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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Obesity".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 79011

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Special Issue Editor

Dr. Javier Gómez-Ambrosi

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Clínica Universidad de Navarra, Metabolic Research Lab, Irunlarrea 1, 31008 Pamplona, Spain
Interests: obesity; dietary treatment; adipose tissue dysfunction; inflammation; adipokines; metabolic surgery; cardiometabolic risk improvement; body composition changes
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Special Issue Information

Dear Colleagues,

Over the last few decades, obesity has become one of the most prevalent metabolic disorders. Excess adiposity favors the development of cardiometabolic alterations such as type 2 diabetes (T2D), cardiovascular disease, dyslipidemia, fatty liver, and cancer, among others. In recent years, our understanding of the pathophysiology of obesity has greatly improved, and novel approaches for the treatment of obesity have emerged. However, the obesity epidemic continues without signs of abatement.

In this Special Issue, we welcome reviews and original articles related to any aspect of obesity management, from the traditional dietary approach (with different types of diets) to metabolic surgery and including pharmacologic treatments. We will consider manuscripts regarding lifestyle modification in relation to physical activity and sleep hygiene. Novel approaches such as the different modalities of intermittent fasting, including aspects relative to their effectiveness or the different physiological mechanisms involved, or the use of innovative technologies such as mobile apps or wearable devices are very welcome. We aim to provide readers with a clear view of the pathophysiological relevance of weight loss and the improvements in cardiometabolic risk factors that take place with different therapeutic approaches, as well as changes in body physiology and energy expenditure that drives toward weight regain. Reviews and original articles analyzing the clinical usefulness of predictors of treatment success and the importance of monitoring body composition in the management of patients living with obesity will also be welcome.

Dr. Javier Gómez-Ambrosi
Guest Editor

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Keywords

obesity
dietary treatment
lifestyle intervention
pharmacological treatment
metabolic surgery
intermittent fasting
cardiometabolic risk improvement
body composition changes
weight regain
predictors of treatment success
use of apps for weight loss
novel targets
treatment of children and adolescents

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Published Papers (13 papers)

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Editorial

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4 pages, 218 KiB

Open AccessEditorial

Recent Progress in the Management of Obesity

by Javier Gómez-Ambrosi

Nutrients 2023, 15(12), 2651; https://doi.org/10.3390/nu15122651 - 6 Jun 2023

Viewed by 1739

Abstract

Obesity represents the most prevalent metabolic disease nowadays, posing a significant public health risk [...] Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

Research

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16 pages, 4382 KiB

Open AccessEditor’s ChoiceArticle

Putting the Personalized Metabolic Avatar into Production: A Comparison between Deep-Learning and Statistical Models for Weight Prediction

by Alessio Abeltino, Giada Bianchetti, Cassandra Serantoni, Alessia Riente, Marco De Spirito and Giuseppe Maulucci

Nutrients 2023, 15(5), 1199; https://doi.org/10.3390/nu15051199 - 27 Feb 2023

Cited by 13 | Viewed by 2335

Abstract

Nutrition is a cross-cutting sector in medicine, with a huge impact on health, from cardiovascular disease to cancer. Employment of digital medicine in nutrition relies on digital twins: digital replicas of human physiology representing an emergent solution for prevention and treatment of many diseases. In this context, we have already developed a data-driven model of metabolism, called a “Personalized Metabolic Avatar” (PMA), using gated recurrent unit (GRU) neural networks for weight forecasting. However, putting a digital twin into production to make it available for users is a difficult task that as important as model building. Among the principal issues, changes to data sources, models and hyperparameters introduce room for error and overfitting and can lead to abrupt variations in computational time. In this study, we selected the best strategy for deployment in terms of predictive performance and computational time. Several models, such as the Transformer model, recursive neural networks (GRUs and long short-term memory networks) and the statistical SARIMAX model were tested on ten users. PMAs based on GRUs and LSTM showed optimal and stable predictive performances, with the lowest root mean squared errors (0.38 ± 0.16–0.39 ± 0.18) and acceptable computational times of the retraining phase (12.7 ± 1.42 s–13.5 ± 3.60 s) for a production environment. While the Transformer model did not bring a substantial improvement over RNNs in term of predictive performance, it increased the computational time for both forecasting and retraining by 40%. The SARIMAX model showed the worst performance in term of predictive performance, though it had the best computational time. For all the models considered, the extent of the data source was a negligible factor, and a threshold was established for the number of time points needed for a successful prediction. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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14 pages, 2127 KiB

