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The 3 Week Diet

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The 3 Week Diet Overview

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My The 3 Week Diet Review

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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this ebook are precise.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Obesity Prevention

Regulation of Appetite and the Management of Obesity 113 10. Fat in the Diet and Obesity 137 of Obesity 163 14. Causes of Obesity and Consequences of Obesity Prevention in Non-human Primates and Other Animal Models 181 241 28. Obesity and Gallstones 399 17. Obesity and Hormonal Abnormalities 19. Drug-induced Obesity 269 21. Social and Cultural Influences on Obesity 305

What Is Obesity And How Is It Measured

At the physiological level, obesity can be defined as a condition of abnormal or excessive fat accumulation in adipose tissue to the extent that health may be impaired. However, it is difficult to measure body fat directly and so surrogate measures such as the body mass index (BMI) are commonly used to indicate overweight and obesity in adults. Additional tools are available for identification of individuals with increased health risks due to 'central' fat distribution, and for the more detailed characterization of excess fat in special clinical situations and research.

Measuring General Obesity

The BMI provides the most useful and practical population-level indicator of overweight and obesity in adults. It is calculated by dividing body-weight in kilograms by height in metres squared (BMI kg m2). Both height and weight are routinely collected in clinical and population health surveys. In the new graded classification system developed by the World Health Organization (WHO), a BMI of 30 kg m2 or above denotes obesity (Table 1.1). There is a high likelihood that individuals with a BMI at or above this level will have excessive body fat. However, the health risks associated with overweight and obesity appear to rise progressively International Textbook of Obesity. Edited by Per Bjorntorp. 2001 John Wiley & Sons, Ltd. Table 1.1 Classification of overweight and obesity in adults according to BMI Table 1.1 Classification of overweight and obesity in adults according to BMI

Dietary Supplement Health and Education

Because herbs cannot be sold and promoted in the United States as drugs, they are regulated as nutritional or dietary substances. Nutritional or dietary substances are terms used by the federal government to identify substances not regulated as drugs by the FDA but that are purported to be effective for use to promote health. Herbs, as well as vitamins and minerals, are classified as dietary or nutritional supplements. Because natural products cannot be patented in the United States, it is not profitable for drug manufacturers to spend the millions of dollars and the 8 to 12 years to study and develop these products as drugs. In 1994, the US government passed the Dietary Supplement Health and Education Act (DSHEA). This act defines substances such as herbs, vitamins, minerals, amino acids, and other natural substances as dietary supplements. The act permits general health claims such as improves memory or promotes regularity as long as the label also has a disclaimer stating that the...

The Global Obesity Problem

The number of people worldwide with a BMI of 30 or above is currently thought to exceed 250 million, i.e. 7 of the world's adult population (Table 1.5) (4). When individual countries are considered, the range of obesity prevalence covers almost the full spectrum, from below 5 in China, Japan and certain African nations to more than 75 in urban Samoa. It is difficult to calculate an exact global figure because good quality and comparable data are not widely available. The assessment in Table 1.5 is a conservative estimate.

Current Prevalence of Obesity

Despite the limited availability and fragmentary nature of suitable country-level data, it is clear that obesity rates are already high and increasing rapidly in all regions of the world. Table 1.6 shows the most current estimates of obesity prevalence, according to a BMI of 30 or greater, in a selection of countries from around the globe. Nationally representative data sets based on measured weight and height are presented where possible. Examination of Table 1.6 reveals large variations in obesity prevalence between countries, both within and between regions. In Africa, for example, obesity rates are extremely high among women of the Cape Peninsula but very low among women in Tanzania. Much of the developed world already has exceptionally high levels of overweight and obesity. In Europe, obesity prevalence now ranges from about 6 to 20 in men and from 6 to 30 in women. Rates are highest in the East (e.g. Russia, former East Germany and Czech Republic) and lowest in some of the...

Classification Of Obesity And Fat Distribution

The epidemiology of obesity has for many years been difficult to study because many countries had their own specific criteria for the classification of different degrees of overweight. Gradually during the 1990s, however, the body mass index (BMI weight height2) became a universally accepted measure of the degree of overweight and now identical cut-points are recommended. This most recent classification of overweight in adults by the World Health Organization is shown in Table 2.1 (1). In many community studies in affluent societies this scheme has been simplified and cut-off points of 25 and 30 kg m2 are used for descriptive purposes. The prevalence of very low BMI (< 18.5 kg m2) and very high BMI (40 kg m2 or higher) is usually low, in the order of 1-2 or less. Already researchers in Asian countries have criticized these cut-points. The absolute health risks seem to be higher at any level of the BMI in Chinese and South Asian people, which is probably also true for Asians living...

Global Prevalence Of Obesity And Time Trends

In many reviews it has been shown that obesity (defined as a BMI of 30kg m2 or higher) is a International Textbook of Obesity. Edited by Per Bjorntorp. 2001 John Wiley & Sons, Ltd. Table 2.1 WHO classification of overweight and obesity (1) Table 2.1 WHO classification of overweight and obesity (1)

Explanations For The Growing Epidemic Of Obesity

Increasing sedentary behaviour has been proposed as one of the principal reasons for a further increase in the prevalence of obesity in countries with established market economies. Sedentary behaviour is poorly measured by the number of hours engaged in sports only. Large and important differences can be seen in the number of hours spent at sedentary jobs and behind television or computer screens during leisure time. Transportation is almost certainly a factor as well. For example, of short trips in the Netherlands 30 are done by bicycle and 18 by walking. In the UK these percentages are 8 by cycling and 12 by walking and in the USA 1 by bicycle and 9 by walking (13). These daily activities accumulated over a year can easily explain the small but persistent changes in energy balance needed to increase the prevalence of obesity. Given the changes in lifestyles over the last decades in many parts of the world it is not surprising that people gain weight on the average although for many...

Obesity In Children And Adolescents

Comparison of prevalence data of obesity in children and adolescents around the world remains difficult because of the lack of standardization and interpretation of indicators of overweight and obesity in these age groups. Usually local or national percentile distributions for weight-for-age, weight-for-height, or BMI-for-age are used. Not only do these differ between regions and nations but they are also subject to change over time. In addition, different percentile cut-off points are used for the definition of overweight or obesity (e.g. 85th, 90th, 95th and 97th percentiles are used in different countries). correspond to the criteria for classification of overweight based on BMI for adults. Recently Cole et al. (17) used data from six large nationally representative cross-sectional growth studies from various parts of the world. They established centiles of the distribution of BMI by age. Those centile curves that, at age 18 years, passed through the widely used cut-points of 25...

Metabolism of dietary fats and blood lipoproteins

Dietary fats are absorbed in the small intestine. Ingested triglycerides (or triacylglycerols) are hydrolysed by pancreatic lipases into glycerol, fatty acids and some mono-acylglycerol. Absorption of dietary fats is almost complete 98 or more. Intestinal mucosal cells take up the hydrolysis products from the gut lumen and largely re-esterify these to triglycerides. Short and medium chain fatty acids (C4 0-C10 0), which make up a very small part of SAFAs in the diet, are not re-esterified but directly taken up in the blood and transported to the liver through the portal vein. All other fatty acids are re-esterified and the newly formed triglycerides are excreted in the lymph in particles called chylomicrons, which then enter the peripheral bloodstream.

Obesity Body Composition

Obesity is clearly associated with chronic diseases such as type 2 diabetes, coronary heart disease, and dyslipidemia, yet the underlying mechanisms are not well defined. However, the evidence is strong that insulin resistance contributes greatly to the pathophysiology of these observed metabolic abnormalities and their associated morbidity (72). Insulin resistance is observed frequently in obese subjects and is considered an independent risk factor for the development of both type 2 diabetes and coronary artery disease (72-75). Although it is established that hyperinsulinemia, insulin resistance, and other obesity-related metabolic abnormalities are significantly associated with overall accumulation of fat in the body, there is considerable evidence that the specific fat distribution is important. Excessive accumulation of fat in the upper body's abdominal area is referred to as ''truncal'' or ''central'' obesity. Central obesity appears to be a better predictor of morbidity than...

The Scale of the Childhood Obesity Problem

Despite the lack of agreement over childhood obesity classification, there is ample evidence to illustrate the scale of the problem across the world. OBESITY AS A GLOBAL PROBLEM Table 1.9 Prevalence of overweight in 6- to 8-year-old children lion children under 5 years are overweight across the world (2). This was based on weight-for-height data from 79 developing countries and a number of industrialized countries. Once the new growth reference is available a more realistic estimate should be possible. Trend data suggest that the childhood obesity problem is increasing rapidly in many parts of the world. In the US, the percentage of young people aged 5-14 who are overweight has more than doubled in the past 30 years. Prevalence has risen from 15 in 1973-1974 to 32 in 1992-1994. Meanwhile, in England, triceps skinfold measurement increased by almost 8 in 7-year-old English boys and by 7 in 7-year-old girls between 1972 and 1994. In Scotland over the same period, triceps skinfold...

Healthy Eating for Children

Fruits and vegetables are the primary sources of vitamins A and C and contain other nutrients such as B vitamins, trace minerals, and fiber.' Breads and cereals are excellent sources of B vitamins and. if enriched, iron. Whole-grain breads and cereals are also good sources of fiber, vitamin E, and trace elements such as magnesium. It is recommended that half the breads and cereals in the diet be whole grain.' Dairy products, especially milk, provide protein and serve as primary dietary sources of calcium and vitamin D. Milk provides the primary source of protein in early childhood. Protein in general provides dietary satiety. When the child makes the transition to Meals should provide adequate amounts of protein, carbohydrates. and fat (Tables 8-2 to 8-6).14 Fat in moderate amounts is an essential component of any diet. It is recommended that no less than M)c < of the calories in a child's diet come from fat. unless the child is on a special high or low fat diet.1 If the child is...

