20^th Global Obesity Meeting August 24-25, 2018 Singapore

Dr. Elena Makarova (PhD – biology) now is a senior researcher in the Laboratory of Physiological Genetics in the Institute of Cytology and Genetics (Novosibirsk, Russia). Her researches focus on the studies of sex-specific influence of maternal leptin on metabolic characteristics in progeny of rodents. She with her colleagues found maternal leptin retarded obesity development in male progeny and improves glucose metabolism in progeny of both sexes in mice.

Maternal obesity increases the risk of obesity in offspring. Leptin is increased in obese animals, and elevation of maternal leptin may affect the metabolic phenotype of the offspring. We explore the effects of leptin elevation during midpregnancy on the offspring metabolic phenotypes, foetal growth, and placental gene expression. C57BL mice received a single injection of leptin or saline on pregnancy day 12. Body weight (BW) was measured weekly in offspring, which consumed standard show or palatable food, and the mRNA expression of glucose and amino acid transporters, insulin-like growth factor 2 and its receptor was measured 3 h, and the placental and foetal weights were measured 24 h after the injection. The offspring born to leptin-treated mothers exhibited growth retardation before and catch-up growth after weaning, and mature male offspring had an increased BW on a standard diet. Prenatal exposure to leptin did not influence the obesity development but prevented the development of obesity-associated hyperglycemia. The leptin injection decreased the foetal weight by 5% and the placental mRNA level of amino acid transporter SNAT2. The results suggest that elevation of maternal leptin in midpregnancy has positive effect on glucose metabolism in mature offspring and this effect is associated with leptin influence on fetal growth and amino acid transporter expression in placentas. (Supported by the RFBR, Grant 17-04-01357).

Tatiana Iakovleva graduated Novosibirsk University in 1988. At the University, she studied the properties and function of estradiol secreted by the adrenal gland. She then studied effects of colour mutations (agouti and non agouti) on the function of pituitary-adrenal system in females and males of Arvicola terestris, effects of colour mutation Agouti yellow on the function of pituitary-adrenal system in mice C57Bl, effects of melanocortin system and estradiol on obesity development and insulin sensitivity in females of C57Bl mice.

The energy-burning capacity of brown adipose tissue (BAT) makes it an attractive target for use in anti obesity therapies. There are sex differences in the metabolic disorders development: high fat diet induces hyperglycemia development in males, but not in females. Serum FGF21 levels are associated with BAT activity. We investigated the effects of high fat and sugar diet (10 weeks) on blood levels of FGF21, insulin, leptine, glucose, on mRNA levels of genes involved in FGF21 signaling (Fgf21, Klotho beta, Pparg), and on mRNA levels of genes related to BAT activity (Ucp1, Slc2a1, Cpt1, Dio2, Hsl) in females and males of C57Bl mice. We found that diet induced obesity, increased blod levels of FGF21, glucose and leptin in females and males and induced hyperinsulinemia development in males. We found also that diet impaired BAT FGF21 signaling only in males: increased mRNA level of Fgf21 and reduced mRNA levels of Klotho beta and Pparg. Obviously due to impaired FGF21 signaling high blood FGF21 levels and increased BAT Fgf21 expression were associated with decreased expression of Slc2a1 and unaltered expression of Ucp1 genes in BAT of obese males. In females, the diet did not affect FGF21 signaling.

Mateusz Åšwierz is a student of Jagiellonian University Medical College. He is planning to be trained as a general surgeon and his main interests focus on this area of medicine. Being a member of Cochrane Poland, he actively propagates the idea of Evidence-Based Medicine and incorporates it into science projects, currently resolving around bariatric surgery and the use of probiotics in surgery.

Background: The most effective treatment for patients with morbid obesity is Bariatric Surgery (BS). To enhance the sustainability of results, certain pre and postoperative interventions could be implemented. Objectives: This systematic review focuses on behavioral lifestyle and nutrition interventions, applied perioperatively, to enhance the sustainability of the results of BS. Methods: Electronic databases (Ovid MEDLINE, Embase, CENTRAL and Web of Science) were searched using adequate strategies with no language and date restrictions. Studies designed as randomized controlled trials, where any type of lifestyle (individual/group sessions aiming to change diet or physical activity through behavioral strategies) or nutrition intervention was provided during perioperative period to patients undergoing BS were included. The primary outcomes are weight loss measured as change in kg/BMI/percentage weight loss from baseline weight/percentage of excess weight loss, change in fat free mass, fat mass. Secondary outcomes are: Change in comorbidities, quality of life, anthropometric parameters and adverse effects. Title/abstract and full text screening were performed by two reviewers independently and any conflicts were resolved by discussion/help from the third reviewer. Every stage was preceded by calibration. We are in the process of data extraction and quality assessment using the Cochrane Risk of Bias Tool. The certainty of evidence will be assessed using GRADE methods. Results: Databases searches yielded 6798 results which after de-duplication provided 5030 references to screen. The screening resulted in 32 references (25 studies) included for extraction and 37 references have been labeled as awaiting classification. These include conference abstracts of unpublished studies (n=32), study protocols (n=2) and papers with unclear follow-up waiting for response from authors (n=3). Within the included studies, the total number of patients randomized in the trials was 2681. Mean age was 42.7±10.09 SD. Female constituted 77.3% of total sample. In the preliminary mapping of the study results for the purpose of quantitative analysis we faced the problems related to the vast diversity of reporting of study results (weight loss) presents the mapping of the ways weight loss results were presented in the studies. Other problems we faced included incomplete reporting of data; some studies presented specific data incompletely or only on charts, which requires additional contacts with the authors to obtain the data. Conclusion: Incomplete reporting of study results and vast diversity of the ways the results of the studies are presented will make synthesis of all the results related to weight loss very difficult. In order to make future comparisons in the field of bariatric more extensive, developing core outcome set will be very useful tool. We have started the process of data extraction and quality assessment.

