A prospective study of dairy consumption in relation to changes in metabolic risk factors: the Hoorn Study

Objective: Higher dairy consumption has been suggested to reduce the risk of obesity and metabolic disturbances. The aim of our study was to investigate the prospective association between dairy consumption and changes in weight and metabolic disturbances. Methods and Procedures: Baseline dairy intake (servings/day) was assessed by a semi‐quantitative food‐frequency questionnaire in 1,124 participants of the Hoorn Study. Linear and logistic regression analyses were performed to investigate the association between dairy intake and 6.4‐year change in weight, fat distribution, and metabolic risk factors (glucoses, lipids, blood pressure) and the incidence of metabolic syndrome (MS). Results: Baseline dairy consumption was not associated with changes in fasting and post‐load glucose concentrations, serum lipid levels (high‐density lipoprotein‐cholesterol, low‐density lipoprotein‐cholesterol, and triglycerides), or blood pressure, nor with the risk of developing the MS in 6.4 years (odds ratio with 95% confidence interval was 0.86 (0.52–1.42) comparing highest with lowest quartile of dairy consumption). In subjects with BMI < 25 kg/m², higher dairy consumption was significantly associated with an increase in BMI, weight, waist, and a decrease in high‐density lipoprotein. Discussion: Our results do not support the hypothesis that a higher dairy consumption protects against weight gain and development of metabolic disturbances in a Dutch elderly population.     

Effect of Fat Sources on Satiety

Objective: There are inconsistent reports on the satiety value of different fatty acids. This study compared the appetitive effects of two fat sources rich in monounsaturated fatty acids (peanut oil and canola oil) with a source rich in saturated fatty acids (butter). Research Methods and Procedures: After an overnight fast, lean participants completed a questionnaire eliciting information about hunger, fullness, desire to eat, and prospective consumption. They then consumed one of the preloads (muffins containing 40 g of each fat source or no fat) and 150 mL of water within 15 minutes. Questionnaires were completed again 30, 60, and 120 minutes after preload ingestion. Participants kept dietary records during the subsequent 24 hours. Results: Canola and peanut oil muffins resulted in higher fullness, and butter, canola, and peanut oil muffins resulted in lower hunger ratings 30, 60, and 120 minutes after preload ingestion compared with the fat‐free preload. No differences were observed among the fat‐containing loads. Although energy intake 24 hours after consumption of the preloads was also comparable on days the three fat‐containing loads were consumed, energy consumption after each study session was higher when the fat‐free muffins were provided. However, total energy intake, including the calories provided by the preloads, was similar across treatments. Discussion: These data do not support a differential satiety effect of fat sources rich in monounsaturated fatty acids relative to one rich in saturated fatty acids.     

Effect of Low‐ and High‐Calcium Dairy‐Based Diets on Macronutrient Oxidation in Humans

Objective: Higher calcium and dairy intakes may be associated with lower body weights, but a mechanism in humans has yet to be elucidated. We compared the effects of a dairy‐based high‐calcium diet and a low‐calcium diet on macronutrient oxidation. Research Methods and Procedures: Subjects (10 men and nine women) consumed a low‐dairy (LD, ～one serving per day, ～500 mg Ca²⁺/d) or high‐dairy (HD, ～three to four servings per day, ～1400 mg Ca²⁺/d) energy balance diet for 1 week. Each diet condition was performed twice. On the 7th day, subjects were studied in a room calorimeter under one of four study conditions, applied in a randomized crossover design. Within each diet condition, subjects were studied under conditions of energy balance and acute energy deficit. The deficit (?600 kcal/d) was induced only for the 24 hours that subjects resided in the room and was achieved by a combination of caloric restriction and exercise. Results: Under energy balance conditions, there was no effect of diet treatment on respiratory quotient or 24‐hour macronutrient oxidation. Under energy deficit conditions, 24‐hour fat oxidation was significantly increased on the HD diet (HD with deficit = 136 ± 13 g/d, LD with deficit = 106 ± 7 g/d, p = 0.02). Discussion: Consumption of a dairy‐based high‐calcium diet increased 24‐hour fat oxidation under conditions of acute energy deficit. We hypothesize that these effects are due to an increased fat oxidation during exercise.     

