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Ana Carolina Proença da Fonseca,1,2 Gabriella de Medeiros Abreu,2 Lohanna Palhinha,1 Verônica Marques Zembrzuski,2 Mario Campos Junior,2 João Regis Ivar Carneiro,3 José Firmino Nogueira Neto,4 Fernanda Cristina C Mattos Magno,5 Eliane Lopes Rosado,5 Clarissa Menezes Maya-Monteiro,1 Giselda Maria Kalil de Cabello,2 Pedro Hernán Cabello,2,6 Patricia Torres Bozza1 1Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 2Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 3Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 4Department of Pathology and Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil; 5Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 6Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, BrazilCorrespondence: Ana Carolina Proença da FonsecaHuman Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, 4365 Brasil Avenue, Leônidas Deane Building – Office 611/615, Rio de Janeiro, RJ 21040-360, BrazilTel +552138658192Fax +552138658239Email ana.proenca@ioc.fiocruz.brBackground: Brain-derived neurotrophic factor (BDNF) is a pro-survival factor in the brain that also regulates energy balance. BDNF loss-of-function point mutations are responsible for haploinsufficiency, causing severe early-onset obesity. Up to date, only a few studies have sequenced this gene to search for rare mutations related to obesity. In this study, we aimed to investigate the prevalence of BDNF variants in a cohort of adults with severe obesity from Brazil.Material and Methods: This study comprised 201 adults with severe obesity (BMI ≥ 35.0 kg/m2) with onset during childhood- or adolescence/youth. As controls, 73 subjects with normal weight (18.5 ≤ BMI ≤ 24.9 kg/m2) were selected. The exclusion criteria were pregnancy, lactation, the use of medication to lose or gain weight, and the presence of symptoms suggestive of syndromic obesity (only for the case group). The coding region of the BDNF gene was screened by Sanger sequencing. Demographic, anthropometric, and blood pressure parameters were obtained from the participants as well as serum hormone and cytokines concentrations and biochemical values.Results: As a result, three missense variants [p.(Thr2Ile), p.(Val66Met), and p.(Arg209Gln)] and four synonymous variants (p.Leu107=, p.Thr149=, p.Ala150=, and p.Ser213=) were identified. The p.(Arg209Gln) was predicted as pathogenic by all in silico algorithms used and was not observed in the control group. The individuals carrying the p.(Val66Met) mutated allele had higher waist circumference, HDL-cholesterol and MCP1 levels, and reduced risk of developing metabolic syndrome.Conclusion: We observed that the common BDNF p.(Val66Met) variant has influenced waist circumference, HDL-cholesterol, and MCP1 levels. This polymorphism has also a protective effect on metabolic syndrome susceptibility. Additionally, we described for the first time a rare potentially pathogenic BDNF variant in a Brazilian patient with severe obesity and childhood-onset.Keywords: BDNF, severe obesity, rare mutation, early-onset obesity, metabolic syndrome

Ana Carolina Proença da Fonseca,1 Gabriella de Medeiros Abreu,1 Verônica Marques Zembrzuski,1 Mario Campos Junior,1 João Regis Ivar Carneiro,2 Fernanda Cristina C Mattos Magno,3 Eliane Lopes Rosado,3 José Firmino Nogueira Neto,4 Giselda Maria Kalil de Cabello,1 Pedro Hernán Cabello1,5 1Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil; 2Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 3Institute of Nutrition Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 4Department of Pathology and Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil; 5Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, Brazil Background: Melanocortin 4 receptor gene (MC4R) is an important regulator of food intake, body weight, and blood pressure. Mutations in MC4R are associated with the most common form of nonsyndromic monogenic obesity. MC4R variations have an autosomal co-/dominant model of inheritance. MC4R screening could reveal individuals previously unrecognized with Mendelian form of obesity for further clinical management and genetic counseling. However, there are limited data regarding MC4R variants in patients with obesity from Brazil. The aim of this study was to screen the coding region of the MC4R gene in a Brazilian cohort of severely obese adults and to investigate the phenotype–genotype correlation within MC4R variant carriers. Methods: This study comprised 157 adult participants, stratified according to the period of obesity onset. The first group included 97 patients with childhood-onset obesity (0–11 years) and the second group comprised 60 subjects with adolescence/youth-onset obesity (12–21 years). The entire coding region of MC4R gene was screened by Sanger sequencing. Results: As a result, five previously described variants (Met1?, Ser36Thr, Val103Ile, Ile98=, and Phe202Leu) were identified. Met1? is a start lost codon variant, which affects the translation of MC4R. It was found in a female patient with childhood-onset obesity. We also compared the anthropometric and metabolic parameters between patients with MC4R missense variants (Ser36Thr, Val103Ile, and Phe202Leu) and noncarriers. Patients carrying MC4R variants had higher median of waist–hip ratio when compared to noncarriers (P=0.048). These missense variants were also associated with hypertension (P=0.014). Additionally, Val103Ile carriers had lower diastolic blood pressure and lower systolic blood pressure compared to noncarriers (P=0.020 and P=0.065, respectively). Val103Ile was also associated with hypertension (P=0.003). Conclusion: This study showed the prevalence of MC4R variants in a cohort of Brazilian adults with severe obesity. We also identified significant phenotype differences between carriers and noncarriers of missense variants in our sample, suggesting an important role of MC4R on body fat distribution and blood pressure. Keywords: MC4R, severe obesity, mutation, start lost, blood pressure

Fernanda Cristina Carvalho Mattos Magno,1 Helena Chrispim Guaraná,1 Ana Carolina Proença Fonseca,2 Giselda Maria Kalil Cabello,2 João Régis Ivar Carneiro,3 Aline Pereira Pedrosa,1 Ana Carolina Ximenes,1 Eliane Lopes Rosado1 1Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 2Oswaldo Cruz Foundation (FIOCRUZ), Oswaldo Cruz Institute (IOC), Human Genetics Laboratory, Rio de Janeiro, RJ, Brazil; 3Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Service of Nutrology, Rio de Janeiro, RJ, Brazil Background: The fat mass and obesity-related (FTO) gene has a strong relationship with obesity, extreme obesity and inflammatory state, and may also be associated with food intake regulation.Objective: The aim of the present study was to evaluate the influence of the rs9939609 single-nucleotide polymorphism of the FTO gene on appetite, ghrelin, leptin, interleukin 6 (IL6), tumor necrosis factor α (TNFα) levels and food intake of morbidly obese women.Materials and methods: The study comprised 70 women, aged between 20 and 48 years, from Rio de Janeiro, Brazil. The participants were selected according to the body mass index between 40 and 60 kg/m2. Anthropometric and biochemical data were measured during fasting. Hormones and inflammatory data were measured before and after the participants ate an isocaloric meal. Dietary records were calculated and analyzed using a nutritional assessment program. Visual analog scales were used for behaviors of the sensations of appetite and food preferences. The FTO rs9939609 variant was genotyped using real-time polymerase chain reaction.Results: Participants with the AA genotype had lower values of ghrelin and IL6 and higher values of leptin than those with TT and TA in the postprandial period. Comparing the plasma concentrations of ghrelin, insulin, IL6 and TNFα intragenotypes, it was observed that those with TT had decreased leptin and increased IL6 at the postprandial period. Subjects with TA showed increased postprandial IL6, and those with AA had decreased postprandial ghrelin. There was no difference in TNFα intra- and intergenotypes. The postprandial sensations of hunger were lower in AA than those with TT. There were differences between genotypes regarding ingested grams of protein by weight, cholesterol, B3, B5, B6 and B12 vitamins, and selenium potassium and sodium minerals.Conclusion: These findings suggest that genetics may exert an influence on physiologic factors and might alter eating behavior. Keywords: obesity, rs9939609, hormones, inflammatory cytokines, food intake, binge eating