General and Dietary Advice

There is no evidence of the impact of the diet on the development and course of CD however, to the perception of most patients, some foods cause or worsen the symptoms of a disease. Elimination of milk and processed milk products from the diet is sometimes recommended. A CD patient's diet should be similar or identical to the general population. Diet modification can be tailored to the individual needs based on the disease symptoms. An interesting observation is that an increasing number of CD patients come from developed countries, which is related to the impact of environmental factors including diet. Dietary recommendations include frequent and small quantity meals 5-6 times per day, high calorie and diversified diet, fluid intake of 2-2.5 L day, vitamin and microelement supplementation and elimination of alcohol and carbonated beverages.

Aldosterone Dietary Sodium and Vascular Injury

Development of aldosterone-mediated vascular injury appears to require the combination of a moderately high salt intake and an underlying co-morbidity, such as hypertension, CHF, or renal disease. Control animals fed a high-salt diet do not develop cardiovascular injury (52). Animals given L-NAME Ang II in the presence of sodium restriction also do not develop cardiovascular damage, despite a 10-fold increase in plasma aldosterone levels compared to animals on a high-salt diet (Fig. 6) (53). Rather, injury occurs in L-NAME Ang II animals on a high-salt diet with low-to-normal plasma aldosterone levels and can be prevented by an MR antagonist. The influence of dietary sodium on the adverse effects of aldosterone in vivo raises concerns regarding the applicability of in vitro studies of aldosterone's actions.

Evidence Linking Fat To Obesity

Cross-sectional evidence from studies linking intake data to degree of obesity clearly suggests that dietary fat is associated with overweight. In a recent review, Lissner and Heitmann (18) found that in more than 80 of the cross-sectional studies reviewed, dietary fat intake was associated with obesity. The diet of obese subjects has been found to contain 5-8 more fat than the diet of the normal weight control groups (19), and this is likely to be a conservative estimate if obesity-related underreporting of fat occurs. Furthermore, most experimental studies provide evidence that, compared to a covert low fat diet, spontaneous energy intake is Table 10.1 Evidence linking fat intake to obesity Normal Moderate overweight Obesity Normal Moderate overweight Obesity increased following ingestion of a high fat diet (20-22). In addition, a number of studies have suggested that appetite control is dissociated from fat since energy intake of a subsequent meal was not suppressed by adding up to...

Evidence Unlinking Fat From Obesity

A number of observational studies have suggested that the role of fat in obesity development may be exaggerated, and suggest that the population differences in weight do not appear to be due primarily to the fat intake (30). For instance, in a recent literature review, it was found that short-term hy-pophagia on low fat diets is compensated in the longer term (18). A report from the National Centre for Health Statistics has shown that Americans today eat less fat but more calories than earlier, a finding that may explain the rise in obesity, but acquits the role of fat (31). In addition, results from prospective observational studies give inconsistent results, and do not support the relation between a high fat intake and subsequent weight gain. Klesges et al. (32), for instance, found a clear positive association between dietary fat and subsequent weight changes, while Colditz et al. (33), using the same dietary instrument, and Kant et al. (34), using a different instrument, could not...

Dietary lipids supply fatsoluble vitamins

Quantities, fat-soluble vitamins are required in microgram quantities per day. Although some fat is necessary in the diet to improve the absorption and utilization of fat-soluble vitamins, there is little evidence that, within the normal range of fat intakes, the amount of dietary fat significantly affects the utilization of fat-soluble vitamins. However, when fat absorption is impaired, insufficient fat-soluble vitamins may be absorbed, leading to a deficiency state. This could occur when the secretion of bile salts is restricted (as in biliary obstruction), when sections of the gut have been removed or damaged by surgery or in diseases, such as tropical sprue and cystic fibrosis, all of which are associated with poor intestinal absorption. When people have access to varied diets, there is little likelihood of dietary deficiencies of fat-soluble vitamins. However, some fat-soluble vitamins are present in a limited number of foods inevitably, when food supplies are limited by economic...

Age Obesity And Glucose Counterregulation

Both the autonomic nervous system and the hypothalamic-pituitary-adrenal axis are activated in excess in the morbidly obese. Before and after bariatric surgery (average weight loss 40 kg over 12 months), severely obese non-diabetic subjects, underwent a hyperinsulinaemic hypoglycaemic clamp (blood glucose 3.4 mmol l). Before weight reduction, patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide, and norepinephrine. After surgery and during hypoglycaemia, all these responses were attenuated and most markedly so for glucagon, which was totally abolished in association with a marked improvement in insulin sensitivity. In contrast, the growth hormone response was increased after weight reduction (Guldstrand et al., 2003).

Withindepot Sitespecific Properties And Obesity

These data together clearly show that certain adipocytes have properties that are minimal or absent in samples from the standard perirenal or epi-didymal depots. Although indistinguishable in his-tological appearance from typical adipocytes, those around major lymph nodes are equipped to participate in local interactions with lymphoid cells, and seem to be at least partially exempt from contributing to whole-body supply during fasting. Bone marrow is another site where adipocytes are contiguous with lymphoid cells, and the combination is known to be capable of functioning like lymph nodes (45). At least in non-ruminants, these marrow adipocytes retain their storage lipid, and even the capacity to accumulate more, during prolonged starvation when those in the 'typical' depots are almost totally depleted (46). The mammalian immune system seems to have organized its own local supplies of the polyunsaturated fatty acids (and perhaps of other metabolites), thereby avoiding the need for...

Dietary lipids and cancer

There is a large body of evidence on the role of dietary lipids in cancer. It is based on epidemiolo-gical studies of various sorts in humans, and on feeding studies in animals. It should be stressed that the evidence is in all cases somewhat conflicting. In 1997-1998, two major reports on diet and cancer were published in which all existing evidence was reviewed (see Further Reading). The expert groups who compiled these reports assessed the literature and graded the evidence for associations between dietary components and specific cancers on a scale from 'convincing' to 'insufficient'. For dietary fat, no association was found to be convincing, and a few 'possible'. There was considered to be strong evidence, however, for a relationship between obesity (particularly central fat deposition) and risk of both endometrial cancer and breast cancer in post-menopausal women. distinguished indirect from direct effects. Indirect effects are mainly related to dietary fat as a form of energy,...

Relationship Between Obesity And Type 2 Diabetes Mellitus

Glucose Tolerance in Obesity Animal models of obesity are highly associated with observations of reduced glucose tolerance (61), and in the non-human primate this glucose intolerance precedes overt type 2 diabetes, as recently Under basal fasting conditions in both monkeys and humans, insulin is secreted with a 10 to 14 minute oscillating periodicity (68, 69), and the amplitude of this periodic secretory output increases with obesity and hyperinsulinemia. This amplification of the secretory output in obesity may play a protective role, or alternatively, may signal disturbed cell functioning and regulation in the prodrome to diabetes. Further, this periodic secretory pattern is completely disrupted by 48 hours of fasting or by the development of diabetes, even when basal insulin levels are above or within the normal range (70). Oscillations are also lost by an exogenous infusion of glucose raising glucose levels to about 6 mmol (71). The presence of oscillations in plasma levels of...

Obesity Cortisol Metabolism

There is evidence for an increased activity in obesity of 5a-reductase and HSD2, which inactivates cortisol. This would be expected to result in less active occupancy of the central glucocorticoid receptors (GR) which regulate cortisol secretion by a negative feedback mechanism (9), and an elevated cortisol secretion would be the expected outcome. In a recent study cortisol measurements have been adjusted for the body mass index (BMI), in an attempt to examine cortisol secretion without the influence of adipose tissue inactivation. This resulted in a visualization of elevated cortisol secretion in obesity (24). Consequently peripheral inactivation of cortisol might explain the elevated cortisol secretion in obesity. It is, however, apparently not possible to explain why cortisol secretion is particularly elevated in centrally localized obesity, since an elevated cortisol secretion along this mechanism would be expected to be dependent on total mass of adipose tissue irrespective of...

Obesity Perinatal Factors

There are experimental studies which indicate potential mechanisms. The HPA axis can be sensitized by intrauterine exposure to immune stress or cytokine exposure or to lipopolysaccharides (27,28), and the handling of newborns has also been shown to be of importance (29). Recent studies have provided further interesting information, probably explaining the effects of prenatal exposure to lipo-polysaccharides. These bacterial endotoxins stimulate the secretion of cytokines. Prenatal exposure to interleukin-6, tumour necrosis factor a or dex-amethasone, a synthetic glucocorticoid which passes the placental barrier, is followed by permanent sensitization of the HPA axis, leptin-resistant obesity and insulin resistance (30). It seems likely that leptin-resistant obesity is caused by the increased corticosterone secretion from the HPA axis, because a similar condition develops after elevated corticosterone exposure in adult rats (31). This is probably applicable also to humans because it is...

Dietary fatty acids and the regulation of gene expression

Genes coding for transport and metabolism of FAs. This is a sparing process that is achieved through the binding of acyl-CoA to a specific DNA binding protein that changes its affinity for DNA response elements. In mammals, the expression of genes involved in transport and metabolism appears to be regulated by FAs in a positive or a negative manner. However, the simple bacterial process could provide the paradigm of the regulation of gene expression by FAs. FAs or derivatives depress genes coding for enzymes involved in lipogenesis and activate those that allow the transport and the oxidation of FAs. FA binding to transcription factors modifies their involvement in the transcription process. As a matter of fact, in mammals several genes coding for proteins involved in lipogenesis or weight control such as leptin, are down-regulated. This mechanism may be related to the decrease in hepatic de novo lipogenesis that can be observed in animals and humans submitted to a polyunsaturated...

