Differential effects of natural palm oil, chemically and enzymatically-modified palm oil on weight gain, blood lipid metabolites and fat deposition in a pediatric pig model

Background: Increasing prevalence of obesity and overweight in the Western world, continue to be a major health threat and is responsible for increased health care costs. Dietary intervention studies show a strong positive association between saturated fat intake and the development of obesity and cardiovascular disease. This study investigated the effect of positional distribution of palmitic acid (Sn-1, 2 & 3) of palm oil on cardiovascular health and development of obesity, using weaner pigs as a model for young children.

Methods: Male and female weaner piglets were randomly allocated to 4 dietary treatment groups: 1) pork lard (LRD); 2) natural palm olein (NPO); 3) chemically inter-esterified PO (CPO) and 4) enzymatically inter-esterified PO (EnPO) as the fat source. Diets were formulated with 11% lard or with palm olein in order to provide 31% of digestible energy from fat in the diet and were balanced for cholesterol, protein and energy across treatments.

Results: From 8 weeks onwards, pigs on EnPO diet gained (P < 0.05) more weight than all other groups. Feed conversion efficiency (feed to gain) over the 12 week experimental period did not vary between treatment groups. Plasma LDL-C content and LDL-C/HDL-C ratio in pigs fed natural PO tended to be lower compared to all other diets. The natural PO lowered (P < 0.02) the plasma triglyceride (TG) content relative to the lard or EnPO diets, but was not different from the CPO diet. The natural PO diet was associated with lower (P < 0.05) saturated fat levels in subcutaneous adipose tissue than the CPO and EnPO diets that had lower saturated fat levels than the lard diet. Female pigs had lower lean and higher fat and fat:lean ratio in the body compared with male pigs. No difference in weight gain or blood lipid parameters was observed between sexes.

Conclusions: The observations on plasma TG, muscle and adipose tissue saturated fatty acid contents and back fat (subcutaneous) thickness suggest that natural palm oil may reduce deposition of body fat. In addition, dietary supplementation with natural palm oil containing palmitic acid at different positions in meat producing animals may lead to the production of meat and meat products with lower saturated fats. An increase in fat content and a decrease in lean content in female pigs resulted in an increased body fat:lean ratio but gender had no effect on blood lipid parameters or insulin concentrations.

An observational approach to testing bi-directional parent–child interactions as influential to child eating and weight

Obesity among children has been on the rise globally for the past few decades. Previous research has centred mainly on self/parent-reported measures examining only uni-directional parental feeding styles and practices. Recent discussions in the literature have raised the importance of bi-directional parent–child interactions in influencing children's weight status. The aims of this paper are to highlight the importance of an observational approach when investigating positive bi-directional parent–child interactions during mealtimes and to outline how these interactions may be linked to positive child eating and weight outcomes. We examine the current literature on self-reported parental patterns and argue for the influential roles of responsiveness, affect and parental control dimensions within the parent–child dyad. Information about the ways in which the parent and the child can influence each other on these dimensions, as observed in parent–child interactions around food, is likely to provide greater insights into the aetiology of childhood obesity.

Organized blood pressure control programs to prevent stroke in Australia : would they be cost-effective?

Background and Purpose—: High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke.

Methods—: A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis.

Results—: For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with >=15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled.

Conclusions—: Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.

Health care use during 20 years following bariatric surgery

Context Bariatric surgery results in sustained weight loss; reduced incidence of diabetes, cardiovascular events, and cancer; and improved survival. The long-term effect on health care use is unknown.

Objective To assess health care use over 20 years by obese patients treated conventionally or with bariatric surgery.

Design, Setting, and Participants The Swedish Obese Subjects study is an ongoing, prospective, nonrandomized, controlled intervention study conducted in the Swedish health care system that included 2010 adults who underwent bariatric surgery and 2037 contemporaneously matched controls recruited between 1987 and 2001. Inclusion criteria were age 37 years to 60 years and body mass index of 34 or higher in men and 38 or higher in women. Exclusion criteria were identical in both groups.

Interventions Of the surgery patients, 13% underwent gastric bypass, 19% gastric banding, and 68% vertical-banded gastroplasty. Controls received conventional obesity treatment.

