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Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgery in which 60% to 80% of the stomach is removed longitudinally, resulting in a smaller stomach that takes the shape of a "sleeve." The mechanism for weight loss is gastric restriction and possible neurohormonal changes resulting from lower levels of ghrelin (an appetite-stimulating hormone), as a consequence of removing the gastric fundus. LSG may be more desirable than laparoscopic adjustable gastric banding because there is no foreign object inside the abdomen and no need for postsurgery appointments to adjust the band. LSG may be preferred over Roux-en-Y gastric bypass (RYGB) because LSG is a less complicated operation that does not result in dumping syndrome or malabsorption, yet weight loss is comparable to RYGB. While LSG is suggested to have advantages over the commonly performed laparoscopic adjustable gastric banding and RYGB, there are no long-term (>5 years) outcomes and few studies specific to nutrition care for LSG patients. This article will present a protocol for pre- and postsurgery nutrition care for LSG and the important role the registered dietitian plays in the multidisciplinary team. Postsurgery diet progression from liquids to solids during 6 to 8 weeks should focus on meeting protein and fluid needs. In addition, LSG patients are at risk for nutrient deficiencies due to decreased hydrochloric acid and intrinsic factor from removed parietal cells and reduced dietary intake due to decreased ghrelin levels. Therefore, LSG patients should take daily micronutrient supplements, including vitamin B-12 and potentially supplemental iron, to prevent deficiencies.

To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care.7-week randomized, controlled intervention.150 moderately hypercholesterolemic men and women, age range 25 to 70 years.The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Program's (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet.Serum lipids and lipoproteins and self-reported lifestyle changes.For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes.In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P.05). The intervention group reported an increase in exercise vs the usual care group (P.05). Both intervention and control groups had a minimal reduction (1%) in body weight compared with baseline (P.0167).A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.

To determine the effect of oral contraceptive pill (OCP) use during adolescence on peak bone mass.Longitudinal observational study.Academic clinical research center.Sixty-two non-Hispanic, white females in The Penn State Young Women's Health Study, who were studied for 8 years during ages 12-20.There were 28 OCP users, who used OCPs for a minimum of 6 months and were still using at age 20, and 34 nonusers who had never used OCPs.Total body bone, dedicated hip bone, and body composition measurements were made by dual-energy roentgenogram absorptiometry.The OCP users and nonusers did not differ at entry in anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OCP use by the user group was 22 months. At age 20, the groups remained indistinguishable in anthropometric, body composition, total body, and hip bone measures, and in age of menarche and sports exercise scores.Oral contraceptive pill use by healthy, white, teenage females does not affect acquisition of peak bone mass.This longitudinal observational study determined the effect of oral contraceptive (OC) use during adolescence on peak bone mass (PBM). The sample comprised 62 non-Hispanic, White females in The Penn State Young Women's Health Study, who were studied for 8 years between the ages of 12 and 20. There were 28 OC users who used OCs for a minimum of 6 months and were still using them at age 20, and 34 nonusers who had never used the regimen. Total body bone, dedicated hipbone, and body composition measurements were made by dual-energy roentgenogram absorptiometry. There was no difference between OC users and nonusers in the anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OC use by the user group was 22 months. At this age, the groups remained indistinguishable in anthropometric, body composition, total body, and hipbone measurements, and in age of menarche and sports exercise scores. These findings suggest that OC use by healthy, White, teenage females does not affect acquisition of PBM.

In the United States, intake of n-3 fatty acids is approximately 1.6 g/d ( approximately 0.7% of energy), of which 1.4 g is alpha-linolenic acid (ALA; 18:3) and 0.1-0.2 g is eicosapentaenoic acid (EPA; 20:5) and docosahexaenoic acid (DHA; 22:6). The primary sources of ALA are vegetable oils, principally soybean and canola. The predominant sources of EPA and DHA are fish and fish oils. Intake data indicate that the ratio of n-6 to n-3 fatty acids is approximately 9.8:1. Food disappearance data between 1985 and 1994 indicate that the ratio of n-6 to n-3 fatty acids has decreased from 12.4:1 to 10.6:1. This reflects a change in the profile of vegetable oils consumed and, in particular, an approximate 5.5-fold increase in canola oil use. The ratio of n-6 to n-3 fatty acids is still much higher than that recommended (ie, 2.3:1). Lower ratios increase endogenous conversion of ALA to EPA and DHA. Attaining the proposed recommended combined EPA and DHA intake of 0.65 g/d will require an approximately 4-fold increase in fish consumption in the United States. Alternative strategies, such as food enrichment and the use of biotechnology to manipulate the EPA and DHA as well as ALA contents of the food supply, will become increasingly important in increasing n-3 fatty acid intake in the US population.

