European Congress on Obesity, Prague: Press Release
**Embargo for all parts: 0001H Prague local time Friday 8 May**
 Living at higher altitude reduces the risk of becoming
overweight or obese
 Vitamin D supplementation aids weight loss in obese people
with vitamin D deficiency
 High-protein diet increases risk of weight gain and death in
people at high risk of cardiovascular disease
 Preliminary results of trial suggest obesity surgery causes
increased effect of alcohol
Living at higher altitude reduces the risk of becoming overweight
or obese
Embargo: 0001H Prague local time Friday 8 May
New research presented at this year’s European Congress on Obesity in Prague (6-9 May)
shows that living at a higher altitude (above 456 metres) results in a 13% lower risk of
becoming overweight or obese compared with living at a lower altitude (124 metres and
below). The research, led by Dr Maira Bes-Rastrollo and Professor Miguel A. MartinezGonzalez, was conducted at the Department of Preventive Medicine and Public Health of
University of Navarra (Spain), part of CIBERobn (Carlos III Institute of Health) and IDiSNA
Research Institute.
Residence at high altitude has been associated with lower obesity rates probably due to
hypoxia conditions, meaning lower concentrations of oxygen in the air. High altitudes
suppress hunger due to increasing secretion of leptin and the regulation of other hormones
involved in appetite control as a compensatory mechanism to hypoxia. This in turn reduces
the use of oxygen in the aerobic metabolism (less food, less oxygen needed to obtain
energy). The authors also speculate such mechanisms could be an ancient adaptive
mechanism to survive at high altitudes where food is not abundant.
However, to date there is no evidence of a reduced risk of obesity at higher altitudes in a
free-living population. Thus the authors analysed the association between the altitude of
residence and incident overweight/obesity within the Seguimiento Universidad de Navarra
(SUN) project cohort.
The SUN project is a dynamic, prospective, multipurpose cohort of Spanish university
graduates with a retention rate of 90%. The authors included in this new study 9,302
participants free of overweight/obesity at baseline. In the baseline questionnaire participants
reported their postal code and the time they had been living in their city/village. The altitude
of each postal code was estimated according to data from the Spanish National
Cartographic Institute. People were divided into three equal groups depending on altitude:
below 124m (low); 124-456m (medium) and above 456m (high).
During a median follow-up of 8.5 years, the team identified 2,099 incident cases of
overweight/obesity. The results were adjusted for a wide range of factors including age, sex,
baseline body mass index, time of residence, physical activity, sedentary behaviours,
smoking (non-smokers, current smokers, former smokers), snacking, following a special diet,
total energy intake, and adherence to the Mediterranean dietary pattern. Following this, the
data showed participants in the high group (>456 m) showed a statistically significant 13%
reduced risk of developing overweight/obesity in comparison to those in the low group (<124
m).
The authors say: “Living in cities of higher altitude was associated with a lower risk of
developing overweight/obesity in a cohort of Spanish university graduates.”
They add: “While it might not be realistic to expect everyone to move further uphill to reduce
obesity levels, it is encouraging to see this effect occurred at only 450m altitude. The results
are in agreement with potential biological mechanisms that are caused by hypoxia.”
The group is currently continuing this work by investigating the effects of altitude on
cardiovascular risk factors that form part of metabolic syndrome.
Dr Maira Bes-Rastrollo, University of Navarra, Spain, and Carlos III Institute of Health,
Spain. T) +34 948425600 Ext. 806602 / mobile +34-606677389 E) mbes@unav.es
Professor Miguel Martinez-Gonzalez , University of Navarra and CIBER-OBN, Carlos III
Institute of Health, Spain. T) +34-636 355 333 E) mamartinez@unav.es
Alternative contact: Tony Kirby of Tony Kirby PR Ltd T) +44 7834 385827 E)
tony@tonykirby.com
For the abstract related to this press release, see:
http://easo.org/wp-content/uploads/2015/05/ECO2015FRIPRESSABSTRACTS.pdf
Vitamin D supplementation aids weight loss in obese or overweight
people with vitamin D deficiency
Embargo: 0001H Prague Local time Friday 8 May
New research presented at this year’s European Congress on Obesity in Prague (6-9 May)
shows that vitamin D supplementation aids weight loss in obese and overweight people with
vitamin D deficiency. The study is by Dr Luisella Vigna, Foundation IRCCS Ca’ Granda and
Department of Preventive Medicine, University of Milan, Italy, and colleagues.
