Publications by authors named "Marwan El Ghoch"

95 Publications

European Guidelines for Obesity Management in Adults with a Very Low-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis.

Obes Facts 2021 21;14(2):222-245. Epub 2021 Apr 21.

Dipartimento di Medicina, Università degli Studi di Padova, Padova, Italy.

Background: The very low-calorie ketogenic diet (VLCKD) has been recently proposed as an appealing nutritional strategy for obesity management. The VLCKD is characterized by a low carbohydrate content (<50 g/day), 1-1.5 g of protein/kg of ideal body weight, 15-30 g of fat/day, and a daily intake of about 500-800 calories.

Objectives: The aim of the current document is to suggest a common protocol for VLCKD and to summarize the existing literature on its efficacy in weight management and weight-related comorbidities, as well as the possible side effects.

Methods: This document has been prepared in adherence with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Literature searches, study selection, methodology development, and quality appraisal were performed independently by 2 authors and the data were collated by means of a meta-analysis and narrative synthesis.

Results: Of the 645 articles retrieved, 15 studies met the inclusion criteria and were reviewed, revealing 4 main findings. First, the VLCKD was shown to result in a significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. Second, when compared with other weight loss interventions of the same duration, the VLCKD showed a major effect on reduction of body weight, fat mass, waist circumference, total cholesterol and triglyceridemia as well as improved insulin resistance. Third, although the VLCKD also resulted in a significant reduction of glycemia, HbA1c, and LDL cholesterol, these changes were similar to those obtained with other weight loss interventions. Finally, the VLCKD can be considered a safe nutritional approach under a health professional's supervision since the most common side effects are usually clinically mild and easily to manage and recovery is often spontaneous.

Conclusions: The VLCKD can be recommended as an effective dietary treatment for individuals with obesity after considering potential contra-indications and keeping in mind that any dietary treatment has to be personalized. Prospero Registry: The assessment of the efficacy of VLCKD on body weight, body composition, glycemic and lipid parameters in overweight and obese subjects: a meta-analysis (CRD42020205189).
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http://dx.doi.org/10.1159/000515381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138199PMC
April 2021

Strength and Performance Tests for Screening Reduced Muscle Mass in Elderly Lebanese Males with Obesity in Community Dwellings.

Diseases 2021 Mar 20;9(1). Epub 2021 Mar 20.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

The reduction in skeletal muscle mass (SMM) is a common phenomenon in older adults. It is associated with several diseases, a reduction in physical fitness, longer periods of hospitalization and high rates of mortality. We aimed to identify the reliability of simple tools for screening for reduced SMM among older adult males in Lebanon. The Tanita MC-780MA bioimpedance analyzer (BIA) was used to assess body composition in a population of 102 community-dwelling elderly males with overweight or obesity, in order to be then categorized as with or without reduced SMM. Participants also performed the handgrip strength test and the 4 m gait speed test. Of the total sample of 102 participants (mean age 67.4 ± 6.96 years; BMI 30.8 6 ± 4.04 kg/m), 32 (31.4%) met the criteria for reduced SMM. Partial correlation analysis showed that handgrip strength (ρ = 0.308, = 0.002) and 4 m gait speed (ρ = 0.284, = 0.004) were both associated with low SMM. Receiver operating characteristic (ROC) curve analysis identified discriminating cut-off points of 1.1 m/s for the 4 m gait speed test and 32.0 kg for the handgrip strength test. Our study showed that participants displayed a substantial prevalence of reduced SMM. Reduced 4 m gait speed and handgrip strength were associated with low SMM. Clear cut-off points for strength and functional tests for screening for this condition in Lebanese older men were identified.
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http://dx.doi.org/10.3390/diseases9010023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006034PMC
March 2021

Association between Levels of Physical Activity, Sarcopenia, Type 2 Diabetes and the Quality of Life of Elderly People in Community Dwellings in Lebanon.

Geriatrics (Basel) 2021 Mar 18;6(1). Epub 2021 Mar 18.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22-0.84, = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22-0.73, = 0.003) by 60%, and higher scores of the physical (β = -7.65; -11.87, -3.43, = 0.0004) and mental (β = -8.47; -13.08, -3.85, = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population.
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http://dx.doi.org/10.3390/geriatrics6010028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005975PMC
March 2021

Nutritional guidelines for the management of insulin resistance.

Crit Rev Food Sci Nutr 2021 Apr 2:1-14. Epub 2021 Apr 2.

Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy.

Obesity and its related co-morbidities, namely type 2 diabetes (T2D), pose a significant global public health problem. Insulin resistance (IR) in muscle and liver is the core pathophysiologic defect that underlies obesity preceding and predicting the onset of T2D in susceptible humans. There is a broad population with IR that has no indication for prescription of medications, who still need medical consultation and specific advice in this respect. This prevalent need can be achieved by appropriate diet, exercise, and other behavioral therapies for lifestyle interventions. Despite a well-recognized role of IR in the progression to metabolic diseases, no specific nutritional recommendations exist to manage this condition, to the best of our knowledge. An international panel of experts reviewed and critically appraised the updated literature published about this topic. This review primarily examines the evidence for areas of consensus and ongoing uncertainty or controversy about diet and exercise approaches for IR. The aim of this article is to present the most common IR states, namely obesity and Polycystic Ovary Syndrome (PCOS), and provide nutritional advice to manage IR, hyperinsulinemia, and reactive hypoglycemia. These nutritional guidelines could prevent progression or worsening of IR with resultant beta-cell failure and, as a result, T2D.
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http://dx.doi.org/10.1080/10408398.2021.1908223DOI Listing
April 2021

Association between dietary practice, body composition, training volume and sport performance in 100-Km elite ultramarathon runners.