Increased prevalence of obesity is associated with the growth of chronic degenerative diseases. One of the main factors associated with this increase is the change in nutritional status of individuals. Medium chain triglycerides (MCT) are rapidly metabolized and less stored in the adipose tissue, being a possible tool for weight control. In order to analyze the influence of consumption of this lipid on satiety, body composition and energy expenditure (EE), a literature review was performed of controlled clinical studies reported in PUBMED and ELSEVIER between the years 2000 and 2010. Fourteen articles were selected presenting short and long-term intervention. Among these, six showed a decrease in body mass of individuals, with consequent loss of weight. Only one showed a positive effect on satiation and four showed an increase in EE. Thus the results are inconclusive and there is a need for further controlled studies with standardized amounts of MCT, so that its use can become an alternative for obesity nutritional treatment. [ABSTRACT FROM AUTHOR]

Background: Obesity is an important and growing health problem whose treatment involves dietary changes. In this context, studying the role of macronutrients in weight loss is required in order to understand which strategies may be applied for weight loss. We aimed to evaluate the effects of diets rich in polyunsaturated (PUFAs) and monounsaturated fatty acids (MUFAs) on resting energy expenditure (REE), substrate oxidation, and weight loss in women with obesity., Methods: Randomized, controlled, single blind, parallel-group clinical trial was conducted for 60 days. Participants (n = 32) were divided into three groups: G1= normocaloric PUFAs-rich diet (12% of total energy expenditure (TEE), 10% of n-6 and up to 2% of n-3); G2= normocaloric MUFAs-rich diet (15-20% TEE); and G3= maintenance of the usual diet. Anthropometric and metabolic variables (REE and substrate oxidation by indirect calorimetry) were evaluated., Results: G2 decreased body weight (-1.92 ± 1.99 kg, P = 0.02), body mass index (BMI) (-0.69 ± 0.70 kg/m 2 ; P = 0.02), waist circumference (WC) (-1.91 ± 1.82 cm; P = 0.02), and body fat (-1.14 ± 1.53 kg; P = 0.04)., Conclusion: MUFAs-rich diet reduces body weight, BMI, body fat, and WC., Clinical Trials: NCT02656940., Clinical Trial Registration: Clinical Trials: NCT02656940., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Obesity is an epidemic, multifactorial and difficult-to-control disease, besides being a risk factor for cardiovascular diseases. Among the multiple intervention proposals, the addition of chia in meals has been considered due to its composition and possible effects on weight loss and cardiovascular parameters., Objective: We evaluate the influence of chia flour (Salvia hispanica L.) intake on body weight, body composition, energy expenditure (EE) and cardiovascular risk in obese women., Methods: This study is a clinical trial performed with 20 adult women with obesity randomized into experimental (chia flour) and control (placebo) groups. We assessed anthropometric and biochemical measurements, as well as clinical, dietary and EE variables before intervention and 90 days later., Results: There were no differences in anthropometric indicators, body composition or EE between groups, but a decrease in HDL-c (p = 0.049) and a trend towards the reduction of systolic blood pressure (SBP) (p = 0.062) was observed in the experimental group., Conclusion: Chia flour had a possible positive effect on SBP control, but negatively affected the lipid profile and did not seem to influence obesity control.

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbimortality. Dietetic, phenotypic, and genotypic factors influencing HDP were analyzed during a nutrigenetic trial in Rio de Janeiro, Brazil (2016-2020). Pregnant women with pregestational diabetes mellitus (n = 70) were randomly assigned to a traditional or DASH diet group. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during prenatal visits and HDP were diagnosed using international criteria. Phenotypic data were obtained from medical records and personal interviews. Genotyping for FTO and ADRB2 polymorphisms used RT-PCR. Linear mixed-effect models and time-to-event analyses were performed. The variables with significant effect on the risk for progression to HDP were: black skin color (adjusted hazard ratio [aHR] 8.63, p = 0.01), preeclampsia in previous pregnancy (aHR 11.66, p < 0.01), SBP ≥ 114 mmHg in the third trimester (aHR 5.56, p 0.04), DBP ≥ 70 mmHg in the first trimester (aHR 70.15, p = 0.03), mean blood pressure > 100 mmHg (aHR 18.42, p = 0.03), and HbA1c ≥ 6.41% in the third trimester (aHR 4.76, p = 0.03). Dietetic and genotypic features had no significant effect on the outcome, although there was limited statistical power to test both.

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease of clinical importance, whose prevalence has increased in Brazil and worldwide. Among the possible factors involved in the genesis and control of the disease, the intestinal microbiota (IM) deserves to be highlighted, but studies that report differences between the IM of patients with T1DM and those who are healthy are still contradictory and scarce., Objective: The objective of this paper was to evaluate the IM profile of T1DM and healthy patients, in order to verify possible differences and to evaluate the possibility of the influence of IM on glycemic control in T1DM., Methods: Of the 2716 articles found, nine were included in this review, and all of which were randomized, observational, cross-sectional, cohort and case-control studies that characterized the composition of IM in adults with T1DM and healthy adults., Results: Studies are very diverse, which makes it difficult to associate the IM profile with T1DM etiology and control, however it was found that there was a prevalence of the phylum Firmicutes in the IM of individuals with T1DM and that there was no significant difference in the relative abundance of Bacteroidetes in both populations., Conclusion: It was also possible to identify an inverse relationship of the genus Bifidobacterium and a positive relationship of the genera Bacteroidetes and Prevotella with the concentration ofglycated hemoglobin. More studies are needed to contemplate the characterization of IM in healthy and T1DM individuals., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: SH2B1 gene encodes an important adaptor protein to receptor tyrosine kinases or cytokine receptors associated with Janus kinases. This gene has been associated with the structural and functional modulation of neurons and other cells, and impacts on energy and glucose homeostasis. Several studies suggested that alterations in this gene are strong candidates for the development of obesity. However, only a few studies have screened SH2B1 point variants in individuals with obesity. Therefore, the aim of this study was to investigate the prevalence of SH2B1 variants in a Brazilian cohort of patients with severe obesity and candidates to bariatric surgery., Methods: The cohort comprised 122 individuals with severe obesity, who developed this phenotype during childhood. As controls, 100 normal-weight individuals were included. The coding region of SH2B1 gene was screened by Sanger sequencing., Results: A total of eight variants were identified in SH2B1, of which p.(Val345Met) and p.(Arg630Gln) variants were rare and predicted as potentially pathogenic by the in the silico algorithms used in this study. The p.(Val345Met) was not found in either the control group or in publicly available databases. This variant was identified in a female patient with severe obesity, metabolic syndrome and hyperglycemia. The p.(Arg630Gln) was also absent in our control group, but it was reported in gnomAD with an extremely low frequency. This variant was observed in a female patient with morbid obesity, metabolic syndrome, hypertension and severe binge-eating disorder., Conclusion: Our study reported for the first time two rare and potentially pathogenic variants in Brazilian patients with severe obesity. Further functional studies will be necessary to confirm and elucidate the impact of these variants on SH2B1 protein function and stability, and their impact on energetic metabolism., Level of Evidence: Level V, cross-sectional descriptive study., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Gut microbiota (GM) after bariatric surgery (BS) has been considered as a factor associated with metabolic improvements and weight loss. In this systematic review, we evaluate changes in the GM, characterized by 16S rRNA and metagenomics techniques, in obese adults who received BS. The PubMed, Scopus, Web of Science, and LILACS databases were searched. Two independent reviewers analyzed articles published in the last ten years, using Rayyan QCRI. The initial search resulted in 1275 documents, and 18 clinical trials were included after the exclusion criteria were applied. The predominance of intestinal bacteria phyla varied among studies; however, most of them reported a greater amount of Bacteroidetes (B), Proteobacteria (P), and diversity (D) after BS. Firmicutes (F), B, and the (F/B) ratio was inconsistent, increasing or decreasing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were conducted, compared to before surgery. There was a reduction in the relative proportion of F. Moreover, a higher proportion of Actinobacteria (A) was observed after RYGB was conducted. However, the same was not identified when SG procedures were applied. Genera abundance and bacteria predominance varied according to the surgical procedure, with limited data regarding the impact on phyla. The present study was approved by PROSPERO, under registration number CRD42020209509.

