Introduction: Short-term (4 weeks) supplementation with n-3 polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has recently been shown to improve protein metabolism in a dose dependent way in normal weight patients with Chronic Obstructive Pulmonary Disease (COPD). Furthermore, EPA/DHA supplementation was able to increase extremity lean soft tissue but not muscle function. No studies are available combining n-3 PUFAs and the leucine metabolite beta-hydroxy-beta-methylbutyrate (HMB) supplementation in chronic clinical conditions. Whether adding HMB to daily EPA/DHA supplementation for 10 weeks enhances muscle and brain health, daily functional performance, and quality of life of patients with COPD by further improving their protein and amino acid homeostasis remains unknown. Methods: Patients with COPD (GOLD: II-IV, n = 46) received daily for 10 weeks, according to a randomized double-blind placebo-controlled three-group design, EPA/DHA (n = 16), EPA/DHA to which HMB was added (n = 14), or placebo (n = 16). The daily dose of 2.0 g of EPA/DHA or soy + corn oil as the placebo was provided via gel capsules, and 3.0 g of Ca-HMB or maltodextrin as placebo as powders. At pre- and post-intervention, a pulse mixture of multiple amino acids was administered to measure postabsorptive net protein breakdown (netPB as primary endpoint) and whole body production (WBP) and conversion rates of the amino acids. As secondary endpoints, lean soft tissue and fat mass were assessed by dual-energy X-ray absorptiometry, upper and lower muscle function by handgrip and single leg isokinetic dynamometry, brain (cognitive, wellbeing) health by assessments, daily functional performance by measuring 6-min walk distance, 4-m gait speed, and postural balance, and quality of life by questionnaire. Plasma enrichments and concentrations were analyzed by LC-MS/MS, and systemic inflammatory profile and metabolic hormones by Luminex. Results: HMB + EPA/DHA but not EPA/DHA supplementation increased postabsorptive netPB (p = 0.028), and WBPs of glutamine (p = 0.024), taurine (p = 0.039), and tyrosine (p = 0.036). Both EPA/DHA and HMB + EPA/DHA supplementation resulted in increased WBP of phenylalanine (p < 0.05). EPA/DHA but not HMB + EPA/DHA was able to increase WBP of arginine (p = 0.030), citrulline (p = 0.008), valine (p = 0.038), and conversion of citrulline to arginine (p = 0.009). Whole body and extremity fat mass were reduced after HMB + EPA/DHA supplementation only, whereas lean soft tissue was increased after EPA/DHA (p = 0.049) and HMB + EPA/DHA (p = 0.073). No other significant findings were observed. Reductions in several proinflammatory cytokines were observed in the HMB + EPA/DHA group including IL-2, IL-17, IL-6, IL-12P40, and TNF-beta (p < 0.05). Conclusions: Ten weeks of supplementation with 2 g of EPA/DHA daily is sufficient to induce muscle gain in COPD but HMB is needed to induce fat loss. Whether HMB is solely responsible for the fat mass loss or has a synergistic effect with EPA/DHA remains unclear. The increase in net protein breakdown observed with HMB + EPA/DHA supplementation may indicate a beneficial enhanced protein turnover cycling associated with increased lean soft tissue. (c) 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

care.BIA was used to assess muscle mass and CRP to assess inflammation.Reduced food intake or malabsorption was defined by questions of the screening tools.Results: In total, 2568 patients (mean age 73±9 yrs, 57% male) were screened.The prevalence of malnutrition according to the GLIM criteria was 30%.The sensitivity of the screening tools was poor to fair and the specificity fair to good (Table 1).The positive and negative predictive values ranged from 57-87% and 77-86% respectively. Conclusion:Due to very low sensitivity, the currently used screening tools are not able to identify malnourished older patients in a hospital setting.Using screening tools as the first GLIM step will result in misclassifying 30-60% of the malnourished patients as well-nourished and therefore not receiving nutritional care.As a future perspective, a set of already available determinants from electronic patient records could be used to improve the sensitivity of malnutrition screening, for example BMI, unintentional weight loss, CRP and a question on appetite and nutritional intake.

