Falls among older adults are associated with increased morbidity, mortality, and healthcare costs; therefore, it is critical to assess modifiable risk factors. This study aimed to determine if low protein intake among older women was associated with injuries among fallers. The Women's Health Initiative ancillary studies, Live Long Study (LLS), Food Intake (FI), and Objective Physical Activity and Cardiovascular Health in Older Women study (OPACH) were combined for analyses (n = 6,580; n = 1,285 fallers). Protein intake was assessed by food frequency questionnaires at LLS/FI/OPACH baseline. Participants completed fall calendars for 13 months and self-reported injuries in interviews. Logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for risk of injurious falls and falls with fracture. Diabetes medication use had a significant interaction between protein density and fall with any injury; thus, models were stratified. Of the participants who fell, 841 (65.4%) fell without injury, 444 (34.6%) fell with injury, and 70 (7.7%) fell with fracture. Lower protein density (<15% calories from protein) increased risk of fracture from falling (OR: 1.73; 95% CI: 1.02-2.92) compared to those with higher protein density (≥15% calories from protein). Among participants with diabetes medication use and lower protein density, the OR for any injury from falling was 5.54 (95% CI: 1.79-17.19) compared to those with higher protein density though based on a small subgroup. Lower protein density increased risk of injurious falls. Dietary and medication screening may facilitate selection and tailoring for behavioral falls prevention to reduce injurious falls and fractures.
MIND diets and probiotics have the potential to positively affect infertility in obese and overweight men, but their effects are not yet fully elucidated. Therefore, this study aims, for the first time, to address this gap by evaluating the effects of a calorie-restricted MIND diet and probiotic supplementation on fertility, sexual function, and quality of sexual life in overweight and obese men. This study will be conducted as a double-blind randomized clinical trial on 84 overweight and obese men in Kerman for 3 months. Participants will be randomly allocated to one of the following four groups: (1) the group receiving the MIND diet with restricted calories + probiotic supplement; (2) the group receiving the MIND diet with restricted calories + placebo; (3) the group receiving a standard low-calorie diet + probiotic supplement; (4) the group receiving a standard low-calorie diet + placebo. Before the intervention and after 3 months, the study variables will be compared between groups. Anthropometric evaluation, spermogram evaluation, serum levels of androgens, sexual function, and quality of sexual life will be assessed at the beginning and at the end of the study. This trial will provide valuable evidence regarding the potential synergistic effects of the MIND diet and probiotic supplementation in managing male infertility associated with obesity. By evaluating both clinical fertility markers and patient-reported outcomes such as sexual function and quality of life, the study findings are expected to contribute to a better understanding of the role of lifestyle interventions in reproductive health, potentially offering a sustainable therapeutic approach for this population. All the work procedures will be carried out in accordance with the guidelines recommended by the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.REC.1402.341). Iranian Registry of Clinical Trials IRCT20240313061277N1. Registered on 31 March 2024.
Humans use soil to supply 97-99% of their calories, but the unprecedented pressure being placed on soil is now causing rapid soil degradation, including through erosion, loss of soil organic matter, acidification, contamination, salinization, and biodiversity loss. Here, we show how this degradation is causing an inherent decrease in global food productionthe loss of soil organic matter, for example, is predicted to cause a 4.3% decrease in yields for staple crops (representing calories for 640 million people) while soil erosion is projected to cause a loss in global crop production of 10% to 2050. While the adverse effects of this degradation on crop yield can often be largely masked or reversed by increased use of anthropogenic inputs such as fertilizer and irrigation, we show that some forms of soil degradation lead to permanent decreases in food production. Regardless, in all cases, we examine how both the soil degradation itself and the additional inputs required thereafter to sustain productivity result in substantial planetary harm, such as through climate change and eutrophication. It is clear that urgent action is required for ensuring both food security and planetary health, including through the development of integrated frameworks for improved policy- and decision-making.