Clin Nutr ESPEN 2021 Apr 8;42:239-243. Epub 2021 Feb 8.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020, Riad El Solh, Beirut, Lebanon. Electronic address:

Background & Aim: Sport performance during competitions is a central goal for athletes, and several factors have been identified that appear to have an association with better performance in different sport disciplines. However, the data are still not conclusive in ultramarathon runners. Accordingly, this study aimed to assess the potential associations between anthropometric, body composition, dietary and training factors and athletic performance in 100-Km elite ultramarathon runners.

Methods: Body mass index (BMI), body composition, training volume, Mediterranean dietary adequacy score (MDAS) and "100-Km race competition record" were assessed in 10 elite ultramarathon runners from the Italian Ultramarathon and Trail Association (IUTA) of the Italian national team.

Results: The study sample had a mean age of 41.1 ± 7.59 years and BMI of 21.66 ± 1.11 kg/m. Female athletes had a lower appendicular skeletal muscle index (ASMI) and 100-Km race competition record, and a higher trunk fat percentage and MDAS compared to males. Correlation analysis revealed a significant association between the 100-Km race competition record and age, gender, ASMI, training volume, total body and trunk fat percentages. However, after correcting for confounders, partial correlation analysis confirmed only the association between training volume and 100-Km race competition record (ρ = -0.891, p = 0.009).

Conclusion: Our findings provide evidence that a higher training volume expressed as Kilometers per week is an independent variable associated with better performance in 100-Km race competitions in elite ultramarathon runners. Future studies are needed to assess the usefulness of programs based on the increase of training volume as a strategy to improve athletic performance in 100-Km races in this specific population.
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http://dx.doi.org/10.1016/j.clnesp.2021.01.029DOI Listing
April 2021

Exploring the effectiveness of a 1.5-Year weight management intervention for adults with obesity.

Clin Nutr ESPEN 2021 Apr 13;42:215-220. Epub 2021 Feb 13.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon. Electronic address:

Background & Aim: Obesity is a growing healthcare problem in Arabic-speaking countries although the effectiveness of the lifestyle modification program for weight management in this region is still lacking. Accordingly, this study aimed to assess long-term outcomes following an adapted lifestyle modification program based on cognitive behavioral therapy for obesity (CBT-OB) in Lebanon.

Methods: Forty-five adult participants with obesity were recruited consecutively at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Patients were offered an individualized form of CBT-OB lasting 18 months comprising two phases (a weight loss phase of 6 months and a weight-maintenance phase of 12 months).

Results: Twenty-five patients completed the treatment, with a mean weight loss of -11.58% after 6 months (-11.46% in the intention-to-treat analysis) and -8.84% after 18 months (-9.51% in the intention-to-treat analysis). Weight loss was associated with improvement in Health-Related Quality of Life (HRQoL) at six-month follow-up and in glycated hemoglobin (HbA1c) and body composition patterns at 18-month follow-up.

Conclusion: Our findings provide evidence supporting the use of CBT-OB for obesity as a standard in 'real-world' clinical setting in Lebanon. Future studies are needed on larger samples and other populations in Arab-speaking countries.
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http://dx.doi.org/10.1016/j.clnesp.2021.01.036DOI Listing
April 2021

How Healthy Are Health-Related Behaviors in University Students: The HOLISTic Study.

Nutrients 2021 Feb 19;13(2). Epub 2021 Feb 19.

Department of Public Health, University of Split School of Medicine, 21000 Split, Croatia.

The aim of this cross-sectional study was to assess the health-related behaviors among university students, with emphasis on health sciences students from Croatia, Italy, Lebanon, Poland, Romania, Spain and Turkey. We included 6222 students in Medicine, Dentistry, Nursing, Pharmacy, Nutrition and Dietetics, Sports Sciences, Veterinary, and Economics enrolled between April 2018 and March 2020. We assessed dietary patterns, sleeping habits, physical activity and perceived stress among students by means of validated questionnaires. The median age ranged between 19 and 24 years, smoking prevalence between 12.0% and 35.4%, and body mass index (BMI) ranged between 21.1 and 23.2 kg/m. Breakfast was less often and more often consumed daily in Turkey (36.7%), and Italy (75.7%), respectively. The highest Mediterranean diet score was recorded in Spain and Italy, and the lowest in Turkey, followed by students from Croatia, Lebanon, Poland and Romania. Sleep duration, physical activity and stress perception also differed between countries. Multivariable regression analysis revealed a small, but positive association between BMI and several characteristics, including age, female gender, smoking, physical activity, mobile phone use, and perceived stress. A negative association was found between BMI and sleep duration on non-working days. Self-rated health perception was positively associated with female gender, breakfast, physical activity, and time spent studying, and negatively with BMI, smoking and stress. Our results demonstrated diverse habits in students from different countries, some of which were less healthy than anticipated, given their educational background. Greater emphasis needs to be placed on improving the lifestyle of these adolescents and young adults, who will be tomorrow's healthcare workers.
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http://dx.doi.org/10.3390/nu13020675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926492PMC
February 2021

Cross-validation of prediction equations for estimating the body fat percentage in adults with obesity.

