Protein supplementation increases muscle mass and strength gains during prolonged resistance-type exercise training in both younger and older subjects.

Fat and carbohydrate are the principal substrates that fuel aerobic ATP synthesis in human skeletal muscle. The relative utilisation of fat and carbohydrate during exercise can vary enormously and depends strongly on exercise intensity. An early stable isotope tracer study (Romijn et al. 1993), which used assumptions to estimate indirectly the oxidation rate of plasma free fatty acids (FFAs), suggested that plasma FFAs provide the majority of the substrate oxidised by skeletal muscle during low-and moderate-intensity (25 and 65 % of maximal oxygen uptake capacity, V O 2 ,max) exercise. In addition, it was suggested that whole-body fat and plasma FFA oxidation rates declined during high-intensity exercise (85 % V O 2 ,max), as muscle glycogen became the main fuel source utilised (Romijn et al. 1993). The primary aim of the present study was, therefore, to quantify accurately the oxidation rates of plasma FFA, triacylglycerol (TG; sum of intramuscular and lipoprotein-derived TG), plasma glucose and muscle glycogen during steady-state exercise at three intensities (40, 55 and 75 % of maximal workload, W max) using contemporary stable isotope tracer methodology (i.e. using direct measurements of plasma FFA oxidation and validated assumptions for plasma glucose oxidation). Understanding the regulation of fuel selection in human skeletal muscle is important, especially as fuel use abnormalities are present in metabolic diseases like type 2 diabetes (Kelley & Simoneau, 1994; Martin et al. 1995) and obesity (Colberg et al. 1995). However, the mechanisms that regulate the relative contribution of carbohydrate and fat during exercise have not been fully elucidated, and remain open to discussion. Randle et al. (1963) proposed the 'glucose-FFA cycle' in an effort to explain the reduction in muscle carbohydrate oxidation rate in the presence of high plasma FFA levels in resting muscle. It was proposed that an increased availability of plasma FFAs could stimulate fat oxidation and decrease carbohydrate oxidation by suppressing pyruvate dehydrogenase complex (PDC) activation (via a rise in the mitochondrial acetyl-CoA/CoA ratio) and by decreasing glycolytic flux (via the inhibitory effect of high citrate concentrations on phosphofructokinase activity). According to this concept, 1. Contemporary stable isotope methodology was applied in combination with muscle biopsy sampling to accurately quantify substrate utilisation and study the regulation of muscle fuel selection during exercise. 2. Eight cyclists were studied at rest and during three consecutive 30 min stages of exercise at intensities of 40, 55 and 75 % maximal workload (W max). A continuous infusion of [U-13 C]palmitate and [6,6-2 H 2 ]glucose was administered to determine plasma free fatty acid (FFA) oxidation and estimate plasma glucose oxidation, respectively. Biopsy samples were collected before and after each exercise stage. 3. Muscle glycogen and plasma glucose oxidation rates increased with every increment in exercise intensity. Whole-body fat oxidation increase...

A consensus meeting was held in Bangkok, 21-23 May 2002, where experts and young scientists in the field of physical activity, energy expenditure and body-weight regulation discussed the different aspects of physical activity in relation to the emerging problem of obesity worldwide. The following consensus statement was accepted unanimously. 'The current physical activity guideline for adults of 30 minutes of moderate intensity activity daily, preferably all days of the week, is of importance for limiting health risks for a number of chronic diseases including coronary heart disease and diabetes. However for preventing weight gain or regain this guideline is likely to be insufficient for many individuals in the current environment. There is compelling evidence that prevention of weight regain in formerly obese individuals requires 60-90 minutes of moderate intensity activity or lesser amounts of vigorous intensity activity. Although definitive data are lacking, it seems likely that moderate intensity activity of approximately 45 to 60 minutes per day, or 1.7 PAL (Physical Activity Level) is required to prevent the transition to overweight or obesity. For children, even more activity time is recommended. A good approach for many individuals to obtain the recommended level of physical activity is to reduce sedentary behaviour by incorporating more incidental and leisure-time activity into the daily routine. Political action is imperative to effect physical and social environmental changes to enable and encourage physical activity. Settings in which these environmental changes can be implemented include the urban and transportation infrastructure, schools, and workplaces.'