Effects of Calcium and Dairy on Body Composition and Weight Loss in African‐American Adults

Objective: Our objective was to determine the effects of dairy consumption on adiposity and body composition in obese African Americans. Research Methods and Procedures: We performed two randomized trials in obese African‐American adults. In the first (weight maintenance), 34 subjects were maintained on a low calcium (500 mg/d)/low dairy (<1 serving/d) or high dairy (1200 mg Ca/d diet including 3 servings of dairy) diet with no change in energy or macronutrient intake for 24 weeks. In the second trial (weight loss), 29 subjects were similarly randomized to the low or high dairy diets and placed on a caloric restriction regimen (?500 kcal/d). Results: In the first trial, body weight remained stable for both groups throughout the maintenance study. The high dairy diet resulted in decreases in total body fat (2.16 kg, p < 0.01), trunk fat (1.03 kg, p < 0.01), insulin (18.7 pM, p < 0.04), and blood pressure (6.8 mm Hg systolic, p < 0.01; 4.25 mm Hg diastolic, p < 0.01) and an increase in lean mass (1.08 kg, p < 0.04), whereas there were no significant changes in the low dairy group. In the second trial, although both diets produced significant weight and fat loss, weight and fat loss on the high dairy diet were ～2‐fold higher (p < 0.01), and loss of lean body mass was markedly reduced (p < 0.001) compared with the low dairy diet. Discussion: Substitution of calcium‐rich foods in isocaloric diets reduced adiposity and improved metabolic profiles in obese African Americans without energy restriction or weight loss and augmented weight and fat loss secondary to energy restriction.     

Effect of 1-year dairy product intervention on fat mass in young women: 6-month follow-up

Objective: Previous results from this laboratory suggest that a 1‐year dairy intake intervention in young women does not alter fat mass. The objective of this study was to determine the impact of the 1‐year dairy intervention 6 months after completion of the intervention. Research Methods and Procedures: Previously, normal‐weight young women (n = 154) were randomized to one of three calcium intake groups: control (<800 mg/d), medium dairy (1000 to 1100 mg/d), or high dairy (1300 to 1400 mg/d) for a 1‐year trial (n = 135 completed). In the current study, 51 women were assessed 6 months after completion of the intervention trial. Body compositions (body fat, lean mass) were measured using DXA. Self‐report questionnaires were utilized to measure activity and dietary intake (kilocalories, calcium). Results: The high‐dairy group (n = 19) maintained an elevated calcium intake (1027 ± 380 mg/d) at 18 months compared with the control group (n = 18, 818 ± 292; p = 0.02). Mean calcium intake over the 18 months predicted a negative change in fat mass (p = 0.04) when baseline BMI was controlled in regression analysis (model R² = 0.11). 25‐Hydroxyvitamin D levels were correlated with fat mass at each time‐point (baseline, r = ?0.41, p = 0.003; 12 months, r = ?0.42, p = 0.002; 18 months, r = ?0.32, p = 0.02) but did not predict changes in fat mass. Discussion: Dietary calcium intake over 18 months predicted a negative change in body fat mass. Thus, increased dietary calcium intakes through dairy products may prevent fat mass accumulation in young, healthy, normal‐weight women.     

A New Dental Approach for Reducing Food Intake

Objective: A behavioral recommendation for weight loss is reduction of size of bites of food. This “proof of concept” study tested the efficacy of a new, patented, dental approach, the DDS System, for reducing food intake. This removable tool is inserted into the upper palate of the mouth, reducing the size of the oral cavity, thereby potentially reducing bite size. Research Methods and Procedures: Thirty‐two adults (18 to 65 years) with BMI between 27 and 40 were randomly assigned to the control or experimental conditions. Participants ate all meals and stayed between meals at a research center. Day 1 served as baseline for both groups. On Day 2, experimental participants utilized the tool during meals. Changes in subjective ratings of hunger and satiety were measured using visual analog scales before and after each meal. Results: Food intake difference scores were calculated for each participant (Day 2 ? Day 1). Analysis of covariance on difference scores, using baseline as a covariate, showed that the experimental group ate significantly less (p < 0.05) on the second day (M = ?659.2 kcal/d) compared with the control group (M = ?125.9 kcal/d). Analysis of covariance, with ratings on Day 1 as a covariate, revealed that the experimental and control group did not differ on visual analog scale difference scores (premeal ? postmeal) from Day 1 to Day 2. Discussion: These findings suggest that use of this tool during meals significantly reduced food intake. This reduction of food intake was not associated with changes in ratings of hunger or satiety.     