Chronotype describes differences in the timing of daily rhythms, regulated by the circadian system. These patterns are classified as morning or evening chronotypes. Studies show increased impulsivity, poorer health behaviors, and greater cardiometabolic risk among evening chronotypes. However, few studies evaluate these effects relative to circadian biomarkers. Additionally, time of day may impact how chronotype affects behaviors. Participants completed an eating in the absence of hunger task during morning and evening sessions. Participants were served oatmeal, then given access to snack foods. Calories consumed from each snack type was the primary outcome. Participants fasted for ≥8 h before a 9 AM morning task. For the evening task, participants fasted for 2 h and completed an 8 PM task. Dim light melatonin onset (DLMO) was measured the day following the morning task. Covariate-adjusted models evaluated differences in caloric intake across food types and sessions, and tested associations between caloric intake and DLMO. 113 participants completed the protocol (57 female; age: M = 35.6, SD = 9.87). Significant time-of-day effects were observed, with lower intake of bland (B = -5.67, p < 0.001) and salty foods (B = -15.53, p = 0.015) in the evening. Order effects showed greater intake during the second administration for total calories and all categories (ps < 0.01). Later DLMO was linked to greater appetite ratings. These finding suggest that those with later circadian timing may have greater hedonic interest in food. Future research should explore interactions between chronotype, circadian timing, and environmental factors shaping eating behaviors.
Intestinal failure-associated liver disease (IFALD) is a recognized complication of long-term parenteral nutrition (PN), with reported prevalence ranging from 25-85%, reflecting heterogeneity in patient populations, diagnostic criteria, and PN practices. We aimed to estimate the prevalence of IFALD in Australian adults receiving long-term home-PN (HPN), describe its biochemical and elastographic features, and identify predictors of IFALD. This was a single-centre, cross-sectional observational study in an Australian tertiary centre. Adults currently receiving long-term HPN (>12 weeks) or had received HPN within the previous decade were included. Patients with malignancy or pre-existing liver disease were excluded. IFALD was defined as persistent, unexplained elevation of liver function tests after exclusion of alternative causes of liver injury. Vibration controlled transient elastography (VCTE) was performed in all patients. Univariate logistic regression was used to evaluate associations between IFALD, nutritional, and biochemical variables. 24 patients were included. The median (inter-quartile range) duration of HPN was 42.5months (15.8-62.3); and weekly calories were 6647 kilocalories (3476.3-8471.3). 15 (62.5%) patients had IFALD. Cholestasis was the predominant biochemical pattern (80%). VCTE demonstrated significant fibrosis (≥ 8 kPa) in 20% and significant steatosis in 40% of IFALD patients. Ongoing HPN was the only variable significantly associated with IFALD on univariate analysis (OR=8, p=0.03). IFALD was highly prevalent and manifested as cholestatic liver injury, with a subset demonstrating elastographic evidence of fibrosis. Ongoing HPN was the main predictor, suggesting potential reversibility with PN cessation. Larger, multicentre studies are needed to identify any clinical predictors of IFALD.
Late eating has been linked to adverse physiological and metabolic effects, suggesting that meal timing may affect dietary intake and weight management. This study investigated whether late eating is associated with energy intake, macronutrient distribution, and food group consumption among 792 patients (56.1 ± 12.45 years; 73.3% women) with obesity, hypertension, type 2 diabetes, or dyslipidemia attending public health clinics in Uberlândia, Brazil. Dietary intake was assessed by a 24-h recall, and participants were classified as early eaters (caloric midpoint ≤12:30 h) or late eaters (>12:30 h). After adjustment for confounders, a later caloric midpoint was positively associated with total energy (β = 0.09, p < 0.001), carbohydrate (β = 0.10, p = 0.03), and sweets intake (β = 0.13, p = 0.001), and negatively associated with milk and dairy consumption (β = -0.09, p = 0.01). Late eaters showed a higher odds of inadequate consumption of meat and eggs (OR = 1.5, 95% CI 1.1-1.9, p = 0.003), oils and fats (OR = 1.4, 95% CI 1.0-1.9, p = 0.01), and sweets (OR = 1.7, 95% CI 1.2-2.5, p = 0.003). These findings indicate that consuming a greater proportion of daily calories later in the day is associated with higher energy intake and poorer dietary quality, highlighting the potential importance of meal timing in nutritional counseling and metabolic health.