Clin Nutr ESPEN 2021 02 18;41:346-350. Epub 2020 Nov 18.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon. Electronic address:

Background & Aim: An accurate estimation of the body fat percentage (BF%) in patients with obesity is of clinical importance. Therefore, we aim to assess the validity of anthropometric-based BF predictive equations in treatment-seeking patients in an outpatient setting.

Methods: BF% was assessed by Tanita MC-780MA bioimpedance (BIA) and considered as a reference method, and anthropometric-based predictive equations were used in BF% estimations among 275 adults of both genders, in the outpatient clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated BF% values were calculated to assess the accuracy of five equations, and the Bland-Altman method was used to assess the level of agreement.

Results: In both males and females, all predictive equations gave significantly different estimates of BF% when compared to those measured by BIA. On the other hand, in both genders, the mean difference between the BF% value estimated by the Jackson equation and that measured using BIA, was not significant, and agreement was confirmed using Bland-Altman plots.

Conclusion: We suggest the Jackson equation for accurate BF% estimation in both genders of patients with obesity in the Lebanese population. However, future studies are still urgently needed to develop and validate new predictive equations suitable for BF% estimations, taking into account ethnicity (i.e., the Arab population).
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http://dx.doi.org/10.1016/j.clnesp.2020.11.003DOI Listing
February 2021

The Mini Sarcopenia Risk Assessment (MSRA) Questionnaire score as a predictor of skeletal muscle mass loss.

Aging Clin Exp Res 2021 Jan 2. Epub 2021 Jan 2.

Department of Medicine, Geriatrics Division, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.

Background: Previous studies showed a strong relationship between reduction of appendicular muscle mass and worsening disability; hence, accuracy in assessing muscle mass is considered a key feature for a sarcopenia screening tool.

Aim: The aim of the study was to evaluate if the 7 items of Mini Sarcopenia Risk Assessment (MSRA) questionnaire predict muscle mass loss in a population of community-dwelling elderly subjects over a 5.5-y follow-up.

Methods: The study included 159 subjects, 92 women and 67 men aged 71.5 ± 2.2 years and with mean body mass index of 26.7 ± 4.0 kg/m. Appendicular skeletal muscle mass (ASMM) as measured with Dual-Energy X-ray absorptiometry (DXA), was obtained at baseline and after 2 and 5.5 years of follow-up where the skeletal muscle index (SMI) was calculated.

Results: A significant reduction of ASMM and SMI was observed at two and 5.5 years of follow-up, in both, men and women. Repeated-measures analysis of variance (ANOVA) found a significant time effect on ASMM for both subjects with MSRA > 30 and ≤ 30 (P < 0.01 and P < 0.001). The group × time interaction was significant (P < 0.001), after even considering separately subjects with normal muscle mass and low muscle mass at baseline (P < 0.05 and P = 0.005). Similar results were obtained for SMI. Considering only the subjects with normal SMI at baseline, subjects with MSRA questionnaire ≤ 30 showed 5.7 (95% CI 1.73-19.03) higher risk of exceeding the low muscle mass threshold.

Conclusion: In a population of community-dwelling elderly men and women, MSRA score of 30 is predictive of a steeper decline in ASMM and SMI and of a higher risk of exceeding the low muscle mass EWGSOP threshold.
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http://dx.doi.org/10.1007/s40520-020-01763-1DOI Listing
January 2021

Fertility and Reproduction after Recovery from Anorexia Nervosa: A Systematic Review and Meta-Analysis of Long-Term Follow-Up Studies.

Diseases 2020 Dec 16;8(4). Epub 2020 Dec 16.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

Reproductive health is compromised during anorexia nervosa (AN). However, it is still unclear whether this medical complication is reversible after recovery from AN. The purpose of this paper was to conduct a systematic review of the major reproductive health outcomes in females after recovery from AN. The review was conducted in adherence to preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 1186 articles retrieved, five studies met the inclusion criteria and were reviewed. These studies monitored weight-restored females who had recovered from AN for a follow-up period of between six and 18 years. Their narrative analysis revealed that appropriate treatment of AN leads to the normalization of reproductive function, especially in terms of fertility, pregnancy, and childbirth rates. The meta-analysis confirmed this finding, where the pooled odds of childbirth rates between the AN group and the general population was not statistically significant (OR = 0.75, 95% CI: 0.43-1.29, = 0.41). We conclude that if patients undergo appropriate eating-disorder treatment and weight restoration, it appears to be unlikely that reproductive health is affected by AN. However, since this finding is derived from only a few studies, it requires replication and confirmation.
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http://dx.doi.org/10.3390/diseases8040046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768504PMC
December 2020

Development of an Easy-to-Use Prediction Equation for Body Fat Percentage Based on BMI in Overweight and Obese Lebanese Adults.

Diagnostics (Basel) 2020 Sep 21;10(9). Epub 2020 Sep 21.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

An accurate estimation of body fat percentage (BF%) in patients who are overweight or obese is of clinical importance. In this study, we aimed to develop an easy-to-use BF% predictive equation based on body mass index (BMI) suitable for individuals in this population. A simplified prediction equation was developed and evaluated for validity using anthropometric measurements from 375 adults of both genders who were overweight or obese. Measurements were taken in the outpatient clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). A total of 238 participants were used for model building (training sample) and another 137 participants were used for evaluating validity (validation sample). The final predicted model included BMI and sex, with non-significant prediction bias in BF% of -0.017 ± 3.86% ( = 0.946, Cohen's d = 0.004). Moreover, a Pearson's correlation between measured and predicted BF% was strongly significant (r = 0.84, < 0.05). We are presenting a model that accurately predicted BF% in 61% of the validation sample with an absolute percent error less than 10% and non-significant prediction bias (-0.028 ± 4.67%). We suggest the following equations: BF% = 0.624 × BMI + 21.835 and BF% = 1.050 × BMI - 4.001 for accurate BF% estimation in patients who are overweight or obese in a clinical setting in Lebanon.
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http://dx.doi.org/10.3390/diagnostics10090728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555778PMC
September 2020

Is There a Link Between Nutrition, Genetics, and Cardiovascular Disease?