BACKGROUND:Production rates of the short-chain fatty acids (SCFA) acetate, propionate, and butyrate, which are beneficial metabolites of the intestinal microbiota, are difficult to measure in humans due to inaccessibility of the intestine to perform measurements, and the high first-pass metabolism of SCFAs in colonocytes and liver. We developed a stable tracer pulse approach to estimate SCFA whole-body production (WBP) in the accessible pool representing the systemic circulation and interstitial fluid. Compartmental modeling of plasma enrichment data allowed us to additionally calculate SCFA kinetics and pool sizes in the inaccessible pool likely representing the intestine with microbiota. We also studied the effects of aging and the presence of Chronic Obstructive Pulmonary Disease (COPD) on SCFA kinetics. METHODS:In this observational study, we designed a two-compartmental model to determine SCFA kinetics in 31 young (20-29 y) and 71 older (55-87 y) adults, as well as in 33 clinically stable patients with moderate to very severe COPD (mean (SD) FEV1, 46.5 (16.2)% of predicted). Participants received in the fasted state a pulse containing stable tracers of acetate, propionate, and butyrate intravenously and blood was sampled four times over a 30 min period. We measured tracer-tracee ratios by GC-MS and used parameters obtained from two-exponential curve fitting to calculate non-compartmental SCFA WBP and perform compartmental analysis. Statistics were done by ANCOVA. RESULTS:Acetate, propionate, and butyrate WBP and fluxes between the accessible and inaccessible pools were lower in older than young adults (all q < 0.0001). Moreover, older participants had lower acetate (q < 0.0001) and propionate (q = 0.019) production rates in the inaccessible pool as well as smaller sizes of the accessible and inaccessible acetate pools (both q < 0.0001) than young participants. WBP, compartmental SCFA kinetics, and pool sizes did not differ between COPD patients and older adults (all q > 0.05). Overall and independent of the group studied, calculated production rates in the inaccessible pool were on average 7 (acetate), 11 (propionate), and 16 (butyrate) times higher than non-compartmental WBP, and sizes of inaccessible pools were 24 (acetate), 31 (propionate), and 55 (butyrate) times higher than sizes of accessible pools (all p < 0.0001). CONCLUSION:Non-compartmental production measurements of SCFAs in the accessible pool (i.e. systemic circulation) substantially underestimate the SCFA production in the inaccessible pool, which likely represents the intestine with microbiota, as assessed by compartmental analysis.

Rationale: Comorbidities frequently develop during aging, negatively affecting health outcomes and quality of life of the older population. It remains unclear whether the presence of comorbidities affects body composition, (muscle and cognitive) functional performance, and wellbeing differently in young-older adults (age 50-70y) as compared to middle-older adults (age 70-95y).

Aim: To compare the efficacy of two popular weight loss approaches on weight loss, body composition, and markers of health in sedentary obese women. Methods: In total, 51 sedentary women (age 34.5 ± 7.7 yrs.; weight 90.0 ± 14.5 kg; BMI 34.0 ± 5.1 kg/m2; 46.5 ± 7.0% fat) were matched and randomized to participate in the Weight Watchers® Momentum™ (WW) or Curves® (CV) Fitness and Weight Management program for 16 weeks. Participants in the WW group (n = 27) were provided a point-based diet program, received weekly progress checks and counseling, and were encouraged to exercise. Participants in the CV group (n = 24) followed a menu-based higher protein/low-fat diet (1200 kcal/d) for 1 week; 1500 kcal/d diet for 3 weeks; and 2000–2500 kcals/d for 2 weeks that was repeated three times (except the last segment) while participating in a supervised circuit-style resistance training program (3 d/wk). A general linear model (GLM) with repeated measures was used to analyze data and are presented as mean changes from baseline (mean [UL, LL]). Results: Supervised CV training resulted in greater amounts of vigorous and total physical activity. After 16 weeks, both groups lost weight (WW −6.1 [−7.8, −4.6], CV −4.9 [−6.2, −3.2] kg, p = 0.264). Participants in the CV group observed greater reductions in fat mass (WW −2.9 [−6.7, −0.2], CV −6.4 [−9.2, −3.6] kg, p = 0.081) and increases in lean mass (WW −2.5 [−4.3, −0.7], CV 1.3 [−0.6, 3.2] kg, p = 0.005) resulting in more favorable changes in percent body fat (WW −1.4 [−4.1, 1.2], CV −4.7 [−7.5, −1.8]%, p = 0.098). Both groups observed improvements in peak aerobic capacity and muscular endurance, although bench press lifting volume was greater in the CV group. Those in the CV group experienced a greater increase in HDLc and reduction in the CHL–HDLc ratio and triglycerides. Conclusion: Both interventions promoted weight loss and improvements in fitness and markers of health. The CV program, which included supervised resistance training and higher protein diet menus, promoted greater fat loss, increases in lean mass, and improvements in percent body fat and blood lipids. Trial Registration: clinicaltrials.gov, #NCT04372771, registered retrospectively 1 May 2020.