Weight loss plateau (WLP) is one of the most significant obstacles for individuals with overweight and obesity during weight loss (WL). Preventing WLP is essential for maintaining long-term WL and minimizing the risk of weight regain. Despite the widespread challenge of combating obesity and barriers to WL, this area has received limited attention in research. Therefore, the present narrative review discusses the reasons, challenges, and management of WLP, which often occurs alongside diet-induced WL. A comprehensive literature search was conducted using search strategies and keywords to identify studies published until January 2025 in several databases. Data were synthesized using a narrative review approach. Given the descriptive and exploratory nature of this review, no formal methodological quality or risk of bias assessment was performed for the included studies. WLP typically emerges approximately 6-8 months into WL programs, although this timeline may vary among individuals. In addition to individual differences related to WLP, even with adherence to dietary and lifestyle modifications, WLP can occur primarily due to metabolic adaptations. These adaptations occur because a reduction in dietary intake decreases all components of total energy expenditure (TEE). Furthermore, calorie restriction can increase appetite and hunger. Reductions in TEE, combined with increased appetite, contribute to the development of an energy gap. Factors such as initial WL, previous WL experiences, a tendency toward passive overconsumption of calories, behavioral changes and genetic factors can contribute to an earlier WLP. Although all components of TEE decrease during WL, the most significant reduction is often observed in non-exercise activity thermogenesis (NEAT). Several strategies may help address metabolic adaptation and prevent and manage WLP. These include caloric reduction, high-protein diets, gradual WL, planned overfeeding, increased physical activity, maintenance of reduced body weight, body recomposition, nonlinear dieting approaches, and appetite-regulating dietary plans.
Goal setting is a key component in behavioral weight loss interventions. Goal setting theory emphasizes having harder goals rather than easier goals. However, few studies have experimentally manipulated goal difficulty levels in digital weight loss interventions. Further, when multiple goals are assigned, it is unclear if harder goals are effective or too overwhelming. Ignite was a pilot optimization trial guided by the Multiphase Optimization Strategy. A 24 factorial design was used to randomize 32 participants (U.S. adults with overweight or obesity) to either an easier or harder goal for four goal domains: calories, steps, eating windows, and Red Zone Foods (i.e., high-calorie, low-nutrition foods). All participants received a 10-week fully digital weight loss intervention with daily self-monitoring of goals, weekly lessons, action plans, and feedback. Data were collected via digital tools (daily) and surveys (baseline, 4-, 10 weeks); feasibility and acceptability were assessed descriptively, while proof of concept was assessed via linear mixed models. Findings were compared to a priori benchmarks. Participants had a mean (SD) age of 47.7 (13.3) years and BMI of 30.1 (3.8) kg/m2 and 47% racial/ethnic minority. Feasibility and acceptability benchmarks were largely met, with high engagement, 94% retention (30/32) at 10 weeks, and 97% recommending the program. For proof of concept, the 3%, but not 5%, weight loss benchmark was met (mean (SD) -3.3 (2.5) kg, or -4.0% (3.6%) at 10 weeks). Participants with a harder calorie goal had greater weight loss than those with an easier calorie goal (difference: -2.3 kg [95% CI, -4.1, -0.6 kg]). No main effects were observed for other goals. With high feasibility of study procedures, high engagement, and moderate-to-high acceptability, the intervention needs only minor refinements prior to proceeding to a fully powered trial testing the efficacy of easier versus harder goals for weight loss. ClinicalTrials.gov NCT05715242. Registered on February 6, 2023.
Web-based and mobile phone-based apps have become widely available for dietary self-monitoring; however, their use may increase the risk of disordered eating. College students frequently demonstrate poor nutrient intake despite consumption of sufficient calories. One way to improve diet quality may be via the use of a smartphone app that encourages intuitive eating. The purpose of this study was to improve diet quality among college students through the use of a novel smartphone app that promotes intuitive eating rather than calorie counting and weight loss. The In2Eat iOS mobile app was developed in SwiftUI and stored user data in a Firebase database. A total of 45 college students completed assessments of intuitive eating, diet quality, and disordered eating before and after 4 weeks of using the In2Eat app. Users evaluated the usability of the app with the System Usability Scale (SUS). Engagement with the app was recorded as the total number of days a meal was logged, the total number of meals logged, and the average number of meals logged per day. After our 4-week intervention, dietary qualities that protect against chronic disease increased by 28%, fruit consumption increased by 63%, and skin antioxidant levels increased by 6.1% (Hedges g=0.16; mean difference 0.33, 95% bias corrected and accelerated [BCa] CI 0.04-0.61; P=.03). Global intuitive eating did not change during the user study; however, the unconditional permission to eat subscale increased (Hedges g=-0.28; mean difference 0.28, 95% BCa CI 0.07-0.49; P=.01, adjusted P=.07). Overall, disordered eating also did not change with app use, although dietary restraint decreased (Hedges g=-0.23; mean difference 0.30, 95% BCa CI -0.61 to -0.04; P=.04, adjusted P=.22). The average SUS score for the In2Eat app was 67.2 (SD 15.5). The number of days a meal was logged was positively correlated with SUS scores (r=0.28; P=.06), and the total number of meals logged had a monotonic association with app usability (ρ=0.31; P=.04). When divided according to the low (mean 10.2, SD 5.3), medium (mean 26.3, SD 2.8), and high (mean 33.6, SD 3.8) number of days logging meals, participants with higher days of logging reported the app as more usable (H=6.75; P=.03). A regression analysis showed that 8% of the variance in system usability (R2=0.080; P=.31) was explained by app use; however, none of the individual predictors contributed substantially to the variance. An intuitive eating smartphone app can improve diet quality without increasing disordered eating. Results suggest that participants who logged more meals tended to rate the app as more usable. Further research is needed with a greater sample size after incorporating features to improve the app's usability.