Objective:  To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM)., Methods:  Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group ( n  = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group ( n  = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose., Results:  Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2 nd ( p  = 0.00) and 3 rd ( p  = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2 nd trimester ( p  = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p  = 0.047)., Conclusion:  Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention., Rebec Clinical Trials Database:  The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n)., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Excessive gestational weight gain (GWG) is associated with increased risk of maternal and neonatal complications. We investigated obesity-related polymorphisms in the FTO gene (rs9939609, rs17817449) and ADRB2 (rs1042713, rs1042714) as candidate risk factors concerning excessive GWG in pregnant women with pregestational diabetes. This nutrigenetic trial, conducted in Brazil, randomly assigned 70 pregnant women to one of the groups: traditional diet ( n = 41) or DASH diet ( n = 29). Excessive GWG was the total weight gain above the upper limit of the recommendation, according to the Institute of Medicine guidelines. Genotyping was performed using real-time PCR. Time-to-event analysis was performed to investigate risk factors for progression to excessive GWG. Regardless the type of diet, AT carriers of rs9939609 (FTO) and AA carriers of rs1042713 (ADRB2) had higher risk of earlier exceeding GWG compared to TT (aHR 2.44; CI 95% 1.03-5.78; p = 0.04) and GG (aHR 3.91; CI 95% 1.12-13.70; p = 0.03) genotypes, respectively, as the AG carriers for FTO haplotype rs9939609:rs17817449 compared to TT carriers (aHR 1.79; CI 95% 1.04-3.06; p = 0.02).

Dietary approaches are essential to control obesity, but the effectiveness of changes in meal frequency (MF) as a strategy for body weight loss or maintenance remain unclear. This study aimed to evaluate the influence of MF of a hypocaloric diet on weight loss, body composition, active ghrelin levels and metabolic indicators of obese women. This is a randomized, parallel clinical trial, including 40 women divided into two groups that received a hypocaloric diet with different MFs: MF6: six meals per day, and MF3: three meals per day. Dietary, laboratory, anthropometric and body composition indicators were assessed, as well as energy expenditure (EE), before and after the 90 days of the intervention. Dietary consumption did not differ between groups, before or after intervention. The two groups reduced their energy intake after intervention, but there were no differences between the groups. Waist circumference (WC) was reduced and resting metabolic rate had increased in the MF3 group at the end compared to baseline. Moreover, there was a significant difference in the triglyceride levels between groups after intervention, with an important reduction in the MF3 group, although changes in body composition, blood glucose, plasma ghrelin levels and EE variables did not differ between the groups at the end. It is concluded that, the hypocaloric diet with different MF each day did not change weight loss, body composition or insulin responsiveness, but there was an improvement of triglyceridemia in the MF3 group. The present study suggests that eating snacks between meals is not an important factor for weight loss and improvement of metabolic health in women with obesity.

Purpose: Monogenic forms of obesity are caused by single-gene variants which affect the energy homeostasis by increasing food intake and decreasing energy expenditure. Most of these variants result from disruption of the leptin-melanocortin signaling, which can cause severe early-onset obesity and hyperphagia. These mutation have been identified in genes encoding essential proteins to this pathway, including leptin (LEP), melanocortin 2 receptor accessory proteins 2 (MRAP2) and proopiomelanocortin (POMC). We aimed to investigate the prevalence of LEP, MRAP2 and POMC rare variants in severely obese adults, who developed obesity during childhood. To the best of our knowledge, this is the first study screening rare variants of these genes in patients from Brazil., Methods: A total of 122 Brazilian severely obese patients (BMI ≥ 35 kg/m 2 ) were screened for the coding regions of LEP, MRAP2 and POMC by Sanger sequencing. All patients are candidates to the bariatric surgery. Clinical characteristics were described in patients with novel and/or potentially pathogenic variants., Results: Sixteen different variants were identified in these genes, of which two were novel. Among them, one previous variant with potentially deleterious effect in MRAP2 (p.Arg125Cys) was found. In addition, two heterozygous mutations in POMC (p.Phe87Leu and p.Arg90Leu) were predicted to impair protein function. We also observed a POMC homozygous 9 bp insertion (p.Gly99&#95;Ala100insSerSerGly) in three patients. No pathogenic variant was observed in LEP., Conclusion: Our study described for the first time the prevalence of rare potentially pathogenic MRAP2 and POMC variants in a cohort of Brazilian severely obese adults., Level of Evidence: Level V, cross-sectional descriptive study.

Purpose: The rs17782313 variant of the MC4R gene plays an important role in the obesity phenotype. Studies that evaluate environmental factors and genetic variants associated with obesity may represent a great advance in understanding the development of this disease. This work seeks to assess the association of the polymorphism of MC4R rs17782313 on plasma parameters, including leptin, ghrelin, tumor necrosis factor (TNFα) and interleukin 6 (IL6), and on the eating behaviors of morbidly obese women., Methods: 70 adult women with BMI between 40 and 60 kg/m 2 were recruited. Laboratory and anthropometric data were recorded. Using a visual analog scale (VAS), the feelings of hunger and satiety were evaluated. The presence or absence of binge eating was evaluated through the Binge Eating Scale (BES) questionnaire. Habitual food intake was analyzed using 3-day dietary records. TaqMan ® assays were conducted using real-time PCR to assess genotype polymorphism variants from peripheral blood DNA., Results: This study found that female patients with the MC4R rs17782313 polymorphism had high levels of ghrelin and reduced levels of IL6 in the postprandial period. We observed a higher prevalence of severe binge eating in more than 50% of women with at least one risk allele., Conclusion: Our hypothesis is that the MC4R rs17782313 polymorphism may influence the release of ghrelin, even without being associated with feelings of hunger and satiety. More than half of women with this polymorphism exhibited severe binge eating., Level of Evidence: Level III: case-control analytic study.