Subgrouping Of Visceral Obesity With The Metabolic Syndrome

Visceral obesity is associated with other endocrine abnormalities than that of cortisol. Indeed, visceral obese individuals with the metabolic syndrome may have all the hormonal abnormalities of the elderly, suggesting that this condition may be a sign of premature ageing (58). The most common deficiencies are those of growth hormone (GH) and sex steroids (59). Whereas men have low testosterone levels (60), women have irregular menstrual cycles (61). Functionally, the growth axis and the reproductive axis are influenced at many levels by the HPA axis. Prolonged activation of the HPA axis thus leads to suppression of GH secretion as well as inhibition of sex steroids (23,62). These endocrine abnormalities have a profound effect on peripheral tissues. While cortisol promotes accumulation of visceral fat and insulin resistance in muscle tissue, the GH and sex steroids, often in concert, do the opposite (42). Low GH and sex steroid secretions will thereby multiply the pathogenetic effects...

Dietary Recommendation

In comparing dietary advice from different textbooks it becomes obvious that national and even regional variations exist to such an extent that diets developed in one region are not applicable elsewhere. In the Summerbell chapter on dietary treatment of obesity, a diet for an Englishman is described which would not be well understood in a Scandinavian setting, where items such as a 'Cornish pastie' are not even recognized (6). During the production of a Nordic textbook on obesity it became clear that the Finnish dietary recommendations containing several milk and cereal products were not recognized in Denmark (7). Thus, in this context it seems more practical to concentrate on the general principles of these diets than to list specific items which always tend to be nationally, culturally and socially specific. Basic dietary principles are shown in Tables 30.2 and 30.3.

How Do Increased Stress And Time Pressures Lead To Less Exercise An Unhealthy Diet And Obesity

An unhealthy high fat, high salt, quick, convenience food diet leads to obesity and associated diabetes and high blood pressure. These important risk factors are more potent and dangerous in women and, particularly after the menopause, may lead to coronary heart disease. Coronary heart disease is increasing in women more than in men. Therefore, it is possible that in the future, coronary heart disease may become more common in women than in men.

Other Dietary Treatment Programmes

Dietary treatment of obesity can vary between total starvation to diets which are only slightly hy-pocaloric. The most extreme form of diet is total starvation which means that no energy is given, whereas losses of water, electrolytes, vitamins and trace elements are compensated. Starvation obviously results in fast initial weight loss but requires medical supervision. Lethal complications have been described, probably because of cardiac arrhythmias (25). Starvation has the disadvantage of leading to considerable loss of lean body mass. Since most of the combustion takes place in such tissues, an increased breakdown of muscle in particular will result in a disproportionate reduction of the basic metabolic rate. VLCD treatment may also be used in place of an ordinary meal. However, since most patients substitute the lunch meal, which often is not the most energy containing meal of the day, the effects of this strategy are generally modest. Probably, a dietary programme substituting...

What Is The Relationship Between Women And Obesity

This is a big and growing problem in many parts of the world. Being overweight increases substantially the risk of coronary heart disease and also increases the risk of strokes and cancer. Children are fatter and less active than their grandparents. Many fat young girls (and boys) become fat adults. Just being overweight is bad enough, but people who are overweight often have high blood pressure and a high level of blood fats and are less likely to do regular exercise. All of these individual risk factors are even more dangerous when they exist together. The more overweight a woman is, the more likely she is to have a heart attack. The type of obesity may also make a difference. It has been suggested that women who are fat around the tummy (apple shape) are more likely to suffer heart attacks then women who have relatively slim tummies but who are fat around the hips (pear shape). Most women are concerned about their appearance and understand that being overweight is unhealthy. After...

Longterm Results Of Dieting

Weight loss after dieting generally is 6-12 kg, most of which occurs during the first 6 months of treatment. Treatment results will be improved if dietary treatment is combined with exercise and behaviour modification. Although many programmes reported in the literature (8) are unimpressive, long-term studies showing excellent results have been described, such as the Finnish programme by Kar-vetti and Hakala demonstrating that a dietary programme for 1 year resulted in sustained weight loss for both men and women during a follow-up period of up to 7 years (49). We also demonstrated sustained weight loss and acceptable adherence with a combined dietary-behavioural modification programme after 10-12 years of monitoring (50). During recent years it has become obvious that weight loss and weight maintenance after such weight loss represent two different components of the treatment strategy. Numerous programmes have shown considerable weight loss whereas weight maintenance after initial...

Economic Consequences Of Obesity And Weight Loss In

In cross-sectional studies of SOS patients it was shown that independent of age and gender, sick leave was twice as high and disability pensions twice as frequent as in the general Swedish population (32-34). The annual extra indirect costs (sick leave plus disability pension) attributable to obesity were estimated to be 6 billion SEK, or 1 million US dollars per 10000 inhabitants per year. The direct costs attributable to obesity and their changes after weight loss are currently being examined in the SOS study. So far we know that weight loss is associated with decreased costs for medication for diabetes and cardiovascular disease (36).

Inconsistent Trends In Obesity And Fat Intake

Fat Intake And Obesity Trend

Although trends in fat intake have been found to correlate closely with trends in cardiovascular disease, several studies have demonstrated that obesity is increasing at the same time that fat intake is decreasing (7). In fact, some of the countries that have experienced a substantial decrease in fat intake have noted the most dramatic increases in obesity prevalences. In Finland, for instance, prevalence of obesity rose from 10 to 14 in men and from 10 to 11 in women between the late 1970s and early 1990s (8) while at the same time fat intake decreased from approximately 38 to 34 (3). In the USA, data from the National Health and Nutrition Examination Survey (NHANES) show that while fat intake was decreasing, prevalences of severe obesity increased from 10 to 20 in men and from 15 to 25 in women (9). Although the possibility of ecological fallacy must be considered when interpreting such results, it cannot be excluded that the secular trends in obesity may have been even more...

The Hypothalamus Regulates Eating Behavior

Arcuate Nucleus Third Ventricle

Classically, the hypothalamus has been considered a grouping of regulatory centers governing homeostasis. With respect to eating, the ventromedial nucleus of the hypothalamus serves as a satiety center and the lateral hypo-thalamic area serves as a feeding center. Together, these areas coordinate the processes that govern eating behavior and the subjective perception of satiety. These hypothalamic areas also influence the secretion of hormones, partic- Lesions in the ventromedial nucleus in experimental animals lead to morbid obesity as a result of unrestricted eating (hyperphagia). Conversely, electrical stimulation of this area results in the cessation of eating (hypophagia). Destructive lesions in the lateral hypothalamic area lead to hypophagia, even in the face of starvation,- electrical stimulation of this area initiates feeding activity, even when the animal has already eaten. The regulation of eating behavior is part of a complex pathway that regulates food intake, energy...

A few dietary lipids may be toxic

Much of the discussion in this chapier is concerned with the positive contributions made by dietary lipids, especially fatty acids, to nutrition and health. It is equally important to consider whether dietary lipids can also have adverse or toxic effects. Of the fatty acids, those containing a cyclopropene ring (Section 2.1.4) have been considered toxic as a result of their ability to inhibit the A9-desaturase. One result of this is to alter membrane permeability as seen in 'pink-white disease'. If cyclopropene fatty acids are present in the diet of laying hens, the permeability of the membrane surrounding the yolk is increased, allowing release of pigments into the yolk. Rats given diets containing 5 of dietary energy as sterculic acid (see Table 2.4) died within a few weeks and at the 2 level, the reproductive performance of females was completely inhibited. Cottonseed oil is the only important oil in the human diet that contains cyclopropene fatty acids. However, their...

Testosterone Shbg And Obesity

Author No. of Men Body Mass Index Waist-to-Hip Ratio Author No. of Men Body Mass Index Waist-to-Hip Ratio determine whether visceral fat is more closely linked to low testosterone than is total body fat, but results have been conflicting (26). Glass et al. (25) also first noted that low testosterone levels in obese men could be partly explained by a decrease in SHBG, but whether SHBG is more highly correlated with abdominal obesity or with body mass index remains controversial. A summary of several studies reporting cross-sectional correlations between SHBG and body mass index and waist-to-hip ratio (WHR) is found in Table 2. In massively obese men, weight loss after bariatric surgery can reverse the SHBG abnormalities when near-normal body weight is achieved (27). Whereas a low level of SHBG is the major reason for low testosterone levels in mild to moderately obese men, free and non-SHBG-bound testosterone levels are also reduced in massive obesity (28,29) and correlate inversely...

The monoacylglycerol pathway is important mainly in rebuilding TAG from absorbed dietary fat

The main function of the monoacylglycerol pathway (Fig. 3.6) is to resynthesize TAG from the monoacylglycerols formed during the digestion of fats in the small intestine. Therefore, this mechanism is one by which existing TAG are modified rather than one by which new fat is formed (Section 5.1.3). During the hydrolysis of dietary TAG in the intestinal lumen by pancreatic lipase, the fatty acids in positions 1 and 3 are preferentially removed. The remaining 2-monoacylglycerols are relatively resistant to further hydrolysis. When 2-mono-acylglycerols, radiolabelled in both fatty acid and glycerol moieties, were given in the diet, the molecules were absorbed intact, reacylated and secreted into the lymph without dissociation of the label. The pathway involves a stepwise acylation first of monoacylglycerols, then diacylglycerols and was first discovered by Georg Hubscher's research team in Birmingham, UK in 1960.

Other Lifestyle Dietary Factors Affecting the Adult Male

Cryptorchidism Human Males

The preceding section dealing with scrotal temperature obviously applies as much to sedentary lifestyles outside, as well as inside, of the workplace. Probably the most important other factors are dietary habits, particularly obesity and alcohol intake, smoking, stress, and recreational sporting drug use. Unlike the well-established relationship between caloric intake and maintenance of menstrual cycles in women, there is no such clear relationship in men regarding sperm production and semen quality. However, obesity in men is clearly associated with a fall in total testosterone levels, and this may be severe in massively obese individuals (57-60). One large study found no clear relationship between dietary factors and testosterone levels (60), but one smaller study showed a positive relationship to carbohydrate intake (59). Protein and fiber intake may also affect testosterone bioavailability via effects on sex hormone-binding globulin (SHBG) (61). There is a well-established...