Policy Points Acute dietary switching from ultra-processed food to minimally processed food elicits no physiological withdrawal, a key indicator that people rely on ultra-processed foods for reasons other than food addiction. France and Japan are countries with low adult obesity prevalence attributable to agricultural and school nutrition policies that encourage greater consumer reliance on a diversity of fiber-rich, polyphenol-rich, minimally processed foods. Traditional, high-fiber dietary patterns optimize gut-microbiota function, elevating the biological precursors required for the natural expression of the satiety hormone glucagon-like peptide-1 (GLP-1). Public health progress in reducing US obesity prevalence will be more effectively achieved by subsidizing and expanding consumer access to whole foods than from efforts to prevent the food industry from making their ultra-processed food products hyperpalatable. In this commentary, we applaud Gearhardt and colleagues' focus on the negative health effects of consuming ultra-processed foods but suggest that the bigger dietary contributor to obesity risk is American consumers' lack of access to a diverse range of gut microbiota-accessible foods. We cite scientific literature supportive of the health benefits of consuming fiber-rich, polyphenol-rich, minimally processed plant foods, which are more likely to provide substrate to one's commensal gut microbes than would consuming ultra-processed foods. We also cite results from randomized, controlled feeding studies showing that study participants who were switched from an ultra-processed food condition to a minimally processed food condition did not report withdrawal symptoms or evidence of tolerance, thereby undermining Gearhardt and colleagues' thesis that consumers' overconsumption of calories could be attributed to the addictiveness of ultra-processed foods. We cite scientific literature illustrating the health benefits of consuming traditional dietary patterns, such as the Mediterranean dietary pattern, which feature a diversity of fiber-rich, polyphenol-rich, minimally processed foods. We conclude that government agricultural and educational policies that increase consumer access to gut microbiota-accessible foods may be a more effective long-term approach to reducing nutrition-related chronic diseases than policies that limit the ability of the food industry to increase the hyper-palatability of ultra-processed foods.
Background: Image-based dietary assessment provides a more intuitive approach for nutritional monitoring and health management. However, in multi-category bowl-based meals, food boundary adhesion, spatial stacking, and staple-food occlusion by upper-layer dishes still affect the accuracy of volume, weight, and nutritional composition prediction. Methods: This study proposes a nutrition prediction method for bowl-based foods by integrating semantic segmentation, multi-view three-dimensional reconstruction, and occlusion compensation. The improved DBP-FDSNet was used to extract food-category masks from top-view RGB images, while detail enhancement, boundary-assisted supervision, and spatial position encoding were incorporated to improve the segmentation quality of food boundaries and adhesion regions. The visible food surface inside the bowl was reconstructed using a bowl instance model and RGB-TSDF-based multi-view fusion, and the two-dimensional semantic results were mapped into the height-field parameter domain for category-level volume integration. For partially occluded, severely occluded, or completely invisible staple foods, a layered compensation strategy was introduced to reduce staple-food volume prediction errors and the erroneous assignment of upper-layer food volume. Food weight and whole-bowl Calories, Fat, Carbohydrate, and Protein were finally predicted using food density and a nutritional composition database. Results: DBP-FDSNet achieved a meanIntersectionoverUnion (mIoU) of 80.51% and a BoundaryF1 Score (bF1) of 85.73%. At the whole-bowl level, the MeanAbsolutePercentageError (MAPE) values for Calories, Fat, Carbohydrate, Protein, and total food mass were 13.23%, 18.51%, 14.18%, 13.35%, and 10.85%, respectively. Conclusions: The method improves the stability of category-level volume and nutritional composition prediction in complex bowl-based meal scenarios, providing a feasible solution for image-based dietary assessment and intelligent nutrition management.