J Cardiovasc Dev Dis 2020 Aug 27;7(3). Epub 2020 Aug 27.

Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

Cardiovascular diseases (CVDs) are a group of disorders that mainly include coronary, cerebrovascular and rheumatic heart diseases [1].[...].
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http://dx.doi.org/10.3390/jcdd7030033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570096PMC
August 2020

Relationship between multiple weight cycles and early weight loss in patients with obesity: a longitudinal study.

Eat Weight Disord 2020 Aug 20. Epub 2020 Aug 20.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020, Riad El Solh, Beirut, Lebanon.

Purpose: To assess the relationship between multiple weight cycling (WC) and early weight loss (e-WL).

Methods: Using a longitudinal prospective design conducted between May 2017 and November 2019, early weight loss was assessed at month 2 of a weight management programme in 100 adult participants with overweight or obesity, at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Weight cycling was defined as intentional weight loss of ≥ 3 kg followed by involuntary weight regain of ≥ 3 kg and participants were then categorized as multiple WC if they had experienced ≥ 2 cycles.

Results: Of the 100 participants with a median age of 34.90 (22.94-50.67) years and a median BMI of 35.25 (32.75-39.48) kg/m, 75 met the criteria for WC and displayed a lower e-WL percentage than those without WC (4.69 ± 2.78% vs. 6.58 ± 2.80%; p = 0.006). Linear regression analysis showed that e-WL was lower by ≈ 2% (β = - 1.935; 95% CL - 3.221, - 0.648; p = 0.004) in the WC group compared to the non-WC group after adjusting for age, gender and baseline BMI.

Conclusion: In a 'real-world' clinical setting, multiple WC decreases e-WL rates. New strategies could be adopted for these patients to improve this early clinical outcome, since e-WL predicts longer-term success.

Level Of Evidence: III, prospective longitudinal study.
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http://dx.doi.org/10.1007/s40519-020-00989-2DOI Listing
August 2020

Effect of a standard schema of self-monitoring blood glucose in patients with poorly controlled, non-insulin-treated type 2 diabetes mellitus: A controlled longitudinal study.

J Popul Ther Clin Pharmacol 2020 07 12;27(S Pt 2):e1-e11. Epub 2020 Jul 12.

Unit of Endocrinology, Department of Internal Medicine, Endocrinology, Metabolism, and Geriatrics, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.

The effect of self-monitoring of blood glucose (SMBG) on glycemic control with regard to non-insulin-treated Type 2 diabetes mellitus (NIT-Type 2 DM) is still a controversial topic. Against this backdrop, we sought to compare the effect of a continuous short-term SMBG schema with as-usual treatment, based on changes in oral antidiabetic treatment in patients with poorly controlled Type 2 DM. We reviewed 492 NIT-Type 2 DM record charts, selecting 27 patients, with poor glycemic control, who were thought to self-monitor their blood glucose levels (SMBG group). We then compared them with 27 patients treated with modifying drugs or diets to achieve and maintain the glycemic target (Control Group). Haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) were evaluated at baseline, after 3 and 6 months. HbA1c values decreased after 3 and 6 months in the SMBG group (P < 0.001 on both occasions) and in the control group (P < 0.05 and P < 0.01, respectively), but without a significant difference between the two groups when compared at the same time. The FPG progressively decreased in both groups, reaching a significant difference in the SMBG group after 3 months and in the control group after 6 months, and without a significant difference between the two groups. The SMBG schema used in our study could be adopted for target groups before proceeding to the next therapeutic enhancement drug step, representing a useful tool that can help diabetic patients in raising awareness of and treating their disease.
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http://dx.doi.org/10.15586/jptcp.v27iSP2.680DOI Listing
July 2020

Let food be the medicine, but not for coronavirus: Nutrition and food science, telling myths from facts.

J Popul Ther Clin Pharmacol 2020 04 2;27(S Pt 1):e1-e4. Epub 2020 Apr 2.

Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.

The entire globe is facing a dangerous pandemic due to the coronavirus disease (COVID-19). The medical and scientific community is trying to figure out and adopt effective strategies that can lead to (i) preventing virus expansion; (ii) identifying medications for the management of critical care and reducing rates of mortality; and (iii) finally discovering the highly anticipated vaccine. Nutritional interventions have attained considerable scientific evidence in disease prevention and treatment. The main question, "What is the role of nutrition and food science in this scenario?" requires urgent answer as many theories suggesting that specific food or dietary supplements can fight coronavirus infection have received extensive coverage in most popular social media platforms. In this editorial, we focus on some frequent statements on the role of nutrition and food science in the battle against COVID-19, distinguishing between myths and facts. We highlight that social distancing and hygiene precautions are the best practices for reducing the risk of COVID-19 transmission. We further underline the importance of nutrition in its wholistic concept, pointing out the risk of unproven dietary options that could lead individuals to weaken effective precautionary measures.
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http://dx.doi.org/10.15586/jptcp.v27iSP1.682DOI Listing
April 2020

Obesity and Higher Risk for Severe Complications of Covid-19: What to do when the two pandemics meet.

