150 employers. Most PwO (>60%), HCPs (>89%) and employers (>71%) considered obesity a chronic medical condition; 74% of PwO believed that obesity impacts overall health. Many PwO (74%) believed weight management was completely their responsibility. While PwO (55%) reported knowing how to manage their weight, only 1/10 reported maintaining ≥10% weight loss for >1 year. ‘Improvements in eating habits’ (PwO 38%; HCP 63%) and ‘being more active’ (PwO 39%; HCP 54%) were ranked as most effective approaches to long-term weight management. Only 34% of HCPs considered consulting a nutritionist/dietitian or bariatric surgeon (43%) effective for long-term weight management; <6% of PwO shared this belief. Similarly, 95% of employers versus 47% of PwO believed that wellness programmes help with weight management. Perceived barriers to weight management included: delayed PwO/HCP discussion regarding weight issues; a need for more HCP education; and limited understanding of PwO's interest/motivations for weight management among HCPs. Only 6% of HCPs believed current guidelines were effective for obesity management.

Conclusion

While many PwO considered weight management their responsibility and reportedly knew what to do, few reported successful long-term weight management. Although all groups acknowledged obesity as a chronic medical condition, PwO and HCPs shared the belief that ‘eat-less-move-more’ was the most effective approach. PwO and HCPs may benefit from a collaborative understanding of the complex nature and management of obesity.

Conflicts of Interest

Abstract preparation supported by Novo Nordisk.

Obes Facts. 2018 May 26;11(Suppl 1):336.

T4P226 Changes in calcium and vitamin D levels in patients after biliopancreatic diversion

P Hlavatý 1, P Šrámková 1

Introduction

The primary function of vitamin D is to regulate the homeostasis of calcium and phosphorus. In the intestine makes it easier for the absorption of calcium and phosphate in the kidneys increases the reabsorption of calcium. In the ideal case more than 90% of the required amount of vitamin D in the skin under the influence of UV radiation, but this creation is generally significantly lower and in the adult population's tendency to deficit of vitamin D. The higher the prevalence is higher in obese and older people. Sufficient level of 25 (OH)2(D) is considered to be higher than the concentration 50–75 nmol/l.

Methods

In patients after malabsorptive procedures significantly affecting the absorption of nutrients including calcium series. The recommended dose of substitutions is 1000-2000 mg calcium/day. Substitution of vitamin D is recommended in a dose of 800 – 3.000 IU/day with a gradual increase to up to 300 000IU/week, according to the formal concentration of 25 (OH)2D in serum. Despite adherence to recommended substitution, however, occurs for continuous decline depending on the distance from the operation. After 2 years from the implementation of BPD is described vitamin D deficit in more than 70% of the patients and 50% is present secondary hyperparathyroidism.

Results

The results of the monitoring of our patients after BPD point to similar conclusions. Despite the increasing substitution of vitamin D we often fail to achieve its sufficient levels in serum. However, often we do not observe a decline in levels of calcium. The rise of PTH is often only temporary. An important factor that contributes to this fact is to ensure adequate calcium intake and compliance p.o. patient respect for substitution treatment.

Obes Facts. 2018 May 26;11(Suppl 1):336–337.

T4P227 The effect of appetite awareness training on mental health and eating habits among participants in obesity treatment

H R Einarsdottir 1, L Níelsdóttir 2, Þ Karlsson 2

Introduction

Appetite Awareness Training (AAT) is an intervention intended to increase the ability to rely on internal appetite cues to regulate eating behavior rather than responding to environmental, cognitive, or affective cues. Research has shown that AAT reduces binge eating and overeating as well as decreases the sense of control loss concerning eating behavior and associated psychological distress. Objective The study's aim was to assess AAT's effectiveness by comparing pre and post scores on self-measurement scales (Binge Eating Scale; BES, Beck Anxiety Scale; BAI, Beck Depression Scale; BDI-II, Depression Anxiety Stress Scale; DASS and Appetite Awareness Scale; AAS).

Methods

Method Data came from 38 groups (N = 375) at the outset of obesity treatment at Reykjalundur Rehabilitation Centre from March 2012-Oct. 2015. All groups participated in a six-session appetite awareness group therapy as the first intervention in their obesity treatment. All self-measurement scales were administered at the beginning of the first session of AAT and again at the end of the last session.

Results

Significant differences occurred for AAS (Appetite Awareness Scale, p < 0.001, r = 0.74), BES (Binge Eating Scale, p < 0.001, r = 0.63), BDI-II (Beck Depression Inventory-II, p < 0.001, r = 0.54), BAI (Beck Anxiety Inventory, p < 0.001, r = 0.37), and DASS anxiety symptoms (p < 0.001, r = 0.33), but neither for DASS depression nor DASS stress symptoms. Figure. Mean scores on Binge Eating Scale (BES), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and Depression Anxiety Stress Scale (DASS) before and after Appetite Awareness Training (AAT).

Conclusion

The main purpose of AAT is getting participants to focus more on their internal cues of hunger and satiety, to become more aware of their eating habits and to help them in adopting more mindful and healthier eating habits. The results of this study – that symptoms of binge eating decrease and appetite awareness increases, support that AAT is effective in implementing those behavior changes in participants. Reduction of anxiety and depression symptoms are in line with previous research on AAT which has furthermore shown that symptoms of depression and anxiety often occur in people with obesity and people with obesity and mental disorders seem to show greater resistance to treatment than people with obesity and no history of mental disorders.

Fig. 1.

Fig. 1

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Obes Facts. 2018 May 26;11(Suppl 1):337.

T4P228 Accuracy of abdominal visceral fat area estimation by bioelectrical impedance analysis with reference to abdominal computed tomography in 1614 Koreans

D Lee 1, S Lim 2, TJ Oh 2, KM Kim 2, JH Moon 2, SH Choi 2, HC Jang 2

Introduction

Computed tomography (CT) scanning is widely used for measuring abdominal visceral fat area (VFA). But it has several disadvantages such as radiation hazard and high cost. In contrast, bioelectrical impedance analysis (BIA) is a good alternative tool to assess body composition because of its simplicity and noninvasiveness. Recently, abdominal VFA estimation using BIA is tried. We evaluated accuracy in abdominal VFA measurement by a BIA machine with reference to abdominal CT value in a large number of Korean subjects. We also assessed clinical characteristics which might affect accuracy of BIA.

Methods

In 1614 individuals (mean age 54.5 ± 13.0 [19–87] years, mean BMI 25.8 ± 3.7 [16–45] kg/m2, 53.6% men), abdominal VFAs measured by CT were compared with those estimated by a multifrequency BIA machine (InBody720, InBody, Seoul, Korea). Concordance rates between two methods were assessed using correlation analyses and Bland–Altman plots. Subgroup analyses were conducted according to clinical and laboratory parameters.

Results

Mean abdominal VFAs by CT (134.9 ± 60.0 cm2) were correlated with those by the BIA (109.5 ± 34.7 cm2) (r = 0.566, P <0.011). The mean difference between two methods was 25.9 ± 47.6 cm2, which was greater in men than in women (41.7 ± 47.0 cm2 vs. 7.7 ± 41.4 cm2, P <0.05). Increasing tendency in the difference was observed according to BMI increment. People in higher waist circumference, BMI, and serum triglyceride levels and in lower HDL-cholesterol levels, the BIA machine underestimated abdominal VFA than their counterparts.

Conclusion

The VFAs estimated by a BIA machine showed good concordance rate with those measured by CT scan. However, the BIA method underestimates abdominal VFA in obese individuals. More accurate formula in the assessment of abdominal VFA using BIA is needed particularly in these subjects.

Obes Facts. 2018 May 26;11(Suppl 1):337.

T4P229 Positive factors affecting weight reduction using mHealth anti-obesity program

H Shin 1

Introduction

Using mHealth in weight loss programs is popular and the positive effects of mHealth have been reported constantly. However, the analysis of the various factors that affect weight reduction among the functions provided by mobile application, offline consultation with physicians and nutrition consultation, and anti-obesity-drugs is limited. This study is to analyze the factors influencing weight loss through a community based anti-obesity program.

Methods

We recruited 112 people with BMI of 23kg/m2 or more who using a smartphone and living in Ilsan, Gyeonggi Province. Metabolic risk factors and body composition were assessed. Eight week anti-obesity program was provided including clinic visits every 4 weeks, interviews with a physician and a nutritionist, Noom Coach anti-obesity application with paid service(Noom Inc., New York, NY USA). Obesity drugs and prescriptions for chronic disease were provided when needed.

Results

Thirty men and eighty two women (mean age, 47.8 ± 10.2, mean baseline BMI 28.8 ± 3.3) participated in the study. The amount of weight loss was correlated with frequency of diet record, frequency of exercise record, frequency of weight record, frequency of article reading, frequency of group writing, frequency of sending message to coach, the amount of exercise per week, walking steps per day. By stepwise multiple regression analysis, number of face to face consult with nutritionist, anti-obesity drug, frequency of article reading, and attending orientation were significantly associated with weight loss(ß coefficient, p value; –5.52, <0.001; 0.94, 0.002; –0.01, 0.006; 0.35, 0.03, respectively).

Conclusion

Among the variable functions in an anti-obesity program with mHealth, face to face consult with nutritionist and frequency of article reading were positively associated in the effectiveness of weight loss. Further studies are needed to evaluate the long-term effect in weight control program with mHealth.

Obes Facts. 2018 May 26;11(Suppl 1):337–338.

T4P230 Effectiveness of a total meal replacement program (OPTIFAST® program) compared with a reduced-energy food based diet plan on weight loss: results from the OPTIWIN study

J Ard 1, A Auriemma 2, S Coburn 3, K Lewis 1, J Loper 4, L Matarese 5, S Periman 6, W Pories 5, A Rothberg 7

Introduction

Standard of care obesity treatment often includes lifestyle interventions with calorie restricted food-based diets; however, success can be limited for a significant group of patients. Total meal replacement (TMR) may be more effective, but evidence is limited to nonrandomized or small, short-term trials.

Methods

We conducted a 52-week multicenter, open-label RCT in adults with a BMI of 30-55 kg/m2, with 26-week weight-loss and weight-maintenance phases. Participants (n = 330) were stratified by type 2 diabetes status and randomized to the OPTIFAST Program (OP), a TMR diet (800-980 kcal/day) with lifestyle intervention or to a reduced-energy (–500 to –750 kcal/day) food-based diet with lifestyle intervention (FB) based on the Diabetes Prevention Program. The primary objective was to study the effectiveness of the OP, comparing relative change in body weight (RWL) from baseline to 26 weeks between OP and FB, followed by a confirmatory analysis at 52 weeks. Primary endpoints were analyzed using a modified intent to treat approach, including all randomized participants who initiated treatment with at least one follow up weight measure. Missing data were imputed using last observation carried forward. Hypotheses were tested using a two-tailed significance level of 0.05. We used linear mixed models to adjust for baseline weight, age, sex, site, race, and diabetes status. Statistical analysis was performed using SAS Version 9.3.

Results

273 (82.7%) participants had at least 1 measured follow up body weight. Mean age was 47.1 ± 11.2 years; 82.4% were female. Mean baseline body weight was 108.4 ± 22.1 kg. RWL at 26 weeks was 12.2 ± 0.6% in the OP vs. 5.9 ± 0.6% in the FB (difference 6.2 ± 0.8%, p < 0.01). RWL at 52 weeks was 10.3 ± 0.6% for the OP versus 5.5 ± 0.6% in the FB (difference 4.8 ± 0.8%, p < 0.01) (Figure 1). At week 52, higher proportions of OP participants achieved 5% (63.7%) and 10% RWL (43.7%) compared to FB (42% and 21.7%, respectively) (p < 0.01). Mild or moderate adverse events (AE) were reported by 76.8% of OP participants and 62.7% of FB. Serious AEs were reported by 4.5% (7/155) of OP and 3.3% (5/150) of FB participants. No serious AEs were deemed related to the investigational product. Discontinuation rates were not statistically different between groups (29.3% OP; 31.9% FB). Main reasons for discontinuation were subject request to no longer participate in the program (11.0% OP; 18.7% FB) or lost to follow-up (11.0% OP; 9.6% FB). Baseline demographics and characteristics

Conclusion

This multicenter 52-week trial showed that a behavioral weight loss intervention using total meal replacement (OPTIFAST program) was more effective than a food-based intervention. The OPTIFAST program resulted in significantly greater relative weight loss and higher proportions achieving clinically significant weight loss at 26 and 52 weeks. Conflicts of Interest: I am a paid consultant and have received grant funds from Nestle Health Science.

Conflicts of Interest

I am a paid consultant and have received grant funds from Nestle Health Science.

Fig. 1.

Fig. 1

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Tab. 1.

Measure
 Optifast Program (N = 135)
 Food-Based Program (N = 138)
Mean (SD) or n (%)
Age, years 47 (11.2) 47.2 (11.3)
Female 116 (85.9) 109 (79)
Race
Caucasian 100 (74.1) 95 (68.8)
African American 22 (16.3) 37 (26.8)
Asian/Pacific Islander 4 (3.0) 2 (1.4)
Hispanic 5 (3.7) 4 (2.9)
Other 4 (3.0) 0
Weight, kg 106.8 (20.8) 109.9 (23.2)
BMI, kg/m2 38.4 (5.5) 39.2 (6.2)
Obesity Class III (≥40 kg/m2) 48 (35.6) 61 (44.2)
Type 2 Diabetes diagnosis 13 (9.6) 20 (14.5)
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Obes Facts. 2018 May 26;11(Suppl 1):338.

T4P231 Evaluation of a Questionnaire for General Practitioners to Assess the Use of Practical Recommendations in the Lifelong Care to Post-Bariatric Patients: a Pilot Study

T Ranzenberger-Haider 1, M Krebs 2, T Stamm 3, K Schindler 1

Introduction

There is a growing number of patients undergoing bariatric surgery requiring lifelong follow-up. BagEL (Bariatric Patients in Primary Care: Post-operative Nutrition and Lifestyle Management) is a survey to evaluate a newly developed structured disease management program including nutrition and lifestyle management in primary care. We present a pilot study aiming to evaluate tools including a questionnaire to assess the use of practical recommendations by general practitioners (GP).

Methods

A questionnaire for GP was developed to assess the usability of a structured post-operative care system regarding nutrition and lifestyle management for bariatric patients in primary care described in a so called “pass” for every patient. The questionnaire and pass were presented during the interview or sent by email. For evaluation of this questionnaire, randomly selected physicians completed the questionnaire either in a structured face-to-face or phone interview. Additionally, outcomes research experts from the Center for Medical Statistics, Informatics and Intelligent Systems of the Medical University of Vienna were interviewed in regard of analyzability.

Results

15 practitioners (13 general and 2 internal practitioners) were contacted. 7 (46,7%, 5 general and 2 internist practitioners) participated, 6 (40,0%) were not reachable and 2 (13,3%) were not interested. The wording of the questionnaire was described as “easy to understand” (14,3%), “well understandable” (71,4%) and “very understandable” (14,3%). All physicians assessed the number of questions as “ok”. And all of them affirmed to answer and to return the questionnaire for each patient in the BagEL study twice. All 7 physicians appreciated the idea of a follow up system providing a pass with practical recommendations for post-bariatric patients. Due to analyzability the questionnaire needs to be adjusted for redundant questions.

Conclusion

This study indicates that the newly developed questionnaire can be used within the BagEL study form the perspective of GPs involved in the care for post-bariatric patients.

Obes Facts. 2018 May 26;11(Suppl 1):338–339.

T4P232 The relationship between waist to height ratio and physical activity status

N Acar Tek 1, G Akbulut 1, F Ayyıldız 2

Introduction

Physical inactivity has been identified as one of the leading preventable causes of mortality due to cardiovascular diseases, diabetes, colon and breast cancer and depression. Waist-to-height ratio (WHtR) is a proxy for central (visceral) adipose tissue. It also received attention as a marker of early health risk. This study was planned to determine physical activity status according to waist to height ratio classification.

Methods

This study was conducted among 980 individuals (365 males and 615 females). Physical activity status was evaluated using IPAQ (International Physical Activity Questionnaire-Short Form). Metabolic Equivalent Task (MET) was calculated by IPAQ evaluation. Physical activity was classified in three categories as low, moderate, high. Body waist and height were measured and waist to height ratio (WHtR) was calculated. Beside actual waist to height ratio (WHtR) of individuals were assessed according to Ashwell classification as ‘no increased risk’ (WHtR <0.5), ‘increased risk’ (WHtR ≥0.5 and ‘very high risk’ (WHtR ≥0.6).

Results:

Males and females who had low level physical activity had no increased health risk according to WHtR (79.2% and 71.4% respectively). 6.6% of males and 6.5% of females had very high risk and low level physical activity. While physical activity was high level both males and females, only 3.5%of males and 3.6% of females had very high health risk according to waist to height ratio. There was no significant association of physical activity with waist circumference or waist to hip ratio in both gender (p > 0.05).

Conclusion

Any anthropometric measure isn't sufficient in identifying people at ‘early health risk. Further studies must be investigated a lot of risk factors such as sex, age, ethnicity, socioeconomic status, and family history.

Tab. 1.

Physical activity status according to waist to height ratio classification

Waist/heigt ratio classification
No increased risk (<0.5)
 Increased risk (0.5–0.6)
 Very high risk (≥0.6)
 Total
Physical activity n % n % n % n %
Male Low 19 79.2 4 16.7 1 4.2 24 100.0
(n:365) Moderate 126 55.8 85 37.6 15 6.6 226 100.0 χ2:6.28
High 67 58.3 44 38.3 4 3.5 115 100.0 p:0.179
Famale Low 30 71.4 11 26.2 1 2.4 42 100.0
(n:615) Moderate 320 69.4 111 24.1 30 6.5 461 100.0 χ2:2.73
High 83 74.1 25 22.3 4 3.6 112 100.0 p:0.603
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Obes Facts. 2018 May 26;11(Suppl 1):339.

T4P233 Is dietary fiber type different intake in young adults?