The stated purpose of nutrient profiling (NP) models is to help implement dietary guidelines by addressing prevailing health issues. In high-income countries, obesity and non-communicable diseases are the main health issues of concern. As a result, NP models typically penalize packaged processed foods that contain calories, total or added sugar, sodium, and saturated fat. This negative nutrition approach may not be optimal for Southeast Asia, where nutrient shortfalls and nutrient deficiencies are still prevalent. A more positive approach featuring nutrients to encourage might be more appropriate. NP models should incorporate protein, fibre, calcium, iron, zinc, vitamin A, B vitamins, vitamin B12, and vitamin E. The specific choice of index nutrients may depend on population health needs. Further, given the diversity of Asian food cultures, it may be time to go beyond packaged foods and apply the NP methodology to mixed dishes and to complete meals. This article illustrates the application of NP models to composite meals.
Ulcerative colitis (UC) is increasingly influenced by dietary habits. Antioxidants in the diet have been suggested to mitigate inflammatory processes associated with UC, warranting investigation into their role in disease management. This study investigates the association between dietary total antioxidant capacity (DTAC) and the severity of UC. In a cross-sectional study conducted at Imam Reza Hospital in Tabriz, Iran, 158 UC patients were assessed. Dietary intake was evaluated using a validated food frequency questionnaire, and DTAC was calculated using the ferric reducing antioxidant power (FRAP) method. UC severity was measured using the Mayo Score. Statistical analyses included one-way ANOVA and logistic regression, adjusting for confounders such as demographics, lifestyle, and diet-related factors. Significant variations in demographic and dietary characteristics were observed across DTAC tertiles. Compared with patients in the lowest tertile of FRAP scores, those in the highest tertile had higher employment rates (P = 0.006), were more likely to be married (P = 0.015), and had significantly greater intake of calories (P < 0.001), protein (P < 0.001), and carbohydrates (P < 0.001). Adjusted logistic regression analyses showed that participants in the highest DTAC tertile had significantly decreased odds of active UC [OR: 0.27 (95% CI: 0.09-0.85); P = 0.023]. Higher dietary antioxidant capacity was associated with lower UC severity, highlighting the potential of antioxidant-rich diets in UC management. Future longitudinal studies are needed to further explore this association.
Bulking strategies in resistance-trained individuals typically involve high meal frequency and long eating windows. The present study aimed to investigate whether time-restricted eating (TRE (16:8 protocol)) can affect nutrient intake, body composition, 1-repetition maximum (1RM) performance and resting hormone levels during a bulking phase in resistance-trained individuals. Twenty-three healthy individuals were randomly assigned to either a TRE or a control (CON) group. All participants completed intense resistance training 3x/week for 12 weeks and were instructed to consume 300-500 kcal above their individualized daily energy requirements. Body composition (measured by single-frequency bioelectrical impedance analysis) and 1RM performance were assessed every four weeks. Hormone levels were measured at baseline and post-intervention and the Hooper questionnaire for monitoring well-being was completed daily. TRE consumed significantly fewer calories than prescribed (target intake: 37.50±4.87; actual intake: 31.86±7.52 kcal/kg body weight (BW), p=0.001), with lower protein intake (1.60±0.20; 1.44±0.31 g/kg BW, p=0.025) and lower carbohydrate intake (5.27±1.19; 3.97±1.29 g/kg BW, p<0.001). Despite this, both groups showed similar increases in fat-free mass (TRE: +1.34±0.78; CON: +1.38±1.42 kg) and muscle mass (+1.07±0.94; +1.13±0.61 kg). The CON group showed significantly greater increases in body weight (+2.19±2.40; +3.90±2.14 kg; p=0.018) and fat mass (+2.00±2.49; +4.36±2.26 kg; p=0.009). Similar increases in 1RM performance were observed for both deadlift (+26.36±10.92; +26.04±8.01 kg) and bench press (+12.95±7.23; +11.04±3.61 kg). There were no meaningful differences between the groups regarding hormone levels and questionnaire results. The lower total energy intake in the TRE group was associated with smaller increases in fat mass, reflecting reduced adherence to the prescribed energy surplus within the restricted eating window. Nevertheless, the results indicate that sufficient macronutrients were consumed to support increases in muscle mass and strength comparable to those observed in the control group.