Monika Storman, a PhD candidate at Department of Internal Medicine and Diabetology, Medical University of Warsaw, graduated from Jagiellonian University Medical College, Krakow, Poland. The presented abstract was created as part of the project: “Systematic Insight into Obesity” in Jagiellonian University Medical College in Krakow, financed as Grant from European Operational Programme Knowledge Education Development 2014 - 2020.

Background: AMSTAR 2 is a critical appraisal tool for the methodological quality of systematic reviews (that include randomised or non-randomised studies or both) of healthcare interventions. It has 16 items, among them 5 are identified as critical domains (which can affect the validity of a review and its conclusions). Objectives: To assess the quality of studies published as SR or MA in the field of bariatrics (BS) in 2016-2017. Methods: Following a protocol published in PROSPERO (CRD42017080394) we identified SR and MA in BS by searching of 3 databases using prespecified search strategy. Two authors independently: reviewed all titles and abstracts, assessed full texts of potentially eligible studies and are extracting the data and assessing the quality of included studies using AMSTAR 2 checklist. Any discrepancies are resolved with discussion and help from the third reviewer. Results: Out of 4084 identified papers 74 were finally included. Based on results of 54 studies: Minority of studies were assessed as high quality in AMSTAR 2 (Fig.1): decisions as “yes” (denotes a positive result) in critical domains were: in item 2. (protocol registered before commencement of the review) - 3.6%, 4. (adequacy of the literature search) - 5.4%, 7. (justification for excluding individual studies) - 3.6%, 9. (risk of bias from individual studies being included in the review) - 12.5%, 11. (appropriateness of meta-analytical methods) - 8.9%, 13. (consideration of risk of bias when interpreting the results of the review) - 16.1% and in item 15. (assessment of presence and likely impact of publication bias) - 21.4%. Conclusions: The quality of studies published as SR and MA in 2016-2017 in BS is highly unsatisfactory.

Syaiyed Jamaluddin is a Clinical Nutrition Specialist Program participant at Faculty of Medicine, Hasanuddin University, Makassar, Indonesia since 2012. He was graduated medical doctor in 2001 with a study entitled Nutritional Status of Children which were Registered at Rumah Singgah in Makassar. He worked at some Health Centers in Maros Regency near Makassar from 2002 till 2012 and involved in some health programs: Leprosy, Tuberculosis, Malaria, HIV-AIDS and Nutrition.

Background: Central obesity related to atherogenic dyslipidemia which was characterized by high serum triglycerides, increased sLDL, and decreased HDLc. Cocoa powder rich in polyphenols as antioxidant sources reduced atherosclerosis risk. Objective: to investigate the influence of cocoa supplementation to atherogenic dyslipidemia in central obesity male subjects by assessing lipid profiles and oxidised LDL. Design: Thirty four healthy male (aged >25–55 years, waist > 90 cm) were recruited to participate in an 8 week randomized and double blind study: 17 subjects received 4 gram cocoa in capsules and the other 17 subjects received placebo. Both groups had 15% energy restriction and fat < 25% of total energy, no changes in activities. Results: after 8 weeks, no changes in total cholesterol and triglycerides in both groups (p >0,05). LDLc level decreased significanly in both groups (cocoa p=0,003 vs placebo p=0,004,). HDLc level increased significantly only in cocoa group (p < 0,05). Oxidised LDL level showed no changes in both groups (p >0,05). If we compared atherogenic cocoa group with atherogenic placebo group (n=17), we found no changes in total cholesterol in both groups (p >0,05), but higher reduction in triglyceride showed in atherogenic cocoa group p=0,043). HDLc level increased significanly only in atherogenic cocoa group (p=0,011), no changes in atherogenic placebo group (p=0,575). Oxidised LDL level showed no changes in both atherogenic groups (p >0,05). Conclusions: Cocoa supplementation on central obesity male within a hypocaloric and low fat diet increased HDLc in dyslipidemia and atherogenic dyslipidemia, higher reduction in triglyceride in atherogenic dyslipidemia then placebo. No significant changes showed in Oxidised LDL level in both dyslipidemia and atherogenic dyslipidemia.