F Ayyıldız 1, I Ülker 1, H Yıldıran 2

Introduction

Dietary fibers are known to be protective effect against gastrointestinal diseases, constipation, colon cancer, obesity, diabetes, stroke, hypertension and cardiovascular diseases. Soluble and insoluble fiber may have different mechanism in body. Postprandial glucose concentrations are associated with especially increased soluble fiber intake. Insoluble fibre intake effect on especially bowel movement. Both soluble and insoluble fiber may lead to weight loss. It was aimed to evaluate relationship between different fibre intake and body weight.

Methods

This cross sectional study was conducted including young adults. Body weight and height were measured and BMI (Body Mass Index) was calculated. Beside actual BMI measures of individuals were assessed according to World Health Organization (WHO) BMI classification. While BMI is 20-25 kg/m2 as normal weight, BMI is 25-30 kg/m2 as overweight. The datas were analysed SPSS. p value of <0.05 was considered statistically significant.

Results:

Total dietary fiber, soluble and insoluble fiber intakes were higher in males with normal weight. Total fiber intake was higher in normal weight females but soluble fiber intake was higher in overweight females. There was no statistically differences between fiber intake and BMI in both gender (p > 0.05).

Conclusion

This study there was no relationship between fiber types and body weight. Dietary fiber intake has a lot of important health affects so 14 g fiber/1000 kcal in adults is consumed according to Dietary Reference Intake (DRI).

Tab. 1.

The evaluation of fiber type intake according to BMI
Normal weight (20–25 kg/m2)
 Overweight (25–30 kg/m2)
x±SD x±SD p
Males (n:92) Fiber (g) 19.8 ± 9.76 (n:90) 15.5 ± 2.12 (n:2) 0.13
Soluble fiber (g) 6.5 ± 4.14 3.5 ± 1.23 0.12
Insoluble fiber(g) 12.9 ± 6.21 6.9 ± 2.14 0.11
Females (n:208) Fiber (g) 18.2 ± 8.68 (n:130) 17.9 ± 6.06 (n:78) 0.72
Soluble fiber (g) 6.1 ± 3.16 11.5 ± 5.33 0.36
Insoluble fiber(g) 11.5 ± 5.33 11.3 ± 4.15 0.73
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Obes Facts. 2018 May 26;11(Suppl 1):339.

T4P234 Is chia seed useful in the treatment of obesity?

A Özturan 1, MS Macit 2

Introduction

The incidence of obesity and obesity related diseases are increasing all over the world. For this reason, nutrition strategies are being investigated to prevent obesity. The aim of the researches are to prevent excessive energy intake and to get regular and healthy eating habits. Therefore nutritional advice is being developed on satiety and appetite control. Whole grains are foods that become popular and recommended for body weight control. One of these is chia seed (Salvia hispanica L.) is a herbaceous plant belonging to Lamiaceae family.

Methods

Chia seed contains 15-25% protein, 30-33% fat, 26-41% carbohydrate and 18-30% fiber. In addition, 60% of the fat content of the chia seed is composed of omega-3 alpha linolenic acid and 20% omega-6 linoleic acid. Chia seed contains saturated fatty acids at low levels and also contains high fiber and antioxidants. It is protective against cardiovascular diseases due to their unsaturated fatty acids. Also, it has a beneficial effect on bowel health because of the fiber and gluten-free content. It can be useful to control appetite in diabetic obese individuals due to post-prandial glucose control and satiety. In addition, chia seed was found to be associated with decreased energy intake and body weight loss in obese individuals in some studies. However, studies on changing in body composition are contradictory.

Results

As a result, chia seed, which contains protein, fiber and omega-3 fatty acid, is a popular functional food. More research should be done because the mechanisms of glycemic control, body weight loss and adipose tissue effects of chia seed, which are recommended as complementary treatment in obese individuals, are still unclear.

Conclusion

Nutrition, Metabolism & Cardiovascular Diseases (2017) 27:138-146 J Food Sci Technol (2016) 53(4):1750–1758 Food and Health (2018) 4(2):140-146 Nutrition Research and Practice (2017) 11(5):412-418 Nutrition Research (2009) 414–418 Rocz Panstw Zakl Hig (2017) 68(2):123-129 Journal of Biomedicine and Biotechnology (2012)

Obes Facts. 2018 May 26;11(Suppl 1):340.

T4P235 Intolerance of plant foods (vegetables, fruit and nuts) – distribution and features of the Bulgarian population.

AI Agovska 1, M G I 1

Introduction

Food intolerance is extremely widespread and it is estimated that 45% of the population could be affected. Importantly, the spread of nutritional intolerances to plant foods such as vegetables, fruits and nuts is due to the increasing attention to these foods in a variety of diet regimes such as vegetarianism, vegans, weight loss diets, detoxifying diets, other “modern” diets. The problem is relevant for Bulgaria, but no research has been done on this issue at the moment.

Methods

A Blood Test - Food Detective - CNS (Cambridge Nutrition Sciences Ltd) has been used to identify food products to which the body is intolerant. The basis of the study are the forming antibodies of class IgG, markers for intolerance to surveyed foods. The individuals are tested for 13 types of vegetables, 6 types of fruit, 5 types of nuts. A total of 1697 people were surveyed.

Results

Vegetables - the most common is potato intolerance (19.0%), followed by peppers (22.5%), celery (14.2%), carrots (12.3%), tomatoes (11.7%), mushrooms (10.4%) and leeks (6.6%), and the most rare of olives (0.8%), broccoli (0.5%) and cucumbers. Fruits – the most frequently is oranges and lemons intolerance (13.2%) and strawberries (8.7%), grapefruit (3.8%), blueberries (1.1%), melon and watermelon (1.0%), apple (0.5%), cucumbers (0.3%). Nuts - Very high intolerance to all kinds of nuts is found, over 30% of all tested have one or more intolerances to nuts. The highest share of caste intolerance (39.9%), followed by almonds and peanuts (35.7% and 34.9%), Brazil nuts (24.4%). Nuts are best tolerated - only 7.5% of those surveyed are intolerant. Combined intolerances to more than one product have also been studied. Correlation analysis was also carried out.

Conclusion

The results of the study have not only informative value, but also use in nutritional practice: prevention, diagnosis, regulation of metabolic disorders, overweight management and many others.

Obes Facts. 2018 May 26;11(Suppl 1):340.

T4P236 The challenge of tackling health care costs through obesity reduction: the case of Uruguay

R Kaufmann 1, NA Pontet 1

Introduction

Abstract Government-funded medical expenditure in Uruguay for the last ten years has tripled in US dollars. The increase in the prevalence of overweight (BMI ≥25) and obesity (BMI ≥30) has contributed to this growth. According to the World Health Organization (WHO), Uruguay is the country with the highest and growing trend in the prevalence of overweight and obesity in South America. This reality encouraged us to study in depth obesity health care costs and its related diseases. Our estimate is that health care costs linked to these diseases will be more than 500 million US dollars by 2020, a figure close to 1% of the country’ s GDP. The anti-obesity policies implemented in the last decade have shown a hard-to-measure performance and in some cases have turned out to be apparently inefficient, probably more due to the hurdles in implementation and follow-up than to the policies and programs themselves. In this study, we tried to generate a measure of value to ascertain the cost of inaction in the fight against obesity and its consequences over several non-communicable diseases. The cost of inaction is not defined as the cost of not doing, but as the cost of not implementing the right policies (in this case health prevention policies) at the right time.

Methods

Direct Costs estimation of health costs for Uruguay (UY). The direct costs can be further divided into medical costs (e.g., including doctor's fees, medicines, and medical operations) as well as nonmedical direct cost (e.g., transportation costs of the patient to the hospital). Due to lack of data we developed a methodology to estimate the direct costs in a sound and robust way. The underlying idea of our approach was to use the case of the US as a baseline scenario. For the latter, we have solid estimates for the direct costs of overweight and obesity. First, we assumed that the relative weight of the direct health care costs of obesity in UY (between the years 2011 - 2016) correlates with the relative weight of the direct costs of obesity in the USA (2000-2005), since the prevalence of Obesity was similar. Second, we supported our estimation with the argument that GDP per capita is an appropriate way to adjust to different price levels between the two aforementioned countries. Even when adjusting by the price level, Uruguay cannot afford the same total health care expenditures compared to the US. We therefore also adjusted for the total amount of health care expenditures.

Results

Our estimate is that health care costs linked to these diseases will be more than 500 million US dollars by 2020, a figure close to 1% of the country’ s GDP. The anti-obesity policies implemented in the last decade in Uruguay have had a difficult performance in terms of measurement, and in some cases have been inefficient, not so much because of the policy or the program itself, but because of the difficulties in implementation, measurement and follow-up.

Conclusion

This figure - 500 mio / annual - should call for the need of further reflection on resource management and their impact in prevention policies, both for public and private healthcare providers, as well as insurance companies. In turn, the use of policies that involve the food industry for example through tax breaks on healthy foods and increasing taxes on non healthy foods, could have a positive impact in the consumption habits.

Obes Facts. 2018 May 26;11(Suppl 1):340.

T4P237 This abstract has been withdrawn

 

Obes Facts. 2018 May 26;11(Suppl 1):341–358.

Author Index

A

Aarestrup J. T3P80

Aarts E. T1P158

Aarts E.O. O3.5, T1P158

Aasbrenn M. O7.2, T1P147

Aasprang A. O4.5, T4P7, T4P51

Abawi O. T3P17, T4P106

Abbott S. T4P74

Abdul-Ghani M. O14.4

Abdurrahmanoğlu E. T2P52

Abete I. T2P189, T4P135

Abid Dogra S. O13.6

Aboueid S. T2P48

Abrahamsson N. T4P31

Abrantes F.G. T2P78

Abu Eid S. O14.1

Abu-Omar K. T2P12

Acar Tek N. O4.1, T1P85, T1P86, T1P92, T1P131, T2P59, T2P71, T2P72, T2P75, T2P76, T2P81, T2P99, T2P100, T2P150, T2P171, T2P195, T2P196, T4P82, T4P148, T4P152, T4P157, T4P206, T4P219

