The aim of this randomised controlled trial was to investigate the effects of breakfast high or low in protein on body composition and cardiometabolic markers in young women with overweight. In total, fifty-six women aged 18–30 years consumed a breakfast containing either high protein (34 g protein, n 26) or low protein (6 g protein, n 30) for 12 weeks. Measurements of body composition by dual-energy X-ray absorptiometry, waist circumference, glucose tolerance, fasting glucose, insulin and lipid profile were performed before and after this period. The primary outcome was fat mass. Satiety and hunger were evaluated by self-reported Visual Analogue Scale (VAS) scores. Dietary intake was estimated by 4-d dietary records, and calcium intake was estimated by FFQ. At baseline, relative daily protein intake was 15·2 ± 2·8 E%, which increased to 19·3 ± 3·4 E% in high protein but was unchanged in low protein (P < 0·001 between groups). High protein reported higher satiety compared with low protein (P = 0·02). Yet, no group differences were observed in changes in energy intake, body composition, blood lipid profile or measures of glucose tolerance (all P > 0·10). However, bone mineral content tended to increase in high protein (P = 0·05) and decrease in low protein (P = 0·07, interaction effect: P = 0·01). Conclusively, a high v. low content of protein in breakfast increased satiety but did not affect body composition or cardiometabolic markers in young women with overweight. This study adds to the sparse evidence on the effects of breakfast with different macronutrient compositions on health parameters in women with overweight. Registered at clinicaltrials.gov: NCT04518605.

Dietary fatty acids (FA) affect metabolic risk factors. The aim of this study was to explore if changes in dietary fat intake during energy restriction were associated with plasma FA composition. The study also investigated if these changes were associated with changes in liver fat, liver stiffness and plasma lipids among persons with non-alcoholic fatty liver disease. Dietary and plasma FA were investigated in patients with non-alcoholic fatty liver disease (n 48) previously enrolled in a 12-week-long open-label randomised controlled trial comparing two energy-restricted diets: a low-carbohydrate high-fat diet and intermittent fasting diet (5:2), to a control group. Self-reported 3 d food diaries were used for FA intake, and plasma FA composition was analysed using GC. Liver fat content and stiffness were measured by MRI and transient elastography. Changes in intake of total FA (r 0·41; P = 0·005), SFA (r 0·38; P = 0·011) and MUFA (r 0·42; P = 0·004) were associated with changes in liver stiffness. Changes in plasma SFA (r 0·32; P = 0·032) and C16 : 1n-7 (r 0·33; P = 0·028) were positively associated with changes in liver fat, while total n-6 PUFA (r −0·33; P = 0·028) and C20 : 4n-6 (r −0·42; P = 0·005) were inversely associated. Changes in dietary SFA, MUFA, cholesterol and C20:4 were positively associated with plasma total cholesterol and LDL-cholesterol. Modifying the composition of dietary fats during dietary interventions causes changes in the plasma FA profile in patients with non-alcoholic fatty liver disease. These changes are associated with changes in liver fat, stiffness, plasma cholesterol and TAG. Replacing SFA with PUFA may improve metabolic parameters in non-alcoholic fatty liver disease patients during weight loss treatment.