Open AccessArticle

Ketogenic Diet Applied in Weight Reduction of Overweight and Obese Individuals with Progress Prediction by Use of the Modified Wishnofsky Equation

by Gordana Markovikj, Vesna Knights and Jasenka Gajdoš Kljusurić

Nutrients 2023, 15(4), 927; https://doi.org/10.3390/nu15040927 - 12 Feb 2023

Cited by 5 | Viewed by 3909

Abstract

Ketogenic diet is often used as diet therapy for certain diseases, among other things, its positive effect related to weight loss is highlighted. Precisely because of the suggestion that KD can help with weight loss, visceral obesity, and appetite control, 100 respondents joined the weight loss program (of which 31% were men and 69% were women). The aforementioned respondents were interviewed in order to determine their eating habits, the amount of food consumed, and the time when they consume meals. Basic anthropometric data (body height, body mass, chest, waist, hips, biceps, and thigh circumferences) were also collected, in order to be able to monitor their progress during the different phases of the ketogenic diet. Important information is the expected body mass during the time frame of a certain keto diet phase. This information is important for the nutritionist, medical doctor, as well as for the participant in the reduced diet program; therefore, the model was developed that modified the original equation according to Wishnofsky. The results show that women lost an average of 22.7 kg (average number of days in the program 79.5), and for men the average weight loss was slightly higher, 29.7 kg (with an average of 76.8 days in the program). The prediction of expected body mass by the modified Wishnofsky’s equation was extremely well aligned with the experimental values, as shown by the Bland-Altman graph (bias for women 0.021 kg and −0.697 kg for men) and the coefficient of determination of 0.9903. The modification of the Wishnofsky equation further shed light on the importance of controlled energy reduction during the dietetic options of the ketogenic diet. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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11 pages, 903 KiB

Open AccessArticle

Is There a Link between Obesity Indices and Skin Autofluorescence? A Response from the ILERVAS Project

by Enric Sánchez, Marta Sánchez, Carolina López-Cano, Marcelino Bermúdez-López, José Manuel Valdivielso, Cristina Farràs-Sallés, Reinald Pamplona, Gerard Torres, Dídac Mauricio, Eva Castro, Elvira Fernández and Albert Lecube

Nutrients 2023, 15(1), 203; https://doi.org/10.3390/nu15010203 - 31 Dec 2022

Cited by 1 | Viewed by 3241

Abstract

There is controversial information about the accumulation of advanced glycation end-products (AGEs) in obesity. We assessed the impact of total and abdominal adiposity on AGE levels via a cross-sectional investigation with 4254 middle-aged subjects from the ILERVAS project. Skin autofluorescence (SAF), a non-invasive assessment of subcutaneous AGEs, was measured. Total adiposity indices (BMI and Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE)) and abdominal adiposity (waist circumference and body roundness index (BRI)) were assessed. Lean mass was estimated using the Hume index. The area under the receiver operating characteristic (ROC) curve was evaluated for each index. Different cardiovascular risk factors (smoking, prediabetes, hypertension and dyslipidemia) were evaluated. In the study population, 26.2% showed elevated SAF values. No differences in total body fat, visceral adiposity and lean body mass were detected between patients with normal and high SAF values. SAF levels showed a very slight but positive correlation with total body fat percentage (estimated by the CUN-BAE formula) and abdominal adiposity (estimated by the BRI). However, none of them had sufficient power to identify patients with high SAF levels (area under the ROC curve <0.52 in all cases). Finally, a progressive increase in SAF levels was observed in parallel with cardiovascular risk factors in the entire population and when patients with normal weight, overweight and obesity were evaluated separately. In conclusion, total obesity and visceral adiposity are not associated with a greater deposit of AGE. The elevation of AGE in obesity is related to the presence of cardiometabolic risk. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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9 pages, 267 KiB

Open AccessArticle

Effects of Nutrition Intervention on Blood Glucose, Body Composition, and Phase Angle in Obese and Overweight Patients with Diabetic Foot Ulcers