Acevedo L. O8.6, T4P115, T4P221, T4P222

Acosta F. T2P147

Adab P. O13.6

Adamo K.B. T1P89, T1P94, T2P154

Adamo M. T4P43

Adamson A. T3P78

Adamson AJ. S18.3

Adan R.A.H S23.2

Affonso L.H. T4P176

Afonso L. O9.6

Agagunduz D. T1P85, T1P86, T2P99, T4P82, T4P147, T4P152

Agosti F. T4P103

Aguilera C. T3P32

Aguirre L. T1P44, T1P54

Ahlin S. T4P27

Ahlstrom H. T3P75

Ahn A. T2P74

Ahn H.-Y. T2P110

Ahonen I. T1P37

Ahonen S. T3P20

Ahrens W. O6.3, S13.1, T3P11

Ainscough K.M. T4P15

Airaksinen K. T1P37, T1P149

Akande V. T2P5

Akbari P. T1P89, T1P94

Akbas F. T4P131, T4P943

Akbulut G. T2P75, T2P76, T2P81, T2P99, T2P171, T2P196, Akder R.N. T2P210

Åkerlund M. T3P20

Akiyama D. T2P46

Aksionova M. T4P116

Al Rasheid N. T4P137

Al Sowaidi S. T4P137

Alaba O. T2P54

Alberdi G. T2P206

Alberga A. O13.3

Albuquerque D. T4P105

Alcantara J.M. O3.2, T2P147

Alderborn A. T3P75

Aldhoon-Hainerová I. T2P58, T3P81, T3P105

Aldiss P. T1P40

Aldred S. T2P172

Alegre R.E. T4P119

Alexander S. T3P67, T3P70, T3P85

Alexiadou K. T4P42

Alexy U. T2P111

Alfares M.N. T3P8

Algarin C. O3.3

Al-Gindan Y. O3.1

Ali V. T2P186

Alisi A. O11.3

Aljaber M. T2P186

Al-Kudairy L. S24.1

Allen-Walker V. T3P62

Alnoor T.A.A. T3P53

Alonso-Vale M.I.C. T1P57

Al-Qawasami S. T1P141

Alsaadi K. T2P186

Alsayrafi M. T2P186, T4P137

Alsowidi S. T2P186

Altabas V. T1P76

Altunc U. T3P64

Alvares R.S.R. T4P85

Alves M. T4P90

Amaral Santos P. S6.4

Amaro-Gahete F.J. O3.2

Amato V. T1P84

Amoroso A. T2P125, T3P56

Amos D. T2P37

Anand S.S. T3P34

Ananthapavan J. T3P21a

Andersen J.R. O4.5, T4P7, T4P51

Anderson R. T4P172, T4P224

Andersson D.P. T4P25, T4P145

Andersson-Assarsson J. T3P10, T4P27

Ando T. T1P90

Andrada P. T4P37

Andrade A.Q. T4P85

Andrade M.D.A. T1P139

Andrade-Silva S.G. T4P174

Andres A. T2P32

Andrés Valero S. T4P119

Ang T.-L. T4P8

Angelmaier L. O10.3, T3P133

Angelov K. T4P34

Ängquist L. O11.2, T3P15

Annemans L. O13.4

Antoni R. T4P17

Anveden Å. O7.6

Apolzan J.W. T4P79

Ara T. O5.1

Aranky R. O10.5, T4P28

Arau R.T. T4P119

Araújo G. T1P108

Araujo-Soares V. S18.3, T2P34

Argalasova L. T3P127

Argyrakopoulou G. T4P42

Arhire L.I. T2P87

Arias-Tellez M.J. O3.2

Arija Val V. O4.2, T3P54

Arikan M. O1.6

Arkenbosch L.A..J. T4P186

Armasu I. T1P59

Armendariz A.L. T2P66

Arner P. T4P25, T4P145

Arngrimsson S.A. T3P108

Arnoldner M. T4P29

Arnoldussen I.A.C. S6.4, T1P158

Aron Wisnewsky J. S4.3, T4P3

Arsenijevic D. T1P119

Artyushin A. T4P116

Arvidsson L. T3P11

Asan S.A. T2P151

Assarsson J.C. O7.6

Asselin J. T4P172

Astbury N.M. T4P165

Astrup A. O5.4, O8.4, S1.4, T1P38, T1P63, T1P118, T4P201

Atalay S. T2P9

Atanasiu V. T4P199

Athanasopoulou E. T4P42, T4P76

Atkinson R.L. T3P105

Atkinson S. T3P34

Auer A. T2P149

Aveyard P. T4P136, T4P165

Ayer J. T3P85

Ayhan B. T2P19, T2P20

Ayyıldız F. T1P160, T2P31, T2P65, T2P93, T4P77

Azcona-Sanjulián M.C. T3P102, T3P114

Azevedo L. S24.1

Aziz N.A. T1P159

Azizi F. O4.6, T2P16

B

Baak M.A..V. T2P70, T4P186

Babio N. T2P189, T4P135

Babjakova J. T3P127

Bäckdahl J. T4P25, T4P145

Backholer K. O10.6, T3P21a

Badcock C.-A. T4P61, T4P62, T4P63

Baek J. T2P123

Baena J.A. O7.1, T1P109, T1P128

Baetz D. T1P151

Bagger M. O9.4

Baixauli J. T1P32

Bajer B. T4P173

Baka O. T4P175

Bakacs M. T3P138

Bake T. S23.4

Baker J.L. O11.4, T2P6, T3P7, T3P80

Bakken I.J. T4P133

Bąk-Sosnowska M. T2P157

Bala M.M. T4P56, T4P59

Balanda K. S13.3

Balas L. T1P9

Balaz M. T1P95

Baldane S. T4P160

Balibrea J.M. O7.1

Ball G. T3P82

Balla Z. T3P60

Balslev-Harder M. O7.2

Balter L.J. S2.3, T2P172

Baltieri L. T2P27, T2P158, T2P208, T2P209, T4P158

Bamonti F. T4P101

Banderali G. T3P99

Bandoni D. T2P159

Banharo M.M. T2P197

Baños R. S2.1

Banzer W. T4P150, T4P209

Baptista F. T4P78

Baran J. T4P155

Barańska M. T3P45

Barber S. O13.6

Barbosa A.R. T2P137, T2P199

Barbosa M.M. T4P90

Barbu C. T4P22

Barcin C. T4P160

Barclay S.H. T4P62

Baretić M. T1P76

Barnes A.C. T4P12, T4P92

Barquera S. S1.5

Barr S. T3P19

Barreto Silva M.I. T2P78, T4P142, T4P210, T4P213

Barrett N. T3P35

Barros I. T4P90

Barton J. T3P25

Bas M. T2P9, T2P52, T2P91, T2P151, T3P41, T3P94

Bashraheel A. T4P137

Bashraheel A.S. T2P186

Basora Gallisà J. O4.2, T4P198

Basora Gallisà T. O4.2

Basran J. T2P166

Bast A. S22.3

Basterfield L. T3P78

Batista T.M. T1P16

Battaglia M. T1P29

Batterham R.L. T4P43, T4P50

Battersby J. T2P54

Battezzati A. T4P103

Bauld L. O2.5

Baumgartner-Parzer S. S6.3, T1P41

Baur L. S24.1, T3P67, T3P85

Bayrak H..F. T2P104

Bayram F. T4P160

Bazzani P. O4.3

Beaulieu K. T1P17, T1P67

Becerril S. T1P32, T1P36

Beck A. O8.2

Becker A.B. T3P34

Becker M. T3P131

Bedogni G. O11.3, T4P103

Beeken R. T4P83

Behrens D. T2P7

Beiroa D. T1P24

Belancic A. T2P130

Beleigoli A.M. T4P6, T4P85

Bellicha A. T4P70

Bellido D. T4P21, T4P214

Bellón A. T4P214

Belo S. T4P38, T4P47, T4P49, T4P53, T4P54

Belova E. T1P123

Bel-Serrat S. O6.4, T3P52

Bendtsen L.Q. O8.4

Benenati N. T4P122

Bennett D. T2P117

Beraud S. T3P113

Bercier P. O5.5

Berends F.J. O3.5

Berg A. T4P150, T4P209

Berg C.M. T3P140

Bergö M. O7.6

Bergsten P. T3P75

Berkachy R. T2P63

Berner S. T3P37

Berral De La Rosa F.J. T1P58

Berteotti M. T4P11, T4P171

Bertoli S. T4P103

Bertolt C.J. T1P63

Bertrand E. T3P113

Bertz F. T4P129

Beschea-Chiriac M. T2P87

Bes-Rastrollo M. T2P131

Bevan S.M. S3.3

Beyene J. T3P34

Biagé A. T3P38

Biernacka K.M. T3P25

Bigolin F. T4P11

Bilban M. T1P41

Bilgin D. T3P94

Bilici S. T2P19, T2P20, T2P77, T2P82, T2P83, T2P84

Billich N. O10.6

Bindelle J. T4P202

Bindels L.B. T4P202

Binks M. T1P161

Birch L. T3P14, T3P25

Birkenfeld A.L. O8.1, T4P118

Bissolati M. T1P29

Biswal B.B. O3.3

Bitzer J. T4P57

Bjarnason R. T3P83, T3P84, T3P108

Bjerregaard L.G. T2P6

Björkström N. T1P6

Bjune J.-I. T1P5, T1P7

Bjurvald L.M. T3P5

Blaak E. S17.1

Blaak E.E. O5.6, O14.3, T1P118

Blædel T. O8.4

Blake M. O10.6

Blažičević V. T1P4

Blundell J. O1.4, O2.2, S20.1, T1P17, T1P67

Boal F. T1P151

Boa-Sorte N.A. T3P106, T4P84

Bock M.-D. O5.5

Bogdański P. T1P91, T1P144, T1P145, T2P68, T2P69, T2P943, T2P190, T4P20, T4P146

Bogl L.H. T3P11

Bogner W. O1.5

Boirie Y. O2.2, T1P162, T3P113

Boldarine V. T1P127, T4P66

Boldina G. O5.5

Bolton J. T1P38

Bolze F. S22.3

Bomfim L.H.M. T1P16

Bonel E. T4P113, T4P114

Bongiorno C. T4P208

Bonnel S. T1P38

Bonouvrie D.S. T4P130, T4P225

Boogaard M. T1P159

Boon M.R. S22.1

Boone S.C. T2P15

Borda L.A. T4P119

Bordiú E. T1P164

Börnhorst C. T3P11

Borowitz M. T4P172

Borrelli R. T1P134

Boscaini S. T4P184

Bosch J.A. S2.3, T2P172

Boschero A.C. T1P16

Bosy-Westphal A. T1P14, T1P62

Bottu H.M. T1P134

Bouillot J.-L. T4P3

Boulé N. T4P194

Boulet N. S22.4

Bouloumié A. O5.5

Boult K. S12.4

Bourgeault I. T2P48

Bovolini A.F. T1P139

Boyanov M. T4P109

Boyland E. O2.6, S7.2, S12.4

Bozbulut R. T1P85, T1P86, T4P82, T4P147

Brackmann K. T2P143

Brambilla M. T3P99

Branco R.C.S. T1P16

Branco T.L. T3P119, T4P78

Brandsma A. T4P106

Braumann K.-M. T4P150, T4P209

Braun K. S22.3

Braunack-Mayer A. O10.1, T2P18

Breda J. T2P88

Bregman R. T4P142, T4P210, T4P213

Brekke H.K. T4P129

Breu M. T3P77

Brezinova M. T1P9

Brigidi P. O8.5

Brito L.M.S. T2P193

Brix J. T2P41, T4P99, T4P100

Brockmann G. O5.2

Broers V. T4P193

Brogle B. T3P73

Broom D.R. T4P163

Brosnahan N. O3.1, T4P12, T4P92

Brown T. S24.1

Brown V. O12.6, T3P21a

Brownbill A. O10.1, T2P18

Brownell K. PL4.1

Brudnicka E. T3P45

Brukalo K. T2P12

Brunani A. T4P215

Brunner S. T3P75

Brusco N. T1P56

Bruun J.M. T1P33

Bruyndonckx L. T3P110, T3P111

Bruze G. O9.3

Bryant E. T4P74

Brynjolfsdottir B. T3P83, T3P84

Brytek-Matera A. T2P106

Brzezinski M. T2P178, T3P101, T3P103

Brzozowska A. T4P93

Buchanan M. T1P141

Buchholz A. T3P82

Büchter D.J. T3P73

Buck C. T2P143

Bucksch J. O6.3

Budge H. T1P40

Budui S.L. T4P11, T4P171

Bueno A.A. T1P57

Bueno G. T3P32

Bueno M. O7.1, T1P128, T2P32

Buettner C. S6.3

Bugge A.B. T2P39

Buil-Cosiales P. T4P135

Bujo H. T1P31

Bulló M. S20.3, T4P187, T4P198

Burgdorf K.S. O7.2

Buse J. T4P115

Busetto L. S9.4, T4P11, T4P171

Büsing F. T1P14, T1P62

Butler M. O13.1, T2P204

Butu C.M. T2P87

Buyken A.E. T2P111

Büyükbozkırlı D. T4P48

Byambasukh O. T2P181

Bygdell M. O11.5, O11.6, O12.3

Byrne N. T1P87

Byrne R. O2.3, T3P22, T3P58

Byrom O.S. T3P25

C

Cabrera Rubio R. T4P184

Cadamuro J. T3P75

Cagiltay E. O14.4, T4P48

Caixàs A. O7.1, T2P32

Çakır B. T2P85, T2P103

Calañas A. T2P32

Caldara A. T4P208

Caldas G. T2P159

Caldeira S. T2P200

Calhau C. T1P3

Calleja Núñez J.J. T4P216

Calonne J. T1P119

Calugi S. O4.3, T4P67, T4P134

Calvo E. T1P24

Calvo I. T4P44

Camacho M. T4P1

Camacho-Barcia L. T4P198

Camargo R.L. T1P16

Cameron E. O13.3, T4P217

Campbell-Scherer D.L. T4P172, T4P217, T4P224

Campos R.M.D.S. T3P21b, T4P66

Canbay E. T2P210

Cancello R. O8.5, T4P215

Cândido E.C. T2P27, T2P158, T2P208, T4P158

Cañellas N. T4P187

Canfora E.E. O14.3, T1P118

Cani P.D. T4P202

Cannon B. S22.4

Cano V. T1P75

Cantara S. T1P56

Canto C. O5.3, T1P26

Cañueto D. T4P187

Capehorn M. T4P17, T4P166

Capoccia D. T1P46

Caranti D.A. T4P174, T4P176

Carayol J. O5.4

Carayon A. T1P162

Cardellini S. T1P29

Caria C.R.E.P. T1P98, T1P104, T1P124

Carić T. T2P86

Carlsson B. T4P27

Carlsson L.M. O7.6, O9.3, T3P10, T4P27

Carmona-Maurici J. T1P109

Carmona-Montesinos E. T3P98

Carneiro E.M. T1P16

Carrard I. T2P184

Carreira M.C. T4P21

Carson C.G. O8.1

Carter D. T4P17

Carugo S. T3P99

Carus T. O9.5

Carvalho D. T4P38, T4P47, T4P49, T4P53, T4P54

Carvalho K.T. T4P142, T4P213

Carvalho-Ferreira J.P. T2P159

Casagran O. O7.1

Casanueva F.F. T4P21, T4P214

Casas M. T1P102

Casey J. O13.5

Cassidy R. T4P166

Castiglione F. T1P82

Castiglioni F. T4P11, T4P171

Castillejo N. T4P36

Castillo P. T3P26

Castillo-Rodríguez A. T2P211, T3P47, T3P120

Castro A.I. T4P21, T4P214

Castro H. T3P26, T3P59

Castro M. O14.2

Catalan V. T1P32, T1P36, T4P37

Catalano C. T1P115

Catapano A. T1P134

Catarino F. T2P166

Caterson I.D. T3P67, T4P61, T4P62, T4P63

Cattaldo S. O8.5

Cattani L. O8.5

Cauce V. T2P88

Cavadas A.C.S.M. T4P177

Cavaliere G. T1P134

Cave A. T4P172

Cazzo E. T2P27, T2P158, T2P208, T2P209, T4P158

Cebolla A. S2.1

Celec P. T1P78

Celik A. O14.4, T4P48

Celik B.O. O14.4

Célind J. O11.5, O11.6, O12.3

Censi L. T3P35

Cepeda M.S. T4P164

Cerrone L.A. T4P176

Cesar H.D.C. T1P23, T4P123, T4P125

Çetinarslan B. T4P160

Cevahir Z. T2P91, T3P41

Chabert C. O5.4

Chaichana C. T1P157

Chaim É.A. T2P27, T2P158, T2P208, T2P209, T4P158

Chaim F.D.M. T2P158, T4P158

Chaim F.H.M. T2P158, T4P158

Chang B. T4P202

Chang C.-J. T1P20, T1P129, T2P169, T4P161

Chang S.-S. T4P124

Chang Y.-F. T4P161

Chanprasert C. T1P157

Chaplin J.E. T3P140

Chary G. T4P114

Chassé É. T1P165

Chavez P. T4P44

Chazard E. T4P69

Chen C.-Y. T4P10

Chen M. T1P121, T2P113, T2P118, T3P40, T3P97

Chen Y.C. T3P2

Chen Z. O6.2

Cheng A. T4P24

Cheng G. T1P121, T2P118, T3P40, T3P97

Cheng H. T4P24

Chhina N. T4P2

Chien H.-Y. T1P105

Chignola E. O4.3

Chih P.-C. T2P169

Chikova-Iscener E.N. T3P135

Ching S.S. T4P26

Chisholm K. T3P70, T3P85

Chiu Y.-H. T1P105

Cho B. T2P185

Cho D.-H. T1P122

Cho K.W. T1P122

Choi J. T2P74

Choi J.S. T4P108

Chon S. T2P128

Chou C.-Y. T2P169

Chou Y.-A. T2P115

Christen T. O6.5, T2P124

Christensen A. O13.1

Christiansen P.R. T4P50

Chudek J. T2P161, T4P93

Chueca M. T3P102

Chung H.T. T1P152

Church T.S. T4P79

Churuangsuk C. T4P188

Ciba I. T3P75

Cicha-Mikołajczyk A. T2P116

Ciesla E. T2P187, T3P122

Cifani C. T1P72

Cifre M. T2P212

Cigarroa I.I. T3P117

Cimmino F. T1P134

Cinato M. T1P151

Cinti S. PL7.1

Cioffi I. T1P82

Ciudin A. O7.1, T4P36, T4P164

Ciuoli C. T1P56, T4P122

Claver M. T4P64

Clément K. T4P3

Clements H. S24.1

Cleo G. T2P22

Cloetens L. T2P45, T2P49

Cnop M. T4P202

Coates A. O2.6

Cobbaert C.M. T2P124

Cobcroft M. O10.6

Coccia F. T1P46

Colchero A. S1.5

Cole T.J. O12.4, T3P79

Colledge N. T4P163

Collins C. T4P35

Colom A. T2P189, T4P135

Comas M. T4P36, T4P164

Combet E. T4P188

Conde S.V. T1P53

Confortin S.C. T2P199

Connors A. T4P217

Conroy D. T2P11

Contaldo F. T1P82, T1P83, T1P84, T2P2, T4P207, T4P208

Contreras A. T1P52, T1P75

Contreras-Gomez M.A. T2P147

Cooiman M.I. O3.5

Cook C. S23.4

Cook M.B. T3P7, T3P80

Copaescu C. T4P22, T4P153

Corazza P.R.P. T2P193

Cordeiro A. T1P142

Cordido F. T2P32

Corfield K. T4P165

Corgosinho F.C. T3P21b

Corpeleijn E. O11.1, T2P181

Corrêa L.H.C. T1P108

Côrrea R. T1P108

Correia F. T4P47, T4P53

Cos A.I. T4P44

Costa Larrión E. T4P185

Costa M.S. T2P78, T4P142, T4P213

Costa R. T1P3

Costamagna C. T4P112

Cotter P. T3P109

Cotter P.D. T4P184

Coupaye M. T4P70, T4P170

Coutinho A.P. T2P137

Coutinho S.R. O1.3

Cowell C.T. T3P85

Creger T. T2P113

Cretikos M. T3P67

Croker H. T4P83

Crudele A. O11.3

Crujeiras A.B. T4P21, T4P214

Cruz M.M. T1P57

Cryan J.F. T4P184

Csekő C. T1P71

Cserháti Z. T3P138

Csongova M. T1P78

Cuello E. T1P128

Cuesta M.G. T4P176

Cumming R. T2P13

Cunha F. T4P54

Cuthbertson D.J. T4P39

Cutler L. S18.3

Cvečka J. T1P96

Czepczor-Bernat K. T2P106

Czernin S. S15.5

D

D. Okely A. T3P9

D'Orsi E. T2P137, T2P199

Da Costa L.S. T2P142, T2P197, T4P96, T4P177

Da Silva J.C.F. O13.5

Da Silva M. T2P14

Da Silva P.L. T3P21b

D‘Adamo M. T1P110

Dahlbom M. T3P75

Dahlman I. T4P145

Dalle Grave R. O4.3, T4P67, T4P134

Dalton M. O1.4

Dâmaso A.R. T3P21b, T4P66, T4P75, T4P174

Damborg M.L. T2P6

Daneshpour M.S. O4.6

Daniels L. O2.3, T3P22, T3P55, T3P58

Dankel S. T1P5, T4P140

Dankel S.N. T1P7, T1P51

Dankova M. T4P46

Danytė E. T2P155

Davis T. T1P161

Davison R. S19.2

De Amicis R. T4P103

De Andrade I.S. T1P127

De Araújo Silva L. T4P6

De Avila C. T1P72

De Block C. T2P120, T4P5, T4P141

De Blok C. O1.1

De Bruin J.P. T4P62

De Caprio C. T1P83, T2P2, T4P207

De Fátima Haueisen Sander Diniz M. T4P6

De Filippo C. T1P134

De Filippo E. T2P2

De Git K. S23.2

De Guchtenaere A. T3P110, T3P111

De Henauw S. T3P3, T3P24, T3P35

De Luis D. T1P54, T1P140, T4P21

De Matteis G. O11.3

De Mello M.T. T3P21b

De Moura Nigri Hilário Ferreira M. T4P6

De Mutsert R. O1.1, O6.5, T1P159, T2P15, T2P73, T2P124

De Roeck Y. T2P120

De Roos A. T2P73

De Sousa I.F. T1P127

De Souza R.J. T3P34

De Souza S.R. T2P122, T2P142, T2P163, T2P197, T4P96, T4P177

De Turenne G. T4P3

De Vrind V. S23.2

De Winter B. T3P110, T3P111

De Zwaan M. O9.2

Dean M. T3P62

Debédat J. T4P3

Debono D. O5.5

Deden L.N. T1P158

Dee A. S13.3

Deev D. T2P24, T4P104

Defreyne J. O1.1

Deighton K. T1P19

Del Olmo N. T1P42, T1P52, T1P75

Del Rio L.M. T4P112, T4P113, T4P114

Delvecchio M. T4P126

Delzenne N. T4P193, T4P202

Demaio A. S24.1

Dembinska-Kiec A. T1P944, T1P137

Demir S. T2P19, T2P20

Demirci İ. T4P160

Den Heijer M. O1.1, O6.5, T2P124

Denisova E. T2P44, T2P112

Deniz Güneş B. T1P85, T1P86, T2P75, T2P76, T2P81, T2P99, T2P171, T2P196, T4P82, T4P152, T4P157, T4P219

