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Aston L.M.,MRC Human Nutrition Research | Jackson D.,MRC Human Nutrition Research | Monsheimer S.,Maastricht University | Whybrow S.,University of Surrey | And 11 more authors.
Obesity Reviews | Year: 2010

There is growing evidence that the glycaemic index (GI) of the diet is important with respect to body weight and metabolic disease risk. However, research is limited by the paucity of GI values for commonly consumed carbohydrate-rich foods in European countries. A new methodology has been developed for consistent assignment of GI values to foods across five European databases used in the Diogenes intervention study. GI values were assigned according to five decreasing levels of confidence (1) Measured values for specific foods; (2) Published values from published sources; (3) Equivalent values where published values for similar foods existed; (4) Estimated values assigned as one of three values representing low/medium/high GI ranges and (5) Nominal values assigned as 70, where no other value could be assigned with sufficient confidence. GI values were assigned to 5105 foods. In food records collected at baseline, the contribution to carbohydrate intake of foods assigned levels 1-2 ranged from 16% to 43% depending on country, and this increased to 53-81% including level 3 foods. The degree of confidence to assigned GI values differed across Europe. This standardized approach of assigning GI values will be made available to other researchers to facilitate further investigation into the effects of dietary GI on health. © 2010 International Association for the Study of Obesity.


McConnon A.,University of Surrey | Raats M.,University of Surrey | Astrup A.,Copenhagen University | Bajzova M.,Charles University | And 8 more authors.
Appetite | Year: 2012

Using the Theory of Planned Behaviour (TPB), this study investigates weight control in overweight and obese participants (27kg/m 2≤BMI<45kg/m 2) taking part in a dietary intervention trial targeted at weight loss maintenance (n=932). Respondents completed TPB measures investigating " weight gain prevention" at three time points. Correlation and regression analyses were used to investigate the relationship between TPB variables and weight regain. The TPB explained up to 27% variance in expectation, 14% in intention and 20% in desire scores. No relationship was established between intention, expectation or desire and behaviour at Time 1 or Time 2. Perceived need and subjective norm were found to be significantly related to weight regain, however, the model explained a maximum of 11% of the variation in weight regain. Better understanding of overweight individuals' trajectories of weight control is needed to help inform studies investigating people's weight regain behaviours. Future research using the TPB model to explain weight control should consider the likely behaviours being sought by individuals. © 2011 Elsevier Ltd.


Larsen T.M.,Copenhagen University | Dalskov S.,Copenhagen University | Van Baak M.,Maastricht University | Jebb S.,Human Nutrition Research | And 8 more authors.
Obesity Reviews | Year: 2010

Diogenes is a Pan-European, randomized, controlled dietary intervention study investigating the effects of dietary protein and glycaemic index on weight (re)gain, metabolic and cardiovascular risk factors in obese and overweight families in eight European centres. The article is methodological in character, and the presentation of 'results' will be limited to baseline characteristics of the study populations included. A total of 891 families with at least one overweight/obese parent underwent screening. The parents started an initial 8-week low-calorie diet and families with minimum one parent attaining a weight loss of ≥8%, were randomized to one of five energy ad libitum, low-fat (25-30 E%) diets for 6 or 12 months: low protein/low glycaemic index, low protein/high glycaemic index, high protein/low glycaemic index, high protein/high glycaemic index or control (national dietary guidelines). At two centres the families were provided dietary instruction plus free foods for 6 months followed by 6-month dietary instruction only. At the remaining six centres the families received dietary instruction only for 6 months. The median weight loss during the low-calorie diet was 10.3 kg (inter-quartile range: 8.7-12.8 kg, n = 775). A total of 773 adults and 784 children were randomized to the 6-month weight (re)gain prevention phase. Despite major cultural and dietary regional differences in Europe, interventions addressing effects of dietary factors are feasible with a reasonable attrition. © 2009 International Association for the Study of Obesity.


