Clinical Nutrition 34 (2015) 169e170
Contents lists available at ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Invited editorial
Should ESPEN engage in facing the obesity challenge? The ongoing epidemics of overweight and obesity originates to a large extent from lifestyle changes and altered dietetic habits that occurred over several decades, both in Europe and worldwide [1]. Changes and interventions to reverse this rising tide are being sought intensively, but they are unlikely to occur in the shortterm. Thus, the number of overweight and obese persons continues to rise, thereby enhancing the burden of obesity-associated complications on individuals, families, society and healthcare systems [1,2]. Obesity is characterized by enhanced adipose mass and adipocyte dysfunction, leading to substantial metabolic changes that contribute to high risk of chronic diseases and cancer [3,4]. Importantly, obesity also directly affects the function of many organs and systems in the body, and it interacts with the onset, the course and the outcome of several acute and chronic disorders that are associated with obesity in a multidisciplinary fashion. ESPEN, the European Society for Clinical Nutrition and Metabolism, has by definition a strong interest in obesity, as a relevant nutritional condition causing metabolic alterations that profoundly influence patient treatment and outcome. Since many years, ESPEN is inviting and hosting researchers and practitioners in the fields of obesity and metabolic syndrome at its annual congresses. The comprehensive ESPEN educational programs, including life-long learning (LLL) and ESPEN courses, offer modules on obesity and metabolic syndrome by distinguished international experts. Moreover, many national nutritional societies that are ESPEN blockmembers address the obesity topic at the national level. Finally, ESPEN, as a global Society in the field of clinical nutrition, has gradually broadened its spectrum of activities beyond artificial nutrition by addressing the topic of comprehensive nutritional support of all patients, including the obese. In recent meetings, ESPEN has further discussed the evolving challenges posed by the obesity epidemics, including the management of obese patients regarding artificial and clinical nutritional care, as well as the need for a multidisciplinary approach to tackle obesity in the future. While continuing to pursue research and education in the field of obesity-associated metabolic derangements and complications, two priorities have emerged. 1) Optimal nutritional support for obese patients undergoing acute or chronic disease conditions needs to be identified. In the past, the presence of excess energy stores has suggested potential indications to limit calorie supply [5], but it is acknowledged that evidence is still limited on optimal treatment for obese patients in need of nutritional support. In addition, it is increasingly recognized that obese individuals may be deficient in several micronutrients, with relevant examples including vitamin D and
magnesium [6,7]. Also importantly, obese individuals may be resistant to skeletal muscle protein anabolism [8], resulting in low lean body mass, sarcopenic obesity and related negative prognostic impact [9]. An additional important condition is also provided by the growing population of obese individuals undergoing bariatric surgery, in whom nutritional deficiencies may be exacerbated by surgical treatment, leading to increased need for chronic nutritional follow-up and support [10]. In the light of accumulating evidence on the above derangements, the role of the nutritionist to identify optimal nutritional care in acute and chronic disease settings, beyond weight-reducing calorie-restricted diets, is considered by ESPEN a high priority. 2) Obesity enhances the risk and affects the course of many diseases, calling for interactions between nutritional medicine and other specialties in a multidisciplinary approach aimed at optimal treatment. With the larger overweight and obese patient populations, different specialties are needed besides the more traditional fields of Endocrinology and Diabetology to regularly deal with obesity and its many clinical implications. Such specialties or subspecialties include, but are not limited to, gastroenterology, hepatology, geriatrics, pediatrics, surgery, nephrology, oncology, and intensive care medicine. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential diseasespecific benefits from selected nutritional regimens. Diseasespecific therapeutic decisions are often needed in terms of nutrient selection, interactions, timing and duration of administration. ESPEN traditionally hosts and favors interactions between nutritionists from different specialties, whose expertise can provide the best multidisciplinary approach to ensure optimal choices for nutritional assessment, treatment and follow-up. ESPEN therefore aims to address the field of obesity with a more structured approach, according to the above-outlined nutritional and multidisciplinary priorities. For instance, ESPEN founded the new special interest group (SIG) on obesity at the 2014 annual conference in Geneva, Switzerland. Also, workshops will be organized with special focus on obesity-related nutritional and metabolic challenges. Overall, ESPEN will comprehensively encourage and host initiatives aimed at enhancing teamwork and cooperation between interested ESPEN members, and between national and international nutritional/obesity societies. Building on the strong foundation of more traditional clinical and artificial nutrition areas, our Society will aim to cover the broad spectrum of nutritional abnormalities that are increasingly
http://dx.doi.org/10.1016/j.clnu.2015.01.002 0261-5614/© 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
170
Invited editorial / Clinical Nutrition 34 (2015) 169e170
associated with conditions of positive energy balance in all areas of nutritional support. Conflict of interest None declared.