Background/Objectives: The obesity epidemic coexists with the phenomenon of "hidden hunger" (Type B malnutrition)-a micronutrient deficiency amidst a caloric excess. Traditional dietary assessment methods often distort the actual picture by ignoring technological losses during cooking, which necessitates the use of digital tools. Methods: A cross-sectional study (N = 3267) was conducted using the digital platform "NIAP". The analysis was based on valid 3-7-day dietary records with algorithmic accounting for nutrient retention factors during thermal processing. The nutrient profiles of individuals with a normal body mass index (BMI) and obesity (BMI ≥ 30 kg/m2) were compared. Results: The epidemiology of intake shortfalls was highly prevalent and pronounced: 99.9% of the cohort had ≥1 inadequacy (with a mean negative deviation of -77.3% for vitamin D and -59.2% for Omega-3), and 61.5% exhibited ≥10 simultaneous multiple intake shortfalls. These inadequacy rates remained robust in a sensitivity analysis excluding under-reporters. The obesity group consumed significantly more energy, saturated fatty acids, added sugars, cholesterol, and sodium, but demonstrated a lower relative macronutrient intake (g/kg of body weight). Absolute fiber intake did not differ between the groups, indicating a decrease in its density per 1000 kcal in the diet of individuals with obesity; the intake of Omega-3 polyunsaturated fatty acids (PUFAs) showed a downward trend. The Na:K ratio was significantly higher in the obesity group (1.19 vs. 1.04, p < 0.001). Correlation analysis confirmed an inverse relationship between BMI and the overall nutrient density of the diet. Conclusions: A high-energy diet does not compensate for systemic micronutrient inadequacy among the evaluated cohort. Obesity is associated with a dietary imbalance favoring "empty calories" and pro-inflammatory components against a background of severe multiple dietary inadequacies. The integration of algorithmic dietary assessment that accounts for cooking losses is critical for objective diagnosis and personalized nutritional intervention.
Increasing evidence links ultra-processed food (UPF) intake to obesity and related diseases; however, little is known about the role of UPF in behavioral weight-loss interventions (BWLIs). Thus, the current study investigated whether UPF intake changes during a BWLI and whether these changes are associated with weight-loss outcomes. A total of 449 adults with obesity (mean ± SD age = 49.5 ± 11.4 years, BMI = 35.7 ± 4.0 kg/m2, 83.5% female, 23.4% Black/African American, 9.8% Hispanic) completed a 16-week BWLI. Using dietary intake data collected via the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24), we examined (1) changes in caloric intake and the proportion of calories from UPFs from baseline to post-intervention and (2) associations between these changes and weight loss, overall and adjusting for caloric intake. Participants demonstrated reductions in calorie intake (-461 ± 931 kcal/day), UPF intake (-3.0% ± 2.8% of total energy), and body weight (-7.2 ± 7.6 kg) over the BWLI, ps < 0.001. Greater reductions in UPFs were associated with greater decreases in caloric intake (r = 0.10) and greater weight loss (r = 0.08, ps < 0.001), even after adjusting for changes in caloric intake (p = 0.005); however, effect sizes were small. UPF intake decreased during the BWLI, and greater reductions were associated with greater weight loss, independent of caloric changes, though small effect sizes warrant cautious interpretation. Future research should examine whether targeting UPF reduction in a BWLI enhances weight outcomes. ClinicalTrials.gov Identifier: NCT04116853.