Modulation of the gut microbiota may help in treating obesity by improving host metabolic health. We aimed to evaluate the effects of probiotics or symbiotics on body weight and serum metabolite profile in women with obesity. A double-blind, parallel, randomized, controlled clinical trial was conducted with 32 adult women with body mass index ranging from 30 to 34.9 kg m-2. Volunteers followed a low-energy diet and were subjected to 8 weeks intervention: probiotic group (PG - Bifidobacterium lactis UBBLa-70, n = 10), symbiotic group (SG - Bifidobacterium lactis UBBLa-70 and fructooligosaccharide, n = 11), or control group (CG - placebo, n = 11). Analyses of anthropometric variables, gut microbiota and serum metabolites by 1H nuclear magnetic resonance (NMR) were performed at baseline and after the intervention. Multivariate statistics showed that all groups presented a decrease in glycerol and increase in arginine, glutamine and 2-oxoisovalerate. Therefore, a low-energy diet per se promoted changes in the metabolite profile related to decreased inflammation and positive effects on body weight. SG presented unique changes in metabolites (increase in pyruvate and alanine and decrease in citrate and BCAA). Negative correlations between arginine and glutamine with fat mass were observed in the SG. PG presented a decrease in 1H NMR lipid signals and negative correlation between Verrucomicrobia and Firmicutes with (CH2)n lipids. Both probiotics and symbiotics promoted changes in metabolites related to improved metabolic health. Specific metabolite changes following symbiotic intervention might suggest some advantage in providing Bifidobacterium lactis in combination with fructooligosaccharide in a low-energy diet, rather than probiotics or diet alone. Clinical trial: NCT02505854.

Objectives: The aim of this study was to evaluate polyphenol intake in women with different classes of obesity and identify which are consumed more frequently and what the food sources are., Methods: A cross-sectional study was conducted with 114 women with obesity. The study evaluated polyphenol intake via a 3-d food record using Phenol-Explorer. Anthropometric, biochemical, and dietetic variables were evaluated., Results: The women's habitual food intake was low calorie and adequate in macronutrients. Mean polyphenol intake by the group was 573 ± 490, 614 ± 475, and 379 ± 25 mg/d for class I, class II, and class III obesity (P = 0.002), respectively. The most frequent food or beverage consumed by the group was coffee and caffeoylquinic acid, its phenolic compound. Fruits, vegetables, and nuts contributed the least to the intake of polyphenols., Conclusions: Although the diets of the study participants did include some food sources of polyphenols, they were not of sufficient quality to significantly contribute to a healthy diet; instead, they sometimes were foods may have that contributed to weight gain. Women with class III obesity consumed the most calories; however, they had low fruit, vegetable, and whole foods intake., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The melanocortinergic pathway orchestrates the energy homeostasis and impairments in this system often lead to an increase in body weight. Rare variants in the melanocortin 4 receptor ( MC4R ) gene resulting in partial or complete loss of function have been described with autosomal co-dominant inheritance. These mutations are the most common cause of non-syndromic monogenic obesity. In this context, this study aimed to sequence the MC4R gene in a Brazilian cohort of adults with severe obesity., Methods: This study included 163 unrelated probands with Body Mass Index (BMI) ≥ 35 kg/m 2 , stratified into three groups, according to the period of obesity onset. From the total sample, 25 patients were enrolled in the childhood-onset group (0-11 years), 19 patients in the adolescence/youth-onset group (12-21 years), and 119 patients in the adult-onset group (>21 years). Blood pressure, anthropometric and biochemical characteristics were obtained, and the MC4R coding region of each subject's DNA was assessed using automated Sanger sequencing., Results: Significant anthropometric differences between the groups were observed. Higher body weight and BMI medians were found in patients with childhood-onset or adolescence/youth-onset when compared to the adulthood-onset obesity group. A total of five mutations were identified, including four missense variants: p.Ser36Thr, p.Val103Ile, p.Ala175Thr, and p.Ile251Leu. Additionally, we observed one synonymous variant (p.Ile198=). The p.Ala175Thr variant was identified in a female case with severe obesity and adulthood-onset. This variant was previously described as a partial loss-of-function mutation, in which the minor allele poses dominant-negative effect, probably resulting in reduced cAMP activity., Conclusion: This study showed a prevalence of common and rare variants in a cohort of Brazilian adults with severe obesity and candidates to bariatric surgery. We have identified a rare potentially pathogenic MC4R variant in a Brazilian patient with severe and adulthood-onset obesity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Salum, de Souza, Abreu, Campos Junior, Kohlrausch, Carneiro, Nogueira Neto, Magno, Rosado, Palhinha, Maya-Monteiro, Cabello, Cabello, Bozza, Zembrzuski and da Fonseca.)

Recently, relationship between gut microbiota composition and development of obesity has been pointed. However, the gut microbiota composition of individual with obesity is not known yet. Therefore, this systematic review aimed to evaluate differences in profile of gut microbiota between individuals with obesity and individuals with normal weight. A search performed on August 2019 in the databases Pubmed, Scopus, Web of Science, Cochrane library, Lilacs and gray literature using the terms: "microbiota", "microbiome", "obesity", "obesity morbid", and "humans". Studies assessing the gut microbiota composition in adults with obesity and lean were included. Quality assessment was performed by Newcastle-Ottawa Quality Assessment Scale. Of the 12,496 studies, 32 were eligible and included in this review. Individuals with obesity have a greater Firmicutes/Bacteroidetes ratio, Firmicutes, Fusobacteria, Proteobacteria, Mollicutes, Lactobacillus (reuteri), and less Verrucomicrobia (Akkermansia muciniphila), Faecalibacterium (prausnitzii), Bacteroidetes, Methanobrevibacter smithii, Lactobacillus plantarum and paracasei. In addition, some bacteria had positive correlation and others negative correlation with obesity. Individuals with obesity showed profile of gut microbiota different than individual lean. These results may help in advances of the diagnosis and treatment of obesity.

Coconut oil appears to help in weight loss and improve metabolic parameters associated with obesity. We evaluate the influence of coconut oil on the body composition, lipid profile and glycemia in men with obesity. A controlled, randomized clinical trial was performed with 29 adult men affected by obesity. They were randomized between two groups receiving a daily intake of 1 tablespoon (12 mL) of extra virgin coconut oil (CO, n = 15) or soybean oil (SO, n = 14), and an isoenergetic balanced diet. The anthropometric profile, lipid profile and glycaemia were evaluated at the baseline and 45 days after intervention. The Mann-Whitney test was performed to compare the groups, and the Wilcoxon test was performed to compare the times. We considered a value of p < 0.05 as significant. There was no difference in anthropometric variables between the groups before and after intervention. The level of HDL cholesterol increased (3.67 ± 8.08 versus-3.79 ± 10.98, p = 0.02) and the TC/HDL cholesterol ratio decreased (-0.63 ± 0.82 versus 0.23 ± 0.80, p = 0.03) in the CO group, compared to the SO group. Coconut oil included in the isoenergetic balanced diet could increase HDL cholesterol and decrease the TC/HDL cholesterol ratio in men with obesity.

