Nmt150 Weight Management & Ed 2023 PDF

WEIGHT MANAGEMENT & ED AUTHOR: D R. M A R YA M YAVA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to weight management and protection against cardiometabolic syndrome. Concepts of calories, Consequences of caloric e...

WEIGHT MANAGEMENT & ED AUTHOR: D R. M A R YA M YAVA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to weight management and protection against cardiometabolic syndrome. Concepts of calories, Consequences of caloric excess, visceral adiposity and disease, Caloric Requirements, BMR, Calculations of daily energy requirements, Caloric restriction in the management of obesity  METABOLIC SYNDROME: GOALS Reducing Risk of Atherosclerotic Cardiovascular Disease and Type 2 Diabetes The main goal of the clinical management of MetS is to reduce the risk of atherosclerotic cardiovascular disease and type 2 diabetes. Reducing LDL Cholesterol Levels As one of the primary goals of the clinical management of MetS is to reduce the risk of atherosclerotic disease, the primary target for lipid-lowering therapy is directed at LDL cholesterol levels. Management of Hypertriglyceridemia For individuals with moderate or persistent hypertriglyceridemia, fish oil capsules (2 to 4 g/day of EPA and DHA) or niacin (1200 to 3000 mg/day) taken under a physician's supervision may be effective at reducing triglyceride levels. https://www.sciencedirect.com/science/article/pii/S2211335522001139 METABOLIC SYNDROME Increasing Low HDL Cholesterol Levels For individuals with low HDL cholesterol levels (HDL-C) the most effective strategies for raising HDL-C are: Increased aerobic exercise Smoking cessation Weight loss Moderate alcohol consumption (one to two drinks per day) can also increase HDL-C levels and is associated with a lower prevalence of MetS. However, alcohol consumption is associated with other health risks and should be assessed on an individual basis. (not recommended as an intervention to increase HDL based on the current guideline)  METABOLIC SYNDROME Weight Management Weight management interventions include using behaviour modification, cognitive behavioural therapy, activity enhancement and dietary counselling aimed at reducing caloric intake and increasing physical activity. https://bpsmedicine.biomedcentral.com/articles/10.1186/s13030-020-00177-9 https://www.nhlbi.nih.gov/health/heart/physical- activity/types#:~:text=muscle%2Dstrengthening%20activities.- ,Bone%2Dstrengthening%20activity,examples%20of%20bone%2Dstrengthening%20activities. METABOLIC SYNDROME: KEY RECOMMENDATIONS Mediterranean-style Diet Evidence from epidemiological, cross-sectional and prospective studies suggest that a Mediterranean-style diet is associated with a reduced risk of metabolic syndrome. DASH-style Diet Evidence from cross-sectional and prospective studies suggest that a DASH style diet is associated with reduced risk of developing metabolic syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1090612/ https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.313348 CALORIES  CALORIC EXCESS – CONSEQUENCES & TREATMENT OF OBESITY https://www.flickr.com/photos/181990679@N02/49058922312  BODY MASS INDEX Body mass index (BMI) = weight (KG)/ height (M) squared. BMI 18.5-24.9 = “healthy” weight range. BMI 25.0-29.9 = overweight. BMI > 30.0 = obese. Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens. Obesity is defined as a BMI at or above the 95th percentile for children and teens  BODY MASS INDEX http://www.healthyweightforum.org/eng/calculators/bmi-visual-graph/  WAIST CIRCUMFERENCE Prospective cohort investigation of 41837 women aged 55-69 years. A 100cm waist circumference was taken as the reference measure point. Each increase in 15cm from this measure increased the risk of death by 60% Folsom et al. JAMA. 1993:269(4):483  WAIST TO HIP RATIO “Ratio of waist to hip circumference showed a significant positive association with the 12 year incidence of MI, angina pectoris, stroke, and death”. Lapidus et al. Br Med J. 1984;289(6454): 1257-61.  