Individuals with excess weight are at a higher risk of overall health issues and often seek to modify their diets to lose weight. Weight loss can alter body composition, leading to a decrease in lean body mass (LBM) and resting metabolic rate (RMR). Limited research has examined the relationship between different dietary modifications and body weight, LBM, and RMR. This review aimed to research the impact of weight-loss dietary interventions on body weight, LBM, and RMR in adults with overweight or obesity. The search was conducted using the following databases: CINAHL, Cochrane Library, Embase, PubMed, Scopus, Web of Science, Google Scholar, and Dissertations & Theses Global. The initial search found 8838 studies. The title and abstract screening identified 138 studies for full-text review. As a result, 16 studies were selected for this systematic review. The studies had to be original, published in English over the last 10 years, and include adults as participants. The intervention had to be any weight-loss dietary modification, and the outcomes had to include measurements of body weight, LBM, and RMR. The included intervention groups implemented the following dietary modifications: altering calorie intake, macronutrient composition, and meal timing. Across all studies, the dietary interventions resulted in all participants losing a substantial amount of weight. Changes in LBM and RMR, however, were not as consistent across the groups, but there was an overall downward trend. Physical activity did not confound the outcomes of the included studies. Regardless of the type of dietary modification and inclusion of physical activity, any change in diet resulted in significant weight loss. Changes in LBM and RMR varied, with a tendency to decrease. Future studies should research the long-term effects of diet interventions on the outcomes of interest. PROSPERO registration no. CRD420251074910/.
A large proportion of patients pharmacologically treated for hypertension do not reach blood pressure (BP) treatment targets. In Europe, a stricter target of BP < 130/80 mmHg has recently been recommended. Presently, it is unknown whether the combination of pharmacological approaches and lifestyle changes can help patients achieve these new targets. The Hypocaloric Mediterranean Diet or Physical Activity (MeDiPA) randomized controlled trial aims at investigating the effects of lifestyle modifications in patients with uncontrolled hypertension taking antihypertensives. Here, we present the MeDiPA design and baseline population characteristics. We included participants with office BP ≥ 130/80 mmHg on two occasions, taking minimum two antihypertensives, with BMI 25-40 kg/m2, and waist circumference ≥ 88 cm (women)/≥ 102 cm (men). We excluded participants with BP ≥ 160/100 mmHg, type 1 diabetes, recent history of cardiovascular disease, or chronic kidney disease. Participants were randomized to a hypocaloric Mediterranean-style diet, increased physical activity, or control, for six months. Visits took place at baseline, after three, six, and 12 months. The main outcome is changes in 24-hour ambulatory BP after six months. Exploratory outcomes include changes in metabolic parameters and quality of life. Sixty-six participants were included (56% women): 21, 22, and 23 in the diet, physical activity, and control groups, respectively. Mean (standard deviation) age was 59 (8) years, 85% of participants were Norwegian, and 83% had higher education. Mean BMI was 32.0 (4.5) kg/m2, and waist circumference was 106.3 (11.8) cm (women)/113.3 (8.6) cm (men). Mean BP was 137 (15)/90 (8) mmHg, and 61% of participants had BP > 140/90 mmHg. In general, participants fulfilled three metabolic syndrome criteria. The MeDiPA study included participants at high cardiometabolic risk. This trial will add to the knowledge concerning how lifestyle modifications modulate BP in pharmacologically-treated patients with uncontrolled hypertension. NCT04155112, first submitted 2019-10-23. Many patients medicated for high blood pressure (BP) do not achieve BP as low as recommended.Recently, BP guidelines have become stricter and medicated patients are now recommended BP < 130/80 mmHg.Whether BP medication in combination with lifestyle changes help achieve recommended BP levels is unknown.Our study will investigate the effects of lifestyle changes in patients who take BP medication, but do not reach the recommended BP levels.We included participants with BP ≥ 130/80 mmHg twice, taking at least two BP medications, who were overweight or obese, and had central obesity. Individuals with very high BP, type 1 diabetes, recent history of heart disease or chronic kidney disease were excluded.Participants were randomly distributed to one of three possible groups: a healthy low-calorie diet, increased physical activity, or usual care, for six months. We measured participants at the start of the study, after three, six, and 12 months.Our main interest is changes in 24-h BP, after six months. Additionally, we will investigate other health effects.We included sixty-six participants (56% women): 21 in the diet group, 22 in the physical activity group, and 23 in the usual care group. On average, participants were 59 years old and had BP 137/90 mmHg; 85% were Norwegian, and 83% had higher education. Overall, we included participants at high risk of cardiovascular disease.Our study will help understand how lifestyle changes can affect BP patients who already take BP medication.