Aging and comorbidities are known to influence amino acid metabolism, contributing to reduced muscle and cognitive dysfunction in older adults. Whether these aging-induced manifestations remain after correction for the presence of comorbidities is unclear. Older adults were selected from the MEDIT database. The subjects were divided into two age groups: 264 young old (age 50–70 y: n = 149 with at least 1 comorbidity based on Charlson comorbidity index (CCI > 0) and n = 115 with CCI = 0), and 196 middle old (age 70–85 y: n = 119 with CCI > 0 and n = 77 with CCI = 0). Body composition was assessed by DXA, respiratory and skeletal muscle strength by mouth pressures and dynamometry, and cognition and mood by assessments and questionnaires. Postabsorptive kinetics of multiple amino acids were measured by pulse stable isotope administration and subsequent blood sampling. Plasma amino acid concentrations and enrichments were analyzed by LC-MS/MS to measure whole-body protein production (WBP) and conversion rates. Statistics are done with ANCOVA with sex and BMI and age group as independents. Results expressed as means [95% CI]. The middle old had lower lean mass on whole body level and in the extremities (p < 0.0001), and lower respiratory (p = 0.05) and handgrip (p = 0.005) strength compared to the young old, independent of muscle health lowering effects of CCI. Although no differences were observed in cognition and mood between the groups, an age x CCI interaction was found for depression, anxiety (p = 0.03), and lean mass extremity (p = 0.04). The middle old had lower values for WBP of tau-methylhistidine (p = 0.01), hydroxyproline (P = 0.008), and taurine (p = 0.004), and plasma glutamine concentration (P = 0.016). In addition, the middle old showed higher glutamine to glutamate conversion (p = 0.02). Age x CCI interaction was observed for plasma concentration of tyrosine (p = 0.04). No differences were observed in plasma concentrations and WBP of phenylalanine and the branched-chain amino acids (leucine, valine, and isoleucine) between the groups. Muscle loss and weakness and specific disturbances in amino acid kinetics due to aging exist even after correction for the presence of comorbidities. None

Rationale: Previously we observed an enhanced anabolic response to high quality protein sip feeding in normal weight Chronic Obstructive Pulmonary Disease (COPD) on group level. To further explore this on an individual level and in a larger group of COPD patients, we used a recently developed isotope method (ClinNutr 2019;38:1833-43) to assess whether the efficiency of dietary protein to promote protein anabolism (anabolic capacity) is enhanced and the minimal amount of protein to obtain protein anabolism (anabolic threshold) is altered in COPD patients as compared to healthy controls.