Previous studies have shown that vitamin D deficiency is associated with both developing
obesity and the risk of obesity related complications, but studies on the effects of vitamin D
supplementation have been inconclusive. In this new research, the authors aimed to
establish whether restoration of optimal vitamin D status would promote weight loss and
improve the metabolic profile of obese or overweight people with a vitamin D deficiency. In
North America studies suggest around 40% of adults are deficient in the nutrient. The
authors of this study estimated that in Northern Italy, vitamin D severe deficiency (<10 ng/ml)
ranges from 6% in overweight people (BMI 25-30 kg/m2) to 30-40% in morbid obesity (BMI
above 40). However almost all obese subjects (BMI above 30) did not have their vitamin D
level in the optimal range (above 30 ng/ml).
A total of 400 obese or overweight people were recruited for this study between 2011 and
2013. The cohort was made up of BMI 25-29.9 (overweight): 86 patients; BMI 30-34.9
(obesity – class I): 170 patients; BMI 35 – 39.0 (obesity – class II): 92 patients; BMI > 40
(obesity – class III/morbidly obese): 52 patients. All participants received a balanced
moderately low calorie diet and were assigned to one of three groups: 1) No
supplementation 2) vitamin D supplementation using cholecalciferol 25,000 international
units (UI) per month 3) vitamin D supplementation using cholecalciferol 100,000 UI per
month.
At the start of the study and 6 months later, the authors measured body parameters,
including body mass index (BMI) and waist circumference; body composition; plasma levels
of vitamin D, fasting glucose, fasting insulin and glycated haemoglobin (HbA1c, a standard
measure of blood glucose control used to study diabetes).
Six-month supplementation with 25.000 and 100.000 UI increased serum vitamin D levels,
but only 100.000 allowed achievement of optimal vitamin D status. (see Fig. 1 A and B
below). A significantly greater weight decrease was observed in the 25.000 and 100.000 UI
groups (–3.8 kg and –5.4 kg) compared to no supplementation (-1.2 kg). Waist
circumference reduction was more substantial in the vitamin D group (25.000: –4.00 cm;
100.000: –5.48 cm; no supplementation: –3.21 cm) (Fig. 2). Adjustment for age, sex, and
BMI did not affect statistical significance.
Improved blood sugar control (HbA1c) was noted in patients supplemented with 100.000 UI,
but this finding lost significance after adjustment for weight decrease, meaning this was
probably caused by the weight loss rather than the supplementation.
The authors say: “The present data indicate that in obese and overweight people with
vitamin D deficiency, vitamin D supplementation aids weight loss and enhances the
beneficial effects of a reduced-calorie diet.”
They recommend: “All people affected by obesity should have their levels of Vitamin D
tested to see if they are deficient, and if so, begin taking supplements.”
In other research, this team is investigating whether vitamin D supplementation influences
cardiovascular parameters such as blood fats and body composition in terms of lean mass.
They also plan to evaluate the potential effect of vitamin D on white blood cell counts.
Dr Luisella Vigna, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda
Ospedale Maggiore Policlinico, University of Milan, Italy. T) +39 02 55032592 E)
luisella.vigna@policlinico.mi.it
Alternative contact: Tony Kirby of Tony Kirby PR Ltd T) +44 7834 385827 E)
tony@tonykirby.com
For the abstract related to this press release, see:
http://easo.org/wp-content/uploads/2015/05/ECO2015FRIPRESSABSTRACTS.pdf
Figure 1. A. Plasma 25(OH) increase after 6 months of supplementation with colecalciferol.