Depression and eating disorder (ED) risk are heightened during adolescence(1) and both were exacerbated during COVID-19 lockdowns. This analysis reports changes in self-reported symptoms of depression and eating disorders throughout the Fast Track to Health trial. Fast Track to Health was a 52-week multi-site randomised-controlled trial, conducted 2018-2023, comparing intermittent (IER) and continuous energy restriction (CER) in adolescents with obesity and ≥1 associated comorbidity(2). The Centre for Epidemiologic Studies Depression Scale-revised 10-item version for adolescents (CESDR) was used to assess symptoms of depression (no symptoms, sub-threshold, or possible, probable, major depressive episode). Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED risk; defined as global score ≥2.7, ≥2 episodes of binge eating with/without loss of control, or ≥1 episode of purging within the last 28-days. The Binge Eating Scale (BES) assessed severity of binge eating (no binge eating, mild/moderate, severe). Adolescents were monitored for disordered eating during dietetic consults. Linear mixed models, retaining all data consistent with intention-to-treat analysis, were used to estimate the change in outcomes from baseline to week-52. Descriptive statistics were used to describe the number of participants meeting screening criteria at baseline and week-52. One hundred and forty one adolescents were enrolled and 97 completed the trial, with median (IQR) EDE-Q score 2.28 (1.43 to 3.14), CESDR 9.00 (4.0 to 14.5) and BES 11.0 (5.0 to 17.0) at baseline. EDE-Q (change in estimated marginal means [SE], IER −0.63 [0.18], CER −0.56 [0.17]) and CESDR (IER −2.70 [1.15], CER −3.87 [1.07]) scores reduced between baseline and week-52 in both groups (p<0.05) with no difference between groups. There was a between group difference (p = 0.019) in change in BES. The IER group had a reduction between baseline and week-52 (−3.72 [1.27]) and the CER group had no change. At baseline, 31 (22%) adolescents were classified as having a possible/probable/major depressive episode, 110 (78%) met ≥1 ED criteria and 28 (21%) as mild/moderate or severe binge eating, reducing to 8 (9%), 56 (61%) and 15 (16%) respectively at week-52. A small sub-group of adolescents required additional support for disordered eating. Overall, treatment-seeking adolescents with obesity have symptoms of depression and ED. Although symptoms reduce for most, some required additional support. Screening and monitoring for depression and ED are important to ensure early intervention.

A mother’s diet during pregnancy has the potential to influence both her own and her child’s short- and long-term health. This paper reports the effects of a randomized controlled diet intervention during pregnancy on dietary behavior post-intervention as reported in late pregnancy. The diet intervention was part of a lifestyle intervention targeting both diet and physical activity behaviors among nulliparous women participating in the randomized controlled Norwegian Fit for Delivery study (NFFD). Eligible women were enrolled in early pregnancy from eight healthcare clinics in southern Norway between 2009 and 2013. The diet intervention was based on 10 dietary recommendations that were conveyed during two counseling sessions by phone and in a pamphlet describing the recommendations and their simplified rationale. A diet score was constructed from a 43-item food frequency questionnaire (FFQ) and used to assess intervention effect on dietary behavior (score range 0–10). Between-group dietary differences post-intervention were estimated with analysis of covariance, with adjustment for baseline diet. A total of 508 women completed the FFQ both at baseline and post-intervention. There were no between-group differences in diet score and subscales at baseline. Post-intervention, the intervention group had higher overall diet score (control: 4.61, intervention: 5.04, P=0.013) and favorable dietary behavior in seven of the 10 dietary domains: ‘consumption of water relative to total beverage consumption’ (P=0.002), ‘having vegetables with dinner’ (P=0.027), ‘choosing fruits and vegetables for between-meal snacks’ (P=0.023), ‘buying small portion sizes of unhealthy foods’ (P=0.010), ‘limiting sugar intake’ (P=0.005), ‘avoiding eating beyond satiety’ (P=0.009) and ‘reading food labels’ (P=0.011). The NFFD diet intervention improved dietary behavior. Potential long-term clinical influence in mother and child will be investigated in further studies.

Diet is important in the prevention of CVD, and it has been suggested that a diet high in MUFA is more cardioprotective than a low-fat diet. We hypothesised that the thrombotic risk profile is improved most favourably by a high-MUFA diet compared with a low-fat diet. This was tested in a parallel randomised intervention trial on overweight individuals (aged 28·2 (sd 4·6) years) randomly assigned to a diet providing a moderate amount of fat (35–45 % of energy; >20 % of fat as MUFA) (MUFA diet; n 39), to a low-fat (LF; 20–30 % of energy) diet (n 43), or to a control diet (35 % of energy as fat; n 24) for 6 months after a weight loss of about 10 %. Protein constituted 10–20 % of energy in all three diets. All foods were provided free of charge from a purpose-built supermarket. Fasting blood samples were collected before and after intervention and analysed for factor VII coagulant activity (FVII:c), fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer and plasminogen activator inhibitor (PAI). The fibrinogen concentration was significantly lowered by the LF diet, but not by the MUFA diet. Changes in fibrinogen differed significantly between diet groups. BMI and PAI concentration increased and D-dimer concentrations were reduced irrespective of the diets. No changes were observed for FVII:c and F1+2. Our findings suggest that in overweight subjects after weight loss the thrombotic risk profile is improved most favourably by the LF diet compared with the MUFA diet based on the reduction in fibrinogen concentrations.