Inulin And Oligofructose As Dietary Fiber

6.2.1 Inulin and Oligofructose, and the Concept of Dietary Fiber As discussed above, the five basic attributes of a dietary fiber are Thus, inulin and oligofructose can be described as carbohydrates (oligo- and polysaccharides) that resist both hydrolysis by mammal digestive enzymes and absorption in the small intestine but are, at least partly, hydrolyzed and fermented by the colonic microflora. They should be classified as dietary fiber and labeled as such on consumer food products. 6.2.2 Inulin and Oligofructose, and the Analysis of Dietary Fiber The next question is Do the classical methods for dietary fiber analysis (see Section 6.1.4) quantify inulin and oligofructose Oligofructose is not measured by the AOAC27,28 or Englyst29 dietary fiber methods and inulin is only partly measured. They do not (or only partly) precipitate in aqueous ethanol, a step used to collect the analyte in both methods. But, as discussed above and based on the results of a collaborative validation ring...

Growth Hormone And Abdominal Obesity

Secretion of Growth Hormone in Abdominal Obesity With increased adiposity, GH secretion is blunted with a decrease in the mass of GH secreted per burst but without any major impact on GH secretory burst frequency (69). Moreover, the metabolic clearance rate of GH is accelerated (70). The serum insulin-like growth factor I (IGF-I) concentration is primarily GH dependent and influences GH secretion though a negative feedback system (71). The serum levels of IGF-I are inversely related to the percentage of body fat (69). In addition, the low serum IGF-I concentration in obesity is predominantly related to the amount of visceral adipose tissue and not to the amount of subcutaneous fat mass (72). Serum free IGF-I concentration may, on the other hand, be increased in abdominal obesity (73) possibly as an effect of the concomitant insulin-induced suppression of serum IGF binding protein-1 levels. The relationship between regional fat distribution and GH secretion has only recently been...

Key Features And Patterns Of The Global Obesity Epidemic

Closer analysis of obesity prevalence and trend data from around the world reveals a number of interesting patterns and features. These include an increase in population mean BMI with socioeconomic transition, a tendency for urban populations to have higher rates of obesity than rural populations, a tendency for peak rates of obesity to be reached at an earlier age in the less developed and newly industrialized countries, and a tendency for women to have higher rates of obesity than men. These and others are considered in some detail below. In developed countries there is usually an inverse association between level of education and rates of obesity that is more pronounced among women. In the MONICA survey, a lower educational level was associated with higher BMI in almost all female populations (both surveys) and in about half of male populations. Between the two surveys, there was a strengthening of this inverse association and the differences in relative body weight by education...

Food Guide Pyramid A Guide to Daily Food Choices

Food Guide Pyramid

The food guide pyramid may help in deciding what and how much food to eat from each food group. It suggests adequate nutrients without excess calories, fats, cholesterol, simple sugar, or sodium. It is important to include selections from all five food groups in the diet. Carrying a notebook and marking down your daily food intake may be an eye-opener. At the end of three days, match the food groups and the recommended servings. Then make appropriate changes in your diet. As a complement to the food guide pyramid, the Department of Agriculture has made the following general recommendations about several aspects of nutritional life-style.

Recent New Experience With Antiobesity Drugs

Orlistat Body Weight Eucaloric

Figure 31.1 Structure of sibutramine and orlistat, two recent drugs developed for the treatment of obesity Figure 31.1 Structure of sibutramine and orlistat, two recent drugs developed for the treatment of obesity The pharmacological activity of sibutramine does not appear to be a result of increased serotonin release this differentiates it from the actions of dex-fenfluramine, a predominantly serotonin-releasing compound, and dexamphetamine, which predominantly releases dopamine and noradrenaline. This might explain why sibutramine has not been associated with cardiac valve insufficiency. This was illustrated in a study of 210 obese patients with late-onset diabetes treated with sibutramine or placebo, in which the rate of valve problems was 2.3 in the sibutramine group and 2.6 in the placebo group (52). In in vitro studies as well as trials conducted in animals and humans, sibutramine and its metabolites also showed no significant potential for inducing dopamine release, unlike...

Short Term Eating Behavior Is Set by Ghrelin and PYY336

Dropping sharply just after the meal (Fig. 23-39). Injection of ghrelin into humans produces immediate sensations of intense hunger. Individuals with Prader-Willi syndrome, whose blood levels of ghrelin are exceptionally high, have an uncontrollable appetite, leading to extreme obesity that often results in death before the age of 30. This interlocking system of neuroendocrine controls of food intake and metabolism presumably evolved to protect against starvation and to eliminate counterproductive accumulation of fat (extreme obesity). The difficulty most people face in trying to lose weight testifies to the remarkable effectiveness of these controls.

Epidemiological studies of dietary fatty acids insulin sensitivity and diabetes

Although many epidemiological and human experimental studies have investigated the role of dietary fatty acids in coronary heart disease (CHD), and on cardiovascular risk biomarkers such as cholesterol, there are only a limited number of human studies that have investigated the role of dietary fat, specifically, in the development of insulin resistance. A number of prospective studies have focused on associations between dietary fatty acid intakes or plasma and tissue fatty acid compositions in relation to either insulin action or risk of type 2 diabetes. In the Nurses' Study, intakes of dietary SFA or MUFA were neutral, but intakes of PUFA were negatively, and trans fatty acids were positively, related to increased risk of type 2 diabetes (Salmeron et al., 2001). Other prospective studies have shown that risk of type 2 diabetes is greatest in subjects showing relatively high proportions of SFA and low proportions of unsaturated fatty acids in blood lipids at baseline (Vessby et al.,...

Key Factors Underlying the Increase in Childhood Obesity Rates

The fact that obesity is emerging as the most prevalent nutritional disease among children and adolescents in the developed world is hardly surprising. As outlined earlier, the highly technological societies of today have created an environment where it is increasingly convenient to remain sedentary whilst all forms of physical activity and active recreation are discouraged. Children are particularly susceptible to such changes as many of the decisions about diet and physical activity patterns are beyond their personal control. Parents are becoming increasingly concerned about the safety of their children and are preventing them from walking or cycling to school or playing in public spaces. In addition, lack of resources, space and staff for supervision has led to a reduction in the time spent in active play or sports when children are at school. As a result, the physical activity levels of children are dropping drastically and more sedentary pursuits such as television watching are...

Screening For Obesity To Prevent Type 2 Diabetes

The primary prevention of type 2 diabetes is an urgent issue and weight control in the population seems to be the most important part of the preventive process. The drastic predictions concerning the time trends of obesity and type 2 diabetes call urgently for research aimed at finding a solution or more probably several solutions to the problem. One approach could be a mass screening programme examining the whole population for body weight and offering obese individuals the opportunity to participate in a weight management programme. Another approach could be a selective Table 5.2 Comparing the distribution of new diabetes cases at three different levels of body mass index in two populations Body mass index Body mass index

Health Impact of Obesity in Childhood

Obese children and adolescents are at increased risk of developing a number of health problems. The most significant long-term consequence is the persistence of obesity and its associated health risks into adulthood. Some 30 of obese children become obese adults. This is more likely when the onset of obesity is in late childhood or adolescence and when the obesity is severe. Other obesity-related symptoms include psychosocial problems, raised blood pressure and serum triglycerides, abnormal glucose metabolism, hepatic gastrointestinal disturbances, sleep apnoea and orthopaedic complications.

Risk Factors For Atherosclerotic Cardiovascular Disease In Obesity

Although obesity has been established as an independent risk factor for the development of atheros- Table 25.1 Ventricular dysfunction reported in severely obese patients Lipid and lipoprotein abnormalities are commonly present in obese patients. Population studies have shown a linear relationship between body weight and lipoprotein levels in blood plasma (12). In patients of both sexes between the ages of 20 and 50 years there is a linear relationship between body weight, triglyceride and cholesterol concentrations. In people older than 50 years this relationship is no longer observed (13). Moreover, there is an inverse correlation between body weight and high density lipoprotein (HDL) cholesterol this reciprocity is observed at all ages and in both sexes. Reduction in Table 25.2 Atherogenic risk factors in obesity HDL cholesterol is a consistent finding in overweight patients (14). On the other hand, most patients with hypertriglyceridaemia and decreased HDL cholesterol are...

Sources of Dietary Iron in Man and the Importance of Luminal Factors

The capacity of the human body to excrete iron is severely limited as compared with most other mammals (Finch et al., 1978). Iron loss in human beings (per kg body weight) is only one-tenth that of other mammals (Dubach et al., 1955 Green et al., 1968 Finch et al., 1978) and human dietary intake only one-fiftieth to one-hundredth that of other mammals. It follows, as was originally suggested by McCance and Widdowson (1937), that iron balance in man is primarily determined by iron absorption. There is a reciprocal relationship between iron stores and iron absorption as stores decline, absorption increases. Similarly the rate of erythropoiesis (red cell development) is a major determinant of iron absorption enhanced erythropoietic activity is linked to increased iron absorption. The principal site of iron absorption is the upper part of the gastrointestinal tract (the duodenum). Both the amount and bioavailability of dietary iron, together with the pH and motility of the gut lumen and...

