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Cardiovascular disease is the leading cause of death in firefighters (FF) around the nation. Recent observational studies have emerged suggesting that FF consume calorically dense foods, high in sugar and fat, but low in nutritional value which can exacerbate heart diseases and impair performance. The potential to improve cardiometabolic and performance measurements when following a carbohydrate (CHO) restricted diet (CRD) has gained interest in the literature. To date, only one study has employed a nutrition intervention in FF, yet its’ focus was on nutrient dense foods and antioxidant supplements. Therefore, the purpose of this study was to examine the cardiometabolic and performance effects of a 28-day CRD in FF. 15 career FF participated and finished the present study. Participants reported to the laboratory on 9 separate occasions. Trial 1 consisted of participants having a blood draw performed for assessment of their heart disease risk followed by body composition, blood pressure, and a glucose challenge test (GCT) to assess glucose impairment following ingestion of a 75 g glucose beverage. Trial 2 consisted of a graded exercise cycling test with 5 stages followed by a maximal Wingate for 30 s. Finally, the last trial included the FF physical performance assessment (FPPA) which consisted of a 2.41-km run followed by 2 min of maximal pull-ups, push-ups, and sit-ups. The first 3 trials were used as familiarizations, the second 3 trials were used as baseline measurements, and the last 3 trials followed the 28-day CRD. The CRD consisted of ad-libitum consumption of fat and protein and keeping CHO < 25% daily kilocalorie intake. Dependent variables measured pre- and post-diet included body composition, lipid profile, insulin, cortisol, c-reactive protein (CRP), GCT, substrate oxidation rates, Wingate variables, and the FPPA. Following the diet, participants had significant reductions in CRP, blood pressure, 2.41-km run time, CHO oxidation rates, and fat mass. Participants also had significant increases in high density cholesterol count, fat oxidation rates, and pull-up repetitions. Overall, our results show that a CRD in a high-stress occupation can favorably change markers of heart disease and body composition without decrements to physical performance.

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Sammanfattning   Bakgrund: Övervikt och fetma har blivit en hälsofarlig nödsituation i västvärlden, i synnerhet bukfetma som är en av de viktigaste riskfaktorerna för kardiovaskulära sjukdomar. Den västerländska dieten domineras av högt förädlade livsmedel till låg kostnad vilket snabbt har utvecklat övervikt och överviktsrelaterade sjukdomar. Det finns olika behandlingsmetoder för att minska övervikt och fetma, där kost är en viktig komponent. Lågkolhydratkost kommer alltmer i fokus, som ett alternativ till de rådande näringsrekommendationerna. För att stödja och motivera personer med övervikt och fetma kan sjuksköterskan förmedla en personcentrerad egenvård enligt Orem. Sjuksköterskan skall enligt lag arbeta evidensbaserat och det krävs ständig uppdatering av forskningsläget. Syfte: Syftet var att studera effekten av lågkolhydratkost hos personer med övervikt och fetma. Metod: Litteraturöversikten är av kvantitativ metod och innehåller 15 vetenskapliga artiklar. Analysmodellen som användes var Fribergs analys. Resultat: Effekter av lågkolhydratkost visar signifikanta förbättringar i framförallt viktnedgång men även i blodtryck, blodfetter och blodsocker. De största effekterna av de olika variablerna sågs efter sex månader. Dessa effekter gav ofta en minskad användning av antidiabetika som följd. Slutsats: Då lågkolhydratkost har gynnsamma effekter på viktnedgång, blodfetter och blodsocker är behovet stort av långtidsstudier. Sjuksköterskan har en viktig roll att stödja och motivera personer med övervikt och fetma till livsstilsförändringar. Nyckelord: Viktnedgång, ketogen kost, lågkolhydratkost, egenvård / Summary Low-carbohydrate diets for overweight and obesity - A literature review   Background: Overweight and obesity has become a health hazard emergency in the western world, especially abdominal obesity which is one of the major risk factors for cardiovascular diseases. The Western diet is dominated by highly processed food at low cost, which has rapidly developed obesity and obesity related diseases. There are various treatment methods to reduce overweight and obesity by diet which is an important component. Low-carbohydrate diet comes increasingly into focus, as an alternative to the current nutritional recommendations. To support and motivate people with overweight and obesity, the nurse can convey a person-centered self-care according to Orem. The nurse should, by law, set their work based on evidence and that requires a continuous update of available research. Objective: The objective was to study the effect of low-carbohydrate diet in people with overweight and obesity. Method: The literature review is the quantitative method and contains 15 scientific articles. The analysis model used was Friberg analysis. an important role to support and motivate people with overweight Result: Effects of low-carbohydrate show significant improvements especially in weight loss but also in blood pressure, blood fats and blood sugar. The main effects of the different variables were observed after six months. These effects often gave a reduced use of antidiabetic drugs as a result. Conclusion: Since low-carbohydrate proven to have beneficial effects on weight loss, blood fat and blood sugar there is a great need for long-term studies. The nurse has and obesity to lifestyle changes. Keywords: Weight loss, ketogenic diet, low-carbohydrate diet, self-care

The metabolic syndrome is a cluster of disorders (obesity, dyslipidaemia, hyperinsulinaemia and hypertension) which individually or collectively lead to an increase in the risk of cardiovascular disease. Over the years it has been associated with endothelial dysfunction, raised markers of chronic inflammation, insulin resistance and clotting dysregulation. Studies have shown that the prevalence of the metabolic syndrome in adults over the age of 20 years to be 24%, with approximately 12 million adults within the United Kingdom fulfilling the criteria for diagnosis. Numbers of individuals with the metabolic syndrome continue to rise following population trends of increasing sedentary lifestyle, high calorie intake, smoking, and stress. Associated is an increase in obesity, type 2 diabetes, cardiac disease, stroke and death. The increase is such that we can no longer be complacent about how we address the metabolic syndrome or its associated components. The management of the metabolic syndrome is varied and includes alterations in diet, physical exercise, and oral medication. It is well documented that a 10% reduction in weight leads to reductions in lipid abnormalities, diabetes and diabetes-related deaths, other total morbidity and deaths. Many dietary regimens have been postulated to benefit not only weight gain but improve cardiovascular risk. To address this we investigated the effect three different diets (low fat; low carbohydrate, high fat; and low glycaemic load) had on the metabolic syndrome to assess whether it is the changes in dietary caloric or macronutrient intake, or overall weight loss that had the greater influences on those aspects of metabolic syndrome which could potentially reduce cardiovascular risk.

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Syftet med denna pilotstudie var att studera om man hos pediatriska patienter som lider av sjuklig fetma kan se förändringar i metabolismen genom att ersätta den traditionella kosten med en kost bestående av hög andel fett och låg andel kolhydrater. De frågeställningar som används är om den förändrade kosten leder till en gynnsam förändring av metabola markörer samt hur patientupplevelsen av de nya kostråden är. Studien har både en kvantitativ och kvalitativ design. Totalt ingår 4 barn i åldern 4-17 år. Två av dessa har under fyra veckor ätit en kost bestående av hög andel fett (50-60E%) och låg andel kolhydrater (15-20E%). Efter avslutad intervention undersöktes hur metabola parametrar förändrats (blodprov) samt hur patienterna upplevt kosten (frågeformulär). Resultatet visar på att kostråden leder till en sänkning av triglycerider, glukos, HDL, total kolesterol och ASAT. Bland kontrollpatienterna ser man en ökning av triglycerider, HDL och total kolesterol. Upplevelsen av kostråden beskrivs som positiva, trots att nackdelar finns. Det finns en positiv attityd till att fortsätta med kostråden.