Denize K.M. T1P89, T1P94

Densupsoontorn N. T1P157

Denzer C. T3P131

Déon C. O5.5

Deonandan R. T2P154

Derler M. T3P37

Desai D. T3P34

Desbles C. T3P113

Descombes P. O5.4

Desmedt O. T4P193

Deyneli O. T4P160

Di Battista E.M. T2P7, T4P223

Di Gregorio S. T4P112, T4P113, T4P114

Di Martino M. T1P115

Di Sacco G. T4P117

Di Vincenzo A. T4P58

Di Vincenzo O. T1P82, T1P83, T2P2, T4P207, T4P208

Diamantis T. T4P42

Díaz-Rúa R. T1P163

Dicker D. O7.5, O8.2, S9.1, T1P107

Dickson J.M. T2P174

Dickson S.L. S23.4

Didier M. O5.5

Diels S. T1P11

Dietrich A. O9.5

Digruber A. T1P41

Dimitrov P. T2P121, T3P135, T4P195

Diniz M.D.F. T4P85

Dirinck E. T2P120, T4P5, T4P141

Disse E. T2P198

Ditisheim A. T4P64

Dixon H. O6.1

Dixon J. O14.4

Djafarian K. T4P138, T4P189

Do Carmo S. O3.4

Dodia C. T1P9

Dogliotti E. T1P110

Dohmen C.E.J.M. T4P225

Dombrowski S.U. O3.1

Domene S.M.A. T4P174

Domingues V.F. T1P3

Domingues-Faria C. T1P162

Domonkos E. T1P78

Donini L.M. T1P115

Donnelly J. O4.4, T2P192

Dorner T. T4P57

Dos Santos C.F. T4P84

Dos Santos G.M. T4P176

Dotta F. T1P56, T4P122

Doucet E. T1P18

Dougkas A. T3P19

Dourado V.Z. T4P174

Dourish C.T. S23.1

Dover R. T2P54

Drabsch T. T1P80

Dragomir A. T4P180

Draycott S. T4P212

Drenowatz C. T3P1

Drori A. O14.5

Drygas W. T2P116

Duarte C. O9.1, T1P67, T2P166

Duarte J.A.R. T1P139

Dubern B. T4P170

Duclos M. O2.2

Duhita M.R. T4P205

Duleva V.L. T2P121, T3P135, T4P195

Dulloo A. T1P119, T4P205

Duman S. T2P104

Dumanovic J. T4P159

Dunn C. T4P149

Durand T. T1P9

Durrer D. S3.1, T3P73

Dwyer L. T2P167

Dydak U. O1.5

Dyląg H. T3P45

Dynnyk N. T4P80, T4P175

Dyskin Y. T2P44

Dyson M. T3P82

E

Ebinuma H. T1P31

Ebling F. T1P40

Eftimijadoska F. T3P134

Eghtesadi M. T1P106

Eghtesadi S. T1P106

Eik-Nes T.T. O2.1

Eilenberg M. O1.6, T4P29

Eissa M. T3P33, T3P50

Ejarque M. T1P24

Ejaz A. T1P39

Ekici M. T2P85, T2P103

El Ghoch M. O4.3, T4P67, T4P134

El Helou N. T1P64

El Jardali F. T3P944

Elbe-Bürger A. T1P41

El-Husseini R. T1P88

Elinder L.S. S19.3

Eliopoulos D.G. T4P76

Elkalaawy M. T4P43

Ellingsen S. T1P7

Elliott R. T1P74

Elliott S. T4P194

Ellis P. S20.2

Ells L.J. S18.3, S24.1

Elmes M. T4P212

Emanuelli B. S22.2

Emberson J. T2P117

Endahl L. T4P118

Endo Y. T3P23

Ensell R. S12.4

Erdei G. T3P138

Eriksson Hogling D.J. T4P25, T4P145

Erkkola M. O10.4

Ertaş Öztürk Y. O4.1, T2P59, T4P147

Escalada J. T4P37

Eşer S. T2P85, T2P103

Espersen R. O7.3

Espinós Perez J. T4P119

Espinoza Gutiérrez R. T4P216

Essers Y. O5.6

Estour B. O5.3, T1P26

Estruch R. T4P198

Etikan I. T4P48

Etxeberria U. T1P44

Evans E.H. O9.1

Evans S.L. T4P212

Evcil E. T3P41

Evenhuis I.J. T2P3

Everitt J. T4P223

Eygi M. T3P41

F

Fabre O. T4P201

Fabris R. T4P58

Fagiolini A. T4P122

Fahrenkrug J. T3P46

Fakhoury-Sayegh N. T1P136, T1P146

Falahi F. O11.1

Fan H.-Y. T3P2

Fang C.E.H. T4P35

Fantin C. T2P198

Fares E.-J. T1P88

Faria M.E. T3P106

Farias T.S..M. T1P57

Farpour-Lambert N. S24.1, T3P73, T4P64

Farup P.G. T1P147

Fattinger E. T2P149

Fauvel W. T4P223

Fearnbach S..N. T4P79

Feehily C. T3P109

Felsenreich D.M. T4P29

Fenger M. O7.2

Fenselau, H. S6.1

Fenzl A. T1P41, T1P111

Ferlitsch A. O1.6

Fernandes A. T4P90

Fernandes A.B. T4P1

Fernandes J.F.R. T4P210

Fernandes V. T4P90

Fernandez R. O14.2

Fernández-Alfonso M.S. T1P164

Fernández-García J.C. T2P211, T3P47, T3P120

Fernández-Quintela A. T1P140

Fernandez-Veledo S. T1P24

Fernø J. T1P6

Ferreira C. T2P180

Ferreira M.H. T4P85

Ferreira M.J. T4P38, T4P47, T4P49, T4P53, T4P54

Ferreira S. T1P3

Ferreira Y.A.M. T3P21b

Ferreri C. T1P110

Feskens E.J.M. O12.5

Fetisov R. T2P44, T2P112

Fewtrell M. T3P79

Fica S. T4P22, T4P153

Fidalgo J.P.N. T4P174

Fidel Kinori S.G. T4P164

Fidilio E. O7.1, T4P36

Fielding S. T4P172

Figueiredo R.A. T2P92

Filipponi T. T2P7

Filler A. T3P73

Fillon A. O2.2

Filova A. T3P127

Finlayson G. O1.4, O2.2, T1P17, T1P67, T2P159

Finucane F.M. T4P35

Fiol M. T2P189, T4P135

Fisher A. O1.1, T4P83

Fisher A.B. T1P9

Fitó M. T4P198

Fjære E. T1P7

Flannery O. T4P163

Flodmark C.-E. S15.4

Flølo T.N. O4.5, T4P51

Flury M. T3P131

Foletto M. T4P58

Fonseca H. T3P93, T3P119

Fontaine K. T2P113

Fontana M. T1P115

Ford I. T4P12, T4P92

Forhan M. O13.3, T2P207

Formichi C. T1P56, T4P122

Fornari E. O12.2

Forslund A. T3P75

Fort J.M. O7.1, T4P164

Fortini P. T1P110

Franceschini L. T4P11, T4P171

Franco O.H. O6.2

Francz A.C.L. T4P177

Franik G. T4P93

Franklin J. T4P61, T4P62, T4P63, T4P182

Franx B.A.A. S6.4

Frasinariu O. T3P107

Frederiksen P. T2P126, T3P15

Freira S. T3P93

Freitas P. T4P38, T4P47, T4P49, T4P53, T4P54

Frenay C. T4P202

Freudenthaler A. S6.3

Fried M. S11.4

Friedman R. T2P61

Fritsch M. T3P131

Frost Andersen L. T3P35

Frost G. S23.5

Frühbeck G. T1P32, T1P36, T4P37

Fruhwürth S. T1P70

Fuchs N. T2P86

Fuchs-Neuhold B. T2P33, T3P37, T3P43

Führer-Sakel D. T4P150, T4P209

Fujimoto S. T2P108

Fukuoka R. T3P23

Fulber E. T2P61

Fuller N.R. T4P61, T4P62, T4P63

Fürnsinn C. O14.1, S6.3

Furtado-Alle L. T2P193

Furtunescu F.L. T2P80

G

Gabler S.-M. S22.3

Gac A. T2P178, T3P101, T3P103

Gahagan S. O3.3

Galavazi M. T4P127

Galban C. T4P214

Gálfi M. T3P60

Galgani J.E. O14.2

Galieva M. T4P116

Galller A. T3P131

Galmes A. T4P135

Galmés A. T2P189

Galmés S. T2P212

Galusca B. O5.3, T1P26

Gama Van Eijk V. T4P6

Gaman L. T4P199

Gambero A. T1P98, T1P104, T1P124

Gammal A. O14.5

Gancheva S. O14.6

Ganen A.D.P. T3P21b

Ganguly S. T4P183

García Gavilan J.F. T4P198

García-Prieto C.F. T1P164

Garcia-Rivero Y. O3.2, T2P147

García-Ruiz E. T1P68

Gardiner S.L. T1P159

Gäredal C. T1P99, T1P100

Garinkol Avrahami R. T1P107

Garnett S.P. T3P85

Garup N. S22.2

Gately P. O13.1, T2P204

Gault M. T3P121

Gavasso I. T4P67

Gavelienė E. T4P179

Gazzetta P.G. T1P29

Gea A. T2P131

Geelen A. T2P73

Geets E. T1P11

Geidl B. T3P13

Genser L. T4P3

Georgakopoulos C. T2P186

Georgiev N. T4P196, T4P197

Georgiev O. T4P34

Geraghty A.A. O4.4, T2P192, T2P206, T3P109, T4P15

Gerasimidis K. O3.4

Gerber P.A. T3P13

Gerhart-Hines Z. S22.2

Germain N. O5.3, T1P26

Gestic M.A. T4P158

Gezmen Karadag M. T2P31, T2P65, T2P67, T2P93, T2P94, T2P95, T2P96, T2P97, T4P77

Gheldof N. O5.3, T1P26

Gherasim A. T2P87

Ghosh S. T4P194

Gianfrancesco M.A. T4P202

Giannini S. T2P78, T4P142, T4P213

Giardiello C. O8.3

Giardina S. T4P187

Giardinelli E. T1P134

Gibbons C. O1.4, T1P67

Gibson A. T4P182

Gibson A.M. T3P68

Gibson L.E. S2.1

Gielen J. O13.4

Gil A. T3P32

Gil S.D.S. T4P176

Gilbert P. T2P166

Gilder K. O8.6, T4P115, T4P221, T4P222

Gill A. T3P67

Gilli F. T4P11, T4P171

Gilmour S. T2P168

Gil-Ortega M. T1P164

Gimeno-Ferrer F. T4P105

Gindrat P. T3P73

Giordano F. T4P11, T4P171

Giraudet C. T1P162

Giroux I. T2P48, T3P38

Giusti A. T1P115

Gjærde L.K. O11.4

Gluszek S. T2P187

Gnessi L. T1P115

Gobato R.C. T2P27, T2P158, T2P208

Goday A. T4P214

Goes B.B. T3P106

Gogalis S. T4P69

Goldfield G.S. T1P18

Goldstone A.P. S23.3, T4P2

Golzarand M. T4P190

Gomes R.J. T4P176

Gomez Miranda L.M. T4P216

Gomez-Ambrosi J. T1P32

Gómez-Ambrosi J. T1P36, T4P37

Gomez-Arbelaez D. T4P21, T4P214

Gómez-Donoso C. T2P131

Gommers D. T1P116

Gonçalves V. T4P38, T4P49

Gong Y. T3P40, T3P97

Gonzalez Hernandez M.A. T1P118

Gonzalez L. T4P105

Gonzalez O. T4P36

Goossens G.H. O5.6

Goracci A. T4P122

Goralska J. T1P944, T1P133, T1P137, T4P155

Gordon-Larsen P. S1.1

Gori F. T4P101

Goto T. O5.1, T1P126, T1P156

Gottrand F. T3P35

Govers E. S17.2, T4P72

Gow M.L. T3P85

Goya M. T4P36

Grabovac I. O7.4

Grach D. T2P33

Grammatikaki E. T2P200

Granzotto M. T1P10, T4P58

Grarup N. O7.2

Greber-Platzer S. T3P72, T3P77

Green H. T2P4

Greenberg E. O8.2

Greier K. T3P1

Grgić A. T1P4

Gribsholt S.B. O6.6

Grieco G.E. T1P56

Grišin E. T4P179

Grover L. T2P37

Grozdev K. T4P34

Gruca A. T1P133, T4P155

Grugni G. T4P126

Grugni L. T4P126

Grujić V.R. S18.5

Grundy M. S20.2

Grunseit A. T3P85

Gruszka W. T2P161, T4P93

Grytten E. T4P140

Grzymisławski M. T4P146

Guardiola A. T3P65

Guarisco G. T1P46

Guay C. T1P112

Gudbrandsen O. T1P5

Guerra A.C. T1P3

Guerra C. T2P180

Guerreiro V. T4P47, T4P53, T4P54

Guerrero M. T4P36

Guglielmi V. T1P110

Guilherme De Oliveira Freitas L. T4P6

Guillem K. O7.1

Guillemot J.-C. O5.5

Guillet C. T1P162

Guitou L. T1P151

Güldiken S. T4P160

Gulyaev A. T1P123

Gundlach A. T1P72

Gunzer W. T2P33, T3P37, T3P43

Gupta A. O14.4

Gupta M. T3P34

Gurecka R. T1P78

Gursahani M.S. T1P79

Gutiérrez L. O7.1, T1P128

Guzey Akansel M. T2P38

Guzmán Gutiérrez E.C. T4P216

H

Ha T.Y. T1P152

Hackl M.T. O14.1, S6.3

Hadar R. O14.5

Hadžiomeragić A.F. S18.5

Haenni A. T4P31

Hagberg L. T4P129

Hägele F.A. T1P14, T1P62

Hager J. O5.3, O5.4, T1P26, T1P38

Haghighi M.M. T3P85

Haidar F. T1P136, T1P146

Hainer V. T2P58, T3P81, T3P105

Haire-Joshu D. T4P73

Hajnal A. T1P12

Hajsok A. T2P165

Hakulinen T. O10.4

Halali F. T4P86

Halford J.C..G. T2P174, T4P50

Halili L. T2P154

Hall W.L. O10.2, T4P14

Halle M. T4P150, T4P209

Hallschmid M. S23.1

Halseth A. O8.6, T4P115, T4P221, T4P222

Halsteinli V. T4P133

Haluzik M. S6.2

Hamada Y. T1P60, T1P90

Haman F. T1P89, T1P94

Hamar D. T1P95

Hamilton J. T1P12

Hamilton-Shield J.P. T3P8, T3P14, T3P25

Hammerle S. T1P39

Han J.S.Y. T4P191

Han K.-D. T2P107, T2P139

Han S. T4P108

Hanaki K. T3P23

Händel M.N. T3P46

Handjiev S. T4P196, T4P197, T4P203

Handjieva-Darlenska T. S17.3, T4P34, T4P196, T4P197, T4P203

Hanhineva K. T1P37

Hanjieva-Darlenska T. T1P55

Hanna Wakim L. T2P63

Hannema S.E. T3P17

Hansen D.L. O7.2

Hansen J.B. T1P33

Hansen T. O7.2, O11.2, S4.1, S22.2

Hansen T.T. T4P192

Hardman C.A. S12.4, T2P174, T4P50

Harrington J.M. T3P35, T3P36

Harris J. S18.3

Harrison S. T4P9

Hashemi M. T4P43

Hashmi S. T3P33, T3P50

Haskova A. T4P46

Hassapidou M. T2P12

Hata T. T4P81

Hatz M. T2P149, T3P124

Hatzmann F. T1P39

Haugen C. T1P5

Haugstøyl M.E. T1P6

Hauner H. T1P80

Hausinger P. T3P60

Havaš Auguštin D. T2P86

Have C.T. O7.2, O11.2

Haverals L. T4P141

Havranova A. T4P173

Hayashi K. T4P23

Hayashida M. T4P4

Hayes A. O12.1, O12.6

Haymana C. T4P160

Hazebroek E.J. O3.5, T1P158

Heatherington M. T4P172, T4P217

Hebebrand J. S12.1

Hebestreit A. O6.3, T2P143

Hedesan O.C. T1P41, T1P111

Heerschap A. S6.4

Hegland P.A. T4P7, T4P51

Heinen M.M. O6.4, T3P52

Heitmann B.L. O9.1, T2P126, T3P15, T3P46

Heldt K. T3P73

Helgason T. T3P84

Hemmeryckx B. T1P103

Hendl J. T4P154

Hennessy E. T2P167

Hens W. O13.4

Heo Y. T2P176

Herbig B. O9.5

Heredia M. T2P61

Hermes G. O14.3

Hernandez C. O7.1, T4P36, T4P164

Hernández-Alonso P. T4P187, T4P198

Hernandez-Lizoain J.L. T1P32

Herrerias F. T1P128

Hesseldal L. O9.4

Heu V. T3P75

Heyn G. T1P108

Hibberd A.A. T1P149

Hiel S. T4P202

Higgs S. S2.3, S23.1, T2P172

Hilbert A. O9.2, O9.5, T3P31

Hill A.J. S3.2, T3P141

Hill M. T3P126

Hillier-Brown F. T2P34

Hillman T. T3P140

Hills A. T1P87

Hinton E.C. T3P25

Hintze L.J. T1P18

Hirani V. T2P13

Hirata B.K.S. T1P57

Hirata M. T1P126

Hirosova K. T3P127

Hirotsuka M. T1P156

Hiruta N. T4P23

Hjorth M.F. O8.4, T4P201

Hjorth S. T4P27

Ho C.Y. T4P191

Ho S.Y. T3P49

Hocaoglu M. T3P64

Hochuli M. T3P13

Hocking S. T4P61, T4P62, T4P63

Hocquaux L. T4P70

Hofmann J. T3P75

Holban T. T4P199

Holl R.W. T3P131

Hollander P. O8.6

Hollensted M. O7.2

Holliday A. T1P19

Holly J.M. T3P8, T3P25

Holm J.B. O8.4

Holmberg C. T3P140

Holmin T. O9.3

Holst J.J. O14.3

Holubova M. T1P65

Holubová M. T1P66

Holzapfel C. T1P80

Homsanit M. T1P157

Hong S.-W. T1P114

Honoré A.H. T1P149

Hood K. T4P165

Hooper L. O2.5

Hopkins M. T1P17, T1P67

Hoppichler F. O7.4, O10.3, S26.3, T3P133

Horan M.K. O4.4, T2P192

Horcsh L. T4P112

Horgan G. T1P67, T2P166

Hörl S. T1P39

Horvath J.D.C. T2P61

Hossain A. T1P154

Hosseini-Esfahani F. O4.6

Houdijk E.C. T3P17

Houttu N. T2P152, T2P153

Howard V.J. T2P113

Hristov I. T1P59

Hsiang J. T4P8

Hu C.-Y. T1P20, T1P129

Hu H.-Y. T2P115

Hu S. T1P120

Huang C.-K. T4P139

Huang H.L. T4P10

Huang K.C. T4P95

Huang S.-Y. T3P2

Huang Y.-T. T3P2

Hubens G. T4P5

Hübner C. O9.5, T3P31

Hubner N. T1P9

Hufthammer K.O. O4.5

Hughes A. T3P68

Huhtaniemi I. S25.2

Humeda H.S. T3P53

Huriyati E. T2P70

Huseinovic E. T4P129

Huttl M. T1P15

Huybrechts I. O6.3

Hwang I. T4P167

Hwang I.C. T2P107

Hwang Y.-C. T2P110

I

Ienca R. O8.3

Iida T. T1P154

Illés É. T3P138

Ilonen J. T3P20

Imamura H. T4P23

Imbeault P. T1P165

Imperatore N. T1P82

Imrich R. T4P173

Inchley J. O6.3

Invitti C. O8.5, T4P215

Iorio E. T1P110

Ippolito G. T3P99

Irwin A. T4P39

Isabel Iguacel Azorín I. T3P11

Ishihara N. T4P32, T4P33

Itani T. T1P146

Ivanova E. T4P34

Ivanova L. T2P89

Iwase M. T1P126

Iyer A.M. O1.2

J

Jaccard A. O13.2

Jacobs S. T2P3

Jacobson P. O7.6, T4P27

Jaimovich E. T1P102

Jalabert A. T1P112

Jamar G. T1P23, T4P123, T4P125

James A. T3P14

Janse A.J. O12.5

Jansen E. O2.3, T3P22, T3P55, T3P58

Janson A. T3P5

Janssen I.M.C. O3.5

Jansson S. T4P127

Jaroslavski L.B.D.S. T2P158, T2P208

Jarosz M. T2P36

Jasinska K. T4P56, T4P59

Jazet I.M. T2P124

Jaziri A. T4P170

Jeannot C. T3P113

Jebb S.A. T4P136, T4P165

Jebeile H. T3P85

Jelenik T. O14.6

Jelok I. T1P95

Jendle J. T4P127

Jenkinson A. T4P43

Jensen B.B. T3P28

Jensen B.W. T3P7, T3P80

Jensen H.M. T1P149

Jeong S.J. T4P218

Jepsen C.H. T4P118

Jeremic D. T4P159

Jersin R.Å. T1P7

Jespersen N.Z. S22.2

Jesus I.C. T2P193

Jheng H.F. O5.1, T1P126, T1P156

Jiang M. T1P31

Jo I.G. T1P153

Jocken J.W..E. O5.6

Joe Y. T1P152

Johannsen N. T4P79

Johansson E.H. T4P129

Johnson J.A. T4P172

Johnson W. S13.2

Johnston K.L. O10.2, T4P14, T4P17, T4P166

Johnstone A. T1P67

Jokkala J. T1P37

Jones A. T3P78

Jones AR. S18.3

Jongejan M. T4P106

Jorda A. T3P72

Jorge R. T4P128

Jorquera G. T1P102

Joseph D. T4P61, T4P62, T4P63

Jovani D. O4.2

Jukema J.W. O6.5, T2P15, T2P124

Jukema P..J.W. T1P159

Julian V. O2.2

Jung D.H. T2P145

Jung D.-H. T4P111

Jurkovicova J. T3P127

Juvekar A.R. T1P79

K

Kabisch M. O8.1

Kaddam L. T3P53

Kahan S. T4P115

Kahathuduwa C. T1P161

Kairey L. T3P36

Kaiser S. O9.5

Kalala G. T4P202

Kamada T. T2P108

Kamenov Z. T4P34

Kamitori K. T1P154

Kanai R. T4P4, T4P23

Kanayama S. T3P23

Kanerva N. T2P129

Kang J.-H. T1P117, T2P176

Kang M.-I. T2P139

Kang S. T4P97

Kanno S. T1P90

Kannt A. O5.5

Kantanen T. T4P86

Kaplanian M. O14.1

Kaposvári C. T2P12, T3P138

Kapsdorfer D. T3P127

Karabudak E. T2P77, T2P82, T2P83, T2P84

Karaca E. T2P156

Karaca F.C. T4P48

Karacil Ermumcu M.S. O4.1, T1P160, T2P31, T2P59, T2P65, T2P71, T2P72, T2P77, T2P82, T2P83, T2P84, T2P93, T4P77, T4P147, T4P148, T4P206