Main Outcome Measures Annual hospital days (follow-up years 1 to 20; data capture 1987-2009; median follow-up 15 years) and nonprimary care outpatient visits (years 2-20; data capture 2001-2009; median follow-up 9 years) were retrieved from the National Patient Register, and drug costs from the Prescribed Drug Register (years 7-20; data capture 2005-2011; median follow-up 6 years). Registry linkage was complete for more than 99% of patients (4044 of 4047). Mean differences were adjusted for baseline age, sex, smoking, diabetes status, body mass index, inclusion period, and (for the inpatient care analysis) hospital days the year before the index date.

Results In the 20 years following their bariatric procedure, surgery patients used a total of 54 mean cumulative hospital days compared with 40 used by those in the control group (adjusted difference, 15; 95% CI, 2-27; P = .03). During the years 2 through 6, surgery patients had an accumulated annual mean of 1.7 hospital days vs 1.2 days among control patients (adjusted difference, 0.5; 95% CI, 0.2 to 0.7; P < .001). From year 7 to 20, both groups had a mean annual 1.8 hospital days (adjusted difference, 0.0; 95% CI, −0.3 to 0.3; P = .95). Surgery patients had a mean annual 1.3 nonprimary care outpatient visits during the years 2 through 6 vs 1.1 among the controls (adjusted difference, 0.3; 95% CI, 0.1 to 0.4; P = .003), but from year 7, the 2 groups did not differ (1.8 vs 1.9 mean annual visits; adjusted difference, −0.2; 95% CI, −0.4 to 0.1; P = .12). From year 7 to 20, the surgery group incurred a mean annual drug cost of US $930; the control patients, $1123 (adjusted difference, −$228; 95% CI, −$335 to −$121; P < .001).

Conclusions Compared with controls, surgically treated patients used more inpatient and nonprimary outpatient care during the first 6-year period after undergoing bariatric surgery but not thereafter. Drug costs from years 7 through 20 were lower for surgery patients than for control patients.

Fructose containing sugars modulate mRNA of lipogenic genes ACC and FAS and protein levels of transcription factors ChREBP and SREBPIc with no effect on body weight or liver fat

The aim of this study was to determine the effects of high-glucose, high-fructose and high-sucrose diets on weight gain, liver lipid metabolism and gene expression of proteins involved with hepatic fat metabolism. Rats were fed a diet containing either 60% glucose, 60% fructose, 60% sucrose, or a standard chow for 28 days. Results indicated that high-fructose and high-sucrose diets were associated with higher mRNA levels of gene transcripts involved with fat synthesis; ACC, FAS and ChREBP, with no change in SREBP-1C mRNA. The protein level of ChREBP and SREBP1c was similar in liver homogenates from all groups, but were higher in nuclear fractions from the liver of high-fructose and high-sucrose fed rats. The mRNA level of gene transcripts involved with fat oxidation was the same in all three diets, whilst a high-fructose diet was associated with greater amount of mRNA of the fat transporter CD36. Despite the changes in mRNA of lipogenic proteins, the body weight of animals from each group was the same and the livers from rats fed high-fructose and high-sucrose diets did not contain more fat than control diet livers. In conclusion, changing the composition of the principal monosaccharide in the diet to a fructose containing sugar elicits changes in the level of hepatic mRNA of lipogenic and fat transport proteins and protein levels of their transcriptional regulators; however this is not associated with any changes in body weight or liver fat content.

Control of crystallization in supramolecular soft materials engineering

As one class of the most important supramolecular functional materials, gels formed by low molecular weight gelators (LMWGs) have many important applications. The key important parameters affecting the in-use performance of a gel are determined by the hierarchical fiber network structures. Fiber networks consisting of weakly interacting multiple domains are commonly observed in gels formed by LMWGs. The rheological properties, particularly the elasticity, of a gel with such a fiber network are weak due to the weak interactions between the individual domains. As achieving desirable rheological properties of such a gel is practically relevant, in this work, we demonstrate the engineering of gels with such a type of fiber network by controlling crystallization of the gelator. Two example gels formed by a glutamic acid derivative in a non-ionic surfactant Tween 80 and in propylene glycol were engineered by controlling the thermodynamic driving force for crystallization. For a fixed gelator concentration, the thermodynamic driving force was manipulated by controlling the temperature for fiber crystallization. It was observed that there exists an optimal temperature at which a gel with maximal elasticity can be fabricated. This will hopefully provide guidelines for producing high performance soft materials by engineering their fiber network structures.

Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study.

Aims
To investigate whether diabetes self-care attitudes, behaviours and perceived burden, particularly related to weight management, diet and physical activity, differ between adults with Type 2 diabetes who are severely obese and matched non-severely obese control subjects.

