Objective: Can gestational weight gain in obese women be restricted by 10-h dietary consultations and does this restriction impact the pregnancy-induced changes in glucose metabolism? Design: A randomized controlled trial with or without restriction of gestational weight gain to 6-7 kg by ten 1-h dietary consultations. Subjects: Fifty nondiabetic nonsmoking Caucasian obese pregnant women were randomized into intervention group (n ¼ 23, 2874 years, prepregnant body mass index (BMI) 3574 kg m À2 ) or control group (n ¼ 27, 3075 years, prepregnant BMI 3573 kg m À2 ). Measurements: The weight development was measured at inclusion (15 weeks), at 27 weeks, and 36 weeks of gestation. The dietary intakes were reported in the respective weeks by three 7-day weighed food records and blood samples for analyses of fasting s-insulin, s-leptin, b-glucose, and 2-h b-glucose after an oral glucose tolerance test were collected. Results: The women in the intervention group successfully limited their energy intake, and restricted the gestational weight gain to 6.6 kg vs a gain of 13.3 kg in the control group (P ¼ 0.002, 95% confidence interval (CI): 2.6-10.8 kg). Both s-insulin and s-leptin were reduced by 20% in the intervention group compared to the control group at week 27, mean difference: À16 pmol l À1 (P ¼ 0.04, 95% CI: À32 to À1) for insulin and À23 ng ml À1 (P ¼ 0.004, 95% CI: À39 to À8) for leptin. At 36 weeks of gestation, the s-insulin was further reduced by 23%, À25 pmol l À1 (À47 to À4, P ¼ 0.022) and the fasting b-glucose were reduced by 8% compared with the control group (À0.3 mmol l À1 , À0.6 to À0.0, P ¼ 0.03). Conclusions: Restriction of gestational weight gain in obese women is achievable and reduces the deterioration in the glucose metabolism.

Adiponectin is an adipose tissue-specific protein that is abundantly present in the circulation and suggested to be involved in insulin sensitivity and development of atherosclerosis. Because cytokines are suggested to regulate adiponectin, the aim of the present study was to investigate the interaction between adiponectin and three adipose tissue-derived cytokines (IL-6, IL-8, and TNF-alpha). The study was divided into three substudies as follows: 1) plasma adiponectin and mRNA levels in adipose tissue biopsies from obese subjects [mean body mass index (BMI): 39.7 kg/m2, n = 6] before and after weight loss; 2) plasma adiponectin in obese men (mean BMI: 38.7 kg/m2, n = 19) compared with lean men (mean BMI: 23.4 kg/m2, n = 10) before and after weight loss; and 3) in vitro direct effects of IL-6, IL-8, and TNF-alpha on adiponectin mRNA levels in adipose tissue cultures. The results were that 1) weight loss resulted in a 51% (P < 0.05) increase in plasma adiponectin and a 45% (P < 0.05) increase in adipose tissue mRNA levels; 2) plasma adiponectin was 53% (P < 0.01) higher in lean compared with obese men, and plasma adiponectin was inversely correlated with adiposity, insulin sensitivity, and IL-6; and 3) TNF-alpha (P < 0.01) and IL-6 plus its soluble receptor (P < 0.05) decreased adiponectin mRNA levels in vitro. The inverse relationship between plasma adiponectin and cytokines in vivo and the cytokine-induced reduction in adiponectin mRNA in vitro suggests that endogenous cytokines may inhibit adiponectin. This could be of importance for the association between cytokines (e.g., IL-6) and insulin resistance and atherosclerosis.