Moore C.S.,MRC Human Nutrition Research | Lindroos A.K.,MRC Human Nutrition Research | Kreutzer M.,Copenhagen University | Larsen T.M.,Copenhagen University | And 9 more authors.
Obesity Reviews | Year: 2010

The aim of this study was to describe the development and implementation of a multifaceted, low-fat, weight-loss strategy for a Pan-European randomized controlled dietary intervention study, Diogenes. There were 891 families with at least one overweight/obese parent who underwent screening. Eligible, overweight/obese adults followed an 8-week weight-loss phase with a fixed low-energy diet (800 kcal). On attaining weight loss of ≥8%, families were randomized to a 6- or 12-month low-fat (25-30%E) diet either based on national dietary guidelines or one of four interventions: low protein (LP)/low glycaemic index (LGI), LP/high GI (HGI), high protein (HP)/LGI and HP/HGI. The impact of each diet in preventing weight (re)gain was tested. A points-based system was used to manipulate dietary protein and carbohydrate. Manipulating carbohydrate composition involved substituting foods with a relatively high or low GI. A questionnaire was designed and completed by study investigators, providing feedback on the dietary intervention methods used to inform future interventions. The points system allowed macronutrient manipulations without compromising dietary flexibility or enforcing energy restrictions. Reported centre/participant differences in the ease of implementing the intervention may reflect dietary diversity and personal preferences for specific weight-management strategies. The points system provides a useful starting point for designing improved experimental paradigms for the manipulation of dietary intake in future trials. © 2009 International Association for the Study of Obesity.


Wang P.,Maastricht University | Holst C.,Copenhagen University | Wodzig W.K.W.H.,Maastricht University | Andersen M.R.,Copenhagen University | And 14 more authors.
International Journal of Obesity | Year: 2012

BACKGROUND:Circulating angiotensin-converting enzyme (ACE) was identified as a predictor of weight loss maintenance in overweight/obese women of the Diogenes project.OBJECTIVE:To investigate whether ACE acted also as a predictor in men of the Diogenes study and to compare it with that in women.DESIGN: Subjects, who lost ≥8% of body weight induced by low-caloric diet in an 8-week weight loss period, were assigned to weight loss maintenance with dietary intervention for 6 months.SUBJECTS:125 overweight/obese healthy men from eight European countries who completed whole intervention.MEASUREMENTS:Concentrations and activity of serum ACE at baseline and after the 8-week weight loss, in addition to anthropometric and physiological parameters.RESULTS:Serum ACE concentration decreased by 11.3±10.6% during the weight loss period in men. A greater reduction is associated with less body weight regain during the maintenance period (r=0.227, P=0.012). ACE change was able to predict a weight regain ≤20% after 6 months, with an odds ratio of 1.59 (95% confidence interval (CI): 1.09-2.33, P=0.016) for every 10% reduction, which was independent of body mass index and weight loss. The prediction power was weaker in men than in women, but without a significant sex difference (P=0.137). In pooled subjects (N=218), the odds ratio was 1.96 (95% CI: 1.46-2.64, P<0.001).CONCLUSIONS:A greater reduction of ACE during weight loss is favorable for weight maintenance in both men and women. This can offer useful information for personalized advice to improve weight loss maintenance. It also confirms the role of ACE in the metabolic pathways of weight regulation. © 2012 Macmillan Publishers Limited. All rights reserved.


Aller E.E.J.G.,Maastricht University | Larsen T.M.,Copenhagen University | Claus H.,MRC Human Nutrition Research | Lindroos A.K.,University of Crete | And 10 more authors.
International Journal of Obesity | Year: 2014

Background:A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce.Objective:The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year.Method:After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27 kg m-2) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period.Results:During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0-4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups.Conclusion:A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months. © 2014 Macmillan Publishers Limited All rights reserved.