Febryan Agus Pramuyo has expertise in evaluation and passion in improving the health and wellbeing . He has open and contextual evaluation model based on responsive constructivists, creates new pathways for improving healthcare. He is a Clinical Nutrition resident at Hasanuddin Universty in Makassar, South Sulawesi, Indonesia.

Background : Obesity could cause Multiple diverticulitis induce dietary high Fat and low fiber in daily diet. This case especially Ileum diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches - diverticuli - which can develop in the wall of the small intestine, symptoms typically include upper abdominal pain of a sudden onset. The on set of symptoms however, may also occur over a few days. Other symptoms could be nausea, constipation and diarrhea. gastrointestinal intolerance, electrolyte imbalance and vitamin B12 malabsorption. The main principle in management of wound healing in ileum diverticulitis is recurrent prevention by changing diet, where clinicians need to identify this condition in the patient and improve postoperative outcome and accelerate wound healing and administration of appropriate diets. Methods : A 39 y.o female with obesity history was consulted to clinical nutrition department with moderate malnourished patient.(SGA SCORE B) due to inanition in 5 month previously, Body weight had decreased for around 10%, 24 hours food recall was about 868,5 kcal. The patient metabolic status were : anemia, imun system depletion, hypoalbuminemia, hyperbilirubinemia, hypokalemia and normal gastrointestinal function. Nutritional therapy based on Harris-Benedict equation was 1900 kcal, (protein 22%, carbohydrate 55%, fat 23 %) and admitted via oral and parenteral nutrition containing Branched-Chain Amino Acid (BCAA), Glutamine, micronutrient and vitamin to accelerate wound healing process. Result : After 60 days, there were improvements in nutritional status based antropometric, laboratory value and faster process of postoperative wound healing. Conclusion :Optimal nutritition supported postoperative multiple diverticulitis improvement by giving low fat and high fiber, high protein contain BCAA and Glutamine, micronutrients and vitamins

Maria Angela is a Clinical Nutrition Specialist Program participant in Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. She earned her Medical Doctor at Wijaya Kusuma Surabaya University in 2011. She worked at Premier Hospital Surabaya for 3 years as a Resident Medical Officer and was joined in Palliative Team for Cancer Patients. In 2015, she enrolled in Clinical Nutrition Specialist Program at Hasanuddin University.

Background: Congestive heart failure is a chronic and progressive disease, with one of the symptom is a fluid retention as a result of reduced heart’s ability to pump blood. Case Report: A 40 year-old moderate malnourished male patient was diagnosed with Congestive Heart Failure and Dilated Cardiomyopathy for 14 months. There is history of several times hospitalization in the past 6 months. Patient was readmitted 2 weeks ago with major complaints shortness of breath. Oral intake was reduced. Patient’s BMI before diagnosed with heart problem was 33,9 kg/m2, and the BMI in primary survey was 24,6 kg/m2. Vital sign within normal range, only ascites was found in physical examination accompanied by limited functional capacity. There were abnormal values for WBC, TLC, uric acid and sodium serum. Nutritional assessment was based on Subjective Global Assessment. Nutritional therapy was given gradually with target energy 1750 kcal, and protein 1,1g/kg IBW/day. Fluid requirement was adjusted to the patient's fluid output by maintaining a negative fluid balance. Nutrition target was achieved by seventh day of nutritional therapy, in conjunction with improved physical activity and laboratory values. Conclusion: Obesity contributes to the occurrence of cardiomyopathy. Nutritional therapy and fluid management are crucial in holistic care medicine for patients with congestive heart failure to reduce mortality.

Sentot Handoko is a resident of Clinical Nutrition Department Medical Faculty of Hasanuddin University Makassar Indonesia since 2015. He was graduated medical doctor in 2001 at Medical Faculty of YARSI Jakarta Indonesia. He worked at Simpangan Depok Hospital West Java Indonesia since 2009 until 2015 and he works at Indonesia’s Patent of Contraception Organization since 2013.