Purpose: Sarcopenia is a muscular syndrome that is related to several adverse risks. The present study aimed to evaluate the prevalence of risk of sarcopenia and associated factors in older adults and long-living older adults., Methods: A crosssectional epidemiological study of older adults patients at a geriatric outpatient clinic. The older adults were evaluated for sarcopenia risk using the SARC-F questionnaire supplemented with the measurement of the calf circumference. In addition, nutritional status was characterized using the Mini Nutritional Assessment, and the relationship of sarcopenia with associated factors (comorbidities, polypharmacy, smoking)., Results: A total of 100 eligible older adults with a mean age of 77.2 ± 1.8 years in the older adults and 86.3 ± 4.2 years in the long-living older adults (p < 0.001) were evaluated. The long-living older adults (OR = 6.1; 95 % CI: 1.44-16.09; p = 0.01) and older adults at risk of malnutrition (OR = 13.6; 95 % CI: 1.55-11.38; p < 0.05) had a higher risk of sarcopenia, whereas BMI ≥ 27 kg/m 2 (OR = 0; 95 % CI: 0-0.06; p < 0.001) was a protective factor. The risk of sarcopenia was six times higher in the over-80 s (95 % CI = 1.44, 16.09), while the older adults with malnutrition or at nutritional risk ran a 13 times higher risk of sarcopenia (95 % CI = 1.55, 11.38)., Conclusion: The prevalence of risk of sarcopenia was higher in the long-living older adults and the older adults at nutritional risk, making its early evaluation in clinical practice important., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Obesity is a multifactorial, complex, and public health problem worldwide. Interaction between genes and environment as associated with diet may predispose an individual to obesity. In this sense, nutrigenetics appears to be a strategy that can improve understanding of the gene-diet interaction. The aim of this literature review was to summarize data from studies of genes involved in the regulation of energy intake (melanocortin 4 receptor [MC4R], fat mass and obesity-associated [FTO], ghrelin [GHRL], leptin [LEP], and cholecystokinin [CCK]) and diet interaction in obesity. The presence of polymorphisms in MC4R, FTO, leptin, and the respective receptor appear to be associated with higher energy and total lipid consumption. Polymorphisms in FTO, leptin, and leptin receptor are also related to increased intake of saturated fatty acids. Individuals with the MC4R, FTO, and ghrelin polymorphisms, who submitted themselves for weight loss intervention, appeared to achieve weight loss similar to individuals without polymorphisms in these genes. Additionally, protein seems to interact with these genes, which increases or decreases appetite, or to drive or lessen body weight recovery. Additionally, polymorphisms in these genes were found to be associated with inappropriate eating behaviors, such as increased consumption of sweets and snacks, consumption of large food portions, desire to eat, and eating associated with emotional issues. Preliminary data has supported the gene-diet interaction in determining weight loss and gain in individuals with polymorphisms in the genes involved in energy intake. Despite the advent of nutrigenetics in obesity, it is still too early to define the dietary management for weight loss based on the presence or absence of obesity polymorphisms., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients., Subjects and Methods: The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels., Results: Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change., Conclusions: Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.

Background: Melanocortin 4 receptor gene ( MC4R ) is an important regulator of food intake, body weight, and blood pressure. Mutations in MC4R are associated with the most common form of nonsyndromic monogenic obesity. MC4R variations have an autosomal co-/dominant model of inheritance. MC4R screening could reveal individuals previously unrecognized with Mendelian form of obesity for further clinical management and genetic counseling. However, there are limited data regarding MC4R variants in patients with obesity from Brazil. The aim of this study was to screen the coding region of the MC4R gene in a Brazilian cohort of severely obese adults and to investigate the phenotype-genotype correlation within MC4R variant carriers., Methods: This study comprised 157 adult participants, stratified according to the period of obesity onset. The first group included 97 patients with childhood-onset obesity (0-11 years) and the second group comprised 60 subjects with adolescence/youth-onset obesity (12-21 years). The entire coding region of MC4R gene was screened by Sanger sequencing., Results: As a result, five previously described variants (Met1?, Ser36Thr, Val103Ile, Ile98=, and Phe202Leu) were identified. Met1? is a start lost codon variant, which affects the translation of MC4R . It was found in a female patient with childhood-onset obesity. We also compared the anthropometric and metabolic parameters between patients with MC4R missense variants (Ser36Thr, Val103Ile, and Phe202Leu) and noncarriers. Patients carrying MC4R variants had higher median of waist-hip ratio when compared to noncarriers ( P =0.048). These missense variants were also associated with hypertension ( P =0.014). Additionally, Val103Ile carriers had lower diastolic blood pressure and lower systolic blood pressure compared to noncarriers ( P =0.020 and P =0.065, respectively). Val103Ile was also associated with hypertension ( P =0.003)., Conclusion: This study showed the prevalence of MC4R variants in a cohort of Brazilian adults with severe obesity. We also identified significant phenotype differences between carriers and noncarriers of missense variants in our sample, suggesting an important role of MC4R on body fat distribution and blood pressure., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The aim of the study was to evaluate the food intake of pregnant women with gestational diabetes mellitus (GDM) according to two methods of dietary guidance. A randomised controlled clinical trial was conducted by appointment with a nutritionist and by using data from hospital records (2011-2014). The study population comprised adult women diagnosed with GDM treated in a public maternity hospital in Rio de Janeiro, Brazil. The control group (CG) received nutritional advice by the traditional method and the intervention group (IG) were instructed on carbohydrate counting. The analysis of food intake and the consumption of processed foods (PF) and ultra-processed foods (UPF) were evaluated in the second and third trimester. A total of 286 pregnant women were initially assessed (145 in the CG and 141 in the IG). It was observed that 89/120 (74·2 %) and 183/229 (79·9 %) consumed PF daily in the second and third trimesters, respectively, whereas 117/120 (97·5 %) and 225/231 (97·4 %) consumed UPF daily in the second and third trimesters, respectively. When analysing the intake of macronutrients (%) by quartiles, women who had fat intake in the third quartile had the highest average postprandial blood glucose compared with those who consumed fat in the second quartile (P=0·02). The consumption of PF and UPF was high and dietary intake was similar in both groups, regardless of dietary guidance method deployed, suggesting that both methods tested in the study can be used for monitoring the nutritional status of pregnant women with GDM.

Objective: The aim of this study was to compare the effects of a sucrose-free diet with a sucrose-added diet on glucose variability in patients with type 1 diabetes., Methods: This was a two-way crossover design study in which patients with type 1 diabetes were monitored by blinded continuous glucose monitoring and were selected to receive a sucrose-free diet (<30 g/d), followed by a sucrose-added diet (>80 g/d) for 2 d each. Intra-day glucose variability was assessed by the mean amplitude of glycemic excursions (MAGE), the M-value, J-index, glycemic risk assessment in diabetes equation (GRADE), and continuous overlapping net glycemic action (CONGA 1-3 ). Between-day variability was determined by mean of daily difference (MODD). Statistical analyses were performed with a significance level of 5%., Results: Ten patients with type 1 diabetes were evaluated. The participants were a mean of 26.1 ± 7.1 y of age. The mean duration of disease was 16.5 ± 10.5 y, and patients' mean glycated hemoglobin was 7.4% ± 0.8%. The intra- and inter-day glucose variability indexes did not differ between the diet periods (MAGE: 10.2 ± 5.1 and 10.4 ± 6.8mmol/L, P = 0.98; M-value: 12.9 ± 2 and 15.6 ± 1.3mmol/L, P = 0.29; J-index: 50.9 ± 4.4 and 57.7 ± 3.3mmol/L, P = 0.41; GRADE: 7.2 ± 1 and 4.7 ± 5.3mmol/L, P = 0.07; and MODD: 3.9 ± 1 and 4.3 ± 1.5mmol/L, P = 0.28; for the sucrose-free and sucrose-added diets, respectively). CONGA 1-3 were similar for both diet periods (P > 0.05)., Conclusions: The use of a moderate amount of sucrose, as part of a balanced diet, did not affect the glucose variability or insulin requirements in patients with type 1 diabetes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Genetic variants associated with dietary intake may be important as factors underlying the development of obesity. We investigated the associations between the obesity candidate genes (fat mass and obesity-associated (FTO), melanocortin-4 receptor (MC4R), leptin (LEP) and leptin receptor) and total energy intake and percentage of energy from macronutrients and ultra-processed foods before and during pregnancy. A sample of 149 pregnant women was followed up in a prospective cohort in Rio de Janeiro, Brazil. A FFQ was administered at 5-13 and 30-36 weeks of gestation. Genotyping was performed using real-time PCR. Associations between polymorphisms and the outcomes were investigated through multiple linear regression and ANCOVA having pre-pregnancy dietary intake as a covariate. The A-allele of FTO-rs9939609 was associated with a -6·5 % (95 % CI -12·3, -0·4) decrease in the percentage of energy from protein and positively associated with the percentage of energy from carbohydrates before pregnancy (β=2·6; 95 % CI 0·5, 4·8) and with a 13·3 % (95 % CI 0·7, 27·5) increase in the total energy intake during pregnancy. The C-allele of MC4R-rs17782313 was associated with a -7·6 % (95 % CI -13·8, -1·0) decrease in the percentage of energy from protein, and positively associated with the percentage of energy from ultra-processed foods (β=5·4; 95 % CI 1·1, 9·8) during pregnancy. ANCOVA results revealed changes in dietary intake from pre-pregnancy to pregnancy for FTO-rs9939609 (percentage of energy from ultra-processed foods, P=0·03), MC4R-rs17782313 (total energy intake, P=0·02) and LEP-rs7799039 (total energy intake, P=0·04; percentage of energy from protein, P=0·04). These findings suggest significant associations between FTO-rs9939609, MC4R-rs17782313 and LEP-rs7799039 genes and the components of dietary intake in pregnant women.