J Popul Ther Clin Pharmacol 2020 Jun 29;27(S Pt 1):e31-e36. Epub 2020 Jun 29.

Co-Editor-in-Chief - Journal of Population Therapeutics and Clinical Pharmacology, Brisbane, QLD, Australia.

The coronavirus disease 2019 (COVID-19) pandemic has spread around the globe, infecting more than ten million individuals, with more than 500,000 dead; about one half of the infected people have recovered. Despite this fact, a subgroup of individuals affected by COVID-19 is at greater risk of developing worse outcomes and experience a high rate of mortality. Data on the association between obesity and COVID-19 are growing; the available studies, have reported a high prevalence of overweight and obesity in patients experiencing a severe COVID-19 course, with serious complications requiring hospitalization and admission to intensive care units. This paper attempts to highlight potential mechanisms behind the greater vulnerability to COVID-19 of individuals with obesity. The presence of uncontrolled chronic obesity-related comorbidities, particularly pulmonary diseases, can present a primary fertile soil for respiratory tract infection. Combined with immune system impairments, such as alteration in the T-cell proliferation and macrophage differentiation, and the high pro-inflammatory cytokine production by the adipose organ, this may worsen the general condition toward a systemic diffusion of infection. Prevention remains the first line of intervention in these patients that can be achieved by adhering to social distancing and adopting hygiene precautions, combined with a healthy lifestyle. Patients with obesity require preferential access dedicated to primary care services to ensure they are regularly taking their medications for the treatment of any concurrent chronic diseases. Finally, their physicians must promptly manage any medical signs or symptoms in the case of suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection to prevent the risk of severe outcomes.
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http://dx.doi.org/10.15586/jptcp.v27iSP1.708DOI Listing
June 2020

Revising BMI Cut-Off Points for Obesity in a Weight Management Setting in Lebanon.

Int J Environ Res Public Health 2020 05 28;17(11). Epub 2020 May 28.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

Obesity is defined by the World Health Organization (WHO) as a body mass index (BMI) ≥ 30 Kg/m. This study aimed to test the validity of this BMI cut-off point for adiposity in a weight management clinical setting in Lebanon. This cross-sectional study of 442 adults of mixed gender, categorized by the WHO BMI classification, included: 66 individuals of normal weight, 110 who were overweight and 266 with obesity. The clinical sample was referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon. All participants underwent anthropometric evaluation. The gold standard for defining obesity was based on the National Institutes of Health (NIH)/WHO guidelines for total body fat percentage (BF%). The best sensitivity and specificity were attained to predict obesity, according to the receiver operating characteristic curve (ROC) analysis. The BMI cut-off point for predicting obesity in the clinical sample was nearly 31.5 Kg/m, and more than 90% of individuals with obesity and cardiometabolic disease were above this cut-off point. In conclusion, this new BMI cut-off point, an obesity definition higher than suggested in Western populations, was demonstrated to have clinical usefulness. Obesity guidelines in Lebanon, therefore, need revising.
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http://dx.doi.org/10.3390/ijerph17113832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312945PMC
May 2020

Lifetime Weight Cycling and Central Fat Distribution in Females With Obesity: A Brief Report.

Diseases 2020 Mar 26;8(2). Epub 2020 Mar 26.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut P.O. Box, 11-5020 Riad El Solh, Lebanon.

Weight cycling (WC) is a common phenomenon in patients with obesity, however, its consequence on body composition has not yet been fully understood. Therefore, we aimed to determine whether multiple WC can negatively affect the latter, especially in terms of body fat distribution in female adults seeking treatment that are overweight or obese. Body composition was obtained using a segmental body composition analyser (MC-780MA, Tanita Corp., Tokyo, Japan) in 125 adult females who had been referred to the Department of Nutrition and Dietetics at the Beirut Arab University (Lebanon). WC was defined as intentional weight loss of ≥3 kg followed by involuntary weight regain of ≥3 kg, and participants were categorized as WC if they had experienced ≥2 cycles. Ninety of the 125 participants met the criteria for WC and displayed a higher total and trunk fat mass than those without WC. This was confirmed through linear regression analysis, showing that multiple WC were associated with increased fat mass (FM) by nearly 4.2 kg (β = 4.23, 95%CI: 0.81-7.65, = 0.016)-2.4 kg in the trunk region (β = 2.35, 95%CI: 0.786-3.917, = 0.004) when compared to the non-WC group, after adjusting for age and fat-free mass. In conclusion, multiple WC is associated with increased body fat, especially in the central region. Future studies are needed to examine the impact of this fat distribution on health outcomes in this phenotype of patients.
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http://dx.doi.org/10.3390/diseases8020008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349111PMC
March 2020

Association Between Reduced Daily Steps and Sarcopenic Obesity in Treatment-Seeking Adults With Obesity.

Front Endocrinol (Lausanne) 2020 30;11:22. Epub 2020 Jan 30.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.