Figure 1. B. Proportion of patients with optimal plasma 25(OH)D concentration (> 30 ng/ml)
after 6 months of supplementation.
Figure 2. Change in weight (Kg), BMI (Kg/m2), waist circumference (cm) and body fat mass
(%), respectively, after 6 months of supplementation. P < 0.05 for weight, BMI and waist
circumference variations
High-protein diet increases risk of weight gain and death in people
at high risk of cardiovascular disease
Embargo: 0001H Prague local time Friday 8 May
New research presented at this year’s European Congress on Obesity in Prague (6-9 May)
shows that, in patients at high risk of cardiovascular disease, a high-protein diet increases
the risk of both weight gain and death. The research was conducted by the PREDIMED
Investigators and led by Dr Jordi Salas-Salvadó and Dr Mònica Bulló, Human Nutrition Unit,
Faculty of Medicine and Health Sciences, Pere Virgili Institute for Investigating Health,
Rovira i Virgili University, Reus, Spain, and colleagues.
Although diets high in protein are widely used to manage overweight and obesity, there is a
lack of consensus about their long-term efficacy and safety. The aim of this study was to
simultaneously assess the association of long-term high-protein consumption on body
weight changes and death in subjects with cardiovascular risk factors including overweight
or obesity, type 2 diabetes, hypertension or dislipidemia (abnormal body fats).
The authors did a secondary analysis of the PREDIMED (Primary Prevention of
Cardiovascular Disease with a Mediterranean Diet) Trial, published in 2013. Dietary protein
was assessed using a food-frequency questionnaire during a mean of 4.8 years of follow-up.
The authors found that higher total protein intake was significantly associated with a 90%
greater risk of gaining more than 10% of body weight when protein replaced carbohydrates,
and a non-significant trend when protein replaced fat. No association was found between
protein intake and increased waist circumference. Higher total protein intake was also
associated with a 59% greater risk of all-cause death when protein replaced carbohydrate,
and a 66% increased risk of death when protein replaced fat.
The authors say: “Higher dietary protein intake is associated with long-term increased risk of
body weight gain and overall death in a Mediterranean population at high cardiovascular
risk.”
They add: “At the moment, no evidence supports the use of high-protein diets as a strategy
to lose weight long-term. However, there is some evidence, including our study, showing the
negative affect of a high protein diet on other clinical outcomes.”
The authors explain that the mechanisms underlying the relationship between high-protein
diets and weight gain are still unknown, although some findings support a modulatory role on
the body’s orexin/incretin hormone system that promotes food consumption. They say:
“Regarding the role of a high protein diet in death risk it could be due to increased kidney
disease, changes in glucose and insulin metabolism, and also a modulatory role on blood fat
profiles.”
Dr Mònica Bulló, Human Nutrition Unit, Faculty of Medicine and Health Sciences, Pere
Virgili Institute for Investigating Health, Rovira i Virgili University, Reus, Spain. T) +34
977759312 E) monica.bullo@urv.cat
Alternative contact: Tony Kirby of Tony Kirby PR Ltd T) +44 7834 385827 E)
tony@tonykirby.com
For the abstract related to this press release, see:
http://easo.org/wp-content/uploads/2015/05/ECO2015FRIPRESSABSTRACTS.pdf
Preliminary results of trial suggest obesity surgery causes
increased effect of alcohol
Embargo: 0001H Prague local time Friday 8 May
Preliminary results from a trial in Norway presented at this year’s European Congress on
obesity in Prague (6-9 May) show that obesity surgery using the sleeve gastrectomy
technique leads to patients having a more rapid uptake of alcohol, which also reaches higher
concentrations in their blood and is detectable for longer. The research is by Magnus
Strømmen, Centre of Obesity, Department of Surgery, St Olavs University Hospital,
Trondheim, Norway, and colleagues.
,
There is growing concern that bariatric surgery increases risk of alcoholism postoperatively.