[8] Guillet C, Masgrau A, Walrand S, Boirie Y. Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation. Obes Rev 2012;2(Suppl. 13):51e7. [9] Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 2008;11:693e700. [10] Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 2012;8:544e56.
References [1] Branca F, Nikogosian H, Lobstein T, editors. The challenge of obesity in the WHO European region and the strategies for Response: summary. Copenhagen: WHO Regional Office for Europe; 2007. [2] Withrow D, Alter D. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2010;12:131e41. [3] Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith Jr SC, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120: 1640e5. [4] Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 2014;384:45e52. [5] Dickerson RN. Hypocaloric feeding of obese patients in the intensive care unit. Curr Opin Clin Nutr Metab Care 2005;8:189e96. [6] Earthman CP, Beckman LM, Masodkar K, Sibley SD. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes 2012;36:387e96. [7] Nielsen FH. Magnesium, inflammation, and obesity in chronic disease. Nutr Rev 2010;68:333e40.
R. Barazzoni* Department of Medical, Surgical and Health Sciences, University of Trieste, Italy A. Van Gossum Department of Gastroenterology, Erasme Hospital, Free University of Bruxelles, Bruxelles, Belgium P. Singer Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel S.C. Bischoff Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany *
Corresponding author. Clinica Medica e Ospedale Cattinara, Strada di Fiume 447, 34100 Trieste, Italy. E-mail address: [email protected] (R. Barazzoni). 5 January 2015
Contents lists available at ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Invited editorial
Should ESPEN engage in facing the obesity challenge? The ongoing epidemics of overweight and obesity originates to a large extent from lifestyle changes and altered dietetic habits that occurred over several decades, both in Europe and worldwide [1]. Changes and interventions to reverse this rising tide are being sought intensively, but they are unlikely to occur in the shortterm. Thus, the number of overweight and obese persons continues to rise, thereby enhancing the burden of obesity-associated complications on individuals, families, society and healthcare systems [1,2]. Obesity is characterized by enhanced adipose mass and adipocyte dysfunction, leading to substantial metabolic changes that contribute to high risk of chronic diseases and cancer [3,4]. Importantly, obesity also directly affects the function of many organs and systems in the body, and it interacts with the onset, the course and the outcome of several acute and chronic disorders that are associated with obesity in a multidisciplinary fashion. ESPEN, the European Society for Clinical Nutrition and Metabolism, has by definition a strong interest in obesity, as a relevant nutritional condition causing metabolic alterations that profoundly influence patient treatment and outcome. Since many years, ESPEN is inviting and hosting researchers and practitioners in the fields of obesity and metabolic syndrome at its annual congresses. The comprehensive ESPEN educational programs, including life-long learning (LLL) and ESPEN courses, offer modules on obesity and metabolic syndrome by distinguished international experts. Moreover, many national nutritional societies that are ESPEN blockmembers address the obesity topic at the national level. Finally, ESPEN, as a global Society in the field of clinical nutrition, has gradually broadened its spectrum of activities beyond artificial nutrition by addressing the topic of comprehensive nutritional support of all patients, including the obese. In recent meetings, ESPEN has further discussed the evolving challenges posed by the obesity epidemics, including the management of obese patients regarding artificial and clinical nutritional care, as well as the need for a multidisciplinary approach to tackle obesity in the future. While continuing to pursue research and education in the field of obesity-associated metabolic derangements and complications, two priorities have emerged. 1) Optimal nutritional support for obese patients undergoing acute or chronic disease conditions needs to be identified. In the past, the presence of excess energy stores has suggested potential indications to limit calorie supply [5], but it is acknowledged that evidence is still limited on optimal treatment for obese patients in need of nutritional support. In addition, it is increasingly recognized that obese individuals may be deficient in several micronutrients, with relevant examples including vitamin D and