Objective: Roux-en-Y gastric bypass (RYGB) reduces body weight and the comorbidities associated with obesity. The aim of this study was to evaluate whether glucose and lipid profiles were maintained during a 5-year follow-up period after RYGB., Subjects and Methods: Anthropometric and laboratory data from 323 patients who had undergone this operation were analyzed. Differences in laboratory variables between the baseline and 12, 24, 36, 48 and 60 months postoperatively (PO) were assessed using a one-way ANOVA test to compare the three groups. Delta significance using one-way ANOVA was performed to assess anthropometric variable in the postoperative period (p < 0.05)., Results: 77 patients (24%) were included in Group 1 (G1), 101 (32%) in Group 2 (G2), and 141 (44%) in Group 3 (G3). The majority of patients, 71.7% in G1, 82.8% in G2, and 70% in G3, showed high triglycerides (TG) before surgery. A decrease in weight loss was observed in all groups followed by an increase in body weight in G2 and G3 at 36, 48 and 60 months. Laboratory results for G1, G2 and G3 showed no significant differences between groups at baseline and during the post-operative period., Conclusion: Our results suggest that weight regain after RYGB has no significant impact on the long-term evolution of the lipid profile and glycemia.

Gut microbiota is important for maintaining body weight. Modulation of gut microbiota by probiotics may result in weight loss and thus help in obesity treatment. The aim of this systematic review was to evaluate the effects of Lactobacillus on weight loss and/or fat mass in overweight adults. A search was performed on the Medline (PubMed) and Scopus electronic databases using the search terms: 'probiotics', 'Lactobacillus, 'obesity', 'body weight changes', 'weight loss', 'overweight', 'abdominal obesity', 'body composition', 'body weight', 'body fat' and 'fat mass'. In the total were found 1567 articles, but only 14 were included in this systematic review. Of these nine showed decreased body weight and/or body fat, three did not find effect and two showed weight gain. Results suggest that the beneficial effects are strain dependent. It can highlight that Lactobacillus plantarum and Lactobacillus rhamnosus when combined with a hypocaloric diet, L. plantarum with Lactobacillus curvatus, Lactobacillus gasseri, Lactobacillus amylovorus, Lactobacillus acidophilus and Lactobacillus casei with phenolic compounds, and multiple species of Lactobacillus.

Introduction: Calcium and/or vitamin D deficiency can occur after Roux-en-Y gastric bypass (RYGBP) because of impaired absorption, resulting in secondary hyperparathyroidism and increased risk of reduced bone mineral density (BMD)., Objective: The objective of this study is to assess nutritional status, body composition, and bone health in women after RYGBP., Method: Twenty-five premenopausal women who had undergone RYGBP (test group) and 33 women matched for age and body mass index who had not undergone surgery (control group) participated. Test group received 250 mg of calcium for day. Anthropometric, dietary, laboratory, body composition, and BMD (X-ray absorptiometry) analyses were performed., Results: No differences were found between the groups in waist circumference, fat or lean mass, BMD, or dietary calcium intake, although calcium intake was low in both groups. The test group had better results for complete blood count, total cholesterol, low-density lipoprotein, and triglycerides. The mean parathyroid hormone was higher (p = 0.005) in the test group, although still within normal limits. Plasma levels of 25-hydroxyvitamin D were low in groups but did not differ between them (p = 0.075). Vitamin D concentrations were lower in women with longer time since surgery. The test group had lower intake of energy, protein, lipids, polyunsaturated fatty acids, fiber, phosphorus, and iron than the control group., Conclusion: Elevation of parathyroid hormone, low dietary calcium intake, and vitamin D plasma insufficiency without BMD reduction occurred after RYGBP. Patients who underwent RYGBP had adequate lipid profiles but inadequate intake protein, polyunsaturated fatty acids, fiber, and iron. Vitamin D deficiency may occur in the late postoperative period.

Background: Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and comorbidities, is noticeable., Aim: To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up., Methods: Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records., Results: Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively., Conclusion: Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia., Competing Interests: none

Our aim was to evaluate the influence of the Gln27Glu polymorphism of the β2-adrenergic receptor (ADRβ2) gene, fat intake and physical activity on the energy expenditure (EE) and nutritional status of obese women. Sixty obese women (30-46 years) participated in the study and were assigned to three groups depending on the genotypes: Gln27Gln, Gln27Glu and Glu27Glu. At baseline and after nutritional intervention, the anthropometric and body composition (bioelectrical impedance), dietary, EE (indirect calorimetry) and biochemical variables were measured. All women received a high-fat test meal to determine the postprandial EE (short-term) and an energy-restricted diet for 10 weeks (long term). The frequencies of Gln27Gln, Gln27Glu and Glu27Glu were 36.67, 40.0 and 23.33 %, respectively. Anthropometric and biochemical variables and EE did not differ between groups, although women who had no polymorphism demonstrated decreased carbohydrate oxidation. On the other hand, the Glu27Glu genotype showed a positive relation with EE in physical activity and fat oxidation. The environmental factors and Gln27Glu polymorphism did not influence the nutritional status and EE of obese women, but physical activity in obese women with the polymorphism in the ADRβ2 gene can promote fat oxidation. The results suggest that encouraging the practice of physical exercise is important considering the high frequency of this polymorphism in obese subjects.

Background: Obesity is a chronic disease with high growth in population and bariatric surgery is currently considered the most effective treatment for weight reduction; on the other hand, nutritional deficiencies are observed after this procedure., Aim: To analyze weight loss progression and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation., Methods: Retrospective analysis of 137 patients of both sexes, aged between 18-60 years, using supplemental multivitamins and minerals, were included; personal information, anthropometric and laboratory data in the preoperative, 12, 24, 36 and 48 months postoperatively were collected., Results: Postoperatively, in both sexes, occurred weight loss compared to the pre-operative weight gain at 48 months and maintenance of body mass index. There was a decrease in the percentage of excess weight loss at 48 months postoperatively compared to the time of 12, 24 and 36 months in men and decreased at 48 postoperative months compared to the time of 24 months in females. There was a decreased in serum ferritin in both sexes and increased serum iron at 48 months postoperatively in males. There was a decreased in vitamin B12 and folic acid increased serum at 48 postoperative months in females., Conclusions: Surgical treatment was effective for reducing weight, body mass index reduction and achievement of success in the late postoperative period along with multivitamin and mineral supplementation on prevention of serious nutritional deficiencies and anemia.