Promoting environmentally sustainable dietary patterns can benefit both population and planetary health. Ecolabels on restaurant menus could promote healthful and sustainable choices, but evidence is needed on effects in different restaurant types. To test the effects of different ecolabel designs on menus from 2 fast-food restaurants on the healthfulness of full meal orders, compared to a control label. This randomized clinical trial was conducted online in a nationally representative sample of adults (≥18 years) in the US in April 2025. Participants were recruited from the NORC AmeriSpeak survey panel to participate in this experiment. Participants were randomized via an automated process within the survey platform to 1 of 5 label conditions: (1) control: QR code; (2) low-climate-impact labels; (3) traffic-light labels (TLLs); (4) high-climate-impact labels; or (5) grade-scale labels and asked to order lunch from 2 fast-food menus (1 burger-focused and 1 sandwich-focused). The primary outcome was the healthfulness of meals ordered based on a modified Nutrient Profile Index (NPI) score. Other outcomes included the estimated greenhouse gas emissions (GHGE), calorie and nutrient content, and cost of selected meals, as well as perceptions of labels and knowledge about the climate contribution of different foods. Among the 6210 participants (3274 [51.0%] women; mean [SD] age, 48.1 [18.1] years), 1236 participants were randomized to the control group; 1249 to low-climate-impact labels, 1243 to high-climate-impact labels, 1235 to TLLs; and 1247 to grade-scale labels. Demographic characteristics were similar across groups. Only the TLL was effective at promoting more healthful food choices in the burger restaurant compared to the control label (mean [standard error] NPI score: 49.93 [0.18] points vs 49.25 [0.18] points; P < .001). There were no ecolabel effects on NPI score in the sandwich restaurant. Compared to control, the TLL led to 15.2% lower GHGE for meals in the burger restaurant and 29.8% lower GHGE for meals in the sandwich restaurant. The TLL was the most noticeable (78.30% [95% CI, 75.35%-81.26%]; P < .001) and had the highest percentage of participants who correctly reported what the label was about (88.72% [95% CI, 86.04%-91.39%]; P < .001). There were no differences in the overall cost of the meals selected by label condition. Findings from this web-based randomized clinical trial showed that TLL-style ecolabels on restaurant menus may be an effective strategy to promote more sustainable and, in some instances, more healthful food choices without increasing consumer costs. ClinicalTrials.gov Identifier: NCT06909019.
Evidence comparing the effects of novel alternative dietary strategies on resting energy expenditure (REE) with a hypocaloric standard Mediterranean diet (MedDiet) with continuous caloric restriction remains limited. This study aimed to evaluate the effects of diets with varying ketogenic potentials-including a very-low-carbohydrate diet (ketogenic diet, KD), time-restricted eating (TRE), and modified alternate-day fasting (mADF)-on the REE of individuals with obesity compared to those of a standard MedDiet. This was a secondary post hoc sub-analysis of a three-month, parallel-arm, randomized clinical trial (RCT) including 160 adults with obesity (body mass index > 30 kg/m2). The participants were randomly assigned to one of five calorie-restricted dietary interventions: control (MedDiet), KD, early time-restricted eating (eTRE), late time-restricted eating (lTRE), or mADF. All interventions featured an individualized energy deficit of 600 kcal/day. In this sub-analysis, a total of 102 participants with valid baseline measures were included. The REE was assessed by indirect calorimetry, and longitudinal trajectories were evaluated using Linear Mixed Models (LMMs) in 98 participants to account for baseline variability and to maximize data retention. The mean age of participants in this sub-analysis was 45.3 years (SD 10.8), and 73.1% were women. The longitudinal modeling confirmed no statistically significant differences in the adjusted REE trajectories among the five dietary groups over the 3-month intervention (Group × Time interaction, p = 0.506). Furthermore, the LMMs showed that total body weight (p < 0.001) and biological sex (p < 0.001) were the variables most strongly associated with REE within the model. No independent associations between circulating beta-hydroxybutyrate levels and REE trajectories were detected. Hypocaloric diets with varying macronutrient distributions and fasting windows did not show statistically significant differences in REE trajectories over the 3-month intervention. In this exploratory sub-analysis, the REE trajectories were more closely associated with individual biological characteristics, particularly body weight and sex, than with the specific dietary strategy employed. Given the modest sample size and exploratory nature of the study, these findings should be interpreted cautiously and require confirmation in larger, adequately powered prospective trials.