BACKGROUND:The amount of the macronutrients protein and carbohydrate (CHO) in a mixed meal is known to affect each other's digestion, absorption, and subsequent metabolism. While the effect of the amount of dietary protein and fat on the glycemic response is well studied, the ability of postprandial plasma amino acid patterns to predict the meal composition is unknown.OBJECTIVE:To study the postprandial plasma amino acid patterns in relation to the protein, CHO, and fat content of different mixed meals and to investigate if these patterns can predict the macronutrient meal composition.DESIGN:Ten older adults were given 9 meals with 3 different levels (low, medium, and high) of protein, CHO, and fat in different combinations, taking the medium content as that of a standardized western meal. We monitored the postprandial plasma response for amino acids, glucose, insulin, and triglycerides for 8 h and the areas under the curve (AUC) were subsequently calculated. Multiple regression analysis was performed to determine if amino acid patterns could predict the meal composition.RESULTS:Increasing meal CHO content reduced the postprandial plasma response of several amino acids including all branched chain amino acids (BCAA) (leucine; q < 0.0001, isoleucine; q = 0.0035, valine; q = 0.0022). The plasma BCAA patterns after the meal significantly predicted the meal's CHO content (leucine; p < 0.0001, isoleucine; p = 0.0003, valine; p = 0.0008) along with aspartate (p < 0.0001), tyrosine (p < 0.0001), methionine (p = 0.0159) and phenylalanine (p = 0.0332). Plasma citrulline predicted best the fat content of the meal (p = 0.0024).CONCLUSIONS:The postprandial plasma BCAA patterns are lower with increasing meal CHO content and are strong predictors of a mixed meal protein and CHO composition, as are plasma citrulline for the fat content. We hypothesize that postprandial plasma amino acid concentrations can be used to predict the meal's macronutrient composition.

Gut-related symptoms and an increase in markers of gut dysfunction have been observed in patients with chronic obstructive pulmonary disease (COPD). It remains unclear whether exercise, in relation to inducing hypoxia, plays a role in disturbances in protein digestion and amino acid absorption and whole body protein kinetics. Sixteen clinically stable patients with moderate-to-very severe COPD and 12 matched healthy subjects completed the study. Protein digestion and amino acid absorption, whole body protein kinetics were measured in the postabsorptive state via a continuous infusion of stable tracers in combination with orally administered stable tracer sips during 20 min of walking exercise and up to 4 h post exercise. In addition, concentrations of short-chain fatty acid (SCFA) and amino acids were measured. Patients with COPD completed one study day, walking at maximal speed, whereas healthy subjects completed two, one matched to the speed of a patient with COPD and one at maximal speed. The patients with COPD tolerated 20 min of vigorous intensity walking with an elevated heart rate (P < 0.0001) and substantial desaturation (P = 0.006). During exercise, we observed lower protein digestion (P = 0.04) and higher SCFA acetate (P = 0.04) and propionate (P = 0.02) concentrations on max speed study days, lower amino acid absorption (P = 0.004) in subjects with oxygen desaturation, and lower net protein breakdown (P = 0.03) and propionate concentrations (P = 0.04) in patients with COPD. During late recovery from exercise, amino acid absorption (P = 0.02) and net protein breakdown (P = 0.02) were lower in patients with COPD. Our data suggest that 20 min of walking exercise is sufficient to cause perturbations in gut function and whole body protein metabolism during and up to 4 h post exercise in older adults and in patients with COPD with exercise-induced hypoxia. NEW & NOTEWORTHY Gut function is disturbed in older adults with COPD. As exercise is the cornerstone of pulmonary rehabilitation in COPD, knowledge of the response of the gut to aerobic exercise is of importance.

The central position of methionine (Met) in protein metabolism indicates the importance of this essential amino acid for growth and maintenance of lean body mass. Therefore, Met might be a tempting candidate for supplementation. However, because Met is also the precursor of homocysteine (Hcy), a deficient intake of B vitamins or excessive intake of Met may result in hyperhomocysteinemia (HHcy), which is a risk factor for cardiovascular disease. This review discusses the evidence generated in preclinical and clinical studies on the importance and potentially harmful effects of Met supplementation and elaborates on potential clinical applications of supplemental Met with reference to clinical studies performed over the past 20 y. Recently acquired knowledge about the NOAEL (no observed adverse effect level) of 46.3 mg.kg(-1).d(-1) and the LOAEL (lowest observed adverse effect level) of 91 mg.kg(-1).d(-1) of supplemented Met will guide the design of future studies to further establish the role of Met as a potential (safe) candidate for nutritional supplementation in clinical applications.