Association of the LCT-13910C>T polymorphism with obesity and its modulation by dairy products in a Mediterranean population

The ?13910C>T polymorphism (rs4988235) upstream from the lactase (LCT) gene, strongly associated with lactase persistence (LP) in Europeans, is emerging as a new candidate for obesity. We aimed to analyze the association of this polymorphism with obesity‐related variables and its modulation by dairy product intake in an elderly population. We studied 940 high‐cardiovascular risk Spanish subjects (aged 67 ± 7 years). Dairy product consumption was assessed by a validated questionnaire. Anthropometric variables were directly measured, and metabolic syndrome‐related variables were obtained. Prevalence of genotypes was: 38.0% CC (lactase nonpersistent (LNP)), 45.7% CT, and 16.3% TT. The CC genotype was not associated with lower milk or dairy product consumption in the whole population. Only in women was dairy intake significantly lower in CC subjects. The most important association was obtained with anthropometric measurements. CC individuals had lower weight (P = 0.032), lower BMI (29.7 ± 4.2 vs. 30.6 ± 4.2 kg/m²; P = 0.003) and lower waist circumference (101.1 ± 11.8 vs. 103.5 ± 11.5 cm; P = 0.005) than T‐allele carriers. Obesity risk was also significantly higher in T‐allele carriers than in CC individuals (odds ratio (OR): 1.38; 95% confidence interval (CI): 1.05–1.81; P = 0.01), and remained significant even after adjustment for sex, age, diabetes, physical activity, and energy intake. However, in subgroup analysis, these associations were found to be significant only among those consuming moderate or high lactose intakes (>8 g/day). No significant associations with lipids, glucose, or blood pressure were obtained after adjustment for BMI. In conclusion, despite not finding marked differences in dairy product consumption, this polymorphism was strongly associated with BMI and obesity and modulated by lactose intake in this Mediterranean population.     

Effects of two weeks' mandatory snack consumption on energy intake and energy balance

Objective: Our goal was to compare the effects of mandatory consumption of commercial snack products (CSPs) on energy intakes and energy balance in free‐living adults and to assess the interaction between habitual level of CSP consumption and the interventions. Research Methods and Procedures: Four groups of 18 subjects (lean and overweight, males and females) were studied using a crossover design. Subjects consumed one type of CSP (high‐carbohydrate, high‐fat, or mixed composition) at three manipulations of energy 0 MJ (control), 1.5 MJ (low‐energy), and 3.0 MJ (high‐energy) each day during three 14‐day interventions. The study design was parallel for type of CSP (macronutrient composition) and within‐subjects for energy level. Subjects self‐recorded food intakes between Days 8 and 14, and body weights were investigator‐recorded on Days 1, 8, and 15 of each intervention period. Daily energy expenditure was estimated by heart rate monitoring. Results: Daily energy intakes increased from 10.4 MJ (control) to 11.1 MJ (low‐energy) and 11.5 MJ (high‐energy) (p < 0.001), resulting in a trend (not significant) for body weight gain. Energy balance was more positive when subjects were not recording their food intakes than when they were (p < 0.001). There was a trend (not significant) for greater increases in energy intake with increasing fat content, and energy density, of the interventions. Frequent CSP consumers compensated more for the interventions than did infrequent CSP consumers (R² = 0.125, p = 0.003). Discussion: Subjects partially compensated for energy when supplemented with CSPs over 14‐day periods, although this was insufficient to prevent some increase in energy balance. The level of compensation correlated with habitual energy intake from CSPs.     

Night Eating Syndrome Is Associated with Depression,Low Self‐Esteem,Reduced Daytime Hunger,and Less Weight Loss in Obese Outpatients