Objective: Diets based on carbohydrate counting remain a key strategy for improving glycemic control in patients with type 1 diabetes. However, these diets may promote weight gain because of the flexibility in food choices. The aim of this study was to compare carbohydrate counting methods regarding anthropometric, biochemical, and dietary variables in individuals with type 1 diabetes, as well as to evaluate their knowledge about nutrition., Methods: Participants were allocated in basic or advanced groups. After 3 mo of the nutritional counseling, dietary intake, anthropometric variables, lipemia, and glycemic control were compared between groups. A questionnaire regarding carbohydrate counting, sucrose intake, nutritional knowledge, and diabetes and nutrition taboos also was administered., Results: Ten (30%) participants had already used advanced carbohydrate counting before the nutritional counseling and these individuals had a higher body mass index (BMI) (P < 0.01) and waist circumference (WC) (P = 0.01) than others (n = 23; 69.7%). After 3 mo of follow-up, although participants in the advanced group (n = 17; 51.52%) presented higher BMI (P < 0.01) and WC (P = 0.03), those in the basic group (n = 16; 48.48%) showed a higher fat intake (P < 0.01). The majority of participants reported no difficulty in following carbohydrate counting (62.5% and 88% for basic and advanced groups, respectively) and a greater flexibility in terms of food choices (>90% with both methods)., Conclusions: Advanced carbohydrate counting did not affect lipemic and glycemic control in individuals with type 1 diabetes, however, it may increase food intake, and consequently the BMI and WC, when compared to basic carbohydrate counting. Furthermore, carbohydrate counting promoted greater food flexibility., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Along with the augmentation in obesity rates in recent years, the demand for bariatric surgery has startlingly increased. Nutritional counseling in the preoperative period is very important because it contributes to higher success rate in the post-operative period., Aim: To assess the nutritional status of patients in a multidisciplinary program for the treatment of severe obesity and pre-operatively for bariatric surgery, characterizing the consumption of healthy nutrients., Methods: A retrospective analysis of 30 patients was conducted. Personal information, anthropometric data and dietary assessment by 24-hour food record were collected. The analysis of energy intake was performed in Dietpro 5.1 Professional(r) program. The statistical treatment of the caloric intake was performed by an ANOVA test with Bonferroni's post hoc and for anthropometric data the paired t test was used., Results: From the total, 73% of the patients were women and 27% male, mean age was 48.4+12.9 and 49.8+8.1, respectively. A lower weight in the 5th appointment was observed when compared with the 1st one. There was a reduction in caloric intake in the 2nd, 3rd, 4th and 5th appointments when compared with the 1st. It was observed that in the 5th appointment more than 50% of the patients underwent six meals a day. There was an increase in the consumption of fruit along the appointments and 72.2% of patients consumed 1-2 servings of fruit a day. Vegetables intake was high in all appointments in the pre-operative period and, although low, the whole grain products consumption has increased during the pre-operative period achieving 30% of the study population., Conclusion: There was a decrease in body weight, a trend in the decrease of the body mass index and waist circumference and quantitative and qualitative improvement of food consumption.

Background: It is unclear if the sugar intake may affect metabolic parameters in individuals with type 1 diabetes. Therefore, the purpose of this study was to evaluate the effects of sucrose intake in glycemic, lipemic, anthropometric variables, as well as in C-reactive protein (CRP) levels in these individuals., Methods: Thirty-three subjects with type 1 diabetes were evaluated at baseline and 3-months after intervention. Volunteers were randomized into groups: sucrose-free (diet without sucrose) or sucrose-added (foods containing sucrose in composition). Both groups received the same macronutrient composition and used the carbohydrate counting methods. All underwent an interview and anthropometric evaluation. Blood was drawn for glycated haemoglobin, glucose, total cholesterol, HDL, and CRP measurement, and the medical charts were reviewed in all cases., Results: At baseline, anthropometric, clinical and laboratory variables did not differ between groups, except for the triglycerides. Although at baseline triglycerides levels were higher in the sucrose-added group (p = 0.01), they did not differ between groups after the intervention (p = 0.92). After 3-months, CRP was higher in the sucrose-added than in the sucrose-free group (p = 0.04), but no further differences were found between the groups, including the insulin requirements, anthropometric variables, body composition, and glycemic control. Both groups showed sugars intake above the recommendations at baseline and after intervention., Conclusions: Sucrose intake, along with a disciplined diet, did not affect insulin requirements, anthropometric variables, body composition, lipemic and glycemic control. However, although the sucrose intakes increase CRP levels, the amount of sugar in the diet was not associated with this inflammatory marker.

Introduction: Glucose metabolism may be altered in obesity and genotype for PPAR 2 can influence this variable., Objective: To evaluate the influence of body mass (BM) and visceral adiposity (VA) in glucose metabolism in morbid obese women with Pro12Pro genotype., Methods: Were selected 25 morbidly obese women. Groups were formed according to body mass index (BMI) [G1: 40-45 kg/m² (n = 17); G2: > 45 kg/m² (n = 8)]. Anthropometric, glycemia and insulinemia assessments (fasting, 60 and 120 minutes after high polyunsaturated fatty acids meal) were carried out. The insulin resistance (IR) and insulin sensitivity (IS) were assessed by HOMA-IR and QUICKI respectively., Results: G2 had higher BMI and waist circumference, compared to G1, impaired fasting glucose, low IS and higher IR. The postprandial glucose was normal, but there was a higher insulin peak one hour after the meal in G2., Conclusion: Increased BM and VA were associated with worse glucose metabolism suggesting metabolic differences between morbid obese with Pro12Pro genotype., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Background: Satiety decline is one of the factors that are involved in weight regain in the postoperative period of bariatric surgery. Nutrients such as long-chain n-3 polyunsaturated fatty acid and fibers could assist in food intake control by increasing satiety. Flaxseed is a source of these nutrients, and its consumption could help with possible glycemic control and increased satiety. The aim of this study was to evaluate the influence of whole flaxseed and defatted flaxseed on satiety, postprandial blood glucose, and leptin in post-bariatric women., Methods: A single-blind crossover and randomized study was performed with 18 women in the late postoperative of Roux-en-Y gastric bypass (RYGBP). All women received three test meals containing whole flaxseed, defatted flaxseed, and placebo with 1 week of washout. Satiety was evaluated by a Visual Analog Scale during the fasting period; immediately after ingestion; and 60, 120, and 180 min after meals., Results: There was no difference between test meals for the variables of hunger, satisfaction, fullness, and desire to eat. The basal and postprandial glucose and leptin levels did not differ between the test meals. The intake of defatted flaxseed and placebo muffins resulted in reduced postprandial blood glucose. Postprandial leptin was higher than the baseline (p = 0.02); however, only defatted flaxseed showed increased postprandial leptin levels (p = 0.044)., Conclusions: Whole flaxseed and defatted flaxseed did not promote satiety in women in the late postoperative of RYGBP. However, the test meals with a lower fat content increased the serum leptin levels.