We performed this study as a pilot experiment to investigate the short term effects of two diets of varying composition on weight loss as the primary outcome in obese women with polycystic ovary syndrome (PCOS) seeking fertility.Randomized clinical trial.Academic medical center.Thirty-five obese women with PCOS.We examined the effects of a 1-month dietary intervention on the PCOS phenotype. Participants were randomized to one of two energy-restricted diets; high protein (HP: 30% protein, 40% carbohydrate, and 30% fat) or high carbohydrate (HC: 15% protein, 55% carbohydrate, and 30% fat). The fat content was held constant in both diets.Primary - change in body weight; Secondary - biometric, hormonal, lipid and lipoprotein, and markers of glucose homeostasis and energy metabolism.Twenty-six women completed the study. Both the HP (-3.7 +/- 1.9 kg) and HC (-4.4 +/- 1.5 kg) diets resulted in significant weight loss, but there was no significant difference in mean weight loss between the two groups. There were also no differences between diets on a variety of measures including circulating androgens, measures of glucose metabolism, and leptin. However, the effects of a hypocaloric diet per se on improving metabolic and reproductive abnormalities in a group of PCOS women were marked by a decline in circulating androgens (P=.03), fasting and area under the curve (AUC) insulins (P.05) on a 3-hour oral glucose tolerance test (OGTT), and fasting and AUC leptin levels (P.0001). There was a high prevalence of menstrual bleeding during the trial (14 out of 26 patients).Those who completed the short-term hypocaloric diet had a significant weight loss and a significant improvement in their reproductive and metabolic abnormalities. There was no increased benefit to a high-protein diet. Future diet studies evaluating the ideal composition of a hypocaloric diet in women with PCOS will require a large study population, and will most likely require a multicenter trial.

Many dietary factors affect plasma triglycerides. Those which decrease the triglyceride level include n-3 fatty acids from fish oil, weight loss, alcohol restriction, and a higher fat (unsaturated fat) diet, whereas a high-carbohydrate, low-fat diet increases triglycerides. The individual responses and the associated magnitude of change in triglycerides as a result of these different dietary factors will vary. For patients with hypertriglyceridemia, fish oil supplements will usually elicit the most potent effects. However, some patients can normalize their triglyceride level with weight loss plus exercise, by avoiding or limiting their alcohol intake, and by increasing the total fat content of their diet. In addition, fish oil supplements can help further to reduce plasma triglycerides. Thus, the combined effects of multiple dietary interventions provide the most potent means of maximally lowering the plasma triglyceride level.

Cardiovascular disease (CVD) is the leading cause of death in the United States accounting for more deaths than all other causes combined. Numerous risk factors for CVD are identified, many of which are modifiable by diet and lifestyle practices. Major modifiable risk factors include cigarette smoking, elevated total and low-density lipoprotein (LDL) cholesterol levels, overweight and obesity, hypertension, diabetes mellitus, and a sedentary lifestyle. Other important risk factors that are modifiable by diet are a low level of high-density lipoprotein cholesterol, elevated levels of triglycerides, lipoprotein, insulin, hypertension, altered hemostatic factors, and small, dense LDL particles. This chapter reviews the understanding of how changes in the macronutrient profile of the diet affect CVD risk status. It describes various low saturated fatty acids (SFA) and cholesterol diets that differ in macronutrient content and present the plasma lipid and lipoprotein responses that are reported for these diets. This, chapter highlights the effect of various low SFA , low-cholesterol diet options with differentmacronutrient profiles on newly defined CVD risk factors.

While diet and exercise are the first line of treatment for newly diagnosed hypercholesterolemia, patients often lack the support, understanding, confidence, and skills to initiate and sustain lifestyle changes. In a 7-week randomized, parallel-arm study, 150 hypercholesteroiemic men and women, ages 25–70, were assigned to a support service + soluble fiber foods intervention or a usual care group (Step I/II guidelines) to compare effects on behavior changes and physiological measures. The support service included weekly mailings and phone calls that utilized behavior change theory and integrated best practice in providing information and motivational tools to facilitate behavior changes. Topics covered were dietary fiber and fat, physical activity, weight management and behavior change maintenance. Four or more servings of food sources of soluble fiber containing psyllium (1.7+ g soluble fiber/serving) or oats (0.75g soluble fiber/serving) were consumed each day. As previously reported, the intervention group significantly decreased total cholesterol (−5.6%), LDL cholesterol (−7.1%) and LDL/HDL (−5.6%) versus the usual care group. The intervention group reported significant increases in success, knowledge and confidence to make diet and exercise changes versus the usual care group (p