Objective: The objective of this study was to assess the relationship between the night eating syndrome (NES), measures of depression and self‐esteem, test meal intake, and weight loss in obese participants. Research Methods and Procedures: The study included 76 overweight (body mass index = 36.7 ± 6.5 SD) outpatients (53 women and 23 men; aged 43.5 ± 9.5 years) entering a weight loss program. They completed a Night Eating Questionnaire, the Zung Depression Inventory, and the Rosenberg Self‐Esteem Scale. Based on criteria by Stunkard et al. (Stunkard A, Berkowitz R, Wadden T, Tanrikut C, Reiss E, Young L. Binge eating disorder and the night eating syndrome. Int J Obes Relat Metab Disord. 1996;20:1–6), participants had NES if they reported: (1) skipping breakfast ≥4 d/wk, interpreted as morning anorexia; (2) consuming more than 50% of total daily calories after 7 pm ; and (3) difficulty falling asleep or staying asleep ≥4 d/wk. Eleven (14%) participants met the criteria for NES. After an 8‐hour fast, all participants ingested a nutritionally complete liquid meal through a straw from a large opaque cooler until extremely full. They also completed ratings of hunger and fullness before and after this meal. Results: Night eaters had higher depression (p = 0.04), lower self‐esteem (p = 0.003), and less hunger (p = 0.005), and a trend for more fullness (p = 0.06) before the daytime test meal than the others. However, there were no significant differences in test‐meal intake between groups. Nevertheless, test‐meal intake was greater later in the day only for the night eaters (p = 0.01). Over a 1‐month period, the night eaters lost less weight (4.4 ± 3.2 kg) than the others (7.3 ± 3.2 kg; p = 0.04), after controlling for body mass index. Discussion: NES is a syndrome with distinct psychopathology and increased food intake later in the day, both of which may contribute to poorer weight loss outcome. NES criteria need to be better quantified and NES deserves consideration as a diagnostic eating disorder.     

Calcium and dairy product modulation of lipid utilization and energy expenditure

Objective: The purpose of this study was to investigate the impact of dietary calcium or dairy product intake on total energy expenditure (TEE), fat oxidation, and thermic effect of a meal (TEM) during a weight loss trial. Methods and Procedures: The intervention included a prescribed 500‐kcal deficit diet in a randomized placebo‐controlled calcium or dairy product intervention employing twenty‐four 18 to 31‐year‐old (22.2 ± 3.1 years, mean ± s.d.) overweight women (75.5 ± 9.6 kg). TEM and fat oxidation were measured using respiratory gas exchange after a meal challenge, and TEE was measured by doubly labeled water. Fat mass (FM) and lean mass (fat‐free mass (FFM)) were measured by dual‐energy X‐ray absorptiometry. Subjects were randomized into one of these three intervention groups: (i) placebo (<800 mg/day calcium intake); (ii) 900 mg/day calcium supplement; (iii) three servings of dairy products/day to achieve an additional 900 mg/day. Results: There were no group effects observed in change in TEE; however, a group effect was observed for fat oxidation after adjusting for FFM (P = 0.02). The treatment effect was due to an increase in fat oxidation in the calcium‐supplemented group of 1.5 ± 0.6 g/h, P = 0.02. Baseline 25‐hydroxyvitamin D (25OHD) was positively correlated with TEM (R = 0.31, P = 0.004), and trended toward a correlation with fat oxidation (P = 0.06), independent of group assignment. Finally, the change in log parathyroid hormone (PTH) was positively correlated with the change in trunk FM (R = 0.27, P = 0.03). Discussion: These results support that calcium intake increases fat oxidation, but does not change TEE and that adequate vitamin D status may enhance TEM and fat oxidation.     

Intake of fruits and vegetables in relation to 10-year weight gain among Spanish adults

Objective: Despite the alarming increase in the prevalence of obesity, epidemiologic studies that prospectively examine the fruit and vegetable consumption and other lifestyle factors in relation to weight gain (WG) are still insufficient. We explored the associations between fruit and vegetable intake and WG over a 10‐year period in an adult Mediterranean population. Methods and Procedures: We performed a 10‐year follow‐up study with healthy participants (n = 206) aged 15–80 years at baseline in 1994, who participated in a nutrition survey in Valencia, Spain. Data on diet, lifestyle factors, and body weight were obtained in 1994 and 2004 using a food frequency questionnaire (FFQ) and direct measurements. Results: The average WG over the study period was 3.41 (s.d. 6.9) kg. In multivariate analyses, participants in the third quartile of fruit intake at baseline in 1994 had lower risk of WG ≥ 3.41 kg compared to those in the lowest quartile (oddsratio (OR) = 0.31, 95% confidence interval (CI), 0.11–0.85; P trend = 0.044). Regarding vegetable intake, the risk of WG was lowest in participants of the fourth quartile (>333 g/day), which had an 84% reduced risk of gaining 3.41 kg weight (OR = 0.18, 95% CI, 0.05–0.66; P trend = 0.017). When the intake of fruits and vegetables was combined, the risk of WG decreased across quartiles, with the lowest risk among those in the fourth quartile (OR = 0.22, 95% CI, 0.06–0.81; P trend = 0.022). Further adjustment for an increased intake of fruits and vegetables over the past 10 years reported by participants in 2004 did not appreciably alter the observed ORs. Discussion: Dietary patterns associated with a high intake of fruits and vegetables in Mediterranean populations may reduce long‐term risk of subsequent WG and obesity among adults.     