Rationale: Isoleucine (ILE) is known to modulate glucose metabolism, but it remains unclear if daily ILE supplementation is able to lower fasting and 24-hour plasma glucose concentrations in patients with type 2 diabetes (T2D).

Purpose: To determine whether adherence to a repeating 30-d non-linear diet intervention while participating in a supervised exercise program that includes resistance-exercise would promote weight and fat loss without weight loss plateau and whether alterations in carbohydrate and protein intake may influence results. Methods: Fifty sedentary and obese pre-menopausal females (35.2±7.6 years; 88.7±18 kg, 32.6±6 kg/m2, 42.5±4.2% fat) were randomly assigned to an exercise-only (EX) or EX plus diets containing higher proportions of carbohydrate or protein. Diets were hypoenergetic for 30-d (7-d at 1,200 kcals/d, 21-d at 1,500 kcal/d), more isoenergetic for 30-d (2,200 kcals/d), and repeated three times during a 24-wk intervention. Diets were either 45:30:24 (HCD) or 30:45:25 (HPD) carbohydate:protein:fat. All participants performed 30-min resistance exercise (3 d/wk) and a brisk walking program (3 d/wk). Data were analyzed by general linear model (GLM) statistics with repeated measures and presented as mean changes from baseline (mean [UL, LL]). Results: Participants experienced a significant and reduction in body weight (EX -2.24 [-6.5, 2.0], EX+HCD -6.99 [-9.4, -4.5], EX+HPD -4.49 [-7.1, -1.8] %), fat mass (EX -3.45 [-10.9, 4.03], EX+HCD -12.15 [-16.4, -7.9], EX+HPD -8.54 [-13.2, -3.9] %), and percent body fat (EX -1.30 [-5.6, 3.0], EX+HCD -5.91 [-8.3, -3.5], EX+HPD -4.31 [-7.0, -1.6] %) with those in the EX+HCD experiencing a more linear response. Participants in the EX and EX+HCD groups maintained fat-free mass to a better degree (EX -0.89 [-4.0, 2.2], EX+HCD -3.21 [-5.0, -1.2], EX+HPD -1.92 [-3.8, 0.002] %). Participants dieting generally experiencing greater benefit with some evidence that those in the EX+HPD experienced greater changes in blood lipids. Conclusion: A 30-day repeated non-linear diet can promote fat and weight loss without a plateau. Consuming a HPD may help maintain fat-free mass during weight loss and improve some markers of health compared to HCD interventions.

Rationale: The SCFA acetate (C2), propionate (C3) and butyrate (C4) are fermentation products of the intestinal microbiota and have been positively associated with health and the prevention of several chronic diseases. We tested whether SCFA production rates and concentrations are associated with health characteristics.

Açaí beverage consumption may reduce biomarkers for inflammation and oxidative stress in metabolic syndrome.

While commercial dietary weight-loss programs typically advise exercise, few provide actual programing. The goal of this study was to compare the Curves Complete 90-day Challenge (CC, n = 29), which incorporates exercising and diet, to programs advocating exercise (Weight Watchers Points Plus (WW, n = 29), Jenny Craig At Home (JC, n = 27), and Nutrisystem Advance Select (NS, n = 28)) or control (n = 20) on metabolic syndrome (MetS) and weight loss. We randomized 133 sedentary, overweight women (age, 47 ± 11 years; body mass, 86 ± 14 kg; body mass index, 35 ± 6 kg/m2) into respective treatment groups for 12 weeks. Data were analyzed using chi square and general linear models adjusted for age and respective baseline measures. Data are means ± SD or mean change ± 95% confidence intervals (CIs). We observed a significant trend for a reduction in energy intake for all treatment groups and significant weight loss for all groups except control: CC (-4.32 kg; 95% CI, -5.75, -2.88), WW (-4.31 kg; 95% CI, -5.82, -2.96), JC (-5.34 kg; 95% CI, -6.86, -3.90), NS (-5.03 kg; 95% CI, -6.49, -3.56), and control (0.16 kg, 95% CI, -1.56, 1.89). Reduced MetS prevalence was observed at follow-up for CC (35% vs. 14%, adjusted standardized residuals (adjres.) = 3.1), but not WW (31% vs. 28% adjres. = 0.5), JC (37% vs. 42%, adjres. = -0.7), NS (39% vs. 50% adjres. = -1.5), or control (45% vs. 55% adjres. = -1.7). While all groups improved relative fitness (mL·kg-1·min-1) because of weight loss, only the CC group improved absolute fitness (L/min). In conclusion, commercial programs offering concurrent diet and exercise programming appear to offer greater improvements in MetS prevalence and cardiovascular function after 12 weeks of intervention.