Obesity As A Genetic Disorder

Genetic and metabolic factors in the development of obesity have received increasing attention since the identification of the protein product of the ob gene leptin, and its receptor. Clearly there are cases among humans, as well as in strains of rodents, in which a single gene mutation has been identified as the direct and specific cause of obesity. That obesity is a genetic disorder is rarely disputed today. What remains under discussion is the relative magnitude of the contribution of genes to body weight compared to the contributions of excessive ingestion of calories due to environmental considerations. Excessive ingestion of food and reduced energy expenditure, both of which may be exacerbated by an enriched environment, are sometimes considered to be the primary culprits. Concerning obesity in humans, just as it may be difficult to get a genie back in a bottle, so it may be difficult to 'demodernize' the environment of humans, or to otherwise alter it so as to mitigate the 'New...

Dietary Reference Intakes Linda Gallagher Olsen MEd RD

Dietary reference intakes (DRIs) represent the new approach adopted by the Food and Nutrition Board to provide quantitative estimates of nutrient intakes for use in a variety of settings. The DRIs are the result of a vast expansion in our understanding of the roles of nutrients and other food components that impact long-term health, going beyond deficiency states they expand and replace the series of Recommended Dietary Allowances that have been published since 1941 by the Food and Nutrition Board. The DRIs consist of four reference intakes 1. Recommended Dietary Allowance (RDA) a nutrient intake level used as a goal for the individual a level sufficient to meet the nutrient requirements of nearly all (97 to 98 ) healthy individuals in the group. The population recommendations are broken into gender, life cycle groups (infants, elderly, etc) with more specific age subgroups (see Tables 5-1 and 5-4). Table 5-1. Food and Nutrition Board, National Academy of Sciences National Research...

Dietary monounsaturated fat and cancer

The great interest during the past several decades on the relationship between diet and cancer derives from the large variations on rates of specific cancer among countries, coupled with the dramatic changes in the incidence of these conditions among populations emigrating to regions with different rates. Mediterranean populations are known to be partially protected against coronary heart disease and certain types of cancers (Trichopoulou and Critselis, 2004 La Vecchia, 2004). Their dietary habits with low intake of saturated and polyunsaturated fats together with the high intake of oleic acid, n-3 fatty acids, fibre and natural antioxidants have been proposed to explain this protection (Bingham and Riboli, 2004). Emerging data suggest that the strong protective associations reported for olive oil intake in dietary studies may be due to some other protective components. A multinational study carried out by Simonsen et al. (1998) in five European centres shows that the protective...

Effects of Increased Intra Abdominal Pressure on Laparoscopic Surgery in Severe Obesity

Abdominal Pressure

Laparoscopic surgery has become very popular for the treatment of severe obesity. Obesity can be distributed in either an android fashion, primarily within the abdominal area or centrally as seen primarily in male patients, or in a gynoid manner, in the hips and buttocks, peripherally as seen primarily in female patients. Many of our severely obese female patients have both peripheral and central obesity. We have found that central obesity is associated with a significant increase in intra-abdominal pressure and this pressure is as high or higher than the pressure seen in patients with an acute abdominal compartment syndrome (Fig. 5.1). Data support the finding that this increase in intra-abdominal pressure is associated with a number of obesity related co-morbidity problems leading to the development of a chronic abdominal compartment syndrome. These co-morbidities include obesity hypoventilation syndrome with its high cardiac filling pressures, gastroesophageal reflux disease,...

Dietary fats obesity diabetes and cancer

This chapter focuses on the effects of SAFA and TFA on CHD risk, because the evidence is most extensive and strong for this relationship. However, SAFA and TFA may also have other health effects. Next to CVD, the most important chronic diseases in Western societies for which a role of dietary fats has been suggested are obesity (and the resulting diabetes) and cancer. There has long been and still is debate about the role of the total amount of fat in the diet in the aetiology of obesity (Katan et al., 1997). If the total amount of dietary fat would in the long term increase body weight (Astrup et al., 2000), this would increase CHD risk through adverse changes in blood lipids (Leenen et al., 1993) and higher risk of diabetes. However, data supporting a major role of dietary fat per se in determining body weight are not strong, with long-term clinical trials being scarce and conflicting (Willett & Lebel, 2002). This seems counter-intuitive given the high energy content of dietary...

Dietary Fiber A Concept In Human Nutrition

Lignin Composition Cereals

The health benefits of fiber-rich food have been recognized for at least 2500 years. Indeed, already in 430 B.C., Hippocrates described the laxative effect of coarse wheat in comparison to refined wheat.1 In the 19th century, a recommendation was already made to increase the fiber content in diet, and in 1920, publications by J. H. Kellogg claimed that foods rich in bran increase stool weight, promote laxation, and prevent diseases.2 Hispley was the first to use the expression dietary fiber when he described the cell wall components of plants and suggested that these components of foods might protect against toxemia during pregnancy.3 But it has only been since the 1970s that dietary fiber has become an important concept in nutrition when it was hypothesized that the development of many Western diseases, especially chronic diseases, might be due to a deficit in dietary fiber intake.45 Indeed, at that time, as a result of convergent analytical, physiological, and epidemiological...

Altered Cortisol Metabolism In Obesity

Cortisol Metabolism in Primary Obesity Relatively small case-control studies, almost exclusively in women, showed that obesity, particularly of predominantly abdominal distribution, is associated with increased urinary free cortisol excretion (160-162). However, as detailed above, urinary free cortisol forms a very small fraction of total cortisol metabolite excretion. More convicingly, recent large studies confirm that total cortisol production rate is somewhat enhanced in obesity in men as well as women (131,163,164). This is further supported by evidence of enhanced responsiveness of the hy-pothalamic-pituitary-adrenal axis to ACTH and CRH (161,165). However, in obesity plasma cortisol levels are not consistently elevated. Indeed, peak plasma cortisol levels in the morning are low (166-169). The combination of increased secretion with low morning plasma levels suggests either that diurnal variation of cortisol secretion is disrupted, Previous studies using radioisotope tracers...

Dietary fats and the risk of coronary heart disease 141 Epidemiological studies and clinical trials

Effects of dietary fats on the risk of coronary heart disease have been most widely studied and are established by both epidemiological studies and randomised controlled clinical trials. Of all cardiovascular diseases, a causal relationship with blood lipid levels is most clear for coronary heart disease. Although cholesterol lowering by drug treatment (HMG-CoA-reductase inhibitors, statins) lowers both the risk of coronary heart disease and that of stroke, the epidemiological data on dietary fats and stroke are very limited and show no clear associations with the amount or type of dietary fats (He et al., 2003). In contrast, for CHD there are several epidemiological studies that addressed the associations with dietary fats as well as randomised clinical trials that studied the effects of changing the intake of specific fatty acids (Hu & Willett, 2002) on disease outcome. This section therefore focuses on the relations between intake of saturated and trans...

The Development of Good Bowel Habits Dietary Management

Good eating habits are important to achieving good bowel control. It is important to have a routine and to eat balanced meals at regular times and in a relaxed atmosphere. The intake of adequate amounts of liquid (8 to 12 cups daily) and the addition of fiber to the diet generally alleviates constipation. Dietary fiber is that portion of plant materials that is resistant to digestion its addition to the diet aids in the formation of softer stool and decreases the amount of time required for stool to pass through the intestinal tract. A high-fiber diet includes raw fruits and vegetables, nuts and seeds, and whole grain breads and cereals such as cornmeal, cracked and whole wheat, barley, graham, wild and brown rice, and bran (one of the most concentrated sources of dietary fiber). To increase the amount of fiber in your diet, your daily intake should include

Of Agricultures Food Guide Pyramid

The US Department of Agriculture (USDA) developed the Food Guide Pyramid (Figure 9-1) and released it in 1992 with the view that most Americans have diets that are too high in fat. In addition to the pyramid, the Dietary Guidelines for Americans include the following Maintain or improve your weight. Food pyramids and food labels are tools designed by the USDA to help Americans incorporate the Dietary Guidelines into their daily lives. Each of the food groups provide some of the nutrients we need. No one food group is more important than another, but we are encouraged to primarily choose from the bottom half of the pyramid. The pyramid enables the clinician to make a quick assessment of a client's intake to determine if it is nutritionally adequate. Variety and portion sizes should be taken into consideration when using this as a tool. The pyramid suggests we choose the foods by a range of serv ings, with the

Obesity and the Regulation of Body Mass

TIn the United States population, 30 of adults are obese and another 35 are overweight. (Obesity is defined in terms of body mass index (BMI) BMI weight in kg (height in m)2. A BMI below 25 is considered normal 25 to 30 is overweight, and greater than 30, obese.) Obesity is life-threatening. It significantly increases the chances of developing type II diabetes as well as heart attack, stroke, and cancers of the colon, breast, prostate, and endometrium. Consequently, there is great interest in understanding how body mass and the storage of fats in adipose tissue are regulated. To a first approximation, obesity is the result of taking in more calories in the diet than are expended by the body's energy-consuming activities. The body can deal with an excess of dietary calories in three ways (1) convert excess fuel to fat and store it in adipose tissue, (2) burn excess fuel by extra exercise, and (3) waste fuel by diverting it to heat production (ther-mogenesis) in uncoupled mitochondria....

Defining Obesity in Children and Adolescents

The major factor limiting our understanding of the true extent of the childhood obesity problem is the lack of a standard population-level methodology for measuring overweight and obesity in children and adolescents. Presently a number of different methods or indices are in use with a variety of cut-off points for designating a child as obese. The US National Center for Health Statistics (NCHS) growth reference charts have been recommended by the WHO for international use since the late 1970s but a number of serious technical and biological problems have been identified with their development and application. An expert working group of the International Obesity Task Force investigated this issue and concluded that BMI-for-age, based on a redefined international reference population from 5 to 18 years, was a reasonable index of adiposity and could be used for population studies. They identified a novel approach to determine cut-off values that classify children as overweight or obese...