Background: Burns is damage and or loss of tissue due to contact with sources that have very high temperatures. Malnutrition can lengthening the treatment and wound healing. Nutritional therapy is an important step in the management of burn. Methods: A 23-year-old woman was consulted to clinical nutrition department with complaints of being unable to eat by oral for burns on the entire face and suspected with inhalation trauma. Laboratory tests found albumin 2.8 g/dL, upper arm circumference (UAC) 33 cm. Overweight nutrient status (115.8%), total energy expenditure 2300 kcal/day, with protein 20-25%, carbohydrate 55-65% and fat 20-30%. Hypoalbuminemia corrected with a protein intake of 2-2,5 g/KgBW/day. Supplemented by vitamin B complex, zinc, vitamin C, and vitamin A. Results: After 13 days, patient’s nutritional status had been improved the laboratory value. Wound healing become better. Conclusion: Proper nutrition therapy and supplementation can maintain or improve nutritional status of the patient and accelerate the healing process of burns.

Dr.Chrissander is a 3rd year clinical nutrition resident in Hasanuddin University, Makassar. His interest is in nutrition field, beside of clinical nutrition, also included sports nutrition, related to muscle development, body weight reduction and also as an fitness enthusiast. Formerly work as a general practitioner in Mayapada Internal Hospital, South Jakarta, Indonesia.

Background: Hypocaloric, high protein feeding regimens have been proposed for feeding obese critically ill patients. While both actual and ideal body weight (BW) have been proposed, neither is an accurate reflection of total body protein (TBP) content in obese individuals. Dosing protein based on lean body mass (LBM), which is highly correlated with TBP, might be the most appropriate method for calculating protein needs as defined by actual body composition. We are trying to make a meeting point to determine protein needs to use in hypocaloric feeding for obese patients based on ASPEN which use ideal body weight (IBW) in tune with ESPEN which use LBM Methods: A 39 years old obese female had been admitted to intensive care unit due to congestive heart failure. Actual BW is 160kg (body height:160cm ; BMI:62,5 kg/m2). Patient had low albumin level (3.2g/dl), low potassium, low lymphocyte count (1700/μL) , normal gastrointestinal function. Energy calculation was based on ASPEN 2016 guideline is 1250kcal via oral, protein was based on ESPEN, in which lean protein need (LPN) is 1.8g/kg standard LBM BW <39.6kg> = 71g, and total protein need is LPN x LBM ratio = 7gx1.67 = 120g (ASPEN 2.3g/kgIBW<52.4kg> = 120g), both is equal 38% from macronutrient composition. Carbohydrate and fat composition are 45% (141g) and 17% (23g) respectively, with NPC:N = 41:1 ( according to 30-50:1 in ASPEN). For the supplementation we gave the high dose of multivitamins including 25.8 g branched chain amino acids. Results: Patient was carried out feeding regimens completely, marked by 100% food recall. After 7 days, there were some improvements from clinical and laboratory values, marked by weaning from bilevel positive airway pressure machine, handgrip dynamometry power increment(30kg to 36kg), and elevation of lymphocyte count in conjunction with leukocyte that decreased toward normal. Conclusions: Optimal protein support for obese patient is an important value, either ASPEN or ESPEN method can be used interchangeably.

Wita Tando is Clinical Nutrition Specialist Program participant in Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. She earned her Medical Doctor in 2007. She worked at Community Health Centre for 8 years, focus on prevention and treatment of non-communicable disease. In 2015, she enrolled in Clinical Nutrition Specialist Program at Hasanuddin University.

Background: The rise in the prevalence of obesity in patients with IBD seems to parallel the global obesity epidemic. About 15–40% of patients with IBD are obese, which might contribute to the development of IBD. Obesity is recognized as a perpetual state of chronic low-grade inflammation. There are two approaches that are suspected to link obesity to IBD that is the role of visceral adiposity “creeping fat” and dysbiosis. Visceral adiposity has been independently associated with increased risk of IBD-related complications and disease severity. Obesity might modify response to immunomodulator therapy in IBD. Case report: A 31 year-old man, was referred to us in September 2017 with Severe Chron’s Disase. He was diagnosed with Chron’s Disease in 2013. At that time, the BMI was 28.6 kg / m2 (weight 78 kg). Before illness, patients often consume traditional foods containing red meat, fried food and soft drinks. He rarely eats vegetables and fruits and rarely exercises. In early 2017 patients were diagnosed with Chronic Kidney Disease on regular hemodialysis. Currently patients are treated with hematochezia, anemia, immune depletion, hypoalbuminemia, and electrolyte imbalance. The current weight is 45 kg. Lower Gastrointestinal Endoscopy revealed signs of severe chron's disease, stricture, enterocolic fistula, and anal fissure. Nutritional therapy is given in order to meet energy and macronutrient needs (with consideration of composition and type of nutrition), supplementation of vitamins and minerals with specific doses, decreases inflammation with omega 3 administration, and improves the immune system. Conclusion: Epidemiological studies, in particular prospective cohort study, implicating obesity in the development of IBD are limited, although there is evidence from a pathophysiological perspective. This case report may encourage more prospective research about effects of obesity on incidence, course of disease, and treatment response to IBD and also the effect of obesity treatment to IBD outcomes.