WAIST TO HIP RATIO https://www.nestle.tt/nutrition-health-wellness/wellness-tools/waist-hip-ratio/about  VISCERAL / SUBCUTANEOUS ADIPOSITY Visceral adipose tissue (VAT), is considered a particularly important marker of metabolic risk VAT is directly involved in the pathogenesis of metabolic dysfunction because VAT releases free fatty acids (FFAs) and inflammatory proteins Visceral Adiposity Klein, S Diabetes Care 2010 July 2010: 33(7):1693-1694  PREVALENCE Based on the WHO global estimates between 1975 and 2016, the worldwide prevalence of obesity has almost tripled. As of 2016, 39% of adults aged 18 years and over (39% of males and 40% of female) were overweight. The World Health Organization (WHO) reports, “obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese.” In the United States, the Centers for Disease Control and Prevention (CDC) estimates that more than 40% of the adult population has obesity, placing them at higher risk for heart disease, stroke, type 2 diabetes, and certain cancers. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight  LONG TERM MANAGEMENT … A 2020 review published in The BMJ, analyzed the effect over time of 14 named diets on weight loss and cardiovascular risk factors, working with 121 eligible trials and 21,942 patients. According to the study’s findings, “most macronutrient diets, over six months, result in modest weight loss and substantial improvements in cardiovascular risk factors.” However, the authors also discovered that “at 12 months, the effects on weight reduction and improvements in cardiovascular risk factors largely disappear.” Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials  INFLUENCE OF PROTEIN INTAKE ON RESPONSES TO A WEIGHT-REDUCTION Losing weight may lead to a reduction in lean muscle mass and a decline in physical abilities. A study conducted over a period of six months compared the effects of two different diets: one with a higher protein content of 1.2 grams per kilogram of body weight, and another with the recommended dietary allowance of 0.8 grams per kilogram of body weight. The study's findings suggest that implementing a balanced diet with higher protein content may be a viable way to reduce obesity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836509/  THE EFFECTIVENESS OF BREAKFAST RECOMMENDATIONS ON WEIGHT LOSS Observational evidence suggests an association between breakfast consumption and a lower body weight; however, this does not preclude the possibility that breakfast eaters tend to weigh less because of other factors associated with breakfast eating. Emily J. Dhurandhar et al. conducted a 16-week randomized controlled trial on 309 overweight and obese adults aged 20 to 65 to investigate the relationship between breakfast consumption and weight loss: The study found that a recommendation to eat or skip breakfast was effective in changing self- reported breakfast habits but did not lead to significant weight loss. https://academic.oup.com/ajcn/article/100/2/507/4576452?login=true  MEAL FREQUENCY AND TIMING ARE ASSOCIATED WITH CHANGES IN BMI A study was conducted on more than 50,000 individuals aged 30 and above to identify preventive tools against weight gain: results suggest that eating less frequently, avoiding snacks, having breakfast, and consuming the largest meal in the morning can help prevent weight gain in the long term. Participants who had longer overnight fasts (18 hours or more) were found to have a lower BMI compared to those with shorter overnight fasts. The authors note that although meal patterns emphasizing the above factors were associated with lower BMI, older adults with chronic diseases may need to choose different meal patterns. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572489/  DOES GLYCEMIC INDEX MATTER FOR WEIGHT LOSS? A review was conducted on 35 observational cohort studies with data from 1,940,968 adults to determine the effectiveness of low-glycemic index diets in weight loss and maintenance. The review found no consistent association between BMI and dietary glycemic index in observational cohort studies. The review also analyzed randomized controlled trials and found little evidence to support the notion that low-glycemic index diets are superior for weight loss. The results of the review suggest that low-glycemic index diets may not be effective for weight loss or maintenance. https://pubmed.ncbi.nlm.nih.gov/34352885/ PREVALENCE OF OBESITY IN CANADA Obesity – Prevalence § Based on self- reporting of height and weight, the prevalence of obesity (BMI > 30.0) was 12% in 1991. In 1998, the value had risen to 17.9%. In 1999, the value had risen again, to 18.9%. This 1 year increase was statistically significant. In 2016 the prevalence was 26.4%. § Current estimates of overweight/obesity in USA: 65%-80%  OBESITY IN CANADA In Canada, the prevalence of obesity in adults rose dramatically, increasing three-fold since 1985. Obesity, defined as a BMI ≥ 30 kg/m2, affected 26.4% or 8.3 million Canadian adults in 2016. Severe obesity (BMI ≥ 35 kg/m2), the fastest growing obesity subgroup, increased disproportionately over this same period. Since 1985, severe obesity increased 455% and affected an estimated 1.9 million Canadian adults in 2016. Overweight, defined as a BMI between 25 and 29.9 kg/m2, affected an additional 34% of adults in Canada (10.6 million individuals). One in three children and/or youths between six to 17 years have overweight or obesity, an increase from one in four in 1978/79. The prevalence of obesity among boys, in particular adolescent boys 12-17 years, is significantly higher than for adolescent girls (16.2% versus 9.3%). https://obesitycanada.ca/guidelines/epidemiology/ CLINICAL CONSEQUENCES OF OBESITY  CONSEQUENCES CVD Cancer Cholecystectomy Hysterectomy Back Pain Constant tiredness Number of GP visits increases with obesity / increasing BMI Increased mortality rate Bray GA. Overweight is risking fate. Definition, classification, prevalence and risks. Ann NY Acad Sci 1987;499:14-28. Brown WJ, et al. Int J Obes 1998;22:520-528.  WEIGHT GAIN AND DIABETES RISK Prevalence of type 2 diabetes, gallbladder disease, osteoarthritis, and hyperlipidemia was also closely correlated to increasing BMI. Overweight/ obese individuals under 55 years old to “normal” weight individuals, the prevalence of type 2 diabetes was 3.27x greater. Chan JM, et al. Diabetes Care 1994;17:960-969.  TYPE 2 DIABETES Comparing overweight/ obese individuals greater than 55 years old to “normal” weight individuals, the prevalence of type 2 diabetes was 1.77 times greater. Regarding blood pressure, similar effects were observed. Only examining overweight individuals (excluding the obese), there existed a nearly 2- fold increase in prevalence of hypertension, in individuals under the age of 55  WEIGHT AND CVD RISK Women gaining weight after 18 were compared to women who’s weight did not change since age 18: “Higher levels of body weight within the “normal” range, as well as modest weight gains after 18 years of age, appear to increase risks of CHD in middle aged women” https://pubmed.ncbi.nlm.nih.gov/7654270/  HYPERTENSION For both men and women, the most significant health concern observed relating to body weight was increased blood pressure. “Dose-response” was observed, with both the incidence and severity of hypertension being tightly correlated to segmental increments of BMI. Must et al. JAMA. 1999;282(16):1523-29.  CAUSES OF OBESITY The following factors were directly linearly correlated to obesity; Heavy drinking Sedentary Unemployed Lack of post-secondary education Women who had >3 live births Older age SUGAR!!!!!! Han et al. Int J Epidem. 1998;27:422-30  TREATMENT STRATEGIES – CALORIE RESTRICTION Calories in – Calories out = Caloric Balance https://courses.lumenlearning.com/suny-monroecc-hed110/chapter/balancing-calories/ BASAL METABOLIC RATE (BMR) § BMR § RMR is more commonly used. § Factors influencing the BMR… https://www.thecalculatorsite.com/articles/health/bmr-formula.php  Basal Metabolic Rate +Thermal Effect of Food + Non- Exercise Activity Thermogenesis +Exercise = Calories out http://www.lifetime-weightloss.com/blog/2011/2/13/food-is-more-than-just-calories-in.html Post Meal Thermogenesis (PMT) Also termed the thermic effect of food. This denotes the fact that every time food is consumed, there is an increase in basal energy expenditure, as a result of processes of digestion. This value ranges from 5-15% of BMR. NON- EXERCISE ACTIVITY THERMOGENESIS (NEAT) This denotes all daily activities. For example, brushing teeth, washing dishes, reading, standing ETC, other than exercise APPETITE HORMONES Leptin suppresses appetite as its level increases – produced by fat tissue PYY – suppresses appetite – secreted by SI after meals – counters ghrelin Ghrelin – signals hunger and increased in people who follow traditional diet Insulin – responsible for weight gain!!  