Karam-Sarkis D. T1P146

Karaolia M. T4P76

Karelović D. T2P86

Karen I. T4P154

Karevold K.I. T2P39

Karhunen L. T4P86

Karlsson C. T4P27

Karlsson J. T2P114, T4P127

Karlsson Lindahl L. T4P27

Karolkiewicz J. T1P91, T2P190

Kasama K. T4P32, T4P33

Kashiwabara K. T1P60, T1P90

Katsilambros N. T4P42

Kawada T. O5.1, T1P126, T1P156

Kawakubo S. T4P4

Kawarasaki S. O5.1

Kazdova L. T1P15

Kearney P.M. T3P36, T3P62

Keaver L. O13.2, T2P205

Kebbe M. T3P82

Kefalianou K. T3P104, T3P139

Keijer J. T1P68, T1P163

Keijser B. S6.4

Keiran N. T1P24

Kelleher C.C. O6.4, T3P52

Kelly C. T3P36, T3P62

Kelm S. T2P143

Kennelly M. T4P15

Kenner L. T1P41

Kersting M. T3P35

Keskin İ. T2P104

Kessels R.P.C. T1P158

Khammassi M. O2.2

Khayat N. T4P34

Khazzaka A. T1P136, T1P146

Kherouf M. T4P188

Khoo J. T4P8

Khumkhana N. T1P157

Kiefer F.W. T1P41, T1P111

Kiilerich P. O8.4

Kiliaan A.J. S6.4, T1P158

Kılıç Y.E. T4P48

Kilmurray M. T3P141

Kim B.-Y. T4P143

Kim C.H. T4P218

Kim C.-S. T1P152

Kim D. T4P61

Kim D.-Y. T2P74

Kim H.S. T2P135

Kim J. T2P123

Kim J.Y. T2P128

Kim K. T1P153, T4P167

Kim K.-K.L. T2P170

Kim M.J. T2P145, T4P111

Kim M.-S. T1P69

Kim N.H. T2P135

Kim O.Y. T4P108

Kim S.G. T2P135

Kim S.Y. T4P89

Kim Y. T1P152

Kim Y.A. T2P146

Kimura K. T2P46

Kimura S. T3P23

Kindblom J. O11.5, O11.6, O12.3

King A.J. T1P19

King J.A. O3.6, T1P13

King N. T1P87

Kirk S. O13.3

Kirpichenkova E. T2P44, T2P112

Kisic Tepavcevic D. T2P127

Kıyıcı S. T4P160

Kjartansdottir I. T3P108

Klausz B. T1P71

Klaver M. O1.1

Kleemann R. S6.4, T1P158

Klein D. T4P217

Klein Hazebroek M. T1P68

Klein M.R..S.T. T2P78, T4P142, T4P210, T4P213

Klein O. T4P202

Kleinendorst L. O3.5, T3P17, T4P106

Klemarczyk W. T3P45

Klimesova I. T2P47, T3P27

Klingenspor M. S22.3

Klobucar Majanovic S. T2P130, T2P164, T2P165

Knip M. T3P20

Knopf T. T3P39

Ko K. T4P167

Koborova I. T1P78

Kocaadam B. T2P77, T2P82, T2P83, T2P84, T4P71, T4P204

Koçak T. T2P150

Kocelak P. T2P161, T4P93

Koh G.C.H. T4P191

Koinaki S. T3P139

Kokkinos A. T4P42, T4P76

Koksal E. S12.3, T1P148, T2P77, T2P79, T2P82, T2P83, T2P84, T2P102, T2P105, T2P133, T4P71, T4P204

Köktürk O. T1P160

Kolehmainen M. T1P37

Koliaki C. O14.6, T4P42

Kołodziejczyk N. T2P106

Kolokytha T. T4P76

Kolotkin R. T4P7

Kolotkin R.L. O4.5, T4P51

Komaki G. T4P81

Komorowski A. T4P175

Kondrashov A. T2P26

Konieczna J. T2P189, T4P135

Konrad M. T2P33, T3P37

Koochakpoor G. O4.6

Kopecky J. T1P9

Kopp H.-P. T4P99

Kops N. T2P61

Kořínková L. T1P65, T1P66

Kormas N. T4P61, T4P62, T4P63

Korndal S.K. T4P192

Korolev A. T2P44, T2P112

Kosiukhno S. T4P175

Kösling C. T3P31

Košutzká Z. O1.5

Kosyura S.D. T2P57

Kotmel A. T4P57

Kovacs V.A. T2P12, T3P138

Kovács Z. T1P71

Kovalenko L. T1P123

Kowatsch T. T3P73

Kozakiewicz K. T2P116

Koziel D. T2P187

Kramar B. S22.2

Kravchychyn A.C.P. T3P21b

Krebs M. O7.4, T4P52

Kręgielska-Narożna M. T4P20, T4P146

Kreissl A. T3P72

Kremers S. T2P5

Kreuchwig F. T1P9

Kriaucioniene V. T4P65

Kristensson F.M. T3P10

Kristiansen K. O8.4

Kristinsson H. T3P75

Kronberger A. T2P33, T3P37

Kronberg-Kippilä C. O10.4

Krontiris A. T3P139

Krššák M. S6.3

Krumpolec P. O1.5, T1P96

Kruschitz R. O7.4, T4P52

Kruseman M. T2P184

Krzizek E.-C. T4P99, T4P100

Kucuk Baloglu F. O5.2, T1P45

Kucukerdonmez O. S12.3, T2P101, T2P104, T2P105, T2P210, T4P71, T4P204

Küçükler F. T4P160

Kuda O. T1P9

Kujawska-Łuczak M. T4P146

Kukic M. T2P164, T2P165

Kullberg J. T3P75

Kulseng B. O1.3

Kunduzova O. T1P151

Kuneš J. T1P65, T1P66

Kunesova M. T2P58, T3P81, T3P105, T3P126

Kupers L.K. O11.1

Kurata K. T1P60, T1P90

Kurdiova T. T1P95

Kušec V. T1P76

Kushner R.F. T2P17

Kutlutürk F. T4P160

Kuzmin A. T2P44

Kvaløy K. O2.1

Kvehaugen A.S. T1P147

Kwaśniewska M. T2P116

Kwon H. T2P185

Kwon H.S. T2P139

Kwon J.-W. T2P176

Kwon Y.-J. T4P111

Kyle, T.K. S1.3

Kyttälä P. O10.4

L

L.C. Veldman S. T3P9

Labusca L. T1P59

Lacey B. T2P117

Lafrance R. T4P217

Lagler F. T3P75

Lähteenmäki L. O9.1

Lahti-Koski M. O10.4

Lahtinen S. T1P149

Laitinen K. T2P152, T2P153

Lake A. T2P34

Lal A. T3P21a

Lally P. T4P83

Lam B.C.C. T4P191

Lam T.H. T3P49

Lamb H.J. T2P15, T2P73, T2P124

Lambert E.V. T2P54

Lameck-Marwa W. O13.1

Landa V. T1P9, T1P15

Landin-Olsson M. T2P45, T2P49

Lange C. O6.3

Langer F. O1.6, T4P29, T4P57

Langin D. O5.4, T1P38

Lanthier N. T4P202

Lantigua H.F. T3P6

Lappalainen R. T4P86

Lapveteläinen A. T4P86

Larkin E. O4.4, T2P192

Larsen L.H. O8.4

Larsen M. S22.2

Larsen S.C. T2P126, T3P46

Lasa A. T1P54

Lassandro C. T3P99

László A. T3P60

Laterza S. T1P110

Lattimore P. T2P182

Lauder M. T3P121

Laupsa-Borge J. T4P140

Law N.-M. T4P8

Lazda I. S18.4

Le Bacquer O. T1P162

Le Cessie S. O6.5

Le May M. S23.4

Le Page P. T4P61, T4P62, T4P63

Le Tinier B. T4P64

Lean M.E. O3.1, T2P168, T4P12, T4P92

Lean M.E.J. T4P188

Leandri S. T1P10

Leandro C. T2P198

Leary S.D. T3P8, T3P25

Leca B. T4P153

Lechleitner M. O10.3, T3P133

Leclercq W.K.G. T4P130, T4P225

Lecube A. O7.1, T1P109, T1P128, T2P32

Lederer R. T2P207

Lee D. T4P167

Lee H. T2P74

Lee J. T1P114

Lee J.H. T1P81, T4P18

Lee K.R. T2P107, T4P167

Lee M. S23.1

Lee P.C. T4P183

Lee S.Y. T2P123, T4P162

Lee W.-Y. T1P114, T2P139

Lee Y. T3P2

Lee Y.-H. T1P81, T4P18

Lee Y.Y. T2P70

Lefebvre D. T3P34

Legrand R. T4P201

Lehtinen-Jacks S. O10.4, T3P20

Leis R. T3P32

Leite N. T2P193

Leitgeb J. T2P149

Leitzmann M. S10.1

Lekhal S. T2P39

Lemmer A. T3P131

Lemoine V. T4P70

Lenaerts K. O14.3

Lenzi A. T1P115

Leone A. T4P103

Leonetti F. T1P46

Leong G. T3P67

Leoni S. T4P11, T4P171

Leshem-Lev D. T1P107

Leslie W.S. T4P12, T4P92

Lester K. T4P60

Leu Agelii M. T3P11

Leung L.L. T1P2

Lev E. T1P107

Leva P. T1P134

Levitt N. T2P54

Lewington S. T2P117

Lewis J. T1P40

Lewis K.A. T3P48

Li C.-H. T2P169

Li D. T1P121, T2P118, T3P40, T3P97

Li V. O10.6

Li W.-C. T1P105

Li Y. T1P21

Li Y. S22.3

Liang Y. T3P40, T3P97

Liao Y.Y. T4P95

Liaskos C. T4P42

Liatis S. T4P76

Licaj I. T2P14

Lidström M. T3P75

Lien N. O6.3

Liesionytė K. T2P155

Liew Z.H. T4P183

Lijnen R. T1P103

Lim H. T2P74

Lim K.-W. T1P153

Lima M.D.S. T4P75

Lin B.Y. T4P139

Lin W.-D. T4P139

Lin W.-Y. T4P139

Lin Y.-C. T3P96

Lin Y.-J. T4P16

Lindén-Boström M. T2P114

Lindfors P. O10.4

Lindsay K.L. T4P15

Ling Y. O5.3, T1P26

Liou T.-H. T3P2

Lipatov D. T2P44

Lissau, I S15.1

Lissner L. T2P14, T3P11, T3P140

Lister N. T3P85

Lithander F.E. T3P14

Liu P. T3P63

Liu Y.-N. T1P105

Liu Z. T1P21

Livantsova E.N. T2P57

Llanos P. T1P102

Llorente M. T1P36

Lobstein T. S7.4, S26.1

Loechl C. S18.1

Long A. T1P19

Łoniewski I. T1P144, T1P145, T4P20

Lopes L. T2P180

López-Cano C. T1P128

Lorenzen J.K. O8.4

Lorenzo J.R. T4P84

Loveman E. S24.1

Lovisi M. T4P11, T4P171

Lowe R. T4P165

Lozoff B. O3.3

Lu C.-W. T2P202

Lu F.-H. T1P20, T2P169, T4P161

Lubaczeuski C. T1P16

Lubrano C. T1P115

Lucchetti E. T4P103

Luckman S.M. S23.4

Ludvik B. O7.4, S11.2, T2P41, T4P52, T4P99, T4P100

Luger A. O14.1

Luger M. O7.4, O10.3, T3P16, T3P133, T4P52

Lugo S. T3P51

Luig T. T4P172, T4P217, T4P224

Luijten A.A.P.M. T4P130, T4P225

Luminet O. T4P193, T4P202

Luna A. O7.1

Lund N. T3P28

Lundberg K. O3.4

Lundh M. S22.2

Lung T. O12.1

Lv X. T1P121, T2P118

Lycett D. T4P74

Lynes M.D. S22.2

M

Ma F. T1P21

Ma S. T1P72

Ma T. S22.2

Mabry A. T3P48

Macarulla M.T. T1P140

Maccora C. T1P56, T4P122

Macedo G.A. T1P104

Machado M.M..F. T1P57

Machado P.P. T4P66, T4P75

Macias-Gonzalez M. T4P21

Macit M.S. T1P131, T1P148, T2P79, T2P102, T2P133

Madej P. T4P93

Maderova D. T1P95

Mądry E. T1P91, T2P190

Madsbad S. O7.2

Madsen A.G. T1P7

Madsen L. T1P7

Madsen L.R. O7.3

Maffeis C. O12.2

Magalhães D. T4P38, T4P47, T4P49, T4P53, T4P54

Magalhães G.M. T2P197

Magalhães K.G. T1P108

Magalhães S. T2P125, T3P56

Magarey A. T3P55

Maglio C. T3P10, T4P27

Mahat B. T1P165

Maher S.E. T3P109

Mai S. O8.5, T4P215

Maione F. T1P83, T4P208

Majercak I. T2P40

Malczewska-Malec M. T1P944, T1P133, T1P137, T4P155

Malden D. T2P117

Malden S. T3P68

Malecka-Tendera E. T3P29

Maletinska L. T1P65, T1P66

Malina-Atzlinger E. S15.5, T3P39

Malinowski P. T2P182

Malinska H. T1P15

Malkova D. O3.1, O3.4

Mallan K. O2.3, T3P55

Manco L. T4P105

Manco M. O11.3

Mandhane P. T3P34

Manell H. T3P75

Maniadaki I. T3P104, T3P139

Manios Y. T3P35

Mann KD. S18.3

Männistö S. T2P129

Manson E. T4P61, T4P62, T4P63, T4P182

Mantzoros C. PL3.1

Manz K. O6.3

Marazzi N. T4P103

Marcaida G. T4P105

Marcello A. T1P141

Marchesini G. T4P67

Marcon F. T1P110

Marcoviciu D. T1P107

Marcovicu D. O8.2

Mariani S. T1P115

Maric G. T2P127

Mariën I. T4P5

Mariman E.C. T2P70, T4P186

Marins M. T2P197

Markaki A. T3P104, T3P139

Markel A. O8.2

Markgraf D. O14.6

Markova I. T1P15

Markovic R. T2P130

Markovic T.P. T4P61, T4P62, T4P63, T4P182

Marques O. T4P90

Marra M. T1P82, T1P83, T1P84, T2P2, T4P207, T4P208

Martens D. T3P3

Marti A. T3P102, T3P114

Martin C.K. T4P79

Martin D. T4P61, T4P62, T4P63

Martin J. O6.1, T3P37

Martin S. T1P141, T4P22, T4P150, T4P153, T4P209

Martin-Diana A.B. T1P54, T1P140

Martinez De Tejada B. S25.3, T4P64

Martinez F.V. O4.2

Martínez J..A. T1P44, T2P189, T3P102, T4P21, T4P135

Martinez P.L. T2P66

Martinez-Avila W.D. O3.2

Martínez-González M.A. T2P131, T4P198

Martinez-Puig D. T4P185

Martinez-Tellez B. O3.2, T2P147

Martínez-Villaluenga C. T1P54

Martín-Ramos M. T1P164

Martins C. O1.3

Martins L.C. T2P209

Martins S. T4P78

Martins S.S. T3P119

Martis E. T1P79

Martos E. S26.2

Maruszczak K. T3P136

Marzullo P. T4P215

Masclee A.A.M. O14.3

Masquio D.C.L. T3P21b, T4P66, T4P75

Massa G. T1P11

Massat A.E. T2P21