Methods
The 1795 respondents to the Diabetes MILES—Australia national survey had Type 2 diabetes and reported height and weight data, enabling BMI calculation: 530 (30%) were severely obese (BMI ≥ 35 kg/m2; median BMI = 41.6 kg/m2) and these were matched with 530 control subjects (BMI < 35 kg/m2; median BMI = 28.2 kg/m2). Diabetes self-care behaviours, attitudes and burden were measured with the Diabetes Self-Care Inventory—Revised. Within-group and between-group trends were examined.

Results
The group with BMI ≥ 35 kg/m2 was less likely to achieve healthy diet and exercise targets, placed less importance on diet and exercise recommendations, and found the burden of diet and exercise recommendations to be greater than the group with BMI < 35 kg/m2. The group with BMI ≥ 35 kg/m2 was more likely to be actively trying to lose weight, but found weight control a greater burden. These issues accentuated with increasing obesity and were greatest in those with BMI > 45 kg/m2. There were no between-group differences in other aspects of diabetes self-care: self-monitoring of blood glucose, use of medications and smoking. Moderate-to-severe symptoms of depression were independently associated with reduced likelihood of healthy diet and physical activity, and with greater burden associated with diet, physical activity and weight management.

Conclusions
Severely obese people with diabetes demonstrated self-care attitudes, behaviours and burdens that infer barriers to weight loss. However, other important diabetes self-care behaviours are supported equally by severely obese and non-severely obese individuals.

A review of 16 years of quality control parameters at a mass-rearing facility producing Queensland fruit fly, Bactrocera tryoni

From 1996 to 2012, the mass-rearing facility at Camden (NSW, Australia) has been producing Queensland fruit flies, Bactrocera tryoni (Froggatt) (Diptera: Tephritidae). During this time, the facility has regularly recorded fly quality parameters, creating a unique data set that provides an invaluable opportunity to evaluate the interrelationships among standard quality control (QC) parameters and test for redundant QC variables. Here, we conducted an exploratory data analysis to reveal relationships among the QC parameters. We found that pupal weight, adult lifespan, and longevity under nutritional stress (i.e., survival duration without food or water) had distinct monthly trends, suggesting that these QC parameters are sensitive to seasonal conditions. Furthermore, emergence percentage, flight ability, and adult lifespan were adversely affected by the dyeing/handling/irradiation process associated with sterile insect releases. Using a multivariate approach and controlling for monthly and yearly patterns, we showed that pupal weight and egg hatch are consistently negatively related and that percentage male and emergence rates are consistently negatively related. These results suggest that these correlation pairs measure similar quality information and hence one QC variable from each pair could be dropped. Flight ability was not strongly correlated with any of the QC variables, suggesting that this QC variable remains a useful QC metric. Finally, the longevity under nutritional stress QC appears to be fairly insensitive to QCs and we suggest that it should be replaced by the standard mortality under stress test.

Child weight status: Relationships with mother-child mealtime interactions and child eating behaviours

This doctoral thesis highlighted how mother-child interactions surrounding responsiveness, affect, maternal control and child compliance may be influential to children’s self-regulatory behaviours around food and eating, in turn impacting their weight. Support was found for the potential role of such interactions as risk factors in childhood overweight and obesity.

A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight.

We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento-structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento-structural type interventions, remains crucial.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.

Three year follow-up of an early childhood intervention: what about physical activity and weight status?

Fundamental movement skills are a correlate of physical activity and weight status. Children who participated in a preschool intervention had greater movement skill proficiency and improved anthropometric measures (waist circumference and BMI z scores) post intervention. Three years later, intervention girls had retained their object control skill advantage. The study purpose was to assess whether at three year follow up a) intervention children were more physically active than controls and b) the intervention effect on anthropometrics was still present.

The effects of progressive resistance training combined with a whey-protein drink and vitamin D supplementation on glycaemic control, body composition and cardiometabolic risk factors in older adults with type 2 diabetes: study protocol for a randomized c

While physical activity, energy restriction and weight loss are the cornerstone of type 2 diabetes management, less emphasis is placed on optimizing skeletal muscle mass. As muscle is the largest mass of insulin-sensitive tissue and the predominant reservoir for glucose disposal, there is a need to develop safe and effective evidence-based, lifestyle management strategies that optimize muscle mass as well as improve glycaemic control and cardiometabolic risk factors in people with this disease, particularly older adults who experience accelerated muscle loss.