by Raedeh Basiri, Maria T. Spicer, Thomas Ledermann and Bahram H. Arjmandi

Nutrients 2022, 14(17), 3564; https://doi.org/10.3390/nu14173564 - 30 Aug 2022

Cited by 14 | Viewed by 4929

Abstract

Nutrition can play an important role in the treatment of chronic wounds such as diabetic foot ulcers (DFUs); however, diet therapy is not currently part of the standard care for DFUs. There are numerous controversies about dietary recommendations, especially regarding calories and macronutrients, for overweight and obese patients with DFUs. This study examined the effects of nutrition education and supplementation on body composition in overweight and obese patients with DFUs. Twenty-nine patients with DFUs between the ages of 30 and 70 years were randomly assigned to either the treatment group (nutritional supplements, diet education, and standard care) or the control group (standard care). At baseline, the mean body mass index (BMI) was 33.5 kg/m² for the treatment group and 34.1 kg/m² for the control group. HbA1c decreased in both groups, with no significant difference between the groups. On average, patients in the treatment group lost less lean body mass and gained less fat than the control group ((3.8 kg vs. 4.9 kg) and (0.9 kg vs. 3.6 kg), respectively). While the interaction between group and time did not reach statistical significance for any of the study variables after adjustments for confounding variables, the observed changes are clinically relevant. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

16 pages, 2962 KiB

Open AccessArticle

Personalized Metabolic Avatar: A Data Driven Model of Metabolism for Weight Variation Forecasting and Diet Plan Evaluation

by Alessio Abeltino, Giada Bianchetti, Cassandra Serantoni, Cosimo Federico Ardito, Daniele Malta, Marco De Spirito and Giuseppe Maulucci

Nutrients 2022, 14(17), 3520; https://doi.org/10.3390/nu14173520 - 26 Aug 2022

Cited by 12 | Viewed by 2876

Abstract

Development of predictive computational models of metabolism through mechanistic models is complex and resource demanding, and their personalization remains challenging. Data-driven models of human metabolism would constitute a reliable, fast, and continuously updating model for predictive analytics. Wearable devices, such as smart bands and impedance balances, allow the real time and remote monitoring of physiological parameters, providing for a flux of data carrying information on user metabolism. Here, we developed a data-driven model of end-user metabolism, the Personalized Metabolic Avatar (PMA), to estimate its personalized reactions to diets. PMA consists of a gated recurrent unit (GRU) deep learning model trained to forecast personalized weight variations according to macronutrient composition and daily energy balance. The model can perform simulations and evaluation of diet plans, allowing the definition of tailored goals for achieving ideal weight. This approach can provide the correct clues to empower citizens with scientific knowledge, augmenting their self-awareness with the aim to achieve long-lasting results in pursuing a healthy lifestyle. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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14 pages, 1860 KiB

Open AccessArticle

Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner

by Madhawi M. Aldhwayan, Werd Al-Najim, Aruchuna Ruban, Michael Alan Glaysher, Brett Johnson, Navpreet Chhina, Georgios K. Dimitriadis, Christina Gabriele Prechtl, Nicholas A. Johnson, James Patrick Byrne, Anthony Peter Goldstone, Julian P. Teare, Carel W. Le Roux and Alexander Dimitri Miras

Nutrients 2022, 14(10), 2141; https://doi.org/10.3390/nu14102141 - 20 May 2022

Cited by 7 | Viewed by 3112

Abstract

The duodenal-jejunal bypass liner (Endobarrier) is an endoscopic treatment for obesity and type 2 diabetes mellitus (T2DM). It creates exclusion of the proximal small intestine similar to that after Roux-en-Y Gastric Bypass (RYGB) surgery. The objective of this study was to employ a reductionist approach to determine whether bypass of the proximal intestine is the component conferring the effects of RYGB on food intake and sweet taste preference using the Endobarrier as a research tool. A nested mechanistic study within a large randomised controlled trial compared the impact of lifestyle modification with vs. without Endobarrier insertion in patients with obesity and T2DM. Forty-seven participants were randomised and assessed at several timepoints using direct and indirect assessments of food intake, food preference and taste function. Patients within the Endobarrier group lost numerically more weight compared to the control group. Using food diaries, our results demonstrated similar reductions of food intake in both groups. There were no significant differences in food preference and sensory, appetitive reward, or consummatory reward domain of sweet taste function between groups or changes within groups. In conclusion, the superior weight loss seen in patients with obesity and T2DM who underwent the Endobarrier insertion was not due to a reduction in energy intake or change in food preferences. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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11 pages, 1397 KiB

Open AccessArticle

Are People with Obesity Attracted to Multidisciplinary Telemedicine Approach for Weight Management?

by Luisa Gilardini, Raffaella Cancello, Luca Cavaggioni, Amalia Bruno, Margherita Novelli, Sara P. Mambrini, Gianluca Castelnuovo and Simona Bertoli

