These findings support the hypothesis that defined meal replacements can be used for successful, long-term weight control and improvements in certain biomarkers of disease risk.

Objective: To investigate the contribution of meal and snack replacements for long-term weight maintenance and risk factor reduction in obese patients. Research Methods and Procedures: Prospective, randomized, two-arm, parallel intervention for 12 weeks followed by a prospective single-arm 4-year trial in a University Hospital clinic. One hundred patients, Ͼ18 years old and with a body mass index Ͼ 25 and Յ 40 kg/m 2 , were prescribed a 1200 to 1500 kcal/d control diet (Group A) or an isoenergetic diet, including two meal and snack replacements (vitamin-and mineral-fortified shakes, soups, and bars) and one meal high in fruits and vegetables (Group B). Following a 3 months of weight loss, all patients were prescribed the same energy-restricted diet (1200 to 1500 kcal) with one meal and one snack replacement for an additional 4 years. Results: All 100 patients were evaluated at 12 weeks. Mean percentage weight loss was 1.5 Ϯ 0.4% and 7.8 Ϯ 0.5% (mean Ϯ SEM) for Groups A and B, respectively. At 12 weeks systolic blood pressure, plasma triacylglycerol, glucose, and insulin concentrations were significantly reduced in Group B, whereas no changes occurred in Group A. After 4 years, 75% of the patients were evaluated. Total mean weight loss was 3.2 Ϯ 0.8% for Group A and 8.4 Ϯ 0.8% (mean Ϯ SEM) for Group B. Both groups showed significant improvement in blood glucose and insulin (p Ͻ 0.001), but only Group B showed significant improvement in triacylglycerol and systolic blood pressure compared to baseline values (p Ͻ 0.001). Discussion: Providing a structured meal plan via vitaminand mineral-fortified liquid meal replacements is a safe and effective dietary strategy for obese patients. Long-term maintenance of weight loss with meal replacements can improve certain biomarkers of disease risk.

Results: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. Conclusion: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.

DITSCHUNEIT, HERWIG H., AND MARION FLECHTNER-MORS. Value of structured meals for weight management: risk factors and long-term weight maintenance. Obes Res. 2001;9:284S-289S. Objective: To examine changes in biomarkers of disease risk after 51 months of reduced energy intake and sustained weight loss. Research Methods and Procedures:This study was conducted as a prospective, randomized, two-arm, parallel intervention for 12 weeks followed by a prospective, singlearm, 4-year trial in a university-based hospital clinic. One hundred patients were randomly assigned to one of two dietary interventions for 3 months. Group A was prescribed an energy-restricted diet of 1200 to 1500 kcal/d, and group B was prescribed an isocaloric diet, whereby two of three meals were replaced with nutrient-fortified liquid meal replacements. After 3 months, the patients were prescribed the same caloric reduction and used once-daily replacements for the succeeding 4 years. Body weight and blood pressure were checked monthly. Biomarkers of disease risk were measured after 3, 9, 15, 27, and 51 months. Results: During the 3-month weight-loss period, body weight was reduced by 1.5 Ϯ 0.4% and 7.8 Ϯ 0.5% (mean Ϯ SEM) for groups A and B, respectively. After 4 years, 75% of the patients were evaluated. Total mean weight loss was 3.3 Ϯ 0.8% and 8.4 Ϯ 0.8% for groups A and B, respectively. Both groups of patients showed significant improvement in glucose, insulin, triacylglycerol, and systolic blood pressure. Cholesterol concentrations were reduced in patients with high initial cholesterol levels and maintenance of a 7% weight loss. Discussion: Providing a structured meal plan with liquid meal replacements is an effective treatment for obese subjects. Long-term maintenance of weight loss with meal replacements improves biomarkers of disease risk.

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In this harmonized meta-analysis based on prospective data of older, community-dwelling adults, age, marital status, limitations with walking and climbing stairs, and hospitalization were identified as determinants of incident malnutrition.

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013–2016, was the first action taken by the ‘Healthy Diet for a Healthy Life’ European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC’s work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance.

Individuals with the metabolic syndrome achieved significant weight loss while preserving fat-free mass when treated with an energy-restricted, high-protein diet that included nutrient-dense meal replacements, as compared with the results for conventional protein intake. An intervention with a protein-enriched diet may have advantages for the management of the metabolic syndrome.