Understanding the condition that describes the coexistence of obesity and sarcopenia, termed sarcopenic obesity (SO), is becoming a scientific and clinical priority. In this study, we aimed to assess the prevalence of SO in treatment-seeking adults with obesity and investigate any potential association between SO and a sedentary lifestyle, expressed in terms of daily steps. In this cross-sectional, prospective observational study, body composition and daily steps measurements were obtained using a segmental body composition analyser (Tanita BC-418) and an Omron HJ-320 pedometer, respectively, in 111 adults of both genders with obesity (body mass index; BMI ≥ 30 kg/m), referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon. The participants were then categorized according to the presence of absence of SO, defined as an appendicular lean mass divided by body weight (ALM/weight) × 100%) of less than 23.40 and 29.60 in females and males, respectively. Fifty-five of the 111 participants with obesity, with a mean age of 39.62 ± 16.55 years and a mean BMI of 38.05 ± 5.33 kg/m met the criteria for SO and displayed a significantly higher prevalence of inactivity (<5,000 daily steps), i.e., nearly double (54.5% vs. 32.1%; = 0.017) and they had a lower mean number of daily steps than those in the group without SO (5,279 ± 2,641 vs. 6,732 ± 2,989; = 0.008). Linear regression analysis showed that SO is associated with a lower number of daily steps by 1,421 (β = -1421.4; -2508.9, -333.9; = 0.011) after adjusting for age, gender employment and the presence of cardiometabolic disease. Sarcopenic obesity affects nearly 50% of treatment-seeking adults with obesity. Moreover, it seems to be associated with a lower number of daily steps and a sedentary lifestyle. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programmes should incorporate additional physical activity strategies in this population.
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http://dx.doi.org/10.3389/fendo.2020.00022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003394PMC
February 2021

How valuable is cardiopulmonary exercise testing in patients with severe obesity undergoing bariatric surgery?

Intern Emerg Med 2020 10 20;15(7):1157-1159. Epub 2020 Feb 20.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Riad El Solh, P.O. Box 11-5020, Beirut, Lebanon.

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http://dx.doi.org/10.1007/s11739-020-02285-4DOI Listing
October 2020

The Impact of Sarcopenic Obesity on Health-Related Quality of Life of Treatment-Seeking Patients with Obesity.

Curr Diabetes Rev 2020 ;16(6):635-640

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

Background: There is a paucity of studies on health-related quality of life (HRQoL) and sarcopenic obesity (SO).

Objective: This study aimed to assess the potential association between SO and impaired HRQoL.

Methods: The ORWELL 97 questionnaire was used to assess HRQoL and body composition was measured using a bioimpedance analyser (Tanita BC-418) in 130 patients with obesity, referred to the Nutritional and Weight Management outpatient clinic of Beirut Arab University in Lebanon. Participants were then categorized on the basis of the absence or presence of SO.

Results: Sixty-four of the 130 participants met the criteria for SO (49.2%) and displayed significantly higher total ORWELL 97 scores than those in the group without SO (64.00 vs. 41.00, p=0.001), indicative of poorer HRQoL. Linear regression analysis showed that SO was associated with an increase in ORWELL 97 scores by nearly 24 units (β=24.35, 95% CI=11.45-37.26; p<0.0001). Moreover, the logistic regression analysis showed that SO increased the odds of clinically significant impairment of HRQoL (ORWELL 97 score ≥74.25) by nearly seven-fold (OR=7.37, 95% CI=1.92-28.39; p=0.004).

Conclusion: Our findings show that the presence of SO was associated with increased impairment of HRQoL that reaches clinical significance when compared to obesity only. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programs should incorporate additional strategies to improve HRQoL in individuals with SO.
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http://dx.doi.org/10.2174/1573399816666200211102057DOI Listing
July 2020

Association Between Sarcopenic Obesity and Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis.

Curr Cardiol Rev 2020 ;16(2):153-162

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

Background: In the last two decades, a new phenotype termed Sarcopenic Obesity (SO), in which sarcopenia and obesity coexist, has emerged.

Objective: The aim of this systematic review and meta-analysis was first to assess the prevalence of Metabolic syndrome (Mets) among individuals with and without SO, and second, to determine if SO may increase the relative risk of Mets.

Methods: This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the data were collated by means of metaanalysis and narrative synthesis.

Results: Twelve studies including a total of 11,308 adults with overweight or obesity of both genders met the inclusion criteria and were reviewed, revealing two main findings. First, a similar overall prevalence of Mets in individuals with SO (61.49%; 95% CI: 52.19-70.40) when compared to those without SO (56.74%; 95% CI: 47.32-65.93) was identified. Second, the presence of SO appears not to increase the risk of Mets with respect to those without SO (RR = 1.08, 95% CI: 0.99- 1.17, p = 0.07).

Conclusion: No higher prevalence of Mets among individuals with SO when compared to those with obesity only, nor a significant association between SO and a higher risk of Mets was found.
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http://dx.doi.org/10.2174/1573403X16666200214104122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460704PMC
July 2020

Sarcopenic Obesity Predicts Early Attrition in Treatment-Seeking Patients with Obesity: A Longitudinal Pilot Study.