magnesium [6,7]. Also importantly, obese individuals may be resistant to skeletal muscle protein anabolism [8], resulting in low lean body mass, sarcopenic obesity and related negative prognostic impact [9]. An additional important condition is also provided by the growing population of obese individuals undergoing bariatric surgery, in whom nutritional deficiencies may be exacerbated by surgical treatment, leading to increased need for chronic nutritional follow-up and support [10]. In the light of accumulating evidence on the above derangements, the role of the nutritionist to identify optimal nutritional care in acute and chronic disease settings, beyond weight-reducing calorie-restricted diets, is considered by ESPEN a high priority. 2) Obesity enhances the risk and affects the course of many diseases, calling for interactions between nutritional medicine and other specialties in a multidisciplinary approach aimed at optimal treatment. With the larger overweight and obese patient populations, different specialties are needed besides the more traditional fields of Endocrinology and Diabetology to regularly deal with obesity and its many clinical implications. Such specialties or subspecialties include, but are not limited to, gastroenterology, hepatology, geriatrics, pediatrics, surgery, nephrology, oncology, and intensive care medicine. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential diseasespecific benefits from selected nutritional regimens. Diseasespecific therapeutic decisions are often needed in terms of nutrient selection, interactions, timing and duration of administration. ESPEN traditionally hosts and favors interactions between nutritionists from different specialties, whose expertise can provide the best multidisciplinary approach to ensure optimal choices for nutritional assessment, treatment and follow-up. ESPEN therefore aims to address the field of obesity with a more structured approach, according to the above-outlined nutritional and multidisciplinary priorities. For instance, ESPEN founded the new special interest group (SIG) on obesity at the 2014 annual conference in Geneva, Switzerland. Also, workshops will be organized with special focus on obesity-related nutritional and metabolic challenges. Overall, ESPEN will comprehensively encourage and host initiatives aimed at enhancing teamwork and cooperation between interested ESPEN members, and between national and international nutritional/obesity societies. Building on the strong foundation of more traditional clinical and artificial nutrition areas, our Society will aim to cover the broad spectrum of nutritional abnormalities that are increasingly
http://dx.doi.org/10.1016/j.clnu.2015.01.002 0261-5614/© 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
170
Invited editorial / Clinical Nutrition 34 (2015) 169e170
associated with conditions of positive energy balance in all areas of nutritional support. Conflict of interest None declared.
[8] Guillet C, Masgrau A, Walrand S, Boirie Y. Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation. Obes Rev 2012;2(Suppl. 13):51e7. [9] Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 2008;11:693e700. [10] Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 2012;8:544e56.
References [1] Branca F, Nikogosian H, Lobstein T, editors. The challenge of obesity in the WHO European region and the strategies for Response: summary. Copenhagen: WHO Regional Office for Europe; 2007. [2] Withrow D, Alter D. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2010;12:131e41. [3] Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith Jr SC, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120: 1640e5. [4] Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 2014;384:45e52. [5] Dickerson RN. Hypocaloric feeding of obese patients in the intensive care unit. Curr Opin Clin Nutr Metab Care 2005;8:189e96. [6] Earthman CP, Beckman LM, Masodkar K, Sibley SD. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes 2012;36:387e96. [7] Nielsen FH. Magnesium, inflammation, and obesity in chronic disease. Nutr Rev 2010;68:333e40.
R. Barazzoni* Department of Medical, Surgical and Health Sciences, University of Trieste, Italy A. Van Gossum Department of Gastroenterology, Erasme Hospital, Free University of Bruxelles, Bruxelles, Belgium P. Singer Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel S.C. Bischoff Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany *
Corresponding author. Clinica Medica e Ospedale Cattinara, Strada di Fiume 447, 34100 Trieste, Italy. E-mail address: [email protected] (R. Barazzoni). 5 January 2015
