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EMERGING SCIENCE

DOI: 10.1111/j.1467-3010.2012.01985.x

Emerging science
Emerging science provides a brief summary of a selection of recently published papers or reports in the UK and elsewhere in the area of nutrition and human health
L. Wyness and A. OConnor
British Nutrition Foundation, London, UK

Factors that promote or prevent maintaining weight loss

Reyes NR, Oliver TL, Klotz AA et al. (2012) Similarities and differences between weight loss maintainers and regainers: a qualitative analysis. Journal of the Academy of Nutrition and Dietetics 112: 499505.

It is common to regain one-third to one-half of the weight lost in the rst year after losing weight (Jeffery et al. 2000; Wadden et al. 2007; Perri et al. 2008). As a result, many individuals end up in repeated cycles of weight loss and regain. There has been considerable quantitative research on weight loss maintenance, which suggests that physical activity, self-monitoring of bodyweight, regular weighing and continued contact with a health professional are associated with weight loss maintenance. However, it remains unclear how or why so few people are successful at weight loss maintenance. This qualitative study by Reyes et al. (2012) involved six focus groups to explore which factors promoted or prevented weight loss maintenance among a diverse, urban population. The focus groups included 29 adults who had intentionally lost 10% of their bodyweight in the past 2 years and were categorised as either regainers (n = 19) or maintainers (n = 10) using participants self-reported length of weight maintenance and the amount (%) regained. Regainers reported regaining 33% of their weight loss and maintainers had regained 15%. Participants were mainly AfricanAmerican (58.6%), female (65.6%) with a mean age of 46.9 11.2 years. Reyes et al. (2012) identied four themes that reected similarities between regainers and maintainers, and four that reected differences between the groups. Both groups experienced lapses, used clothing t for feedback on weight status, preferred in-person follow-up and decreased self-monitoring of food intake over time. When compared with regainers, maintainers

more often continued strategies used during weight loss (i.e. they weighed themselves regularly and used productive problem-solving skills and positive self-talk). Regainers reported more difculty than the maintainers in independently continuing food and physical activity behaviours during maintenance. Decreased accountability and waning motivation were identied as barriers to maintaining a healthy bodyweight. Strategies to maintain bodyweight after dieting suggested by the authors included building social networks (e.g. internet-based and participant-driven) that promote support and reinforcement over time. Given the strong empirical support for self-monitoring, applications to promote longer-term self-monitoring, such as mobile phone applications or other methods that can make self-monitoring easier and/or more convenient, may help with weight maintenance. Many who lost weight, noticed weight gain based on how their clothes t rather than on the weighing scales. Therefore, these signals (e.g. clothes are tighter) could be used as teachable moments or triggers for implementing plans for reversing small weight gains. As maintainers reported greater positive self-talk, self-efcacy and productive problem-solving skills, placing more emphasis on cognitive techniques for long-term weight control may help during the weight maintenance period. Although this study was small and used a convenience sampling method (which inhibits the generalisability of the ndings) and self-reported information, the ndings were consistent with the previous work looking at successful and unsuccessful weight loss maintenance (e.g. Byrne et al. 2003; Wing & Phelan 2005; Lindvall et al. 2010). The authors suggest that weight loss maintenance efforts could be improved by addressing challenges such as long-term self-monitoring and problemsolving skills.
Byrne S, Cooper Z & Fairburn C (2003) Weight maintenance and relapse in obesity: a qualitative study. International Journal of Obesity and Related Metabolic Disorders 27: 95562.

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Jeffery RW, Drewnoski A, Epstein LH et al. (2000) Long-term maintenance of weight loss: current status. Health Psychology 19: 516. Lindvall K, Larsson C, Weinehall L et al. (2010) Weight maintenance as a tight rope walk: a Grounded Theory study. BMC Public Health 10: 51. DOI: 10.1186/1471-2458-10-51. Perri MG, Foreyt JP & Anton SD (2008) Preventing weight regain after weight loss. In: Handbook of Obesity: Clinical Applications,(GA Bray, C Bouchard eds), pp. 47488. Informa Healthcare: New York, NY. Wadden TA, Butryn ML & Wilson C (2007) Lifestyle modication for the management of obesity. Gastroenterology 132: 222638. Wing RR & Phelan S (2005) Long-term weight loss maintenance. The American Journal of Clinical Nutrition 82: 222S5S.

White rice and risk of type 2 diabetes

Hu EA, Pan A, Malik V et al. (2012) White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. British Medical Journal 344. [Epub ahead of print].

Diabetes is a major public health problem globally, especially in developing countries. Excess body fat is an important determinant of type 2 diabetes and weight loss can reduce diabetes risk. Although a poor diet is known to be a contributing factor to the diabetes epidemic, the specic dietary strategy to prevent diabetes or delay its onset has been debated for some time (Hu et al. 2001). Some prospective studies suggest that consumption of specic foods, such as white rice, impairs glucose metabolism (Mohan et al. 2009; Sun et al. 2010); however, not all studies have come to the same conclusion (Hodge et al. 2004). Hu et al. (2012) conducted a meta-analysis on all published prospective studies evaluating the effect of consumption of white rice on the risk of type 2 diabetes and quantied doseresponse relations between intake of white rice and risk of type 2 diabetes. From their literature search and study selection process, the authors identied 36 potential articles for inclusion that evaluated white rice intake and incidence of type 2 diabetes and quantied doseresponse relations between intake of white rice and risk of type 2 diabetes. After further examination of the full texts of these publications, four studies met the inclusion criteria and were included in this meta-analysis. Two of the cohort studies were carried out in Asian populations (China and Japan), and the other two cohort studies in Western populations (the USA and Australia). A total of 13 384 incident cases of type 2 diabetes occurred among the 352 384 participants included in the meta-analysis during follow-up periods ranging from 4 to 22 years. Statistical analysis revealed a positive association between rice intake and the risk of type 2 diabetes, comparing high and low white rice consumption levels

