Sonia Roman, … Arturo Pandoro, in Dietary Interventions in Liver Disease, 2019

4.1.1 Limitations on Energy and Weight Loss

weight Losing through exercise and diet is the primary strategy. It is vital to establish realistic goals for sustainable, healthy and sustainable weight reduction. Given that the majority of patients with NAFLD/NASH are overweight or obese, a weight loss strategy of 5% to 10% of the initial weight in 6 months is desirable. 43 According to various therapeutic guidelines for NAFLD/NASH (Table 1.1), the weight loss of 3%-10% is expected. Improved steatosis in the simple form are noticed with a range of 3% to 5 percent loss in body weight and a decrease of 7%-10% improves the histopathological characteristics that are characteristic of NASH. 40 Yet, a weight loss of 10% or more is necessary for the resolution of NASH and the regression of fibrosis. 44 Energy reduction through diet is essential to achieve weight loss. Therefore, it is recommended that energy consumption be cut from 500 kcal/day down to 1000 kcal/day , or 30% less of the total energy requirements. The energy intake recommended in women ranges from 1200 – 1500 calories per day and 1500-1800 calories/day for men (considering the intensity of physical activity and personal needs). The goal is to facilitate healthy weight loss, which amounts to around 0.5-1 kg/week. 43 In contrast, a dramatic drop of >1.6 kg/week should be avoided because it can worsen the effects of NASH and cause the growth the gallstones. 45

Weight Management: Finding the Healthy Balance

Jacqueline B. Marcus MS, RD, LD, CNS, FADA, in Culinary Nutrition, 2013

Diet Aids

Losing weight and keeping it off is difficult because it requires a everyday effort to be aware of your calories and other activities. The temptation to resort to diet aids can be a tempting. Using pills and other potions to take the weight off quickly is a lot less difficult than working out and diet, regardless of the cost. However, are they secure, and what are the long-term consequences?

Supplements to diet and herbal products are commonly used to aid in weight loss. The United States, the Dietary Supplement and Health Education Act of 1994 (DSHEA) permits producers to classify herbal supplements and nutritional supplements as food. But it also allows manufacturers to circumvent certain strict rules in the FDA. Therefore, weight-loss products aren’t subject to the same rigorous standards as prescription drugs or prescription medications. They may be advertised with limited proof of the effectiveness or safety. Manufacturers may present health claims in reliance on their own analysis and interpretation of studies without FDA authorization. However the FDA could take a particular product off the market when it is discovered to be dangerous. This is crucially important in light of the amount of products available are now accessible via the Internet. The US Federal Trade Commission (FTC) helps in regulating the trafficking. Some of these aids to diet are shown in the table 10-2, 24-27]. There is no guarantee that they are reliable or safe, just like other approaches to eating and fitness, let the buyer beware. Certain long-term effects could be extremely dangerous.

A wide range of prescription and non-prescription medications are available to tackle the health issues that are increasing due to weight gain. They do this by inhibiting the enzyme lipase which is essential to digest fats; inducing a numbing of the taste buds by increasing the chemical in the brain norepinephrine, which is a signal for satisfaction; reducing appetite; and other means.

The potential side effects are decreased intake of the fat-soluble vitamins, digestive problems, and an increase in the heart and blood pressure. The even “Dieter’s Tea” which is readily accessible at some supermarkets, may cause extreme extreme dehydration and gastrointestinal issues, and occasionally death.

Pulmonary Disease

LAURA E. NEWTON MA, RD, SARAH L. MORGAN MD, in Handbook of Clinical Nutrition (Fourth Edition) 2006.

Respiratory Function

As the body’s weight decreases and the body weight decreases, there is a reduction in the capacity and size of the diaphragm as well as the functions of respiratory muscles. In emphysema, the hyperinflated lungs alter the length of the respiratory muscles, and reduce their effectiveness. When malnourished the diaphragm, intercostal and accessory muscles are catabolized to produce energy, resulting in an increase in the capacity to breathe. Inflammation, infection, as well as diminished protein intake can cause dropping levels of serum albumin, which lowers the oncotic pressure and result in pulmonary Edema. In addition, undernutrition affects the parenchyma of the pulmonary artery by decreasing collagen synthesis while also increasing proteolysis. It can be manifested as lower production of surfactants and the collapse of the alveoli.

Weight-reducing surgery for women considering pregnancies: where are we right now?

Siara Teelucksingh … Surujpal Teelucksingh Surujpal Teelucksingh, in Obesity as well as Obstetrics (Second Second Edition), 2020

Pregnancy outcomes after weight-reducing surgery

The advantages to reproductive health after weight-reduction surgery not only begin with increased fertility and increased sexual function , but can extend to the outcome of pregnancy too. In a case-control study that compared the outcomes of pregnancy among women who had undergone bariatric surgeries versus BMI and age-matched women who did not have surgery, there were some noteworthy benefits [47and 47]. These findings were similar to the results of a huge analysis and review of the data from more than 8000 pregnancies after bariatric surgery [49]. In conclusion, when compared with those who underwent the bariatric procedure, there were lower rates of gestational diabetics and hypertension due to pregnancy. Additionally, there was a notable reductions in newborns who were large for dates. The requirement for surgical delivery was also decreased (the number needed to treat ranging from 5 to 11). Also, there was a trend toward less postpartum hemorrhage, with the number needed to benefit of 21. The main risk to the fetus was low in the case of dates (odds ratio 2.16 and number needed to harm: 21), IUGR (odds ratio: 2.16 and number needed to cause harm: 66) Preterm birth (odds ratio 1.35 with a number required to harm: 35). In the end, the results showed no change in the occurrence of preeclampsia. For the neonate: needs for ICU involvement or congenital anomalies as well as death were not affected. On the other hand, there was moderately increased risk for low birth weight, preterm delivery, and high risk for small-for-gestational age. However the study suggests that there could an ongoing benefit throughout early childhood. There are also reports from two studies that focus on the expansion of children born to parents after GBS which indicate that the benefits from maternal anti-obesity surgery can be passed on to their children. In the study conducted in the southern region of Brazil where the rate of obesity among babies born to 19 mothers before the surgery occurred at 55%, and the figure dropped to 31% among the children born to these women following bariatric surgery. In the second study, 118 children, aged 2-18 years, born to women following biliopancreatic bypass surgery were compared with children born before these women had surgery. Again the findings suggested that the antiobesity procedure performed on mothers confers advantages to the children they produce and the incidence of obesity was decreased to the level of the general population. In addition, obesity was reduced by 52% and severe obesity was reduced by 45% [49-52 (Tables 31.3 and 31.4).

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