Maston G. T4P182

Masurier J. O2.2

Matos M. O9.1

Matoulek M. T4P46

Matsiyevskaya T. T4P104

Matsubara H. T4P32, T4P33

Matsumura Y. T1P156

Matta J. T2P63

Matta-Coelho C. T4P90

Mattes R.D. S20.4

Mattesich M. T1P39

Mattos A. T4P84

Matu J. T1P19

Matusik P. T3P29

Matvienko-Sikar K. T3P36

Mauger J.-F. T1P165

Maukonen M. T2P129

Maung A.C. T4P183

Maunz S. T2P33, T3P37

Mavrinac M. T2P130

Mazidi M. S1.2

Mazurina N. T4P116

Mazzali G. O4.3

Mazzawi S. O8.2

Mcaleese A. O6.1

Mcanena O. T4P35

Mcauliffe F.M. O4.4, T2P192, T2P206, T3P109, T4P15

Mccarthy D. T4P150, T4P209

Mccarthy R. T2P17

Mccombie L. T4P12, T4P92

Mcconnachie A. T4P12, T4P92

Mcdonald S. T3P34

Mcgeechan G. S24.1

Mcgowan B. O8.1, T4P118

Mchugh S. T3P62

Mchugh T.-L. T3P82

Mckie S. T1P74

Mckinley M.C. T3P36, T3P62

Mclaughlin J. T1P74

Mclin D. T4P221, T4P222

Mead E. S24.1

Megna R. T4P185

Mehegan J. O6.4, T3P52

Meija L. T2P88

Mellgren G. T1P5, T1P6, T1P7, T1P51, T4P140

Melo* B.F. T1P53

Meltzer S. T2P54

Méndez-Giménez L. T1P36

Mendez-Rebolledo G. T1P58

Meneghini V. T2P137, T2P199

Meneses D. T4P44

Meneses-Valdés R. T1P102

Menesguen F. T4P170

Menezes-Júnior F.J. T2P193

Mengi Ö. T3P61

Menna Barreto A.P. T2P78, T4P142, T4P213

Menna Barreto A.P.M. T4P210

Mennitti L.V. T1P23, T4P123, T4P125

Merchan E. O3.2

Merigliano S. T4P58

Merino B. T1P42, T1P52, T1P75

Mesa J. T4P36, T4P164

Mesa M.D. T3P32

Meseri R. S12.3, T2P105, T2P210

Mesquita L.M.S. T1P124

Messias C.B. T4P176

Messing S. T2P12

Mestry S.N. T1P79

Metelska P. T2P178, T3P101, T3P103

Meugnier E. T1P112

Micek A. T1P133

Michałowska J. T2P68, T2P69

Michel D.A. T2P193

Michels N. T3P3, T3P11, T3P24, T3P35

Micic D. T2P127, T4P30, T4P30, T4P159

Micklesfield L. T2P54

Miguet M. O2.2

Mihalache L. T2P87

Mikkelsen M.-L.K. T2P126

Mikol V. O5.5

Milagro F.I. T1P44

Milenković T. T2P53

Miles-Chan J. T1P119, T4P205

Milin Lazovic J. T4P30

Miljus D. T2P127

Millar S. S13.3

Miller C. O10.1, T2P18

Milton I. T1P44, T1P54, T1P140

Miñambres I. T2P32

Minamimae K. T3P23

Minderico C. T4P78

Minshall G. T3P86

Miolanne M. T3P113

Miranda J. T1P140

Mirmiran P. O4.6, T2P16

Mironova D.S. T1P55

Missoni S. T2P86

Mitrache M. T4P153

Mitrou G. S10.3

Mitrović K. T2P53

Mitulovic G. T1P111

Miyashita M. T1P60, T1P90

Miyazaki Y. T4P32, T4P33

Mlejnek P. T1P15

Mocanu V. T1P59

Modena D.A.O. T2P27, T2P158, T2P208, T4P158

Mohamed-Ali V. T4P137

Mohammed A. T2P186

Mohipp C. T3P82

Mok H.Y. T3P49

Mokhova I. T2P24

Mokkala K. T2P152, T2P153

Molarius A. T2P114

Molinari L. T1P10

Molinger J. T1P116

Mollica M.P. T1P134

Molnár Z. T3P60

Moncada R. T1P32, T4P37

Monica Hunsberger M. T3P11

Moniz K. T4P217

Monk-Hansen T. T4P9

Montani J.-P. T1P119, T4P205

Montastier E. T1P38

Monteiro A.M. T4P90

Moodie M. O12.6, T3P21a

Mook-Kanamori D. T2P15

Moore R. T3P109

Moradi-Lakeh M. T1P106

Moraes A. T4P176

Moraes A.D.S. T4P174

Morales L. T1P75

Morales M.J. T2P32

Morandi A. O12.2

Morawska A. T3P22

Morazzini M. T1P110

Moreira C. T2P180

Moreira C.S. T2P197

Moreira D.K.T. T1P104

Morell-Azanza L. T3P102, T3P114

Moreno L.A. S15.3, T3P11, T3P32, T3P35

Morgado V.M. T2P197

Morgen C.S. O11.2

Morinder G. T3P5

Morisson K. T3P34

Morley B. O6.1

Morlino D. T1P84, T4P208

Morretti T. T1P110

Morris E. T4P136

Morris L. T2P166

Morser J. T1P2

Morshed A.B. T4P73

Mortensen E.L. T3P15

Moscalu M. T3P107

Mosenzon O. O8.1, T4P118

Moser N. O10.3, T3P133

Moses A. T3P28

Moslehi N. T2P16

Möstl N. T2P149, T3P124

Mota J. T2P193

Muda W.A.M.W. T2P70

Muhammad H.F.L. T2P70, T4P186

Muhlhausler B. T4P212

Mujkić R. T1P4

Mulders M. T4P202

Müller A. O9.2

Müller M. O14.3

Mulliez A. T3P113

Munda P. O1.6

Muñoz-Hernandez V. O3.2

Munshi R.P. T1P79

Murano T. T1P31

Muratori F. T4P117

Murphy K. T2P131

Murrin C.M. O6.4, T3P52

Muscurel C. T4P199

Musialik K. T4P146

Musić Milanović S. T2P86

Mustikaningrum F. T4P212

Myers A. O1.4, T2P188

Myers C.A. T4P79

N

Naccarato M. T4P207

Nadglowski, J. S1.3

Nagpal S.J. T2P21

Naitoh T. T4P32, T4P33

Nakkash R. T3P944

Nam J. T2P176

Nandiola S. T3P33

Napier D. O9.4, T3P28

Naranjo V. T1P52, T1P75

Nas A. T1P14, T1P62

Nascimento L. T2P158

Nascimento M.A. T4P174

Näslund E. T4P145

Näslund I. O9.3

Natrella F. T4P101

Navruz Varlı S. O4.1, T2P59

Nawrot T. T3P3, T3P24

Nazare J.-A. T2P198

Nebeling L. T2P167

Nedeljkovic I. T4P30

Neder A.M. T2P27, T2P158, T2P208, T4P158

Nedergaard J. S22.4

Negrão R. T1P3

Negro G. T4P207

Neovius M. O9.3

Neprašová B. T1P65, T1P66

Neri O. T4P122

Nethander M. O11.6, O12.3

Neumann M. O9.2

Neves C. T1P3

Neves J. T4P49

Neves J.S. T4P38, T4P47, T4P53, T4P54

Newsome P. T4P9

Neyrinck A.M. T4P202

Nicholson J. T3P55

Nickless A. T4P136, T4P165

Nielson L. T3P48

Nikitenko E. T2P44, T2P112

Nikolaou C.K. T2P168

Nikolova M.G. T4P109

Nilaweera K.N. T4P184

Nilsen I. T4P31

Nişancı Kılınç F. T2P85, T2P103

Nishihara T. T4P81

Nisticò L. T1P110

Nita O. T2P87

Nitescu M. T2P80

Niven P. O6.1

Njardvik U. T3P83

Njølstad P. T1P5

Nobili V. O11.3

Nobles J. O13.1, T2P204

Nobre I. T2P198

Nogueiras R. T1P24

Nøhr E.A. O11.2

Nomura W. O5.1, T1P126

Noordam R. O6.5, T2P124

Nordbø O.P. T1P5

Noronha M. T4P90

Nota N. O1.1

Nothrup H. T3P51

Novikova E. T4P104

Novokmet N. T2P86

Nozaki T. T4P81

Nur T. T2P48

Nyangasa M.A. T2P143

Nymo S. O1.3

O

O'Connor E.M. T3P36

Obeid O. T1P64, T1P88, T1P136

Öberg-Arendt D. T1P99, T1P100

O‘Brien E.C. O4.4, T2P192, T2P206, T3P109

O‘Brien K. T4P223

O‘Brien T. T4P35

Ødegård R. T4P133

Odunitan-Wayas F. T2P54

Oh A. T2P167

Ohlsson C. O11.5, O11.6, O12.3

Ohshiro T. T4P4

Ohta M. T4P32, T4P33

Ojeda-Rodriguez A. T3P102, T3P114

Okazumi S. T4P4, T4P32, T4P33

Oke J. T4P136

Okop K.J. T2P54

Olabi A. T1P64

Olafsdottir A.S. T3P83, T3P84, T3P108

Olechnowicz J. T2P944

Oleynik O. T3P66

Oliveira C. T4P194

Oliveira L. T2P162, T2P163

Oliveira R. T4P90

Oliveira S. T4P47, T4P49, T4P53, T4P54

Oliveira-Maia A.J. T4P1

Oliver P. T1P68, T1P163, T2P212

Oliyarnyk O. T1P15

Olmos P. O14.2

Olsen N.J. T3P15, T3P46

Olszanecka-Glinianowicz M. T2P161, T3P29, T4P93

Olza J. T3P32

O‘Malley G. O6.4, T3P87

Omrani A. S23.2

O‘Neil P.M. O8.1, T4P118

Ong K.K. PL2.1

Onokwai N. T4P2

Onufrio M. T1P84

Oppert J.-M. S8.3, T4P3, T4P70, T4P170

Orellana E. T1P12

Orer H.S. PL1.1

Orrico F. T4P84

Ortega I. O7.1

Ortega V.A. T1P32

Ortiz Ortiz M. T4P216

Örük G. T4P160

Orwin M. S12.4

Oshiro T. T4P23

Osler M. T2P6

Otelea M. T2P80

Ottosson J. O9.3

Ou H.-Y. T1P129

Ouni M. O14.6

Ouyang S. T1P21

Ovadia D. T3P6

Owczarek A. T4P93

Owino V. S18.1

Oyama L.M. T1P23, T3P21b, T4P66, T4P123, T4P125, T4P174

Özata Uyar G. T2P76, T2P79, T2P81, T2P85, T2P102, T2P103, T2P133, T2P171, T3P61, T4P157

Özenir Ç. T2P85, T2P103

P

Pachikian B. T4P193, T4P202

Pacini F. T1P56

Padit R. S23.2

Paepegaey A.-C. T4P170

Pagano M.C. T4P208

Page J. T1P141

Pai S.A. T1P79

Pail E. T2P33, T2P149, T3P37, T3P43, T3P124

Pająk A. T2P116

Pala V. T3P11

Palmeira A. T4P78

Palmeira A.L. T3P119

Palmred J. T1P99, T1P100

Palou A. T1P68, T1P130, T1P163, T2P212, T3P26, T3P57, T3P59

Panajotová V. T1P66

Papadopoulou E. T3P104, T3P139

Papsch M. T3P131

Paquot N. T4P202

Paraschiv-Ionescu A. T2P184

Parastika T.D. T4P2

Pardina E. T1P109

Paredes S. T4P90

Parini A. T1P151

Parizkova J. T3P126

Park C.-Y. T2P110

Park D.J. T2P176

Park J. T2P185

Park J.E. T4P89

Park J.-H. T4P89

Park S.-W. T2P110

Parkinson K. S18.3, T3P78

Parletta N. T2P131

Parramon G. T4P164

Partonen T. T2P129

Parzer V. T2P41

Pasanisi F. T1P82, T1P83, T1P84, T2P2, T4P207, T4P208

Pascual-Gamarra J.M. T2P147

Pasmans K. T1P118

Pasquali R. S25.1

Pastusiak K. T2P68, T2P69

Patkova B. T4P46

Patrac V. T1P162

Paul P. O5.5

Pauliukienė R. T2P155

Paulmichl K. T3P75

Pavlić-Renar I. T1P76

Pavlova A. T4P116

Pawar A.S. T2P21

Payrastre B. T1P151

Pearce MS. S18.3

Pecoraro L. S15.2

Pedersen L. O6.6

Pedersen O. O7.2

Pedersen S.B. T1P33

Pedersen S.D. O8.1, T4P118

Pedrazzoli J.J. T1P98

Pedret Llaberia R. O4.2

Pedro J. T4P38, T4P47, T4P49, T4P53, T4P54

Pedroso A.P. T1P127

Peeters A. O10.6, T3P21a

Pehlivan M. T4P206

Peiffer F. T4P141

Peinado-Onsurbe J. T1P109

Peirano P. O3.3

Peixoto I. T2P180

Pekmezovic T. T2P127

Pelgrim C.E. S6.4

Pellegrino D. T4P117

Pellitero S. T2P32

Peltonen M. O7.6, O9.3, T3P10, T4P27

Peñas E. T1P140

Penesová A. T4P173

Penkov A. T4P109

Penna E. T1P134

Peraramelli S. T1P2

Perehrestenko O. T4P175

Pereira B. T2P180

Pereira M.L. T4P90

Pereira S.E. T1P142

Perez A. T3P82

Pérez S.R. T4P119

Pérez-Ferrer C. T2P205

Perić Kačarević Ž. T1P4

Perks C. T3P8

Perrar I. T2P111

Perriello G. T4P120

Perry I.J. S13.3

Pesenti S. T1P112

Pestana D. T1P3

Peterli R. S9.3

Peters S. T4P72

Peterseil M. T2P33, T3P37, T3P43

Petkeviciene J. T4P65

Petraki M.E. T3P104

Petran M. T4P199

Petrelli A. T1P29

Petricevic N. T1P101

Petrick J. T3P7

Petroni M.L. T4P11, T4P171

Petrou S. O12.6

Petrova S.P. T2P121, T3P135, T4P195

Petzold J. T1P80

Pich S. O7.1

Pickering K. O13.1, T2P204

Picó C. T3P26, T3P59

Pierer G. T1P39

Pietrobelli, A. S15.2

Pigeot I. T3P11

Pijl H. T1P159

Pillai C. T3P50

Pilz R. T3P43

Pimsen K. T1P157

Pinkhasov B. T2P24, T4P104

Pinto G. T4P170

Pires J.V. T2P78

Pisani G. T1P134

Pisani L.P. T1P23, T4P123, T4P125

Pitigoi D. T2P80

Pizzolante F. O11.3

Plavšić L. T2P53

Plaza A. T1P42, T1P52, T1P75

Plengvidhya N. T1P157

Plodkowski R. O8.6

Ploos Van Amstel H.K. O3.5

Plucinska K. S22.2

Podchinenova D. T3P66

Poggiogalle E. T1P115

Poitou C. T4P3, T4P70, T4P170

Pokrajac-Bulian A.