Background: l-Methionine (Met) is an essential amino acid for humans and is important for protein synthesis and the formation of polyamines and is involved in the synthesis of many metabolites, including homocysteine. Free-Met supplements have been claimed to have multiple positive effects; however, it remains unclear what the exact tolerance level is. With aging, Met metabolism changes, and increased plasma homocysteine is more apparent. High plasma concentrations of homocysteine are assumed to be associated with a high risk of developing atherosclerosis.Objective: We estimated the no-observed-adverse-effect level (NOAEL) and the lowest-observed-adverse-effect level (LOAEL) of supplemented, oral, free Met in healthy older adults by examining the increase in plasma homocysteine as the primary determinant.Design: We provided capsules with free Met to 15 healthy older adult subjects for 4 wk at climbing dosages of, on average, 9.2, 22.5, 46.3 and 91 mg · kg body weight-1 · d-1 with washout periods of 2 wk between each intake. Before, at 2 and 4 wk during, and 2 wk after each dosage, we studied a complete panel of biochemical blood variables to detect possible intolerance to increased Met intake. Plasma homocysteine and body composition were measured, and tolerance, quality of life, and cognitive function were assessed via questionnaires.Results: Plasma homocysteine was elevated with the highest dose of supplemented Met. The estimated NOAEL of supplemented Met was set at 46.3 mg · kg body weight-1 · d-1, and the estimated LOAEL of supplemented Met was set at 91 mg · kg body weight-1 · d-1 (on the basis of the actual intakes) in subjects independent of sex. No signs of intolerance were observed via questionnaires or other blood variables at the LOAEL. There were no meaningful changes in body composition.Conclusions: On the basis of plasma homocysteine, the NOAEL of supplemented Met intake is 46.3 and the LOAEL is 91 mg · kg body weight-1 · d-1 in healthy older adults. Both the NOAEL and LOAEL are not associated with meaningful effects on health and wellbeing. This trial was registered at clinicaltrials.gov as NCT02566434.

Background The purpose of this study was to determine whether short-term supplementation of a powdered tart cherry supplement prior to and following stressful endurance exercise would affect markers of muscle damage, inflammation, oxidative stress, and/or muscle soreness. Methods 27 endurance-trained runners or triathlete (21.8 ± 3.9 years, 15.0 ± 6.0 % body fat, 67.4 ± 11.8 kg) men ( n = 18) and women ( n = 9) were matched based on average reported race pace, age, body mass, and fat free mass. Subjects were randomly assigned to ingest, in a double-blind manner, capsules containing 480 mg of a rice flour placebo (P, n = 16) or powdered tart cherries [CherryPURE®] (TC, n = 11). Subjects supplemented one time daily (480 mg/day) for 10-d, including race day, up to 48-hr post-run. Subjects completed a half-marathon run (21.1 km) under 2-hr (111.98 ± 11.9 min). Fasting blood samples and quadriceps muscle soreness ratings using an algometer with a graphic pain rating scale were taken pre-run, 60-min, 24 and 48-h post-run and analyzed by MANOVA with repeated measures. Results Subjects in the TC group averaged 13 % faster half-marathon race finish times ( p = 0.001) and tended to have smaller deviations from predicted race pace ( p = 0.091) compared to P. Attenuations in TC muscle catabolic markers were reported over time for creatinine ( p = 0.047), urea/blood urea nitrogen ( p = 0.048), total protein ( p = 0.081), and cortisol ( p = 0.016) compared to P. Despite lower antioxidant activity pre-run in TC compared to P, changes from pre-run levels revealed a linear increase in antioxidant activity at 24 and 48-h of recovery in TC that was statistically different (16–39 %) from P and pre-run levels. Inflammatory markers were 47 % lower in TC compared to P over time ( p = 0.053) coupled with a significant difference between groups ( p = 0.017). Soreness perception between the groups was different over time in the medial quadriceps ( p = 0.035) with 34 % lower pre-run soreness in TC compared to P. Over the 48-h recovery period, P changes in medial quadriceps soreness from pre-run measures were smaller compared to TC. Conclusion Results revealed that short-term supplementation of Montmorency powdered tart cherries surrounding an endurance challenge attenuated markers of muscle catabolism, reduced immune and inflammatory stress, better maintained redox balance, and increased performance in aerobically trained individuals.