Effects of a Low‐intensity Intervention That Prescribed a Low‐carbohydrate vs. a Low‐fat Diet in Obese,Diabetic Participants

Low‐carbohydrate diets have been associated with significant reductions in weight and HbA_1c in obese, diabetic participants who received high‐intensity lifestyle modification for 6 or 12 months. This investigation sought to determine whether comparable results to those of short‐term, intensive interventions could be achieved over a 24‐month study period using a low‐intensity intervention that approximates what is feasible in outpatient practice. A total of 144 obese, diabetic participants were randomly assigned to a low‐carbohydrate diet (<30 g/day) or to a low fat diet (≤30% of calories from fat with a deficit of 500 kcal/day). Participants were provided weekly group nutrition education sessions for the first month, and monthly sessions thereafter through the end of 24 months. Weight, HbA_1c, glucose, and lipids were measured at baseline and 6, 12, and 24 months. Of the 144 enrolled participants, 68 returned for the month 24 assessment visit. Weights were retrieved from electronic medical records for an additional 57 participants (total, 125 participants) at month 24. All participants with a baseline measurement and at least one of the three other measurements were included in the mixed‐model analyses (n = 138). The low‐intensity intervention resulted in modest weight loss in both groups at month 24. At this time, participants in the low‐carbohydrate group lost 1.5 kg, compared to 0.2 kg in the low‐fat group (P = 0.147). Lipids, glycemic indexes, and dietary intake did not differ between groups at month 24 (or at months 6 or 12) (ClinicalTrials.gov number, NCT00108459).     

Low dairy intake in early childhood predicts excess body fat gain

Objective: To estimate the effect of dairy intake in early childhood on the acquisition of body fat throughout childhood. Research Methods and Procedures: Ninety‐nine of the original 106 families enrolled in the Framingham Children's Study with a child age to 6 years at baseline were followed into adolescence through yearly clinic visits and periodic data collection throughout each year. Dairy intake for these analyses was derived from a mean of 15 days of diet records per subject collected before age 6. A trained examiner took two measurements each year of height, weight, and triceps, subscapular, suprailiac, and abdominal skinfolds using a standardized protocol. Yearly change in body fat was estimated as the slope of these anthropometry measures from ages 5 to 13 years. Early adolescent body fat was estimated as the mean of all available measurements from 10 to 13 years of age. Results: Children in the lowest sex‐specific tertile of dairy intake during preschool (i.e., <1.25 servings per day for girls and <1.70 servings per day for boys) had significantly greater gains in body fat during childhood. These children with low dairy intakes gained more than 3 additional mm of subcutaneous fat per year in the sum of four skinfold measures. By the time of early adolescence, those in the lowest tertile of dairy intake had a BMI that was approximately two units higher and an extra 25 mm of subcutaneous fat. Discussion: Suboptimal dairy intakes during preschool in this cohort were associated with greater gains in body fat throughout childhood.     

Effect of Energy‐Reduced Diets High in Dairy Products and Fiber on Weight Loss in Obese Adults

Objective: Studies suggest that high‐dairy and high‐fiber/low‐glycemic index diets may facilitate weight loss, but data are conflicting. The effects on weight loss and body fat of a high‐dairy diet and a diet high in dairy and fiber and low in glycemic index were compared with a standard diet. Research Methods and Procedures: Ninety obese subjects were recruited into a randomized trial of three diets designed to provide a calorie deficit of 500 calories/d over a 48‐week period. The study compared a moderate (not low)‐calcium diet with a high‐calcium diet. Results: Seventy‐two subjects completed the study. Significant weight and fat loss occurred with all three diets. A diet with 1400 mg of calcium did not result in greater weight (11.8 ± 6.1 kg) or fat (9.0 ± 6.0 kg) loss than a diet with 800 mg of calcium (10.0 ± 6.8 and 7.5 ± 6.6 kg, respectively). A diet with 1400 mg of calcium, increased fiber content, and fewer high‐glycemic index foods did not result in greater weight (10.6 ± 6.8 kg) or fat (8.5 ± 7.8 kg) loss than the standard diet with 800 mg of calcium. Lipid profile, high‐sensitivity C‐reactive protein, leptin, fasting glucose, and insulin improved significantly, but there were no significant differences between the experimental diets and the control diet. Discussion: We found no evidence that diets higher than 800 mg of calcium in dairy products or higher in fiber and lower in glycemic index enhance weight reduction beyond what is seen with calorie restriction alone.     