OBJECTIVE: To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets. DESIGN: Randomized dietary intervention study over six months comparing two ad libitum fat reduced diets (30% of total energy) strictly controlled in composition: High-carbohydrate (HC, protein 12% of total energy) or high-protein (HP, protein 25% of total energy). SETTING AND PARTICIPANTS: Subjects were 65 healthy, overweight and obese subjects (50 women, 15 men, aged 18 ± 55 y) randomly assigned to HC (n 25), HP (n 25) or a control group (C, n 15). All food was provided by selfselection in a shop at the department, and compliance to the diet composition was evaluated by urinary nitrogen excretion. MAIN OUTCOME MEASURE: Change in body weight, body composition and blood lipids. RESULTS: More than 90% completed the trial. Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group (difference 3.7 kg, 95% con®dence interval (CI)(1.3 ± 6.2 kg) P`0.001), and fat loss was 4.3 kg and 7.6 kg, respectively (difference 3.3 kg (1.1 ± 5.5 kg) P`0.0001), whereas no changes occurred in the control group. More subjects lost b10 kg in the HP group (35 %) than in the HC group (9 %). The HP diet only decreased fasting plasma triglycerides and free fatty acids signi®cantly. CONCLUSIONS: Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet, improves weight loss and increases the proportion of subjects achieving a clinically relevant weight loss. More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products, and hence improve adherence to low-fat diets in weight reduction programs.

BACKGROUND: Previous studies have indicated that the secretion of the intestinal satiety hormone glucagon-like peptide-1 (GLP-1) is attenuated in obese subjects. OBJECTIVE: To compare meal-induced response of GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) in obese and lean male subjects, to investigate the effect of a major weight reduction in the obese subjects, and to look for an association between these hormones and ad libitum food intake. METHOD: Plasma concentrations of intestinal hormones and appetite sensations were measured prior to, and every 30 min for 180 min after, ingestion of a 2.5 MJ solid test meal. Gastric emptying was estimated scintigraphically. An ad libitum lunch was served 3 h after the test meal. SUBJECTS: Nineteen non-diabetic obese (body mass index (BMI) 34.1 ± 43.8 kgam 2 ) and 12 lean (BMI 20.4 ± 24.7 kgam 2 ) males. All obese subjects were re-examined after a mean stabilised weight loss of 18.8 kg (95% CI 14.4 ± 23.2). RESULTS: Total area under the GLP-1 response curve (AUC total, GLP-1 ) was lower in obese before and after the weight loss compared to lean subjects (P`0.05), although weight loss improved the response from 80 to 88% of that of the lean subjects (P 0.003). The GIP response was similar in obese and lean subjects. However, after the weight loss both AUC total, GIP and AUC incremental, GIP were lowered (P`0.05). An inverse correlation was observed between AUC incremental, GIP and energy intake at the subsequent ad libitum meal in all groups. In lean subjects ad libitum energy intake was largely predicted by the insulin response to the preceding meal (r 2 0.67, P 0.001). CONCLUSION: Our study con®rmed previous ®ndings of a reduced postprandial GLP-1 response in severely obese subjects. Following weight reduction, GLP-1 response in the obese subjects apparently rose to a level between that of obese and lean subjects. The data suggests that postprandial insulin and GIP responses are key players in short-term appetite regulation.

BACKGROUND:We have previously reported that a fat-reduced high-protein diet had more favourable effects on body weight loss over 6 months than a medium-protein diet. OBJECTIVE: To extend this observation by a further 6-12 months less stringent intervention and a 24 months follow-up. DESIGN: A randomised 6 months strictly controlled dietary intervention followed by 6-12 months dietary counselling period, and a subsequent 24 months follow-up, comparing an ad libitum, fat-reduced diet (30% of energy) either high in protein (25% of energy, HP) or medium in protein (12% of energy, MP). SUBJECTS: A total of 50 overweight and obese subjects (age: 19-55 y; BMI: 26-34 kg/m 2 ). MEASUREMENTS: Change in body weight, body composition and blood parameters. RESULTS: After 6 months, the HP group (n ¼ 23) achieved a greater weight loss than the MP group (n ¼ 23) (9.4 vs 5.9 kg) (Po0.01). After 12 months, 8% had dropped out in the HP vs 28% in the MP group (Po0.07). After 12 months, the weight loss was not significantly greater among the subjects in the HP group (6.2 and 4.3 kg), but they had a 10% greater reduction in intraabdominal adipose tissue and more in the HP group (17%) lost 410 kg than in the MP (Po0.09). At 24 months, both groups tended to maintain their 12 months weight loss, but more than 50% were lost to follow-up. CONCLUSION: A fat-reduced diet high in protein seems to enhance weight loss and provide a better long-term maintenance of reduced intra-abdominal fat stores.