PubMed | Copenhagen University, Institute of Endocrinology, National Multiprofile Transport Hospital, MRC Human Nutrition Research and 4 more.
Type: Journal Article | Journal: Nutrition (Burbank, Los Angeles County, Calif.) | Year: 2014

We investigated the effects of weight loss and maintenance with diets that varied with regard to protein content and glycemic index (GI) on metabolic syndrome (MetSyn) status.Secondary analyses were performed within the Diet, Obesity and Genes (DiOGenes) study (2006-2008), a randomized controlled dietary intervention. Nine hundred and thirty-eight overweight and obese adults from eight European countries entered an 8-wk low-calorie-diet period. Seven hundred and seventy-three adults who lost at least 8% of their body weights were randomized to one of five ad libitum diets for 6 mo: 1) low-protein (LP)/low-GI (LGI); 2) LP/high-GI (HGI); 3) high-protein (HP)/LGI; 4) HP/HGI; and 5) control diet. MetSyn prevalence and a standardized MetSyn score were assessed at baseline, after the low-calorie diet, and after the intervention.Weight loss among participants while on the low-calorie diet significantly reduced MetSyn prevalence (33.9% versus 15.9%; P < 0.001) and MetSyn score (-1.48 versus -4.45; P < 0.001). During weight maintenance, significant changes in MetSyn score were observed between the groups, with the highest increase detected in the LP/HGI group (P = 0.039, partial (2) = 0.023). Protein, GI, and their interaction did not have isolated effects on study outcomes.Neither protein nor GI affected MetSyn status in this sample of European overweight and obese adults. However, a diet with a combination of an increased protein-to-carbohydrate ratio with low-GI foods had beneficial effects on MetSyn factors.


PubMed | Gentofte University Hospital, Copenhagen University, Institute of Endocrinology, National Multiprofile Transport Hospital and 6 more.
Type: Journal Article | Journal: International journal of obesity (2005) | Year: 2014

A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce.The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year.After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27kgm(-)(2)) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period.During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0-4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups.A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months.


Ikonomova K.,National Multiprofile Transport Hospital | Toncheva A.,National Multiprofile Transport Hospital
Revmatologiia (Bulgaria) | Year: 2012

The main bone unit is made up of osteoblasts, osteocytes and osteoclasts. The osteoblasts produce osteoid, consisted of collagen and non-collagen matrix proteins. These cells express variety of receptors and adhesion molecules that are coupled with signaling pathways, responsible for cell activation, proliferation and apoptosis. Osteoblasts produce hormones, growth factors and cytokines. Osteocytes represent 90% of all bone cells in adults. They are terminally differentiated cells and possess a lot of dendrits, through which the communications with other bone cells is realized. Osteoclasts descend from the monocyte stem cells, possess phagocyte properties and are responsible for bone resorption. The organic bone matrix consists of collagen type 1 and non-collagen proteins. The non-organic matrix is made up of calcium salts in the form of hydroxiapatite. The bone cells participate not only in bone structure and remodeling processes but also in energy metabolism, mineral homeostasis and immune function. The considerable progress in the knowledge of cell and molecular structure of the bone provides the medical specialists with a number of reliable laboratory markers of bone formation and resorption. Parallel with the examination of bone markers, a variety of biochemical hematological and hormonal tests are performed.


Ikonomova K.,National Multiprofile Transport Hospital
Revmatologiia (Bulgaria) | Year: 2012

Osteoarthrosis (OA) is the most common chronic joint disease which is the main reason for disability in the elderly. There are many unsolved problems concerning the diagnosis, progression of the disease and treatment. These attract the attention of the scientists and make OA one of the most investigated fields in rheumatology. Biomechanical factors and genetic predisposition participate in the development of OA, as well as the subhondral bone, cytokines and protein kinases. Searching for genetic markers that may predict the onset and development of OA is the main goal of laboratory investigations. The scientists study the role of biomechanical factors that change cartilage metabolism and expression of cytokines and chondrolytic factors. They look for reliable laboratory markers, which are positive before the radiological signs of OA. The introduction of new biomarkers will facilitate the diagnosis, as well as the evaluation of OA activity and progression. It will contribute to more effective therapy directed to the main causes for the onset of pathological processes.

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