Dieting As A Change Behaviour

Dieting is part of a complex process of changing behaviour. Prochaska has described the various steps which a person takes in contemplating a possible change in behaviour before such change is actually implemented and hopefully also maintained during later phases (3). For such changes to take place, realistic goals must be available. Foster et al. have described that most patients joining an obesity clinic have goals which are clearly unrealistic and which may lead to frustration, early drop-out and relapse (4). For practical reasons, goals can be divided into an overall long-term goal (where a 10 maintained weight loss is realistic) and short-term goals (which are helpful to cope with everyday problems). These goals may be changed at short notice in relation to everyday life problems. The point is to make the obese patient in dietary

Dietary Restriction Social and Sexual Dysfunction

The studies reporting on dietary restriction, social restriction, and sexual dysfunction are shown in Table 4. The results from meta-analysis of these outcomes are shown in the Forrest plot in Figs. 3 and 4. The incidence of social restrictions following 58 IPAA and 85 IRA procedures (33, 35), was found to be significantly lower at 3.5 following IRA as compared to 13.8 following IPAA (OR 6.04, CI 1.53-23.78). There was no significant difference between IPAA and IRA in terms of need for dietary restriction and male and female sexual dysfunction. Table 4. Studies reporting dietary restriction, social restriction and sexual dysfunction Dietary restrictions Outcome 01 Dietary and social restrictions 01 Dietary reselricti ns Fig. 3. Meta-analysis of dietary and social restrictions

Implications For Obesity

The integrated impact of the differential regulation of macronutrient intake, digestion, absorption, storage and oxidation generally supports the hypothesis that dietary fat may be particularly associated with weight gain. This has been examined in a number of studies conducted over several days or weeks. Here the period of study must be related to the precision of the measurements of changes in macronutrient balance. Tightly controlled experimental studies performed in calorimeters, where changes in fat stores can be measured to + 9g fat day, can be conducted over just a few days, whereas measurements made in free-living conditions, using in vivo body composition measurements require a period of several weeks or even months, since the precision is of the order of + 1kg fat (28). Community studies, which rely solely on changes in body weight as an index of changes in fat stores, must be conducted over several months in order to provide a reliable indicator of long-term changes in fat...

Pharmacological Treatment of Obesity in Schizophrenia

There have been few studies involving the administration of weight loss agents to psychotic patients. The National Institutes of Health (NIH) guidelines allow the use of weight loss agents for patients with a BMI > 27 kg m2 and obesity-related complications. Weight loss agents can also be administered to patients with BMI > 30 kg m2 who do not have obesity-related complications (Aronne 2001). Amantadine, fenfluramine, and chlorphen-termine have been used with moderate success (Correa et al. 1987 Kolokowska et al. 1987), although there are concerns that these drugs may worsen psychotic symptoms, and fenfluramine is no longer available on the market due to complications of cardiac valve dysfunction and pulmonary hypertension. Medications that have been recently indicated for weight loss such as sibutramine and orlistat (Cerulli et al. 1998) have not been methodically tried or reported in this patient population. Sibutramine is a serotonin and norepinephrine reuptake inhibitor that...

Prevention And Treatment Of Maternal Obesity

It is often said that 'prevention is better than cure', but in the context of pregnancy, this cannot be taken as read. Because excessive gestational weight gain is probably the most important risk factor for maternal obesity, restricting the amount of weight that women gain should theoretically help to reduce the burden of obesity-related disease in women. However, restricting weight gain during pregnancy presents health care workers with a dilemma weight restriction may help to diminish the risk of maternal obesity, but may also affect the development of the growing child. In any event, advocating weight restriction during pregnancy may be a moot point, because there is little empirical evidence to suggest that weight gain is easy to modify during pregnancy (110). Mothers routinely report difficulties in complying with dietary instructions during pregnancy (111,112) because they usually experience a 'surge of appetite' during pregnancy (113) which is difficult to overcome (Dieckmann...

Efficacy Of Dietary Treatment

In the Clinical Guidelines, published by the National Institutes of Health and National Heart, Lung and Blood Institute 1998, an extensive analysis of the efficacy of various treatments for obesity is given (8). In this report, 86 randomized clinical trial publications were evaluated. These diets included ordinary low calorie diets, very low calorie diets (VLCDs), vegetarian, American Heart Association Guidelines and the National Cholesterol Education Program Step 1 Diet, as well as other low fat regimens with varying combinations ofmacronutrients. VLCDs will produce greater initial weight losses than low calorie diets (LCDs), due to the more pronounced initial caloric restriction, but the long-term outcome after one year or more is not different from that of low calorie diets only (14). The overall recommendations in the Clinical Guidelines are summarized as follows LCDs are recommended for weight loss in overweight and obese persons. Reducing fat as part of an LCD is a practical way...

The Epidemic of Obesity

Obesity and its related sequelae represent a growing epidemic in the United States. Overweight is defined by the World Health Organization as a body mass index (BMI) of 25.0-29.9 kg m2, and obesity as BMI > 30 kg m2. Recent data estimate that more than 50 of U.S. adults are overweight, with 31 of men and 35 of women considered obese, or at least 20 above their ideal body weight (Yanovski and Yanovski 1999). Results of the 1999 National Health and Nutrition Examination Survey (NHANES), released in December 2000 by the National Center for Health Statistics, noted that the proportion of obese individuals in the United States in 1999 was 80 greater than the proportion measured by NHANES II in 1976-1980, and 17 greater than that measured by NHANES III in 1997 (Flegal and Troiano 2000). Similarly, the Centers for Disease Control (CDC) performed a telephone survey in 1991 that found that only 4 of the 47 states surveyed had obesity rates of 15 or greater, whereas the 2000 survey, which was...

Obesity in Schizophrenia

In the pre-antipsychotic era, Kraepelin noted that some patients with schizophrenia exhibited bizarre eating habits, and not uncommonly were obese. The taking of food fluctuates from complete refusal to the greatest voracity. The body weight usually falls at first often to a considerable degree. . . . L ater, on the contrary we see the weight not infrequently rise quickly in the most extraordinary way, so that the patients in a short time acquire an uncommonly well-nourished turgid appearance (Kraepelin 1919, p. 125). It is worth noting that this tendency to weight loss during more active phases of the illness has been borne out by results from a recent meta-analysis of multiple antipsychotic drug trials, which noted that placebo-treated patients on average lost weight (Allison et al. 1999a). Nevertheless, there are a number of reasons that patients with schizophrenia might be prone to obesity, including the effect of symptoms such as paranoia and negative symptoms such as apathy and...

Abdominal Obesity Fatty Acids and Neurogenic Hypertension

As noted previously, NEFAs have been linked epidemiologically to hypertension and its genesis. NEFAs have several actions that could contribute to hypertension and help explain the link between the obesity epidemic and increasing prevalence of hypertension (37). Hypertensive patients are more likely to be overweight and obese than normoten-sive individuals. Moreover, when matched for body mass index, hypertensives are more likely to have a centralized fat pattern and a greater amount of visceral to subcutaneous abdominal fat than normotensives (38). Even within the normotensive range, abdominally obese subjects have higher blood pressures than individuals with gluteofemoral obesity, and these blood pressure differences are related to insulin resistance (39). Subjects with abdominal obesity are not only resistant to insulin-mediated glucose disposal, but they are also resistant to insulin's NEFA lowering actions (1,2,40). Moreover, resistance to insulin's effects on fatty acids during...

Screening For Obesity

Although obesity should be regarded as a disease entity of its own, many of its more serious consequences are due to the strong relations that exist between obesity and some common chronic diseases. Obesity is an important risk factor for type 2 diabetes, cardiovascular disease, sleep apnoea, gallbladder disease and certain types of cancer. Why Screen for Obesity The association between obesity and type 2 diabetes is perhaps the strongest of all reasons why a crusade against overweight and obesity must be initiated in the near future. The ongoing secular trends in Westernized societies are alarming. It is a healthy sign that the medical profession is showing an increasing interest in and awareness of the impact lifestyle has on health. However, many health professionals express a pessimistic view over the future with regard to many of our chronic diseases, if the 'Westernized' way of living continues to expand over the world. Headlines such as, 'obesity a time bomb to be defused' (11)...

Stunting and Obesity

A number of studies have indicated that there is an important association between stunting and overweight or obesity in a variety of ethnic, environmental and social backgrounds. Popkin et al. (35), for example, found that the income-adjusted risk ratios of being overweight for a stunted child in four nations undergoing transition ranged from 1.7 to 7.8. Obesity associated with stunting was also more common than obesity without stunting in a shanty-town population in the city of Sao Paulo, in both younger children and adolescents (36). The association between stunting and obesity has serious public health implications, particularly for lower income countries, but the underlying mechanisms remain relatively unexplored. Recently, Sawaya et al. (37) suggested that stunting may increase the susceptibility to excess body fat gain in children who consume a high fat diet. A significant association was found between the baseline percentage of dietary energy supplied by fat and the gain in...

Obesity

Overweight and obesity, although recognized independent risk factors for CHD, are typically not included in coronary risk charts ( Jones et al. 2001). One rationale for this is that obesity has significant comorbidity with hypertension, hyperlipidemia, and glucose intolerance, and in that sense it becomes a surrogate marker for these disorders with well-defined risk parameters. Nevertheless, the plateau in CHD prevalence in the United States is attributed in large measure to the epidemic of obesity, with nearly 27 of the population registering a body mass index greater than 30 kg m2, the established cutoff for defining obesity (Flegal and Troiano 2000). This figure is 80 greater than that noted two decades prior. Longitudinal data, such as the 18-year Nijmegen Cohort Study, which examined changes in serum total cholesterol levels in a cohort of men and women, clearly demonstrate that weight gain correlates over time with increased cholesterol, and weight gain itself exerts a...