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Introduction:Mechanisms for liraglutide-induced weight loss are poorly understood.Objective:We investigated the effects of liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese non-diabetic individuals.Design:Participants (N=49, 18–75 years, body mass index: 30–40 kg m−2) were randomized to two of three treatments: liraglutide 1.8 mg, 3.0 mg, or placebo in a double-blind, incomplete crossover trial. After 5 weeks, 24-h energy expenditure (EE) and substrate oxidation were measured in a respiratory chamber. Gastric emptying (acetaminophen absorption method), glycemic parameters and appetite were assessed during a 5-h meal test. Ad libitum energy intake during a subsequent lunch was also assessed.Results:Five-hour gastric emptying (AUC0–300 min) was found to be equivalent for liraglutide 1.8 versus 3.0 mg (primary end point), and for both liraglutide doses versus placebo, as 90% confidence intervals for the estimated treatment ratios were contained within the prespecified interval (0.80–1.25). However, 1-h gastric emptying was 23% lower than placebo with liraglutide 3.0 mg (P=0.007), and a nonsignificant 13% lower than placebo with liraglutide 1.8 mg (P=0.14). Both liraglutide doses similarly reduced fasting glucose (0.5–0.6 mmol l−1 versus placebo, P<0.0001), glucose Cmax and 1-h AUC versus placebo; only liraglutide 3.0 mg reduced iAUC0–300 min (by ∼26% versus placebo, P=0.02). Glucagon iAUC0–300 min decreased by ∼30%, and iAUC0–60 min for insulin and C-peptide was ∼20% lower with both liraglutide doses versus placebo. Liraglutide doses similarly increased mean postprandial satiety and fullness ratings, reduced hunger and prospective food consumption and decreased ad libitum energy intake by ∼16%. Liraglutide-associated reductions in EE were partly explained by a decrease in body weight. A relative shift toward increased fat and reduced carbohydrate oxidation was observed with liraglutide. Clinicaltrials.gov ID:NCT00978393. Funding: Novo Nordisk.Conclusion:Gastric emptying AUC0–300 min was equivalent for liraglutide 1.8 and 3.0 mg, and for liraglutide versus placebo, whereas reductions in 1-h gastric emptying of 23% with liraglutide 3.0 mg and 13% with 1.8 mg versus placebo were observed. Liraglutide 3.0 mg improved postprandial glycemia to a greater extent than liraglutide 1.8 mg. Liraglutide-induced weight loss appears to be mediated by reduced appetite and energy intake rather than increased EE.

Background -Optimal nutritional choices are linked with better health but many current

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SummaryDiogenes is a Pan-European, randomized, controlled dietary intervention study investigating the effects of dietary protein and glycaemic index on weight (re)gain, metabolic and cardiovascular risk factors in obese and overweight families in eight European centres. The article is methodological in character, and the presentation of 'results' will be limited to baseline characteristics of the study populations included. A total of 891 families with at least one overweight/obese parent underwent screening. The parents started an initial 8-week low-calorie diet and families with minimum one parent attaining a weight loss of Ն8%, were randomized to one of five energy ad libitum, low-fat (25-30 E%) diets for 6 or 12 months: low protein/low glycaemic index, low protein/high glycaemic index, high protein/ low glycaemic index, high protein/high glycaemic index or control (national dietary guidelines). At two centres the families were provided dietary instruction plus free foods for 6 months followed by 6-month dietary instruction only. At the remaining six centres the families received dietary instruction only for 6 months. The median weight loss during the low-calorie diet was 10.3 kg (inter-quartile range: 8.7-12.8 kg, n = 775). A total of 773 adults and 784 children were randomized to the 6-month weight (re)gain prevention phase. Despite major cultural and dietary regional differences in Europe, interventions addressing effects of dietary factors are feasible with a reasonable attrition.