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  • 1.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Johansson, Kari
    Eriksson, Jonas
    Sundström, Johan
    Neovius, Martin
    Marcus, Claude
    Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study.2012In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, no 5, p. 953-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The effectiveness of commercial weight-loss programs consisting of very-low-calorie diets (VLCDs) and low-calorie diets (LCDs) is unclear.

    OBJECTIVE: The aim of the study was to quantify weight loss and dropout during a commercial weight-loss program in Sweden (Itrim; cost: $1300/€1000; all participants paid their own fee).

    DESIGN: This observational cohort study linked commercial weight-loss data with National Health Care Registers. Weight loss was induced with a 500-kcal liquid-formula VLCD [n = 3773; BMI (in kg/m(2)): 34 ± 5 (mean ± SD); 80% women; 45 ± 12 y of age (mean ± SD)], a 1200-1500-kcal formula and food-combination LCD (n = 4588; BMI: 30 ± 4; 86% women; 50 ± 11 y of age), and a 1500-1800-kcal/d restricted normal-food diet (n = 676; BMI: 29 ± 5; 81% women; 51 ± 12 y of age). Maintenance strategies included exercise and a calorie-restricted diet. Weight loss was analyzed by using an intention-to-treat analysis (baseline substitution).

    RESULTS: After 1 y, mean (±SD) weight changes were -11.4 ± 9.1 kg with the VLCD (18% dropout), -6.8 ± 6.4 kg with the LCD (23% dropout), and -5.1 ± 5.9 kg with the restricted normal-food diet (26% dropout). In an adjusted analysis, the VLCD group lost 2.8 kg (95% CI: 2.5, 3.2) and 3.8 kg (95% CI: 3.2, 4.5) more than did the LCD and restricted normal-food groups, respectively. A high baseline BMI and rapid initial weight loss were both independently associated with greater 1-y weight loss (P < 0.001). Younger age and low initial weight loss predicted an increased dropout rate (P < 0.001). Treatment of depression (OR: 1.4; 95% CI: 1.1, 1.9) and psychosis (OR: 2.6; 95% CI: 1.1, 6.3) were associated with an increased dropout rate in the VLCD group.

    CONCLUSION: A commercial weight-loss program, particularly one using a VLCD, was effective at reducing body weight in self-selected, self-paying adults.

  • 2.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Johansson, Kari
    Neovius, Martin
    Randomized controlled trial on weight loss in obstructive sleep apnea: inappropriate analysis limits main conclusion.2011In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 93, no 2, p. 474-474Article in journal (Refereed)
  • 3. Johansson, Kari
    et al.
    Neovius, Martin
    Hemmingsson, Erik
    Karolinska institutet.
    Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials.2014In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 99, no 1, p. 14-23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Weight-loss maintenance remains a major challenge in obesity treatment.

    OBJECTIVE: The objective was to evaluate the effects of anti-obesity drugs, diet, or exercise on weight-loss maintenance after an initial very-low-calorie diet (VLCD)/low-calorie diet (LCD) period (<1000 kcal/d).

    DESIGN: We conducted a systematic review by using MEDLINE, the Cochrane Controlled Trial Register, and EMBASE from January 1981 to February 2013. We included randomized controlled trials that evaluated weight-loss maintenance strategies after a VLCD/LCD period. Two authors performed independent data extraction by using a predefined data template. All pooled analyses were based on random-effects models.

    RESULTS: Twenty studies with a total of 27 intervention arms and 3017 participants were included with the following treatment categories: anti-obesity drugs (3 arms; n = 658), meal replacements (4 arms; n = 322), high-protein diets (6 arms; n = 865), dietary supplements (6 arms; n = 261), other diets (3 arms; n = 564), and exercise (5 arms; n = 347). During the VLCD/LCD period, the pooled mean weight change was -12.3 kg (median duration: 8 wk; range 3-16 wk). Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg [95% CI: 1.5, 5.5 kg; median duration: 18 mo (12-36 mo)], meal replacements by 3.9 kg [95% CI: 2.8, 5.0 kg; median duration: 12 mo (10-26 mo)], and high-protein diets by 1.5 kg [95% CI: 0.8, 2.1 kg; median duration: 5 mo (3-12 mo)]. Exercise [0.8 kg; 95% CI: -1.2, 2.8 kg; median duration: 10 mo (6-12 mo)] and dietary supplements [0.0 kg; 95% CI: -1.4, 1.4 kg; median duration: 3 mo (3-14 mo)] did not significantly improve weight-loss maintenance compared with control.