Nutrients 2022, 14(8), 1579; https://doi.org/10.3390/nu14081579 - 11 Apr 2022

Cited by 6 | Viewed by 2581

Abstract

The forced isolation due to the COVID-19 pandemic interrupted the lifestyle intervention programs for people with obesity. This study aimed to assess: (1) the behaviors of subjects with obesity towards medical care during the pandemic and (2) their interest in following a remotely delivered multidisciplinary program for weight loss. An online self-made survey addressed to subjects with obesity was linked to the official website of our institute. Four hundred and six subjects completed the questionnaire (90% females, 50.2 ± 11.6 years). Forty-six percent of the subjects cancelled any scheduled clinical assessments during the pandemic, 53% of whom had chronic disease. Half of the subjects were prone to following a remotely delivered lifestyle intervention, especially with a well-known health professional. About 45% of the respondents were favorable towards participating in remote psychological support and nutritional intervention, while 60% would practice physical activity with online tools. Male subjects and the elderly were more reluctant than those female and younger, especially for online psychological support. Our survey showed an interest on the part of the subjects with obesity to join a multidisciplinary weight loss intervention remotely delivered. Male subjects and the elderly seem less attracted to this intervention, and this result highlights that, even with telemedicine, the approach to weight management should be tailored. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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Review

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31 pages, 1917 KiB

Open AccessEditor’s ChoiceReview

The Potential of the Mediterranean Diet to Improve Mitochondrial Function in Experimental Models of Obesity and Metabolic Syndrome

by Mohamad Khalil, Harshitha Shanmugam, Hala Abdallah, Jerlin Stephy John Britto, Ilaria Galerati, Javier Gómez-Ambrosi, Gema Frühbeck and Piero Portincasa

Nutrients 2022, 14(15), 3112; https://doi.org/10.3390/nu14153112 - 28 Jul 2022

Cited by 30 | Viewed by 6872

Abstract

The abnormal expansion of body fat paves the way for several metabolic abnormalities including overweight, obesity, and diabetes, which ultimately cluster under the umbrella of metabolic syndrome (MetS). Patients with MetS are at an increased risk of cardiovascular disease, morbidity, and mortality. The coexistence of distinct metabolic abnormalities is associated with the release of pro-inflammatory adipocytokines, as components of low-to-medium grade systemic inflammation and increased oxidative stress. Adopting healthy lifestyles, by using appropriate dietary regimens, contributes to the prevention and treatment of MetS. Metabolic abnormalities can influence the function and energetic capacity of mitochondria, as observed in many obesity-related cardio-metabolic disorders. There are preclinical studies both in cellular and animal models, as well as clinical studies, dealing with distinct nutrients of the Mediterranean diet (MD) and dysfunctional mitochondria in obesity and MetS. The term “Mitochondria nutrients” has been adopted in recent years, and it depicts the adequate nutrients to keep proper mitochondrial function. Different experimental models show that components of the MD, including polyphenols, plant-derived compounds, and polyunsaturated fatty acids, can improve mitochondrial metabolism, biogenesis, and antioxidant capacity. Such effects are valuable to counteract the mitochondrial dysfunction associated with obesity-related abnormalities and can represent the beneficial feature of polyphenols-enriched olive oil, vegetables, nuts, fish, and plant-based foods, as the main components of the MD. Thus, developing mitochondria-targeting nutrients and natural agents for MetS treatment and/or prevention is a logical strategy to decrease the burden of disease and medications at a later stage. In this comprehensive review, we discuss the effects of the MD and its bioactive components on improving mitochondrial structure and activity. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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14 pages, 288 KiB

Open AccessReview

The Impact Once-Weekly Semaglutide 2.4 mg Will Have on Clinical Practice: A Focus on the STEP Trials

by Khaled Alabduljabbar, Werd Al-Najim and Carel W. le Roux

Nutrients 2022, 14(11), 2217; https://doi.org/10.3390/nu14112217 - 26 May 2022

Cited by 13 | Viewed by 9140

Abstract

Obesity is a complex and chronic disease that raises the risk of various complications. Substantial reduction in body weight improves these risk factors. Lifestyle changes, including physical activity, reduced caloric ingestion, and behavioral therapy, have been the principal pillars in the management of obesity. In recent years, pharmacologic interventions have improved remarkably. The Semaglutide Treatment Effect in People with Obesity (STEP) program is a collection of phase-III trials geared toward exploring the utility of once-weekly 2.4 mg semaglutide administered subcutaneously as a pharmacologic agent for patients with obesity. All the STEP studies included diet and exercise interventions but at different intensities. This review paper aims to explore the impact of the behavioral programs on the effect of semaglutide 2.4 mg on weight loss. The results of the STEP trials supported the efficacy of high-dose, once-weekly 2.4 mg semaglutide on body weight reduction among patients with obesity with/without diabetes mellitus. Semaglutide was associated with more gastrointestinal-related side effects compared to placebo but was generally safe and well tolerated. In all the STEP studies, despite the varying intestines of the behavioral programs, weight loss was very similar. For the first time, there may be a suggestion that these behavioral programs might not increase weight reduction beyond the effect of semaglutide. Nevertheless, the importance of nutritional support during substantial weight loss with pharmacotherapy needs to be re-evaluated. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