Poletto J.E. T2P27, T2P158, T2P208, T2P209, T4P158

Poli V.F.S. T4P174, T4P176

Politi E. T3P104

Polovina S. S17.4, T2P127, T4P30, T4P159

Pomar C.A. T3P57

Pontes K.S.D.S. T2P78, T4P142, T4P213

Popkin B.M. PL5.1

Popova R. T2P89

Portheault D. T4P202

Portillo M.P. T1P44, T1P54

Posea M.C. T4P180

Potapov O. T4P175

Potgëns S. T4P202

Potter J.A. T3P121

Pouliot C. T2P48, T3P38

Pouwels S. O14.4, T4P48

Prado C. T4P194

Prager G. O1.6, T4P29, T4P57

Pramono A. O5.6

Pramyothin P. T1P157

Pratt I.S. O6.1

Pravenec M. T1P9, T1P15

Pražienková V. T1P65

Predel G.H. T4P150, T4P209

Prego* C.S. T1P53

Presto J. T1P99, T1P100

Prinz N. T3P131

Prochazka B. T3P126

Provyn S. T3P110

Prud‘Homme D. T3P38

Pucci A. S11.3, T4P43

Pudule I. S18.4, T2P88

Puhl, R.M. S1.3

Puoane T. T2P54

Pupek-Musialik D. T1P91, T2P68, T2P69, T2P190, T4P146

Purim K.S.M. T2P193

Putzhammer C. O10.3, T3P133

Q

Quadro L. T1P111

Quan L. T1P121, T2P118

Queiroz A.P. T3P106

Queiroz F.T. T2P197

Quirke S. T4P223

Qvisth V. T4P145

Qvortrup K. S22.2

R

R. Pereira J. T3P9

Raben A. T1P63

Rácz L. T3P60

Radács M. T3P60

Radić R. T1P4

Radikova Z. T4P173

Radley D. O13.1, T2P204

Radulian G. T4P180

Rafey M.F. T4P35

Ragusa V. T4P120

Rai K.K. O13.6

Raimundo A. T3P119

Ramalho A. T1P142

Ramezani Tehrani F. T2P16

Ramirez B. T1P32, T1P36, T4P37

Ramirez-Navarro A. O3.2, T2P147

Ramiro-Cortijo D. T1P164

Ramos Salas X. S1.3, O13.3

Rangelova L.S. T2P121, T3P135, T4P195

Räsänen S.M. O10.4

Rashidkhani B. T2P119, T2P136

Rasinkangas P. T1P149

Rasmussen S. T4P9

Rastovic M. T4P30

Raustorp A. S8.1

Rayco-Solon P. S24.1

Raymond J.E. T2P172

Raz I. O7.5

Razny U. T1P944, T1P133, T1P137, T4P155

Reaves D.L. T2P174, T4P50

Rebak D. T2P187

Rebasa P. O7.1

Reche A. O4.2

Reddy S. T3P19

Rees K. S24.1

Regent L. T3P114

Reguła J. T1P144

Rehfeld J. O1.3

Reilly J. T3P68

Reinehr T. T3P131

Reistenbach Goltz F. T1P13

Rejnmark L. O7.3

Renders C.M. T2P3

Rendina R. T1P46

Rendo-Urteaga T. T3P102

Rensen P.C..N. O6.5, S22.1

Reyes S. O3.3

Reynés B. T1P68

Rezeberga D. T2P88

Rhee E.-J. T1P114

Rhee S.Y. T2P128

Rhein S.O. T4P66, T4P75

Ribeiro A.L. T4P85

Ribeiro D.J.S. T1P108

Ribeiro E.B. T1P127

Ribeiro G. T4P1

Ribeiro Jr H. T4P84

Ribeiro P.N. T3P119

Riboldi L. T4P101

Ricart-Jané D. T1P109

Richard C. T3P82

Richard K. T4P121

Richelsen B. O6.6, O7.3, T1P33

Rico D. T1P54, T1P140

Rieder A. O10.3, T3P133

Rieusset J. T1P112

Rigal A. T3P113

Rigas G. T4P13

Rigaudiere J.-P. T1P162

Rigla M. O7.1

Riis-Vestergaard M.J. T1P33

Rimkus C.M. O3.3

Rioja S. T2P78

Riordan F. T3P35

Ritz C. T1P63, T4P192

Ritzén H. T1P99, T1P100

Rivas-Arancibia S. T3P98

Rivera-Davila M. T3P51

Rizou E. O3.4

Roager H.M. O8.4

Roberts A. T4P83

Robertson H. T3P67

Robertson M.D. T4P17

Rocha J.B. T2P197

Rocha J.E. T3P106

Rocha L.D.C.G. T4P177

Rocha P. T4P78

Roden M. O14.6

Rodrigues B.C. T1P142

Rodrigues I. T1P3

Rodrigues M.D.L.G. T2P78, T4P142

Rodriguez A. T1P32, T1P36, T4P37

Rodríguez A.M. T1P130

Rodriguez J. T4P202

Rodriguez-Buritica D. T3P51

Rodríguez-López R. T4P105

Rodriguez-Perez L. O3.2

Rodziyevska O. T3P50

Roefs A. S2.2

Roh E. T1P69

Rohde J.F. T3P46

Romaguera D. T2P189, T4P135

Romano-Zelekh O. O7.5

Rome S. T1P112, T1P112

Romero D. T4P164

Romero J.A. T4P114

Romon M. T4P69

Roos R.A.C. T1P159

Rosário R. T2P180

Rosenbauer J. T3P131

Rosenberg G. O2.5

Rosendaal F.R. O6.5, T1P159, T2P15, T2P73, T2P124

Rosengren A. O11.5

Rosique-Esteban N. T4P198

Rossato M. T1P10, T4P58

Roßbach S. T2P111

Rossi A. O4.3

Rossi S. T4P176

Rossignon F. T1P162

Rosso V.V. T1P23, T2P159, T4P125

Rostrup E. T4P140

Rotellar F. T1P32, T4P37

Rotshtein P. S23.1

Roumans N.J..T. T4P186

Rounge T.B. T2P92

Rowicka G. T3P45

Roy R. T2P11

Rozhko S. T4P80

Rubele S. O4.3

Rubio M.Á. T1P164

Rubio N. T3P6, T3P50, T3P65

Ruddock H.K. S12.4

Rüegger D. T3P73

Ruiter R. T2P5

Ruiz J.R. O3.2, T2P147, T3P35

Ruiz-Gayo M. T1P42, T1P52, T1P75

Ruiz-Montero P.J. T2P211, T3P47, T3P120

Ruperez A.I. T3P32

Rurane A. T2P88

Russell-Mayhew S. O13.3

Rust P. T3P16

Ruy C.C. T1P124

Rydén M. T4P25, T4P145

Rylander C. T2P14

Rymill S. O10.2

S

Sá R.D..C..C. T1P57

Saarela A.-M. T4P86

Saarinen M.T. T1P149

Saat Z. T2P156

Saboya C.J. T1P142

Sabuncu T. T4P160

Sacks G. T3P21a

Sacramento J.F. T1P53

Sadeghipour A. T1P106

Sadilkova A. T4P46

Sagen J.V. T1P5, T1P7

Sahota P. O13.1, T2P204

Saibene A. T1P29

Saiki A. T4P4, T4P23, T4P32, T4P33

Sainsbury A. T4P61, T4P62, T4P63, T4P182

Sainsbury K. O9.1

Sainz N. T1P36

Sajoux I. T4P21, T4P214

Saka M. T2P38

Sakran N. O7.5

Salas E. O7.1

Salas-Salvadó J. T2P189, T4P135, T4P187, T4P198

Salazar D. T4P38, T4P47, T4P49, T4P53, T4P54

Saldaña C. T2P32

Saleh R.K. T3P944

Salis A. T1P87

Salles J. T1P162

Salvador J. T1P32, T4P37

Salvetti S. T4P11, T4P171

Sameda M. T4P4

Sammarco R. T1P82, T1P83, T1P84, T2P2, T4P207, T4P208

Samohyl M. T3P127

Samoylova J. T3P66

Sampaio L.C. T4P177

Samsam W. T2P186

Samsam W.H. T4P137

Sanches R.B. T4P174

Sánchez E. O7.1, T1P128, T2P32

Sánchez J. T3P26, T3P57, T3P59

Sánchez-Bazán K. S1.5

Sanchez-Deglado G. T2P147

Sanchez-Delgado G. O3.2

Sanders J. T3P65

Sandsgård E. O2.1

Sandu P. T2P12

Sanlıer N. T4P147

Santaliestra-Pasías A.M. T3P35

Santamarina A.B. T1P23, T4P123, T4P125

Sant‘Ana L. T1P108

Santanam N. T1P141, T2P37

Santarpia L. T1P84, T2P2, T4P207

Santiprabhob J. T1P157

Santoro S. O14.4

Santos I. T4P128

Santos J.L. O14.2

Santos P.S. T1P98, T1P124

Santos R. T2P180, T3P9

Sanz Y. S4.2

Šarac J. T2P86

Sardinha L. T4P78

Sargeant J.A. O3.6

Saris W. O5.4, T1P38, T1P118

Sarkadi-Nagy E. T2P12

Sartori E. T4P11, T4P171

Sartorio A. T4P103, T4P126

Sasaki A. T4P32, T4P33

Satman İ. T4P160

Sattar N. T4P12, T4P92

Saunders J. O13.1, T2P204

Sava E. T4P22, T4P153

Savas M. O1.2, T4P107

Sawamoto R. T4P81

Sayegh R. T1P136, T1P146

Sbraccia P. T1P110

Scacchi M. O8.5, T4P215

Scerri I. T1P119

Schäfer L. O9.5

Schantl S. T3P37

Schätzer J. O10.3, T3P133

Schätzer M. O10.3, T3P16, T3P133

Scheele C. S22.2

Schéle E. S23.4

Schena F. T4P11, T4P171

Scherer T. O14.1, S6.3

Schiano R. O8.3

Schildkamp J. T4P72

Schindler K. O7.4, S14.2, T3P136, T4P52

Schlensak M. O14.6

Schmid M. T3P16

Schmidt R. T3P31

Schneider J. T2P182

Schneider T. O1.1

Schnurr T.M. O7.2, O11.2

Scholze J. T4P150, T4P209

Schon M. O1.5

Schoufour J.D. O6.2

Schuh C. S6.3

Schuren F. T1P158

Schürmann A. O14.6

Schutz Y. T4P205

Schwandt A. T3P131

Schwarz C.D. T4P73

Scott D. T2P13

Scott E. T4P166

Scott S. T3P82

Scroyen I. T1P103

Sears M. T3P34

Sebastiani G. T1P56

Sebekova K. T1P78

Sebert C. T3P31

Seckiner S. S12.3, T2P105

Sedin Å. T2P45, T2P49

Sedliak M. O1.5, T1P95, T1P96

Segurado R. T2P206

Seidell J.C. T2P3

Seidl R. T3P77

Seidler A. T1P141, T2P37

Seki Y. T4P32, T4P33

Selyatitskaya V. T2P24, T4P104

Senol B. T2P156

Seo E. T4P4

Seo M.H. T2P107

Seok K.-J. T2P55

Sepp K. T3P60

Serin Y. T4P71, T4P204

Serpa J.Q.D.A. T2P162, T2P163

Serra F. T2P212

Serra R. T4P58

Seto Y. T4P32, T4P33

Sevcikova L. T3P127

Severcan F. O5.2, T1P45

Seyam A. T4P137

Seyfried F. O9.5

Seyller C. T4P150, T4P209

Sezgin B. T3P64

Shab-Bidar S. T2P16, T4P138, T4P189, T4P190

Shaghouli A. O10.5, T4P28

Shaikh M. T3P34

Shannon O.M. T1P19

Sharma A.M. O13.3, T4P172, T4P194, T4P217, T4P224

Sheikh M.A. T2P143

Shekerdjiiska S. T4P196, T4P197

Shekerdjiiski R. T4P196, T4P197

Shen W.-J. T1P2

Sherry A. T4P15

Shih C.-H.I. T3P73

Shilton T. O6.1

Shimizu H. T4P32, T4P33

Shin H. T2P123

Shin H.-J. T1P81, T4P18

Shin Y. T1P81, T4P18

Shohat T. O7.5

Siani A. T3P11

Siervo M. T4P194

Sifaki M. T3P104, T3P139

Signore F. O11.3

Signore M. T1P110

Siksna I S18.4

Silhavy J. T1P9, T1P15

Silivestru-Cretu I. T1P59

Silva A. T2P180, T4P78

Silva C. T1P32, T4P37

Silva C.C.M. T4P213

Silva D.L. T3P106

Silva H.S. T4P213

Silva L.A. T4P85

Silva R.M. T1P104

Silveira L.R. T1P16

Silver J. T4P14

Silvestrin V. T1P10

Sim K.A. T3P67

Simakova M. T1P15

Simic T. T4P159

Simion G. T2P87

Simó A. O7.1

Simo R. O7.1, T4P36, T4P164

Simonelli V. T1P110

Sioen I. T3P3, T3P24

Sirbu A. T4P22, T4P153

Siuba-Strzelińska M. T2P36

Sjödin A. T4P192

Sjöholm K. O7.6, O9.3, T4P27

Skacel G. T3P72

Skafidas S. T4P11, T4P171

Skrypnik D. T1P91, T1P144, T1P145, T2P68, T2P69, T2P944, T2P190, T4P20, T4P146

Skrypnik K. T1P91, T1P144, T1P145, T2P944, T4P20, T4P146

Skurk T. T1P80

Slagboom P.E. T1P159

Slapo H. T2P39

Slevin T. O6.1

Slimani N. O6.3

Slobodova L. O1.5, T1P96

Smaldone G. T1P134

Smeu B. T4P22

Smidt H. O14.3

Smit R.A.J. O6.5

Smith K. T3P65

Smith S. T2P34

Smithers, L. O10.1, T2P18

Šnajder D. T1P4

Snieder H. O11.1

Sniehotta F.F. O9.1

Soare I. T4P22

Soave F. O4.3

Sobieska M. T1P145, T4P20

Socci C. T1P29

Sokolovska N. T4P3

Solea A. T3P11

Solnica B. T1P944, T1P133, T1P137, T4P155

Solomando A. T3P59

Somekawa Y. T4P88

Somoza B. T1P164

Somoza V. T1P78

Sondén A. O11.5

Song K.-H. T1P122

Sônia Rodrigues Álvares R. T4P6

Sönmez A. T4P160

Sonnabend K. T2P164

Soo D. T2P11

Soranna D. T4P215

Sørensen H.T. O6.6

Sorensen J. T3P87

Sørensen T.I..A. O7.2, O11.2, O11.4, T2P6, T3P7, T3P80

Sousa S.I. T1P3

Sousa-Sá E. T3P9

Souteiro P. T4P38, T4P47, T4P49, T4P53, T4P54

Souto S.B. T4P90

Souza A. T2P61

Souza S. T2P180

Sözlü S. T4P71

Sozmen E. T2P210

Speakman J.R. S1.2, T1P120, T4P184

Specter F. T4P70

Speranza A. T1P134

Speranza E. T1P83, T2P2, T4P207, T4P208

Spetter M.S. S23.1

Spinas G.A. T3P13

Spiroski I. T3P134

Spirovska S. T3P134

Sprung V. T4P39

Spyreli E. T3P62

Stahl B. T1P149

Stalker C. T2P166

Stamataki N. T1P74

Stamenkovic-Pejkovic D. T4P159

Starodubova A.V. T2P57

Staufer K. O1.6

Stazi M.A. T1P110

Stecher L. T1P80

Steele C. T4P17

Steele T. T4P39

Steflova A. T3P126

Stella G. T4P208

Stenberg H. T1P99, T1P100

Stenman L.K. T1P149

Stensel D.J. O3.6, T1P13

Stepaniak U. T2P116

Stift J. O1.6

Stiglund N. T1P6

Štimac D. T2P130

Stohr J. T1P66

Stoian I. T4P199

Storman D. T4P56, T4P59

Storman M. T4P56, T4P59

Stougaard M. T3P46

Straka I. O1.5

Strand K. T1P6

Strucińska M. T3P45

Stubbs R.J. O9.1, T1P67, T2P166

Stulnig T.M. T1P2

Subbarao P. T3P34

Sudo N. T4P81

Suh H. T4P167

Suh Y.-S. T2P55

Suliburska J. T1P91, T1P144, T1P145, T2P944, T4P20

Suliga E. T2P187, T3P122

Sulistyoningrum D.C. T2P70

Sulz I. T3P136

Sulzbach A.M. T2P193

Sumarac Dumanovic M. T4P30, T4P159

Süme N.N. T2P19, T2P20

Summerbell C.D. O13.6, T2P34, T3P19

Sundbom M. T4P31

Sung E. T2P176

Suprikyan T. T1P103

Sustarsic E.G. S22.2

Šutovský S. O1.5, T1P96

Suzuki K. T1P60

Svacina S. T4P154

Svendstrup M. O7.2

Svensson P.-A. O9.3, T4P27

Swanson M. O6.1

Sweeney G. T2P4

Swenson S. T1P12

Swierz M. T4P56, T4P59

Swinburn B. T2P11

Swora-Cwynar E. T4P146

Symonds M. T1P40

Szczerbowska I. T4P93

Szcześniewska D. T2P116

Szendroedi J. O14.6

Szommer A. T3P11

Szulińska M. T1P91, T1P144, T1P145, T2P190, T4P20, T4P146

Szybiak M. O6.1

T

Tabak R.G. T4P73

Taban G. T2P104

Taddei M. T4P11, T4P171

Tadiotto M.C. T2P193

Taeymans J. O13.4

Tagliaferri A. T4P215

Tahrani A.A. T4P74

Takahashi H. O5.1, T1P126

Takahashi N. T1P126

Takakura S. T4P81

Takao T. T2P108

Talbot M.L. T4P13

Tallapragada D.S.P. T1P51

Tam C. T4P13

Tam J. O14.5

Tamini S. T4P126

Tan A. O12.1

Tan C.S. T4P24

Tan E.J. O12.6

Tan M. T4P61, T4P62, T4P63

Tanaka S. T4P32, T4P33

Tangjittipokin W. T1P157

Tantucci A. T4P120

Tao C. T4P8

Tashima A.K. T1P127

Tatsuno I. T4P4, T4P23, T4P32, T4P33

Taube M. O7.6, T4P27

Tauber M. T4P170

Tavares C.P. T2P197

Tavasoli S. T1P106

Taxova Braunerova R. T3P126

Taylan M.B. T2P91

Taylor C. T4P61, T4P62, T4P63

Taylor R. T4P12, T4P92

Tecklenburg E. T2P12

Teixeira C.L.S. T4P176

Teixeira P. T4P78

Teixeira P.J. O9.1, T4P128

Teixeira V.H. T4P128

Tejera C. T4P214

Teleky B. T4P57

Tell G.S. O4.5

Telles M.M. T1P57

Temd Study Group &. T4P160

Tentolouris N. T4P42, T4P76

Teo K.K. T3P34

Teoh H. T4P191

Teplan V. S5.2

Testa M. T1P46

Tezoto-Rizzo D.V. T2P208

Thackray A.E. T1P13

Tham K.W. T4P183

Thanos P.K. T1P12

Thibault H. T1P151

Thil G. O5.5

Thissen J.-P. T4P202

Thivel D. O2.2

Thom G. O3.1, T4P12, T4P92

Thomas C. O2.5, T4P149

Thomas D. T4P79

Thomas F. O2.5

Thomas G. T4P223

Thomas J.M. S23.1

Thomas P. T4P223

Thomsen R.W. O6.6

Thorell A. T4P25, T4P145

Thorning T.K. T1P63, T4P201

Thorsteinsdottir S. T3P83, T3P84

Thumann B. O6.3

Tian G. T3P40

Tighe B. T4P74

Tiihonen K. T1P37

Timi A. T4P120

Timofeeva E. T1P72

Timofte D.V. T1P59

Timotin A. T1P151

Tinahones F.J. T4P21

Tirone A. T1P56

Tirpáková V. O1.5, T1P96

Tock L. T3P21b, T4P66, T4P75

Todorov G. T4P34

Todorović S. T2P53

Todurov I. T4P175

Toft E. T4P145

Togo J. T1P120

Tokuda M. T1P154

Toledo E. T2P189

Tomás R. T4P128

Tomasselli F. O12.2

Tommasi M. O12.2

Toplak H. T4P150, T4P209

Toppari J. T3P20

Torres A. T1P164

Torres S. O9.6, T4P1

Torti J. T4P172

Tovee M. S18.3

Trak-Smayra V. T1P136

Trandafir L. T3P107

Trauner M. O1.6

Trefois P. T4P202

Trier J. T2P17

Trinchese G. T1P134

Trompet S. O6.5, T1P159, T2P124

Tronchere H. T1P151

Troost F. O14.3

Troshina E. T4P116

Truby H. O1.3

Truelsen T.C. O11.4

Truschner K. T3P72

Tsai P.-F. T4P10

Tseng Y-H. S22.2

T‘Sjoen G. O1.1

Tsolekile L. T2P54

Tsujino M. T4P32, T4P33

Tufik S. T3P21b

Tully L. T3P62, T3P87

Turčáni P. O1.5, T1P96

Tureck L.V. T2P193

Turro Homedes J. T4P119

Turroni S. O8.5

Turvey S.E. T3P34

Twells L.K. T4P41, T4P60

Tykarski A. T2P116

Tyutev R. T2P26

Tzirogiannis K.N. T4P76

U

Ucsnik L. T4P57

Ugale S. O14.4, T4P48

Ugi S. T4P32, T4P33

Uittenbogaart M. T4P130, T4P225

Ukropcova B. O1.5, S8.2, T1P95, T1P96

Ukropec J. O1.5, T1P95, T1P96

Ulicna O. T1P78

Unamuno X. T1P36

Urhan M. T2P101

Uroić V. T1P76

Uspele L. T2P88

Usta Atmaca H. T4P944

Ustulin M. T2P128

Utrini M. T4P158

Uys M. T2P54

V

Vafa M. T1P106

Våge V. O4.5, T4P51

Vajda M. O1.5, T1P96

Valença D.C.T. T2P78, T4P142

Valenti V. T1P32, T4P37

Valerie D. T4P69

Valet P. T1P151

Valkovič P. O1.5, T1P96

Valkusz Z. T3P60

Vallová S. O1.5, T1P96

Valsesia A. O5.4, T1P38

Vamosi M.E. T3P128

Van Aart C. T3P3, T3P24

Van Den Akker E.L. T3P17, T4P106, T4P107

Van Den Akker E.L.T. O1.2

Van Der Heijden L.B. O12.5

Van Der Kamp H.J. T3P17

Van Der Ploeg H.P. O6.3

Van Der Valk E.S. T4P107

Van Der Zwaag B. O3.5, T3P17, T4P106

Van Dessel K. T2P120, T4P141

Van Dielen F.M.H. T4P130, T4P225

Van Duyvenvoorde W. S6.4

Van Eekelen E. T2P73

Van Eyck A. T3P110, T3P111

Van Gaal L. O13.4, T1P11, T2P120, T4P5, T4P9, T4P141

Van Haelst M. T4P106, T4P107

Van Haelst M.M. O3.5, T3P17

Van Helvoirt M. T3P111

Van Hoorenbeeck K.