J Cardiovasc Dev Dis 2020 Jan 27;7(1). Epub 2020 Jan 27.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

Attrition is a major cause of failure in obesity treatment, which is still not fully understood. The identification of factors related to this outcome is of clinical relevance. We aimed to assess the relationship between sarcopenic obesity (SO) and early attrition. Early attrition was assessed at six months, and two groups of patients were selected from a large cohort of participants with overweight or obesity enrolled at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Body composition was measured using a bioimpedance analyser (Tanita BC-418) and participants at baseline were categorized as having or not having SO. The "dropout group" included 72 participants (cases) compared to 31 participants (controls) in the "completer group", with the former displaying a higher prevalence of SO than the latter (51.0% vs. 25.8%; p = 0.016). In the same direction, Poisson regression analysis showed that SO increased the relative risk of dropout by nearly 150% (RR = 1.45; 95% CI = 1.10-1.89; p = 0.007) after adjustment for age, gender, body mass index (BMI), age at first dieting, sedentary habits and weight-loss expectation. In conclusion, n a "real-world" outpatient clinical setting, the presence of SO at baseline increases the risk of dropout at six months. New directions of future research should be focused on identifying new strategies to reduce the attrition rate in this population.
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http://dx.doi.org/10.3390/jcdd7010005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151049PMC
January 2020

Validation of predictive equations for resting energy expenditure in treatment-seeking adults with overweight and obesity: Measured versus estimated.

J Popul Ther Clin Pharmacol 2020 01 18;27(1):e32-e47. Epub 2020 Jan 18.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

The quantification of resting energy expenditure (REE) in patients with obesity is an important measure. We aimed to evaluate the validity of predictive equations in estimating REE compared with indirect calorimetry (IC) in treatment-seeking Arab adults with overweight or obesity. Twenty-three predictive equations were compared with REE values measured by IC (Vmax Encore 229) in 89 adult participants with overweight or obesity (mean age = 40.62 ± 15.96 years and mean body mass index [BMI] = 35.02 ± 4.60 kg/m) referred to the Department of Nutrition and Dietetics of Beirut Arab University (Lebanon). The accuracy of the predictive equations was evaluated on the basis of whether the percentage prediction was within 10% of the measured REE, and the mean difference between predicted and measured values (bias). The Bland-Altman method was used to assess the agreement between the predicted and measured values. The equations that demonstrated the closest agreement with IC were the De La Cruz equation in males (accurate predictions: 68.2%; bias: -19.52 kcal/day) and the Mifflin equation in females (accurate prediction: 61.2%; bias: -36.43 kcal/day). In conclusion, we suggest that these two equations produce the least biased estimations for REE in this population.
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http://dx.doi.org/10.15586/jptcp.v27i1.653DOI Listing
January 2020

Understanding Sarcopenic Obesity in Terms of Definition and Health Consequences: A Clinical Review.

Curr Diabetes Rev 2020 ;16(9):957-961

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

Background And Aim: Research interests in a new phenotype termed as sarcopenic obesity (SO), which refers to a decrease in lean body mass and muscle strength associated with an increase in body fat deposition, have grown. However, neither SO definition nor its impact on health outcomes is clear. In the current paper, we aim to summarize the available literature on the dilemma surrounding the definition of SO, and the potential health consequences of this phenomenon on individuals with overweight and obesity.

Methods: A literature review using the PubMed/Medline database was conducted and data were summarized by applying a narrative approach, based on clinical expertise in the interpretation of the available evidence base in the literature.

Results: Some definitions that account for body mass (i.e., body weight, body mass index) seem to be more suitable for screening of SO and revealed as clinically useful. The association between SO and certain health outcomes has also been investigated, especially those related to obesity; however, little is known about the association of SO with psychosocial distress and health-related quality of life impairment, as well as harsh outcomes such as mortality.

Conclusion: International consensus regarding SO definition is needed, which would allow for a better understanding of its prevalence. Moreover, future investigations should be conducted in order to determine whether SO has an adverse effect (i.e., cause-effect relationship, in addition to association) on health. Once these issues are achieved, confirmed and clarified, evidenced-based protocols of treatment may become necessary to address the increase in the prevalence of obesity and sarcopenia worldwide.
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http://dx.doi.org/10.2174/1573399816666200109091449DOI Listing
November 2020

Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity.

Curr Diabetes Rev 2020 ;16(4):381-386

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

Background And Aim: An accurate estimation of Resting Energy Expenditure (REE) in patients with obesity is crucial. Therefore, our aim was to assess the validity of REE predictive equations based on body composition variables in treatment-seeking Arab adults with obesity.

Methods: Body composition and REE were measured by Tanita BC-418 bioimpedance and Vmax Encore 229 IC, respectively, and predictive equations based on fat mass and fat-free mass were used in REE estimations among 87 adults of both genders, in the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated REE values were calculated to assess the accuracy, and the Bland-Altman method was used to assess the level of agreement.

Results: Ten predictive equations were included. In males, all the predictive equations gave significantly different estimates of REE when compared to that measured by IC. On the other hand, in females, the mean difference between the REE value estimated by Huang and Horie-Waitzberg equations and that measured using IC was not significant, and the agreement was confirmed using Bland-Altman plots.

Conclusion: Huang and Horie-Waitzberg equations are suggested for accurate REE estimation in females; however, new validated REE estimation equations for males in this population are still needed.
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http://dx.doi.org/10.2174/1573399815666191030085915DOI Listing
June 2020

Reduction of Resting Energy Expenditure and Sarcopenic Obesity in Adults with Overweight and Obesity: A Brief Report.

Curr Diabetes Rev 2020 ;16(4):376-380

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

Background And Aim: The last decade has seen the emergence of a new condition, describing the coexistence of obesity and sarcopenia, termed Sarcopenic Obesity (SO). The aim of this study was to assess the potential association between SO and reduced Resting Energy Expenditure (REE).