Appetite Hormones https://erinburkes.com/are-your-hormones-making-you-hangry-6-simple-rules-to-follow-to-control-hunger-and-help-burn-fat/ https://www.123rf.com/photo_44567679_stock-vector-leptin-is-a-hormone-made-by-adipose-cells-that-helps-regulate- appetite-control-of-metabolism-energy-.html  CLINICAL NOTE: TO BOOST LEPTIN A diet that is designed to lower triglycerides could help to boost leptin in body: Berries Berries like blueberries, blackberries, and strawberries are lower in sugar than some other fruits and can help to lower triglyceride levels. Unsweetened Beverages herbal, black, or green teas, or drink water with lemon or a fruit infusion to lower triglycerides levels and boost leptin https://www.webmd.com/diet/foods-to-boost-leptin  CLINICAL NOTE: TO BOOST LEPTIN Healthy Oils Olive oil Vegetables Eating vegetables raw, steamed, or roasted helps lower the triglyceride levels. Also it is recommended to choose kale or cauliflower instead of starchy vegetables like corn or potatoes. https://www.webmd.com/diet/foods-to-boost-leptin  CLINICAL NOTE: TO BOOST LEPTIN Legumes Beans, peas, and lentils are great sources of protein and fiber that can boost the functionality of leptin in body. Lean Meat, Poultry, and Fish Fish is the best choice for lowering triglycerides. Moderate consumption of other animal protein, with a healthy oil. https://www.webmd.com/diet/foods-to-boost-leptin  CLINICAL NOTE: TO BOOST LEPTIN Whole Grains brown rice instead of white and whole-grain breads instead of refined loaves. also switching to whole-grain pasta or a healthier version like those made from chickpeas to lower triglycerides levels. Salad Greens with salad dressings low in salt, sugars, and fats. Mushrooms Mushrooms are high in nutrients and low in calories, which can help to regulate your triglyceride levels and boost leptin. https://www.webmd.com/diet/foods-to-boost-leptin SUMMARY Eating less frequently, consuming breakfast, and eating the largest meal in the morning may be effective long-term preventive tools against weight gain. Low-glycemic index diets may not be effective for weight loss or maintenance(but helps blood sugar regulation) Very low calorie diets (less than 800 calories per day) have not been proven to be more effective in the long term and require close medical supervision SUMMARY Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes. A healthy diet and regular physical activity are key factors in preventing and managing metabolic syndrome. Intermittent fasting may improve metabolic syndrome markers, but more research is needed. SUMMARY A healthy diet and regular physical activity are important for maintaining vascular health. Consuming a diet rich in fruits, vegetables, whole grains, and healthy fats can help lower the risk of heart disease. Smoking cessation, blood pressure control, and cholesterol management are also important factors in maintaining vascular health. QUESTION Which of the following strategies is most effective/best recommendation for raising HDL cholesterol levels (HDL-C) in individuals with low HDL-C? A) Increased resistance exercise B) Smoking cessation C) Weight gain D) Moderate alcohol consumption E) None of the above REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. WileyBlackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. Katz, D.Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins, 2008. Katsilambros, N Clinical Nutrition in Practice. Wiley-Blackwell 2010 Jones, D. Textbook of Functional Medicine: The Institute for Functional Medicine. Gig Harbour Washington. Pizzorno, J and Katzinger, J. Clinical Pathophysiology. Mind Publishing, 2012 THANK YOU!