19 pages, 3069 KiB

Open AccessEditor’s ChoiceReview

Time to Consider the “Exposome Hypothesis” in the Development of the Obesity Pandemic

by Victoria Catalán, Iciar Avilés-Olmos, Amaia Rodríguez, Sara Becerril, José Antonio Fernández-Formoso, Dimitrios Kiortsis, Piero Portincasa, Javier Gómez-Ambrosi and Gema Frühbeck

Nutrients 2022, 14(8), 1597; https://doi.org/10.3390/nu14081597 - 12 Apr 2022

Cited by 56 | Viewed by 8584

Abstract

The obesity epidemic shows no signs of abatement. Genetics and overnutrition together with a dramatic decline in physical activity are the alleged main causes for this pandemic. While they undoubtedly represent the main contributors to the obesity problem, they are not able to fully explain all cases and current trends. In this context, a body of knowledge related to exposure to as yet underappreciated obesogenic factors, which can be referred to as the “exposome”, merits detailed analysis. Contrarily to the genome, the “exposome” is subject to a great dynamism and variability, which unfolds throughout the individual’s lifetime. The development of precise ways of capturing the full exposure spectrum of a person is extraordinarily demanding. Data derived from epidemiological studies linking excess weight with elevated ambient temperatures, in utero, and intergenerational effects as well as epigenetics, microorganisms, microbiota, sleep curtailment, and endocrine disruptors, among others, suggests the possibility that they may work alone or synergistically as several alternative putative contributors to this global epidemic. This narrative review reports the available evidence on as yet underappreciated drivers of the obesity epidemic. Broadly based interventions are needed to better identify these drivers at the same time as stimulating reflection on the potential relevance of the “exposome” in the development and perpetuation of the obesity epidemic. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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38 pages, 492 KiB

Open AccessFeature PaperEditor’s ChoiceReview

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies

by Samuel J. Dicken and Rachel L. Batterham

Nutrients 2022, 14(1), 23; https://doi.org/10.3390/nu14010023 - 22 Dec 2021

Cited by 126 | Viewed by 22922

Abstract

Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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Other

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11 pages, 662 KiB

Open AccessPerspective

Obesity Subtyping: The Etiology, Prevention, and Management of Acquired versus Inherited Obese Phenotypes

by Edward Archer and Carl J. Lavie

Nutrients 2022, 14(11), 2286; https://doi.org/10.3390/nu14112286 - 30 May 2022

Cited by 13 | Viewed by 4792

Abstract

The etiology of obesity is complex and idiosyncratic—with inherited, behavioral, and environmental factors determining the age and rate at which excessive adiposity develops. Moreover, the etiologic status of an obese phenotype (how and when it developed initially) strongly influences both the short-term response to intervention and long-term health trajectories. Nevertheless, current management strategies tend to be ‘one-size-fits-all’ protocols that fail to anticipate the heterogeneity of response generated by the etiologic status of each individual’s phenotype. As a result, the efficacy of current lifestyle approaches varies from ineffective and potentially detrimental, to clinically successful; therefore, we posit that effective management strategies necessitate a personalized approach that incorporates the subtyping of obese phenotypes. Research shows that there are two broad etiologic subtypes: ‘acquired’ and ‘inherited’. Acquired obesity denotes the development of excessive adiposity after puberty—and because the genesis of this subtype is behavioral, it is amenable to interventions based on diet and exercise. Conversely, inherited obesity subsumes all forms of excessive adiposity that are present at birth and develop prior to pubescence (pediatric and childhood). As the inherited phenotype is engendered in utero, this subtype has irreversible structural (anatomic) and physiologic (metabolic) perturbations that are not susceptible to intervention. As such, the most realizable outcome for many individuals with an inherited subtype will be a ‘fit but fat’ phenotype. Given that etiologic subtype strongly influences the effects of intervention and successful health management, the purpose of this ‘perspective’ article is to provide a concise overview of the differential development of acquired versus inherited obesity and offer insight into subtype-specific management. Full article

(This article belongs to the Special Issue Feature Articles on Nutrition and Obesity Management)

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