Van Hul W. T1P11

Van Klinken J.B. O6.5, T2P124

Van Rossum E.F. T3P17, T4P106, T4P107

Van Rossum E.F.C. O1.2

Van Schothorst E.M. T1P163

Van Strien T. S2.1

Vaňková M. T2P58

Vant Veer P. T3P35

Vantieghem S. T3P110

Varaeva Y.R. T2P57

Varekova R. T2P47, T3P27

Varela A. T4P38, T4P47, T4P49, T4P53, T4P54

Varela Mato V. T1P13

Varga B. T1P71

Vázquez Z. T2P189, T4P135

Vázquez-Cobela R. T3P32

Veerman L. T3P21a

Veidebaum T. T3P11

Veiga H. T1P3

Veijola R. T3P20

Velasquez M. T4P36, T4P164

Veldhuis L. T2P3

Vendrell J. T1P24

Ventura A.K. T3P22

Vercalsteren E. T1P103

Verdino V. T4P122

Verduci E. T3P99

Verhaeghe N. O13.4

Verhulst S. T1P11, T3P110, T3P111

Verrijken A. T1P11, T2P120, T4P141

Verschuren L. S6.4

Vestergaard H. O7.2

Vettor R. T1P10, T4P58

Vettorazzi J.F. T1P16

Vial G. T1P112

Vicente S.E.D.C.F. T3P21b

Victor H. T2P54

Vidal H. T1P112

Videira-Silva A. T3P93

Vieira R.D.P. T2P209

Vierhapper M. T1P41

Viertler H.-P. T1P39

Vietti R. O8.5

Vigna L. T4P101

Vignati F. T4P117

Vignerova J. T3P126

Viguerie N. O5.4, T1P38

Vilarrasa N. O7.1, T2P32

Vilegas W. T1P124

Vilén H. T3P75

Viljakainen H.T. T2P92

Villalobos Martínez F. T3P54

Villalobos Martínez M. T3P54

Villavicencio R. T4P112

Villedieu C. T1P151

Vinglid J. T2P175

Vink R.G. T4P186

Vinuesa Fernández A. O4.2

Virtanen S.M. O10.4, T3P20

Visser J.A. T4P107

Vissers D. O13.4

Vito P. T4P137

Vizuete Martinez R.E. O3.4

Vizzuso S. T3P99

Vlcek M. T4P173

Vohra J. O2.5

Volat F. O5.5

Volkmann A. O9.4

Volynkina A. T4P116

Vondrova D. T3P127

Voortman T. O6.2

Voss S. T2P186

Vranckx C. T1P103

Vreeken D. T1P158

Vuković R. T2P53

Vuolo G. T1P56

Vyth E.L. T2P3

W

Wahi G. T3P34

Wakefield M. O6.1

Waldegger P. T1P39

Walkowiak J. T1P91, T2P190

Wall C.R. T2P11

Walleczek N.-K. T3P77

Wallner M. T2P33, T3P37, T3P124

Walsh C. T3P109

Wang J.-S. T4P10

Wang L. T1P120

Wanko B. T1P2

Warland S. T1P162

Waśkiewicz A. T2P116

Watson P. T2P182

Watts, K. S1.3

Webber L. O13.2, S13.3, T2P205

Weghuber D. T3P75, T3P136

Weiderpass E. T2P14, T2P92

Weir C. O13.1, T2P204

Weker H. T3P45

Wells J. T3P79

Wesley D. O14.5

Wester V.L. O1.2

Westerholm T. T3P20

Wharton S. O8.1, T4P118

Whiteman O. T1P19

Whybrow S. T1P67

Wicklum S. T4P217

Widhalm K. S15.5, T3P35, T3P39, T3P75

Więch M. T3P45

Wielemaker E.M. S6.4

Wielinga P. S6.4

Wiepjes C. O1.1

Wiesmann M. S6.4, T1P158

Wilding J. O8.1, T4P39, T4P118

Willems A. T1P7

Willems Van Dijk K. O6.5, T1P159, T2P15, T2P124

Williams G. T3P11

Williams K.J. T1P70

Willis S.A. O3.6

Wilson A. T3P25

Wilson J. T3P34

Winkens L.H.H. S2.1

Winkler F. O1.6

Winkvist A. T4P129

Winter M.-P. O14.1

Winzer E. O7.4, O10.3, T3P16, T3P133

Wittmannova J. T2P47

Wollgast J. T2P200

Wolters M. O6.3

Wong A.S.Y. T4P26

Wong M.T.K. T4P191

Woo J.-T. T2P128

Wood R. T1P87

Woodside J.V. T3P36, T3P62

Worm D. O7.2

Wrank B. T3P37

Wright C.M. O12.4, T3P78, T3P79

Wu H.-T. T1P20, T1P129, T4P161

Wu J.-S. T1P20, T1P129, T2P169, T4P161

Wu X. T1P70

Wu Y. T1P120

Wyskida K. T4P93

X

Xu B. O13.2, T4P68

Xu H. T2P147

Xu M. T4P68

Xue H. T1P121, T2P118, T3P40

Y

Yadgarov Y. T1P107

Yafi M. T3P6, T3P33, T3P50, T3P51, T3P65

Yamaguchi T. T4P32, T4P33

Yamamoto H. T4P32, T4P33

Yamamoto R. T1P60, T1P90

Yamanaka Y. T2P108

Yamaura K. T4P4

Yamwong P. T1P157

Yanaoka T. T1P60, T1P90

Yang D. T1P120, T3P97

Yang K.C. T4P95

Yang W. T3P97

Yang Y.-C. T1P20, T1P129, T2P169, T4P10, T4P161

Yau Qiu Z.X. T1P130

Yde C.C. T1P149

Yenchitsomanus P.T. T1P157

Yener S. T4P160

Yeo M.K.T. T3P58

Yeramian A. T1P128

Yesildemir O. T1P92, T2P100, T2P195

Yetman R. T3P65

Yıldıran H. T1P160, T2P31, T2P65, T2P67, T2P79, T2P93, T2P94, T2P95, T2P96, T2P97, T2P102, T2P133, T3P61, T4P77

Yılmaz B. T2P67, T2P94, T2P95, T2P96, T2P97

Yılmaz T. T2P156

Yokote K. T4P32, T4P33

Yoo S.J. T2P139

Yoo S.-J. T1P114, T2P170

Yoo S.-K. T1P153

Ysebaert M.K. T3P110, T3P111

Yu R. T1P152

Yuliana A. O5.1

Yum M.P.S. T4P191

Yumuk V. T4P160

Z

Zachayus J.-L. O5.5

Zajc Petranović M. T2P86

Zajdel-Cwynar O. T3P29

Zakeri R. T4P43

Zaki B. T4P2

Zalaket J. T2P63

Žalinkevičius R. T2P155

Zamariola G. T4P193, T4P202

Zambelli D. T3P99

Zambon A. T4P215

Zamboni M. O4.3

Zamrazilova H. T2P58, T3P81, T3P105, T3P126

Zapata Lamana R.E. T3P117

Zarnani A.-H. T1P106

Zarricueta M.L. T1P104

Zdrojewski T. T2P116

Zdzienicka A. T1P137, T4P155

Zdzienicka A.Z. T1P133

Zemkova E. T1P95

Zhang D. T4P79

Zhang X. T1P121, T2P118, T3P97

Zhang Z. T3P9

Zhou Q. T1P2

Zidek V. T1P15

Ziegler M.L. T1P149

Zoetendal E.G. O14.3

Zoppi A. T1P134

Zoppi C.C. T1P16

Zsoldos F. T3P75

Zucker J.-D. T4P3

Zugun-Eloae F. T1P59

Żuk E. T1P144

Zulet M.A. T4P21

Zulyniak M.A. T3P34

Zwerschke W. T1P39

Zwierzina M.E. T1P39

T4P82, T4P157, T4P219

Late-Breaking Abstracts

A

Abreu S. T2P222, T2P223, T2P227

Acar Tek N. T1P167, T2P217, T2P225, T2P230, T4P232

Agnelli G.M. T4PLB3

Agostinis-Sobrinho C. T2P222, T2P223, T2P227

Agostoni C. T3P146

Agovska A.I. T4P235

Akbulut G. T1P167, T2P217, T2P225, T4P232

Allen L. T1PLB2

Álvarez-Sauras M. T3P146

Anesten F. T1PLB3

Ard J. T4P230

Arslan S. T2P230

Auriemma A. T4P230

Ayyıldız F. T1P167, T2P217, T2P218, T2P219, T2P225, T4P232, T4P233

B

Bake T. T1PLB3

Barnard J.E. T2P220

Bélanger A. T4PLB4

Bellman J. T1PLB3

Bernard M. T2PLB6

Boldarine V. T2P224

Boscaini S. T1PLB6

Brunani A. T4PLB3

C

Calonne J. T2P226

Candal L. T2PLB1

Capitanio G. T2P231

Capodaglio P. T4PLB3

Carson V. T4PLB4

Chang Y.-J. T2P215, T2P228, T2P229

Chauvin A. T1PLB5

Chessa M. T2P231

Choi S.H. T4P228

Cholewińska P. T2P214

Christensen R.A. T4PLB2

Chun E.J. T1PLB1

Clinciu A.I. T2PLB3

Coburn S. T4P230

Consonni D. T4PLB3

Crézé C. T2PLB1

Cros J. T2PLB1

D

Derous D. T1PLB6

Deschutter O. T2PLB5

Dickson S.L. T1PLB3

Dolan L.M. T3PLB1

Dulloo A. T2P226

Dumanic M. T1P173

E

Einarsdottir H.R. T4P227

Evaristo O.S. T2P222, T2P223, T2P227

F

Fankhänel T. T2PLB6

Fares E.-J. T2P226

Ferrer P. T3P146

Fildes A. T3P142

Flores-Barrantes P. T3P146

G

Gao Z. T3PLB1

Genissel M. T1PLB5

Georges J. T1PLB5

Grasser E.K. T2P226

Grün N.G. T1P173

H

Haase C.L. T4PLB2

Hachul H. T2P224

Hägg D.A. T1PLB3

Hauner H. T4PLB1

Helbich T.H. T1P173

Heslehurst N. T2PLB4

Hlavatý P. T4P226

Horowitz M. T1PLB5

Ho S.Y.D. T3P144

Hsu Y.-W. T2P215, T2P229

I

Iglesia I. T3P146

J

Jang H.C. T1PLB1, T4P228

Jansson J.-O. T1PLB3

Jarosz M. T2P214

K

Karacil Ermumcu M.S. T2P230

Karlsson Þ. T4P227

Kassier S. T2P220

Kaufmann R. T4P236

Kellerer T. T4PLB1

Kelly A.S. T3PLB1

Khoury P.R. T3PLB1

Kimball T.R. T3PLB1

Kim K.M. T1PLB1, T4P228

Kim N.H. T2P221

Kim S. T2P221

Knebel J.-F. T2PLB1

Koçak T. T2P216

Koksal E. T2P216

Köse S. T2P230

Krah J. T4PLB4

Krebs M. T4P231

Kwon A.R. T1P171

L

Lam T.H. T3P144

Langlois M. T4PLB4

Lawlor D. T4PLB4

Lee C.C. T1PLB4

Lee D.-H. T1PLB1, T4P228

Le Gouevec F. T1PLB5

Lepage S. T4PLB4

Lewis K. T4P230

Lim S. T1PLB1, T4P228

Lin Y.-L. T2P229

Liu A. T4PLB2, T4PLB4

Liu S.-Y. T2P215

Llewellyn C.H. T3P142

Loper J. T4P230

Lopes L. T2P222, T2P223, T2P227

Luck-Sikorski C. T2PLB6

M

Macit M.S. T4P234

Mackay N. T4PLB4

Macklin D. T4PLB4

Malavazos A.E. T2P231

Malbert C.-H. T1PLB5

Mancini J. T4PLB2

Matarese L. T4P230

Matelloni I.A. T2P231

Menikdiwela K. T1PLB2

Miguel-Berges M. T3P146

Mitchell S. T1PLB6

Mohamed Noor M.I. T3P147

Mok H.Y. T3P144

Monnard C. T2P226

Moon J.H. T4P228

Moreira C. T2P222, T2P223, T2P227

Morosanu A. T2PLB3

Morosanu M. T2PLB3

Morricone L. T2P231

Mortaş H. T2P230

Mota J. T2P222, T2P223, T2P227

Moustaid-Moussa N. T1PLB2

N

Nam G. T2P221

Nardo A.D. T1P173

Nascimento C.O.D. T2P224

Naufel M.F. T2P224

Níelsdóttir L. T4P227

Nikolaou C.K. T2PLB5

Nikolova M.G. T4P235

Nilaweera K.N. T1PLB6

Nørtoft E. T4PLB2

Nychyk O. T1PLB6

O

Oberhuber G. T1P173

Ohlsson C. T1PLB3

Oh S.W. T1P171

Oh T.J. T4P228

Oldfield B.J. T1PLB4

Oliveira A. T2P222, T2P223, T2P227

Oliveira_Santos J. T2P222

Oliveira-Santos J. T2P223, T2P227

Oyama L.M. T2P224

Özturan A. T4P234

P

Pakseresht A. T4PLB2, T4PLB4

Palsdottir V. T1PLB3

Pedersen S.D. T4PLB4

Periman S. T4P230

Poh B.K. T3P147

Pontet N.A. T4P236

Pories W. T4P230

Póvoas S. T2P223, T2P227

Power S.G. T4PLB2

R

Ramalingam L. T1PLB2

Ramos-Salas X. T4PLB4

Rankin J. T2PLB4

Ranzenberger-Haider T. T4P231

Ribeiro E.B. T2P224

Riedel-Heller S.G. T2PLB6

Rodríguez G. T3P146

Rothberg A. T4P230

Rushton S. T2PLB4

Ryder J.R. T3PLB1

S

Samper P. T3P146

Santos G.M.S.D. T2P224

Santos R. T2P222, T2P223, T2P227

Scerri I. T2P226

Schéle E. T1PLB3

Schindler K. T4P231

Schneiter P. T2PLB1

Scoggin S. T1PLB2

Seyssel K. T2PLB1

Sharma A.M. T4PLB4

Shin H.-Y. T4P229

Siuba-Strzelińska M. T2P214, T3P145

Skarżyńska G. T2P214

Skurk T. T4PLB1

Slack E. T2PLB4

Speakman J.R. T1PLB6

Šrámková P. T4P226

Stamm T. T4P231

Stefanidis A. T1PLB4

Stefanoni N. T2PLB1

Stella E. T2P231

Stulnig T.M. T1P173

Sun J.-J. T2P228

T

Tappy L. T2PLB1

Tatar T. T2P230

Toepel U. T2PLB1

Tollosa D.N. T2PLB2

Tomaino L. T3P146

Tomaino S.C. T4PLB3

U

Ülker İ. T2P218, T2P219, T4P233

Urbina E.M. T3PLB1

V

Vallis M. T4PLB4

Vanderlelie S. T4PLB2

Veldman F. T2P220

Vigna L. T4PLB3

W

Walsh A. T1PLB6

Wharton S. T4PLB2

Windahl S.H. T1PLB3

Wiśniewska K. T3P145

Wong J.E. T3P147

Wrzosek M. T3P145

Wu S.K. T3P147

Y

Yerli M.T. T2P213

Yıldıran H. T2P218, T2P219, T4P233

Yoon Y.S. T1P171

Young R. T1PLB5

Z

Zeyda M. T1P173

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