Physical activity patterns during weight maintenance following a low-energy density dietary intervention

Objective: The objective was to determine the role of physical activity (PA) and energy intake on weight maintenance among former University of Alabama at Birmingham EatRight Weight Management Program participants. Research Methods and Procedures: Eighty‐nine former participants completed follow‐up visits ≥1 year after completing EatRight. BMI was calculated using measured height and weight. Diet intake was estimated from 4‐day food records. PA was assessed using a module from the Behavioral Risk Factor Surveillance System Survey. Cut‐off points were chosen based on the distribution of minutes of activity. For moderate and total activity, cut‐off points were 0, 1 to 30, 31 to 60, and >60 minutes. For vigorous activity, the categories were 0, 1 to 20, 21 to 30, and >30 minutes. General linear models determined the association of PA with change in weight at follow‐up controlling for gender and total energy intake (kcal/d). Results: At follow‐up, 80% (n = 71) of participants maintained (regained <5% of program end weight) their body weight and 20% had gained weight. Mean weight change was 1.0 ± 6.5 kg. Maintainers consumed 384 fewer kcal/d on average. Maintainers had a lower energy density dietary pattern (1.58 vs. 2.01 kcal/g, p < 0.01). There was no significant difference in PA min/d reported by maintainers and gainers. Discussion: Our results suggest that, despite being minimally active, weight‐reduced individuals can successfully maintain their newly achieved body weight with appropriate caloric intake. Adopting a lower calorie, low energy density dietary pattern may reduce the amount of PA that is truly necessary for weight maintenance.     

Water and Food Consumption Patterns of U.S. Adults from 1999 to 2001

Objective: High water consumption has been proposed as an aid to weight control and as a means of reducing the energy density of the diet. This study examines the relationship between water consumption and other drinking and eating patterns. Research Methods and Procedures: The National Health and Nutrition Examination Survey 1999 to 2001, with responses from 4755 individuals ≥18 years of age, provides the data for this cross‐sectional analysis. A cluster analysis was performed using z‐scores of specific food and beverage consumption to examine patterns. A multinomial logit analysis was used to examine sociodemographic characteristics of each dietary pattern and to examine the effects of water consumption on the likelihood of consuming a non–dairy caloric beverage. All results were weighted to be nationally representative and controlled for design effects. Results: Within the sample, 87% consumed water, with an average daily consumption of 51.9 oz (1.53 liters) per consumer. Water consumers drank fewer soft/fruit drinks and consumed 194 fewer calories per day. Water consumers (potentially a self‐selected sample) consumed more fruits, vegetables, and low‐ and medium‐fat dairy products. Four distinct unhealthy dietary patterns were found that included little or no water consumption. Older and more educated persons used healthier food patterns. Mexican dietary patterns were much healthier than dietary patterns of blacks. Discussion: Water consumption potentially is a dietary component to be promoted, but much more must be understood about its role in a healthy diet. Because high water consumption is linked with healthier eating patterns—patterns more likely to be followed by higher‐educated, older adults—the target of water promotion and healthy diet options should focus on younger and less educated adults.     