    CONCLUSION: Anti-obesity drugs, meal replacements, and high-protein diets were associated with improved weight-loss maintenance after a VLCD/LCD period, whereas no significant improvements were seen for dietary supplements and exercise.

  • 4.
    Larsen, Filip J
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Schiffer, Tomas A
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.
    Mattsson, Mathias P
    Checa, Antonio
    Wheelock, Craig E
    Nyström, Thomas
    Lundberg, Jon O
    Weitzberg, Eddie
    Dietary nitrate reduces resting metabolic rate: a randomized, crossover study in humans.2014In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 99, no 4, p. 843-50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nitrate, which is an inorganic anion abundant in vegetables, increases the efficiency of isolated human mitochondria. Such an effect might be reflected in changes in the resting metabolic rate (RMR) and formation of reactive oxygen species. The bioactivation of nitrate involves its active accumulation in saliva followed by a sequential reduction to nitrite, nitric oxide, and other reactive nitrogen species.

    OBJECTIVE: We studied effects of inorganic nitrate, in amounts that represented a diet rich in vegetables, on the RMR in healthy volunteers.

    DESIGN: In a randomized, double-blind, crossover study, we measured the RMR by using indirect calorimetry in 13 healthy volunteers after a 3-d dietary intervention with sodium nitrate (NaNO3) or a placebo (NaCl). The nitrate dose (0.1 mmol · kg(-1) · d(-1)) corresponded to the amount in 200-300 g spinach, beetroot, lettuce, or other vegetable that was rich in nitrate. Effects of direct nitrite exposure on cell respiration were studied in cultured human primary myotubes.

    RESULTS: The RMR was 4.2% lower after nitrate compared with placebo administration, and the change correlated strongly to the degree of nitrate accumulation in saliva (r(2) = 0.71). The thyroid hormone status, insulin sensitivity, glucose uptake, plasma concentration of isoprostanes, and total antioxidant capacity were unaffected by nitrate. The administration of nitrite to human primary myotubes acutely inhibited respiration.

    CONCLUSIONS: Dietary inorganic nitrate reduces the RMR. This effect may have implications for the regulation of metabolic function in health and disease.

  • 5. Saltin, Bengt
    et al.
    Åstrand, PO
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Free fatty acids and exercise.1993In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 57, no 5 Suppl, p. 752S-757S; discussion 757SArticle in journal (Refereed)
    Abstract [en]

    Although the great explorers were well aware that eating fat was an efficient way to meet their large energy demand, it was not until some decades into this century that it could be demonstrated that lipids are metabolized directly by contracting skeletal muscles. The 1950s produced the first studies with [14C]-tagged fatty acids (FAs), proving that fat is transported into the cell as FAs. An FA-transporting protein that is present in the sarcolemma and in the cytoplasma has been identified. For FA transport into the mitochondria, carnitine and carnitine transferase are needed. It is still unclear how the use of lipids as an energy source for the muscle during exercise is limited. The supply of free fatty acids (FFAs) far exceeds what is taken up by the muscle. Seldom more than 2-4% of the amount of FFAs delivered to an exercising limb is taken up by the muscles and only part of it is oxidized. Physical training induces changes that enhance the uptake of FAs by the contracting muscles, and a larger fraction of this uptake is oxidized, but it is not yet clear which mechanism is behind this adaptation. What is known is that this uptake occurs despite no elevation in the amount of FA supplied to the limb.

  • 6.
    Åstrand, PO
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Physical activity and fitness.1992In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 55, no 6 Suppl, p. 1231S-1236SArticle in journal (Refereed)
    Abstract [en]

    There is unanimous agreement that regular exercise is essential for optimal function of the human body. It is evident that extrinsic factors, such as diet and exercise habits, are reflected in the morbidity and mortality statistics, especially in aging. Aging is obligatorily associated with reduced maximal aerobic power and reduced muscle strength, ie, with reduced physical fitness. As a consequence of diminished exercise tolerance, a large and increasing number of elderly people will be living below, at, or just above "thresholds" of physical ability, needing only a minor intercurrent illness to render them completely dependent. Physical training can readily produce a profound improvement of functions also essential for physical fitness in old age. From a nutritional viewpoint one advantage of physical activity, and increased metabolic rate, is that a higher energy intake can better secure an adequate intake of essential nutrients.

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