Methods: Body composition and REE were measured using a bioimpedance analyser (Tanita BC-418) and Indirect Calorimeter (Vmax Encore 229), respectively in 89 adults with overweight or obesity of both genders, referred to the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Participants were then categorized on the basis of having SO or not.

Results: Thirty-nine of the 89 participants met the criteria for SO (43.8%), and these participants displayed a significantly lower REE per unit body weight than those in the group without SO (19.02 ± 2.26 vs. 20.87 ± 2.77; p = 0.001). Linear regression analysis showed that the presence of SO decreases REE by 1.557 kcal/day for each kg of body weight (β = -1.557; CI = -0.261 - (-0.503); p = 0.004), after adjusting for age and gender.

Conclusion: SO appears to be present in a high proportion of treatment-seeking adults with overweight or obesity of both genders, and it seems to be associated with a reduced REE, compared with those without SO. Future studies are needed to clarify whether this may influence clinical outcomes.
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http://dx.doi.org/10.2174/1573399815666191030092138DOI Listing
June 2020

IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META-ANALYSIS.

J Popul Ther Clin Pharmacol 2019 07 31;26(2):e25-e37. Epub 2019 Jul 31.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

The resumption of menses (ROM) is an important outcome in anorexia nervosa treatment and is considered as a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and exploratory meta-analysis of the association between total body fat percentage (%BF) and ROM after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, only seven studies comprising a total of 366 adolescent and young adult females with anorexia nervosa met the inclusion criteria and were reviewed, and preliminary results revealed three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.74, 95% CI: 2.26-5.22). Secondly, %BF was found to be an independent predictor of the ROM in this population and an increase of only one unit of %BF can increase the odds of menstruation by ≈15-20%. Thirdly, despite the paucity of data, a cut-off point of %BF≈21was suggested as the minimum needed for ROM. In conclusion, a higher %BF seems to be associated with the ROM in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration. The PROSPERO Registry - A systematic review and meta-analysis of the factors associated with the resumption of the menstrual cycle in females with anorexia nervosa after weight restoration (CRD42019111841).
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http://dx.doi.org/10.15586/jptcp.v26i2.601DOI Listing
July 2019

CHALLENGES AND NEW DIRECTIONS IN OBESITY MANAGEMENT: LIFESTYLE MODIFICATION PROGRAMMES, PHARMACOTHERAPY AND BARIATRIC SURGERY.

J Popul Ther Clin Pharmacol 2019 05 23;26(2):e1-e4. Epub 2019 May 23.

Department of Nutrition and Dietetics, Faculty of Health Sciences; Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon.

Obesity is a growing health problem worldwide, and it is associated with serious medical and psychosocial comorbidities, impairment of health-related quality of life (HRQoL) and an increased risk of mortality. This article aims to discuss challenges faced by health-care providers when managing patients with obesity and to highlight sustainable policies in clinical practice and future research. All health professionals dealing with obesity should consider lifestyle-modification programmes within a multidisciplinary setting as the key element of weight management. However, standardisation is needed in terms of nature, content and duration of these programmes in order to facilitate their implementation in clinical practice at different levels. Moreover, health professionals should be aware that these programmes, for patients indicating "non-response," can be combined with recently approved anti-obesity drugs such as liraglutide, naltrexone/bupropion, lorcaserin and phentermine/topiramate, as well as with relatively less invasive bariatric surgery techniques such as Lap Band, endoscopic sleeve gastroplasty and gastric bypass. In any case, neither anti-obesity medication nor bariatric surgery should be considered as a miracle treatment in itself. At the same time, the field of obesity is still lacking in literature on some hot topics that need further investigation, including (i) a new phenotype termed , to clarify its definition, potential health consequences and eventual treatment if necessary; (ii) issues that go beyond body weight, for instance, HRQoL that has been poorly studied in some populations affected by obesity; and (iii) the long-term effect of sleeve gastrectomy technique, which is becoming the most commonly used bariatric surgical procedure, perhaps to be studied using long-term randomised controlled trials that guarantee completeness of follow-up, in order to avoid misunderstanding and bias in interpretation of results.
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http://dx.doi.org/10.15586/jptcp.v26i2.599DOI Listing
May 2019

Association Between Smoking Hookahs (Shishas) and Higher Risk of Obesity: A Systematic Review of Population-Based Studies.

J Cardiovasc Dev Dis 2019 Jun 16;6(2). Epub 2019 Jun 16.

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon.

The American Heart Association has published a scientific statement on the effect of hookah smoking on health outcomes; nevertheless, hookah smoking continues to be popular worldwide, especially among the young. Recent reports mention a potential link between hookah smoking and obesity; however, uncertainties still surround this issue. The aim of the current study was to conduct a systematic review to clarify whether hookah smoking is associated with a higher risk of obesity among the general population. This study was conducted in compliance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and data were collated by means of a meta-analysis and a narrative synthesis. Of the 818 articles retrieved, five large-population and low-bias studies comprising a total of 16,779 participants met the inclusion criteria and were reviewed. All included studies reported that, regardless of gender, hookah smoking increases the risk of obesity among all ages and observed an association between the two after a correction for several confounders or reported a higher prevalence of obesity among hookah smokers. This was confirmed by the meta-analysis. Therefore, hookah smoking seems to be associated with a higher risk of obesity. Public health policymakers should be aware of this for the better management of obesity and weight-related comorbidities.
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http://dx.doi.org/10.3390/jcdd6020023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617155PMC
June 2019