What is Obesity

Obesity may be simply defined as the degree of body fat storage associated with elevated health risks (1). Due to the difficulties of measuring body fat under field conditions the practical definition of obesity for adults is based on body mass index (BMI) (1). It should be noted that adult BMI cutpoints are not considered appropriate for children. Body mass index, also known as Quetelet's index, is calculated as an individual's weight (kg) height2 (m2). Various cut-points and measures of obesity have been used in the past, but a World Health Organization (WHO) consultation on obesity proposed a system of classification based on BMI (1) (Table 24.1), which is similar to classifications used in a number of past studies. International Textbook of Obesity. Edited by Per Bjorntorp. 2001 John Wiley & Sons, Ltd.

Weight Control

Often, especially when the capability to exercise is limited, the choice is made to help regulate body weight by not eating very much. This may be risky because eating enough of the right kinds of foods is as important as exercise in overall weight management. Most often, very low calorie diets do not lead to effective weight control in the long run but may actually make the body store more fat.

Dietary Assessment

Although diets for obesity treatment may vary according to financial, personal, cultural, religious and social beliefs, it is essential before any such diet is prescribed that a background describing the patient's habitual eating habits is obtained. Dietary habits can be assessed by numerous techniques. In specialist clinics where dieticians are available sophisticated methods can be used and also evaluated. In a primary health care setting where specialists may not be available to interpret a diet, simpler techniques may have to be relied upon. Specialists are well aware of the numerous pitfalls associated with the interpretation of dietary records. For many patients, the suggestion to keep a diet record in itself is provocative and may cause even violent reactions and questioning. For others, the records may actually serve as a helpful and constructive tool to identify eating habits, of which the subject was actually unaware until a record was kept. For others again, the diet record...

Dietary Fibre

The effects of dietary fibre on weight control can be summarized as follows Few controlled clinical studies have been carried out showing that supplementation with dietary fibre improves weight loss. In one study, patients were asked to maintain their dietary habits, while receiving 10 g guar gum twice daily for 8 weeks average weight fell from 95.6 to 91.3 kg, but this was difficult to evaluate, since no control group was included (33). In further studies patients were given a reduced diet of 1000kcal day, which in one group was supplemented with 24 g of fibre as oat bran biscuit, for 8 weeks (34). Weight loss in the fibre group was reported as high as 5.1 + 1.7 kg week, compared with 3.8 + 1.8 kg in the control group. This study was, however, not blind, as the authors themselves also point out. A few studies with adequate designs have been published that demonstrate that dietary fibre supplementation improves weight loss. Tuomilehto et al. (35) demonstrated that in a 16-week study...

Female Obesity

The prevalence of female obesity has increased steadily over the last 40 years in both the UK and the USA (1,2). Even during the last decade, the prevalence of female obesity (BMI > 30) in Britain rose from 8 in 1980 to 12 in 1987 (3). This increase led the British government to identify 'the reduction of obesity' as one of its main targets for health improvement (4), yet in spite of this initiative female obesity continues to rise and currently stands at 20 (5). Paradoxically, the increasing prevalence of obesity has occurred in the face of remarkable social pressure to be thin, and data from weight surveys consistently show more women than men to be affected (Figure 20.1). If pregnancy is a determinant of obesity, then this might explain the higher prevalence of obesity in women. The accelerated rate of weight gain observed among young women might also be a reflection of the current trend towards encouraging women to gain more weight during pregnancy (6). PREGNANCY AS A CAUSE OF...

Dietary Factors

A possible link among atherosclerosis, thrombotic events, and dietary factors has been explored in several epidemiologic studies. The first, referred to as the Seven Country Study (153), observed a correlation between total calories consumed as saturated fats and the occurrence of coronary heart disease-related death. The potential direct impact of dietary factors on cardiac events was investigated in the Lyon Diet Heart Study (154). Patients with a prior MI were given a diet previously shown in the Seven Country Study to be associated with a low cardiovascular mortality (the Cretan Mediterranean Diet, high in a-linolenic acid). Compared with a control group, dietary intervention patients had a lower incidence of MI and cardiac death during a 27-mo follow-up period (risk ratio 0.27 p 0.001). Hypercholesterolemia, induced by a high dietary intake of saturated fatty acids and cholesterol, is associated with increased platelet coagulant activity, platelet aggregation, thromboxane A2...

Edited by Ira Wolinsky

Robert-McComb Childhood Obesity Prevention and Treatment, Jana Par zkov and Andrew Hills Alcohol and Coffee Use in the Aging, Ronald R. Watson Handbook of Nutrition in the Aged, Third Edition, Ronald R. Watson Vegetables, Fruits, and Herbs in Health Promotion, Ronald R. Watson Nutrition and AIDS, Second Edition, Ronald R. Watson Advances in Isotope Methods for the Analysis of Trace Elements in Man, The Mediterranean Diet Constituents and Health Promotion, Antonia-Leda Matalas,

Prevention Of Deficiencies To Reduction Of Risk Due To Excessive Consumption Of Nutrients

Functional food has been introduced as a new concept because the science of nutrition has changed. During the 20th century, nutritionists have discovered the essential nutrients, and they have established nutrient standards (Dietary Reference Intakes), dietary guidelines, and food guides (Figure 1.1). The main objectives of nutrition research was to make recommendations in order to support body growth, maintenance, and development to prevent nutrient deficiencies1 and, more recently, to avoid excessive consumption of some of these nutrients after recognizing their potential role in the etiology of miscellaneous (mostly chronic) diseases.2-3 In such a context, one of the major contributions of nutrition science during the 20th century has been the concept of the balanced diet (Figure 1.1) defined as an appropriate mixture of food items that provides, at least, the minimum requirements of nutrients and a few other food components needed to support growth and maintain body weight, to...

Nutrition At The Turn Of The 21st Century New Challenges

At the turn of the 21st century, the balanced diet and the recommendations it supports remain key concepts. At least in the society of abundance that characterizes most of the occidental and industrialized countries, new nutrition concepts need to be developed and new dietary recommendations need to be elaborated as new challenges have appeared (Figure 1.2). These challenges include, among others

Health Related Effects Associated with Colonic Microflora

Hydrolysis and fermentation of nondigestible carbohydrates (dietary fibers, oligosaccharides) Hydrolysis and fermentation of nondigested proteins and peptides Hydrolysis of nondigested lipids and production of free fatty acids Partial salvage of energy of nondigested dietary components Production of

The Physiology Of Calcium 1021 Calcium Metabolism6

Dietary ca' The fecal Ca pool represents the biggest proportion of excreted Ca. It is composed of the nonabsorbed dietary Ca plus the endogenous Ca that is secreted in the gastrointestinal tract (from saliva, pancreas, bile, or intestinal mucosa). Once Ca has reached the bloodstream, the main excretion route is the urine (plus very small losses through hair and skin, and in sweat) but the kidney reabsorbs 98-99 of all Ca that it filters. The amount of Ca excreted in the urine varies considerably with age (reduced excretion in old age), sex (men excrete more than women, who excrete more after than before menopause) but also with dietary habits (high with high intakes of sodium and protein but low with high intakes of phosphorus).

Improving Calcium Intakes and Calcium Bioavailability in the Population18

The dietary deficiency of Ca identified in some population groups may be addressed in a number of ways. This includes changing eating behavior at the population level by increasing the consumption of foods that are naturally rich in Ca (e.g., milk and milk products), Ca fortification of foods consumed by target groups, or increasing Ca intakes from Ca supplements. These may be seen as complementary rather than alternative strategies, and each has advantages and disadvantages.31 For example, it is notoriously difficult to achieve changes in the diet of entire populations, and thus persuading individuals to consume more dairy produce represents a considerable challenge. The use of Ca supplements can be effective in increasing Ca intake in individuals who consume them regularly, but it has limited effectiveness at the population level due to the poor compliance with supplement use.31 Ca-fortified food products could provide additional choices for meeting Ca requirements however,...

Magnesium Requirements and Recommendations

The main dietary sources of Mg are cereals and chocolate, but it is widely distributed in most foods. Estimations of the daily requirements vary from 100 to 1000 mg71,72 and the daily intake in adults varies between 250 and 500 mg.73 In France, the recommended daily intake is 6 mg kg d, but some 18 of men and 23 of women have an intake lower than 4 mg kg d. However, such an apparently low value is still in agreement with the recommendation of the European Community, i.e., 3.4 mg kg d for adults.74 The recommendations of the National Research Council in the U.S. are 280-350 mg d or 5 mg kg d for young women and men.4

Inulin Type Fructans and Phosphate Absorption

However, in their publication of 1993, Ohta et al. had reported a slight (+13.5 ) but significant increase (p < 0.05) in that parameter in rats fed a diet containing 15 (w w) oligofructose.109 But, and in the same publication, these authors reported either no change or an increased phosphate absorption as well as an increased P content of femur (+19 ) at a dietary oligofructose concentration of 5 . The increse in Ca absorption declined progressively with time (+13.5, +6, and +5 at day 7, 18, and 31, respectively).109

Nutrition And Gastrointestinal Defense

With regard to gastrointestinal defense functions, it is increasingly becoming known that specific food components have also a beneficial effect on the body's defense mechanisms by positively modulating them. Among these, the best immu-nomodulating food components so far studied are dietary fiber, probiotics, and prebiotics (see Section 12.5). 12.3.1 Dietary Fiber and Immune Function As discussed above (see Chapter 6), fermentable dietary fiber alters the structure and miscellaneous functions of the gut. To date, relatively few studies have been conducted on their effects on gastrointestinal defense functions. Thus, it is not possible at this time to draw conclusions on the effects of specific fibers. However, although exploration in this area is still in its infancy, animal studies have demonstrated that dietary fiber content and type have the potential to modulate defense

Inulin Type Fructans and Absorption of Iron 10611 Animal Data

In healthy growing male rats (body weight 100-210 g) fed standard diet supplemented with oligofructose or inulin (1, 3, 5, or 10 w w), results are contradictory (Table 10.3), some groups reporting a significant increase in Fe absorption112,113 whereas other groups reported an increase or a slight decrease, depending on the composition of the dietary fiber fraction of the diet (i.e., cellulose 5 , oligofructose 5 , or cellulose 2.5 + oligofructose 2.5 )140 or no effect.141 In addition to Fe absorption, Delzenne et al. and Lopez et al. have also investigated the effect of inulin-type fructans (10 w w in diet) on iron concentration in plasma (DM) and showed no significant changes.112,113 Lopez et al. have also analysed markers of iron status, i.e., liver iron concentration (Dg g dry tissue), and transferin saturation ( ) in control rats and in rats fed a diet containing phytic acid (7 w w) and reported no effect of inulin. In control rats fed a standard diet, inulin had no effect on...