Objective Commercial weight loss programs offer consumers a pre‐programmed means of managing weight. However, such programs differ in dietary advice and physical activity recommendations. The aim of this investigation was compare the Curves ® Complete 90‐day Challenge (CC), Weight Watchers ® Points Plus (WW), Jenny Craig ® At Home (JC), and Nutrisystem ® Advance Select™ (NS) on metabolic syndrome (MetS) and weight loss. Methods We examined 133 sedentary overweight women (47±11 yr, 86±14 kg, 35.4±6 kg/m 2 ) randomized into CC (n=29), WW (n=29), JC (n=27), NS (n=28), or control (n=20) for 12‐wks. Body mass and MetS were obtained at baseline and follow‐up (12 w). The primary outcome was MetS expressed as a categorical variable and summed z‐score (zMetS) as a continuous variable. Secondary outcomes included total caloric intake, body mass, respective anthropometry and measured physical activity (PA). Data were analyzed using a chi‐square and general linear model covaried for age and prevalence of MetS at baseline. Data are mean ± SD and mean change ± 95% CI when applicable. Results We observed significant reductions in total energy intake for all treatment groups except Control (−103 kcal, 95% CI, −277, 70): CC (−413 kcal, 95% CI, −573, −254), WW (−531 kcals, 95% CI, −675, −387), JC (−604 kcal, 95% CI, −753, −455), NS (−631 kcal, 95% CI, −778, −485). While post‐hoc analysis showed JC and NS to be greater than CC, weight loss was similar for all groups (−4.0 ± 4.2 kg). At baseline, the prevalence of MetS was: CC (35%), WW (31%), JC (37%), NS (39%) and control (45%). At follow‐up we observed a significant trend (p=0.008) in reduction of MetS prevalence such that CC (14%) and WW (28%) was significantly lower than JC (42%), NS (50%) and control (55%); however, WW was not significantly different than JC, NS, or control. When expressed as zMetS, only the CC group demonstrated a significant reduction in zMetS (−0.11, 95% CI −0.21, −0.004) vs. WW (−0.89, 95% CI −0.18, 0.02), JC (−0.05, 95% CI −0.16, −.06), NS (−0.06, 95% CI −0.16, 0.05) and control (−0.05, 95% CI, −0.18, 0.07). Other than exercise contained within the CC program, no significant changes were otherwise noted in total PA for any treatment group: CC (4645 MET min/week; 95% CI, −1638, 10929), Weight Watchers (−3361 MET min/week; 95% CI, 3208, 2988), Jenny Craig (−448 MET min/week; 95% CI, −6949, 6053), Nutrisystem (−967 MET min/week; 95% CI, −7401, 5468) or Control (5128 MET min/week; 95% CI, −2529, 12785). Conclusions Notwithstanding the minor differences in energy intake favoring JC and NS, each program demonstrated similar amounts of weight loss. However, a significant reduction in MetS was demonstrated only in CC and WW via categorical analysis and CC via zMetS. Thus, despite recommendations by each program to increase PA, the program including a structured fitness routine in conjunction with diet exhibited the greatest impact on changes in MetS. Support or Funding Information Curves International

Creatine monohydrate (CrM) and nitrate are popular supplements for improving exercise performance; yet have not been investigated in combination. We performed two studies to determine the safety and exercise performance-characteristics of creatine nitrate (CrN) supplementation.