To evaluate the influence of ω-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on body composition, insulin resistance, and lipemia of women with type 2 diabetes, the authors evaluated 41 women (60.64 ± 7.82 years) with high blood pressure and diabetes mellitus in a randomized and single-blind longitudinal intervention study. The women were divided into 3 groups: GA (2.5 g/d fish oil), GB (1.5 g/d fish oil), and GC (control). The capsules with the supplement contained 21.9% of eicosapentaenoic acid and 14.1% of docosapentaenoic acid. Biochemical (glucose, glycated hemoglobin, total and fractional cholesterol, triglycerides, and insulin) and anthropometric (body mass, stature, waist circumference [WC], and body composition) evaluations were performed before and after the 30 days of intervention. Homeostasis model assessment-insulin resistance and the Quantitative Insulin Sensitivity Check Index were used to evaluate the insulin resistance and insulin sensitivity (IS), respectively. GB presented a greater loss of body mass and WC (P < .05), greater frequency of glycemic and total cholesterol reduction, and an increase of high-density lipoprotein cholesterol compared with GA. Thus, a high dose of ω-3 PUFA can reduce IS. A lower dose of ω-3 PUFA positively influenced body composition and lipid metabolism.

Background/aims: To determine the influence of the Pro12Ala polymorphism of the PPARγ2 gene and the dietary lipid intake on energy metabolism and nutritional outcomes in obese women after an acute fat load or following a low-calorie diet for 10 weeks., Methods: Sixty obese women (aged 30-46 years) participated in the study and were assigned to 2 groups depending on the genotype: Pro12Pro and Pro12Ala/Ala12Ala carriers. At baseline and after 2 nutritional (short- or long-term) interventions, measurement of anthropometrical and body composition (bioelectrical impedance) variables, dietary assessments, energy metabolism (indirect calorimetry) measurements as well as biochemical and molecular (PPARγ2 genotype) analyses were performed. All women received a high-fat test meal to determine the postprandial metabolism (short term) and an energy-restricted diet for 10 weeks (long term)., Results: The frequencies of the Pro12Pro and Pro12Ala/Ala12Ala genotypes were 83.33 and 16.67%, respectively, and reached Hardy-Weinberg equilibrium. Interestingly, the postprandial energy expenditure after the fat load was higher in subjects carrying the Ala allele. At baseline, the habitual monounsaturated fatty acid (MUFA) intake inversely correlated with fat oxidation and body mass index in the obese Pro12Ala/Ala12Ala carriers, while a lower PUFA intake (%) in the long-term trial was associated with an increase in the respiratory quotient only in Ala carriers but not in the Pro12Pro genotyped group., Conclusions: The Pro12Ala polymorphism in the PPARγ2 gene influenced energy metabolism in the assayed short- and long-term situations since the response to both nutritional interventions differed according to the genotype. The results suggest that fat oxidation and energy expenditure may be lower in Pro12Pro carriers compared to Pro12Ala/Ala12Ala genotypes, while in obese women with Pro12Ala/Ala12Ala polymorphisms in the PPARγ2 gene fat oxidation was negatively correlated with the MUFA and PUFA (%) intake., (Copyright © 2010 S. Karger AG, Basel.)

In order to evaluate the effect of polymorphism in the PPARgamma2 and beta2-adrenergic genes and diet lipids on body composition, energy expenditure and eating behavior of obese women, 60 subjects were submitted to anthropometric, biochemical, dietary, molecular, basal and postprandial metabolism (indirect calorimetry) and eating behavior (visual analog scale) evaluation. Fat and saturated fatty acid (SFA) high diet was used to assess postprandial metabolism. The frequency of Pro12Pro/Gln27Gln, Pro12Pro/Gln27Glu, Pro12Pro/Glu27Glu and Pro12Ala/Gln27Glu genotypes was 35.71%, 30.37%, 23.21% and 10.71%, respectively. These values were not significant (p>0.05) for the dietary, anthropometric, biochemical and metabolic parameters. The Pro12Ala/Gln27Glu group was found to present greater energy used in postprandial period (EUPP). The presence of the PPARgamma2 gene variant, independent of beta2-adrenergic gene polymorphism, resulted in fat oxidation increase. Also, this group presented higher satiety, compared to the Pro12Pro/Gln27Gln group. The presence of the variant alleles in the PPARgamma2 gene suggests benefits in food intake control.

The obesity is a multicausal disease that includes exogenous and endogenous factors. We emphasized the leptin, a hormone produced by adipose tissue, whose receiver is in the hypothalamus. The leptin has been considered important in the development of the obesity, because it influences in the energy intake and expenditure. In the revision one sets out to evaluate the leptin like factor related to the development of the obesity, as well as the influence of diet in the secretion and action of leptin. In the human obesity, the deficiency of functional leptin is rare, nevertheless, can exist leptin resistance. After the loss weight it happens reduction in the leptin levels, which can be in the recovery of body weight. The leptin is regulated by food intake and their circulating levels and potential of action are associated with content of macronutrients of the diet and the body composition individually. Nevertheless, studies demonstrated the high and the low food intake can influence in the leptin secretion, independent of the effect on adiposity. In addition, the fat of diet presents important effect in secretion and action of leptin. Also the zinc deficiency has been associated with the reduced levels of leptin. Several experimental studies have been made to evaluate the effect of the administration of leptin in treatment of obesity, by means of injections, inhalation or more active forms of leptin. Nevertheless, we need similar studies with humans. Is important the development of studies that associate the environmental factors, particularly the diet, with regulation of serum levels and action of leptin in humans.

Objective: To evaluate the effect of diet and PPARgamma2 and beta2-adrenergic receptor genes on energy metabolism and body composition in obese women., Material and Methods: 60 obese women, aged 34.59 +/- 7.56 years were studied at the Department of Physiology and Nutrition at Navarra University. Anthropometric, biochemical, metabolic and molecular evaluations were carried out, and the women were submitted to short-term and long-term hypocaloric diets, varying the macronutrients. The groups were formed according to gene polymorphism, as follows: Pro12Pro(PPARgamma2)/Gln27Gln (beta2-adrenergic receptor genes) - A, Pro12Pro (PPARgamma2)/Gln27Glu (beta2-adrenergic receptor genes) - B, Pro12Pro (PPARgamma2)/ Glu27Glu (beta2-adrenergic receptor genes)-C and Pro1Ala (PPARgamma2)/Gln27Glu beta2-adrenergic receptor genes) - D., Results: In group A, fat oxidation was correlated positively with body mass index (BMI), but an increase in fat and saturated fatty acids (SFA) in the diet did not reflect in increased oxidation. In group B, total fat and SFA intake did not lead to fat oxidation increase. In group C, fat and complex carbohydrates (CHO) resulted in lower fat oxidation, and long-term increase of monounsaturated fatty acid (MUFA) intake resulted in increase of CHO oxidation and smaller weight loss. In group D, greater energy expenditure was obtained after diet high in SFA in a short-term, and fat basal and postprandial oxidation correlated positively with its intake. Hypocaloric diet high in polyunsaturated fatty acid (PUFA) resulted in increase of fat oxidation., Conclusions: Polymorphism in PPARgamma2 gene resulted in increased fat oxidation, regardless of genotype of beta2-adrenergic receptor gene. It is recommended control of the total intake of fats and SFA in Pro12Pro/Gln27Gln and Pro12Pro/Gln27Glu, and complex CHO and MUFA in Pro12Pro/Glu27Glu. In Pro12Ala/Gln27Glu, AGPI intake can result in greater body weight loss.