Protocols and Methodologies

Has been discussed in detail.83,84 143 It is based on the assumption that the orally and intravenously administered isotopes (minimal quantities to avoid perturbation in mineral metabolism) are metabolized at the same rates once Ca pools have reached equilibrium.124 The main advantage over the metabolic balance methodology is that it measures true absorption by allowing a separate distinction between exogenously unabsorbed and endogenously secreted minerals. Because it is hypothesized that the effects of inulin-type fructans on mineral absorption take place in the large bowel where they are fermented, it is essential that urine is adequately collected to allow accurate measurement of all components of minerals absorption.84 Indeed, if, in normal circumstances, very little calcium absorption occurs in the colon,144 it is the case in the presence of nondigestible carbohydrates that shift part of the absorption process in the lower part of the intestine. Thus, it has been argued that a...

Inulin Origin Chemistry Biochemistry and Technological Properties

Chapter 6 The Digestive Functions Inulin and Oligofructose as Dietary Fiber 6.1 Dietary Fiber A Concept in Human Nutrition 6.1.1 History 6.1.2 Definition of Dietary Fiber 6.1.3 The Dietary Fiber Components 6.1.4 Analysis of Dietary Fiber 6.1.5 Physicochemical Properties of Dietary Fiber 6.1.6 Physiological Properties of Dietary Fiber Their Effects on Upper Gastrointestinal Tract 6.1.7 Physiological Properties of Dietary Fiber Their Effects on the Large Bowel 6.2 Inulin and Oligofructose as Dietary Fiber 6.2.1 Inulin and Oligofructose, and the Concept of Dietary Fiber 6.2.2 Inulin and Oligofructose, and the Analysis of Dietary Fiber 6.2.3 Inulin and Oligofructose, and the Physicochemical Properties of Dietary Fiber 6.2.4 Inulin and Oligofructose, and the Effects of Dietary Fiber on the Gastrointestinal Tract in Genetically Modified Animals Prone to Develop Obesity or Hypercholesterolemia 12.3.1 Dietary Fiber and Immune Function 12.3.1.1 Effects of Fermentable Dietary Fibers on Immune...

Roberfroid M 1983 A Review Comparing

Slavin, J., Dietary fibre and non-digestible oligosaccharides, in Colonic Microbiota, Nutrition, and Health, Gibson, G. R., Roberfroid, M. B., Eds., Kluwer Acadamic, Dordrecht, The Netherlands, pp. 125-147, 1999. 3. Hispley, E. H., Dietary fibre and pregnancy toxaemia, Br. Med. J., 2, 420-422, 1953. 4. Burkitt, D. P., Walker, A. R. P., Painter, N. S., Effect of dietary fibre on stools and transit times, and its role in the causation of disease, Lancet, 2, 1408-1412, 1972. 5. Burkitt, D., Don't Forget the Fibre in Your Diet to Help Avoid Many of Our Commonest Diseases, Martin Dunitz, London, pp. 8, 1983. 6. Trowell, H., Ischemic heart disease and dietary fibre, Am. J. Clin. Nutr., 25, 926-932, 1972. 8. Trowell, H., Southgate, D. A., Wolever, T. M. S., Leeds, A. R., Gassul, M. A., Jenkins, D. J. A., Dietary fibre redefined, Lancet, 1, 967, 1976. 9. Roberfroid, M., Dietary fiber, inulin, and oligofructose a review comparing their physiological effects. CRC Crit. Rev. Food Sci. Nutr., 33,...

Digestion Of Carbohydrates In The Gastrointestinal Tract

Digestion Carbohydrates

In the human diet, the most common carbohydrates are starch, sucrose, lactose, fructose, glucose, and dietary fibers. Most ( 50-60 of daily intake) carbohydrates are starch, which is a mixture of linear (amylose) and branched (amylopectin) polymers of glucose with D-1, 4 and D-1, 4 + D-1, 6 linkages, respectively. Starch, as well as the disaccharides lactose and sucrose, is hydrolyzed in the upper part of the gastrointestinal system (Figure 4.1), essentially the oral cavity and the small intestine, whereas the dietary fibers are not. The monosaccharides that preexist in the diet (fructose and glucose) and that are produced by the hydrolysis of starch and disaccharides (lactose and sucrose) are absorbed and reach the systemic circulation via the portal vein. But the oligo- and monosaccharides that reach or are produced in the large bowel, essentially by bacterial hydrolysis of dietary fibers and, in some populations, lactose, are not absorbed but fermented. Strictly speaking, the...

Gastrointesttinal Tract

A., Xu, D., Lu, Q., Berg, R., Elemental diet-induced immune suppression is caused by both bacterial and dietary factors, J. Parenter. Enter. Nutr., 17, 332-336, 1993. 94. Chiang, B. L., Sheih, Y. H., Wang, L. H., Liao, C. K. Gill, H. S., Enhancing immunity by dietary consumption of a probiotic lactic acid bacterium (Bifidobacterium lactis HN019) optimization and definition of cellular immune responses, Eur. J. Clin. Nutr., 54, 849-855, 2000. Shu, Q., Lin, H., Rutherford, K. J., Fenwick, S. G., Prasad, J., Gopal, P. K., Gill, H. S., Dietary Bifidobacterium lactis (HN019) enhances resistance to oral Salmonella typhimurium infection in mice, Microbiol. Immunol., 44, 213-222, 2000. Takahashi, T., Nakagawa, E., Nara, T., Yajima, T., Kuwata, T., Effects of orally ingested Bifidobacterium longum on the mucosal IgA response of mice to dietary antigens, Biosci. Biotechnol. Biochem., 62, 10-15, 1998. Cassidy, M. M., Satchitanandam, S., Calvert, R. J., Vahouny, G. V., Leeds, A....

The Anaerobic Fermentation Of Proteins

Protein Fermentation End Product

Nitrogen in the chyme that reaches the large bowel is almost exclusively in the form of proteins and peptides, both form exogenous (dietary) and endogenous (pancreatic enzymes, mucins, etc.) origin. Daily, in an average European-type diet, a total amount of 7-15 g of proteins reach the colon and are likely to be fermented, these include 3-9 g of dietary and 4-6 g of endogenous (mainly pancreatic enzymes) peptides and proteins.15 For the carbon, nitrogen, and energy of these compounds to benefit the bacteria and, eventually, the host, proteins and peptides need to be hydrolyzed. The colon, which contains both pancreatic and bacterial endopeptidases, is a very effective proteolytic environment16 that makes available short peptides and free amino acids. Indeed, bacterial proteases (serine, thiol, and metallo-preoteases) complement pancreatic enzymes to hydrolyze peptides and proteins, and especially the globular proteins that resist largely the activity of the sole pancreatic serine...

In Vivo Models to Study the Fermentation of Carbohydrates by the Colonic Microflora

To study fermentation of dietary carbohydrates in humans, two major approaches are used The other approach to study fermentation of dietary carbohydrates in humans is rather straightforward. It consists in collecting feces after oral feeding and quantitatively measuring the concentration of the residual carbohydrate. If all fecal samples are collected over, e.g., 24 or 48 h, the test allows the determination of the proportion of the carbohydrate that has been digested and or fermented. But if adequate tests have demonstrated that the product is nondigestible (see Chapter 4, Table 4.1), then it is a measure of fermentation and, if the feces contain no residual carbohydrate, then the carbohydrate tested is completely fermentable.

Mechanisms of the Effects of Fermentable Fibers on immune Functions

Even though the mechanism for the effect of fermentable dietary fibers on immune function in the intestine has not been fully established, interesting hypotheses have been proposed that include Production of SCFAs from fiber fermentation. A number of studies support the direct or indirect immunomodulatory properties of SCFAs.79,80 Indeed, supplementing total parenteral nutrition with SCFAs results in increased natural killer cell activity.79 Moreover, other studies have demonstrated antiinflammatory properties of SCFAs, especially butyrate that was reported to suppress both constitutive and cytokine-induced expression of the transcription factor NFDB in the colonic cell-line HT-29.81 But whether these effects occur at concentrations seen after consumption of usual dietary concentrations of fermentable fiber is not known. It has also been suggested that high SCFAs production, particularly butyrate in the colon due to fermentation of dietary fibers, may reduce the requirement of...

The Large Bowel and Colonic Microflora78

The large bowel is an organ of the gastrointestinal system in which lives a large population of mainly anaerobic bacteria. The specific symbiotic association of this bacteria largely governs its functions. A major function of the large bowel is to ferment and thus breakdown oligo- and polysaccharides (especially the nondigestible oligosaccharides, dietary fibers, and resistant starches) and proteins that are not completely digested in the upper gut. The products of the fermentation are the linear and branched short-chain carboxylic acids known as short-chain fatty acids (SCFAs), various amines, phenols, and gases (Table 2.3).

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