Background. Excessive energy intake has been implicated in diabetes, hypertension, coronary artery disease, and obesity. Dietary restraint has been unsuccessful as a method for the self-regulation of eating. Recognition of initial hunger (IH) is easily learned, can be validated by associated blood glucose (BG) concentration, and may improve insulin sensitivity. Objective. To investigate whether the initial hunger meal pattern (IHMP) is associated with improved insulin sensitivity over a 5-month period. Methods. Subjects were trained to recognize and validate sensations of IH, then adjust food intake so that initial hunger was present pre-meal at each meal time (IHMP). The purpose was to provide meal-by-meal subjective feedback for self-regulation of food intake. In a randomised trial, we measured blood glucose and calculated insulin sensitivity in 89 trained adults and 31 not-trained controls, before training in the IHMP and 5 months after training. Results. In trained subjects, significant decreases were found in insulin sensitivity index, insulin and BG peaks, glycated haemoglobin, mean pre-meal BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), energy intake, BMI, and body weight when compared to control subjects. Conclusion. The IHMP improved insulin sensitivity and other cardiovascular risk factors over a 5-month period.

Background/Aims: In obesity, many gastro-oesophageal reflux promoting factors are present. Weight reduction is advised to symptomatic overweight subjects. The aim of the present study was to investigate the influences of untreated obesity, weight loss, and chronic gastric balloon distension on the lower oesophageal sphincter (LOS) function. Methods: Patients entering a randomized, double-blind, sham-controlled study of balloon treatment, consisting of 4 months of either sham balloon or balloon treatment followed by 4 months of balloon treatment. Manometry and 24-hour pH measurements were performed at the start of the study and after 13 and 26 weeks. Results: Before treatment, LOS dysfunction was present in 7 of 32 patients (21.9%). Increased upright and supine reflux was present in 8 patients (25%). Sham treatment resulted in a weight loss of 9.7% with improved LOS function (a significant 0.6-cm increase in LOS length and a non-significant 2.6 mm Hg higher LOS pressure) and in a significantly decreased upright reflux (acid reflux time decreasing from 8.0 to 5.5% and number of meal-related and postprandial reflux episodes decreasing from 49 to 32). These improved values deteriorated after 4 months of balloon placement, with significantly increasing total, upright, and supine reflux to 7.5, 7.6, and 6.7% of the time, respectively, with oesophageal lesions after an overall 17.8% weight loss. Four months of balloon treatment induced a similar weight loss (9.9%) with significantly increased supine reflux from 1.6 to 6.7% of the time. After a second 4-month balloon period and an overall 13.8% weight loss, LOS and reflux values returned towards baseline values. A comparison of both groups demonstrated the adverse effects of balloon positioning after a period of substantial sham-induced weight loss. Conclusions: Impaired LOS function and increased gastro-oesophageal reflux were observed in one quarter of the untreated obese subjects. Weight loss ameliorated manometry and pH values, but subsequent balloon positioning tended to counteract these beneficial changes. In patients on balloon treatment from the start, adverse effects seemed to wear off with prolonged treatment.

Background Lately, attention for the role of sleep in health and wellbeing has increased. Short sleep duration and poor quality of sleep are associated with a higher chance at several (mental) health issues, including a higher mortality risk. Furthermore it is associated with attention problems and lower academic achievement. Poor sleep has a high prevalence, especially among students. We aim to provide (policy) recommendations from studying the associated factors on an individual and social level with poor sleep and its consequences. Methods In a cross-sectional survey design (N = 493), the extent of sleep problems and its associated factors was studied amongst a group of Dutch students. The Pittsburg Sleep Quality Index (PSQI) was used. Linear regression analysis was performed. Participants were recruited through social media and e-mail (Male 43%; Female 57%; mean age, 22 years). Additionally, experts were questioned in a small survey to come up with solutions (N = 24). Results 59% of higher educational students suffer from poor sleep quality. Factors that were significantly associated with worse sleep quality were: sleep need, behavior and psychology (effects stress overload), having a paid job in the evening/night, loneliness, having the Chinese and other ethnicity and having a sleep-related disorder. Sleep was significantly associated with worse mental health, vitality and drug use. Additionally, sleep was a significant predictor for attention problems and worse academic performance in the current academic year. Conclusions Nearly 2 out of 3 students suffered from poor sleep quality, reconfirming the high prevalence amongst higher educational students in other studies. Universities can contribute to better sleep quality of their students by educating their students more about sleep hygiene (including effects of drugs and how to deal with high work pressures), and make them more aware of the availability of student psychologists and student general practitioners. Key messages Students in higher education are a population at high risk for poor sleep quality. More attention for the importance of sleep for health, wellbeing and academic achievements should be implemented in the university institutional context.