Long-term dietary intervention trials: critical issues and challenges

ABSTRACT: BACKGROUND: There are many challenges involved in running randomised controlled dietary intervention trials that investigate health outcomes. The aim of this paper was to evaluate the recruitment process, retention of participants and challenges faced in our dairy intervention trial, and to provide strategies to combat the difficulties of running long-term dietary intervention trials. METHODS: A 12-month, randomised, two-way crossover study in overweight adults with habitually low dairy food consumption designed to assess the effects of a high dairy intake (HD; 4 serves of reduced fat dairy per day) compared to a low dairy intake (LD; 1 serve of reduced fat dairy per day) on measures of cardiometabolic and cognitive health was conducted. On completion of the HD phase, each participant was interviewed about their experience in the trial and responses were used to evaluate the key issues for study participants. RESULTS: Although the recruitment target was achieved, high rates of attrition (49.3%) and difficulties maintaining participant compliance (reported by 37.8% of participants) were major threats to the viability of the study. Factors that contributed to the high attrition included inability to comply with the dietary requirements of the study protocol (27.0%), health problems or medication changes (24.3%) and time commitment (10.8%). CONCLUSIONS: Attrition and adherence to study requirements present challenges to trials requiring longer-term dietary change. Including a run-in period to further assess the motivation, commitment and availability of participants, maintaining regular contact with participants during control phases, minimising time commitment, providing flexibility with dietary requirements, facilitating positive experiences, and stringent monitoring of diet are some key recommendations for future dietary intervention trials.     

Medium‐Chain Triglycerides Increase Energy Expenditure and Decrease Adiposity in Overweight Men

Objective: The objectives of this study were to compare the effects of diets rich in medium‐chain triglycerides (MCTs) or long‐chain triglycerides (LCTs) on body composition, energy expenditure, substrate oxidation, subjective appetite, and ad libitum energy intake in overweight men. Research Methods and Procedures: Twenty‐four healthy, overweight men with body mass indexes between 25 and 31 kg/m² consumed diets rich in MCT or LCT for 28 days each in a crossover randomized controlled trial. At baseline and after 4 weeks of each dietary intervention, energy expenditure was measured using indirect calorimetry, and body composition was analyzed using magnetic resonance imaging. Results: Upper body adipose tissue (AT) decreased to a greater extent (p < 0.05) with functional oil (FctO) compared with olive oil (OL) consumption (?0.67 ± 0.26 kg and ?0.02 ± 0.19 kg, respectively). There was a trend toward greater loss of whole‐body subcutaneous AT volume (p = 0.087) with FctO compared with OL consumption. Average energy expenditure was 0.04 ± 0.02 kcal/min greater (p < 0.05) on day 2 and 0.03 ± 0.02 kcal/min (not significant) on day 28 with FctO compared with OL consumption. Similarly, average fat oxidation was greater (p = 0.052) with FctO compared with OL intake on day 2 but not day 28. Discussion: Consumption of a diet rich in MCTs results in greater loss of AT compared with LCTs, perhaps due to increased energy expenditure and fat oxidation observed with MCT intake. Thus, MCTs may be considered as agents that aid in the prevention of obesity or potentially stimulate weight loss.     

Calcium and Dairy Acceleration of Weight and Fat Loss during Energy Restriction in Obese Adults

Objective: Increasing 1, 25‐dihydroxyvitamin D in response to low‐calcium diets stimulates adipocyte Ca²⁺ influx and, as a consequence, stimulates lipogenesis, suppresses lipolysis, and increases lipid accumulation, whereas increasing dietary calcium inhibits these effects and markedly accelerates fat loss in mice subjected to caloric restriction. Our objective was to determine the effects of increasing dietary calcium in the face of caloric restriction in humans. Research Methods and Procedures: We performed a randomized, placebo‐controlled trial in 32 obese adults. Patients were maintained for 24 weeks on balanced deficit diets (500 kcal/d deficit) and randomized to a standard diet (400 to 500 mg of dietary calcium/d supplemented with placebo), a high‐calcium diet (standard diet supplemented with 800 mg of calcium/d), or high‐dairy diet (1200 to 1300 mg of dietary calcium/d supplemented with placebo). Results: Patients assigned to the standard diet lost 6.4 ± 2.5% of their body weight, which was increased by 26% (to 8.6 ± 1.1%) on the high‐calcium diet and 70% (to 10.9 ± 1.6% of body weight) on the high‐dairy diet (p < 0.01). Fat loss was similarly augmented by the high‐calcium and high‐dairy diets, by 38% and 64%, respectively (p < 0.01). Moreover, fat loss from the trunk region represented 19.0 ± 7.9% of total fat loss on the low‐calcium diet, and this fraction was increased to 50.1 ± 6.4% and 66.2 ± 3.0% on the high‐calcium and high‐dairy diets, respectively (p < 0.001). Discussion: Increasing dietary calcium significantly augmented weight and fat loss secondary to caloric restriction and increased the percentage of fat lost from the trunk region, whereas dairy products exerted a substantially greater effect.