As several surgical procedures exist, insight into how different operative techniques
influence bioavailability relatively can be valuable information when deciding the appropriate
surgical procedure. In this study, the authors set up a trial to compare the effect of sleeve
gastrectomy (where the stomach is reduced to a narrow tube, but keeping the sphincter)
versus gastric bypass (where the stomach is downsized to a small pouch connected directly
to the intestine) on bioavailability of alcohol both three months and one year after their
surgery. This first report comes from the three month tests for the first 5 sleeve gastrectomy
patients (3 men and 2 women, mean age 45 years).
Participants, all with a body mass index (BMI) of over 40 kg/m , underwent fasting and then
had a standardised breakfast one hour prior to alcohol administration. Ethanol (alcohol)
dosage was calculated on basis of measured preoperative total body water. Dosage was 0.4
g/kg TBW for women and 0.5 g/kg TBW for men. Both an oral and intravenous test was
performed (in random order) on every participant to calculate the bioavailability of ethanol,
meaning the fraction of alcohol that reaches systemic circulation. As the liver is central in
metabolising alcohol, it was necessary also to perform the intravenous tests to control for
eventual changes in liver function due to the surgery or weight loss.
2
For the oral test, participants consumed, in 5 minutes, vodka 40% diluted with orange juice
to a concentration of 20%. For the intravenous test, ethanol 40% was diluted with glucose
5% to a concentration of 5 g/100 ml, and administered as infusion over 30 minutes. Blood
alcohol content was analysed with a lower detection limit of 2.2 mmol/L at a series of time
points. This gave the basis for detecting peak blood ethanol concentration (Cmax), time at
which Cmax is observed, and the area under curve, which reveals the total ethanol exposure
over time.
For the purpose of evaluating the participants’ intoxication, the authors performed
neuropsychological tests measuring attention and working memory at the point when alcohol
reached maximum levels. These results have not yet been analysed.
However, the data so far shows that 3 months postoperatively, uptake of alcohol was more
rapid, reached higher concentrations and was detectable longer. Relative bioavailability was
considerably higher than prior to surgery. The authors say: “We believe the main reason is
that sleeve gastrectomy leave patients with a reduced gastric surface, which in turn
decreases the oxidation of alcohol by enzymes in the stomach. This trial aims at comparing
the magnitude of this effect relative to that of the gastric bypass-procedure. If one of the two
surgical procedures show considerably less effect on bioavailability of alcohol, this would
provide clinicians better basis for recommending what is the best treatment on an individual
level.”
The authors conclude: “Obesity surgery using sleeve gastrectomy seems to increase
bioavailability of ethanol which in turn may enhance its toxicological effects. Patients seeking
obesity surgery should be informed about how alcohol uptake and intoxication qualitatively
may change after surgery with implications for both safety and possible dependence.
Increased awareness among clinicians to detect possible alcohol abuse at an early stage
postoperatively, is recommended. This study can contribute to the understanding of earlier
findings showing increased rates of death due to accidents and suicide in patients
undergoing obesity surgery. For instance, patients who have had obesity surgery should be
warned against using common ‘morning after calculators’ for deciding whether or not to
drive.”
Based upon the existing research as well as the preliminary results from the above trial, the
Obesity Clinic at St Olavs University Hospital has incorporated this into its patient education
programme under the title: “Learning to drink all over again”.
Magnus Strømmen, Centre of Obesity, Dept. of Surgery, St. Olavs University Hospital,
Trondheim, Norway. T) +47 9170 1010 E) magnus.strommen@stolav.no
Tony Kirby of Tony Kirby PR Ltd T) +44 7834 385827 E) tony@tonykirby.com
For the abstract related to this press release, see:
http://easo.org/wp-content/uploads/2015/05/ECO2015FRIPRESSABSTRACTS.pdf
Tony Kirby
Director, Tony Kirby PR Ltd
T) +44 7834 385827
E) tony@tonykirby.com