[pooled relative risk (RR) was 1.27; 95% condence interval (CI) was 1.041.54], although signicant heterogeneity was detected (I2 = 72.2%; Cochrane Q test P = 0.001). Rice intakes varied greatly between studies. For example, Asian populations had a higher consumption of white rice (34 servings/day, on average) than Western populations (12 servings/day, on average). The data were then stratied for ethnicity. Comparing the highest with the lowest category of rice intake, Asian populations had a greater risk of developing type 2 diabetes (pooled RR: 1.55; CI: 1.20, 2.01) than Western populations (pooled RR: 1.12; CI: 0.94, 1.33). A dose response meta-analysis of the total population showed that each serving per day of white rice intake was associated with an 11% increase in risk of type 2 diabetes (RR: 1.11; CI: 1.08, 1.14) (P for linear trend <0.001). The authors of the study acknowledged that because all individual studies were observational in nature, the results of these studies may still be subject to residual confounding or other biases. Low socio-economic status (or indeed other factors) which is a known risk factor for type 2 diabetes and a predictor of rice consumption in both Asian and Western populations was not adjusted for in the statistical model. This may have led to inaccurate results in terms of the strength of the association and also the direction of the effect identied. The ndings of this meta-analysis can only show associations, not cause and effect, and as type 2 diabetes is inuenced by many lifestyle factors such as obesity and inactivity, it is difcult to assess whether other factors could have inuenced the results of this meta-analysis. In order to validate the ndings of this study, ideally, an adequately powered, randomised controlled trial in which white rice is modied in the intervention group is required. However, as this would be very difcult and take many years to conduct, it would be more useful to investigate the potential mechanisms of this suggested association between white rice consumption and the increased risk of type 2 diabetes.
Hodge AM, English DR, ODea K et al. (2004) Glycaemic index and dietary bre and the risk of type 2 diabetes. Diabetes Care 27: 27016. Hu FB, Mason JE, Stampfer MJ et al. (2001) Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. New England Journal of Medicine 345: 7907. Mohan V, Radhika G, Sathya RM et al. (2009) Dietary carbohydrates, glycaemic load, food groups and newly detected type 2 diabetes among urban Asian Indian population in Chennai, India (Chennai Urban Rural Epidemiological Study 59). The British Journal of Nutrition 102: 1498506. Sun Q, Spiegelman D, van Dam RM et al. (2010) White rice, brown rice, and risk of type 2 diabetes in US men and women. Archives of Internal Medicine 170: 9619.

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The satiating power of foods and drinks containing nutritive and non-nutritive sweeteners
Bellisle F, Drewnowski A, Anderson GH et al. (2012) Sweetness, satiation, and satiety. Journal of Nutrition 142: 1149S54S. [Epub ahead of print].

Satiation occurs during an eating episode and brings it to an end, whereas satiety starts after the end of eating and prevents further eating before the return of hunger. Enhancing satiation and satiety derived from foodstuffs can potentially affect total intake and facilitate weight control. Although sweetness is a potent sensory stimulus of intake, sweet-tasting products produce satiation and satiety as a result of their volume as well as their nutrient and energy content. There is an on-going debate as to whether energy intake from uids is as satiating as energy ingested from solid foods. Bellisle et al. (2012) reviewed evidence relating to this issue and considered the satiating power of foods and drinks containing nutritive and non-nutritive sweeteners, as well as the brain mechanisms of food reward in terms of liking and wanting. The authors concluded that uncertainty remains as to whether energy from uids is as satiating as energy from solids. The evidence suggests that volume can exert satiety effects in the very short-term, whereas nutrient and energy contents play a decisive role in the longerterm. Regarding European health claims on increased satiety and/or reduced sense of hunger/appetite, the European Food Safety Authority stated that Changes in appetite ratings after consumption of a test food

should also be observed after chronic consumption of the food (e.g. after 1 month), and therefore tests performed on a single occasion would not be considered sufcient for substantiation (EFSA Panel on Dietetic Products, Nutrition and Allergies 2011). Bellisle et al. suggested that the medium-term and longer-term effects of a food or drink on satiation and satiety should be established before they are recommended in the context of a weight control programme. The authors reported that earlier hypotheses that lowcalorie sweeteners might stimulate excessive energy intake and encourage weight gain have not been conrmed by more recent research. Studies of free-living users of low-calorie sweeteners indicate that these sweeteners can be used in the context of a healthy diet for the purpose of limiting energy intake. A new and interesting area of research is the investigation of the cerebral mechanisms underpinning food reward. New methods of brain imaging have allowed researchers to identify brain sites where activity corresponds to food liking and food wanting. Activity in these brain sites differs according to whether the person is hungry or sated and also between overweight and normal-weight individuals, particularly under stress. This is an interesting area for future research.
EFSA Panel on Dietetic Products, Nutrition and Allergies (2011) Draft guidance on the scientic requirements for health claims related to appetite ratings, weight management, and blood glucose concentrations released for public consultation. EFSA Journal. Available at: http://www.efsa.europa.eu/en/consultations/ call/nda110426.pdf (accessed 28 May 2012).

2012 The Authors Journal compilation 2012 British Nutrition Foundation Nutrition Bulletin, 37, 285287