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*Corresponding Author: Entela Puca, Service of Endocrinology, American Hospital, Tirane, Albania.
Citation: Entela Puca, Edmond Puca, Blertina Olldashi, Ilir Akshija, Carmelo Rizzo, (2024), Dietary Strategies for Weight Loss and Reducing Low Grade Inflammation: Evaluating Mediterranean Diet versus Mediterranean Diet plus Food Intolerance Elimination Diet in Obese Patients, J Clinical Research and Reports, 17(2); DOI:10.31579/2690-1919/435
Copyright: © 2024, Entela Puca. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 13 November 2024 | Accepted: 18 November 2024 | Published: 25 November 2024
Keywords: obesity; Mediterranean diet; low-grade inflammation; food intolerance elimination diet; inflammation
Background
Obesity is associated with chronic low-grade inflammation, which believed to play a role in causing insulin resistance. Food intolerances (FI) are also one of the probable causes of low-grade inflammation and may contribute to the onset of obesity.
The aims of this study were to evaluate the effect of Mediterranean Diet (MedDiet) modified according the FI test (MedDiet plus FI) versus only MedDiet on inflammatory markers, metabolic parameters and anthropometric data.
Material and methods: The study consisted of 20 patients with BMI over 30. FI test was done in 10 patients. The FI group was given modified MedDiet according FI results while the control group was given only MedDiet. The body composition and metabolic parameters were measured in the beginning and 8 weeks.
Results: In the MedDiet plus FI group, patients lost weight from 101.8 kg to 94.5 kg. The biochemical assessment showed a significant decrease in values of triglycerides, total-Cholesterol, HDL-cholesterol; and LDL-cholesterol. The metabolic assessment showed a significant decrease in values of insulin and HOMA- IR 37.64% vs 47.47%, respectively; in the MedDiet plus FI group vs MedDiet group alone. A significant decrease in the average value of fibrinogen and CRP in both groups was seen.
Conclusion: The result suggests that food intolerance elimination diet (FIED) gave positive changes on body composition and metabolic parameters in obese patients. Obese patients who cannot lose weight by low-calorie diet alone can do it with elimination diet according to the results of FI test.
Obesity is one of the more concerns of public health in now days. It is a complex disease associated with an increase of inflammatory biomarkers, leading to chronic low-grade inflammation (1–3). Body mass index (BMI) and waist circumference (WC) are two indicators of visceral fat and predictors of metabolic syndromes. Individuals that are overweight (BMI>30) and obese have altered serum levels of inflammatory cytokines (1,3–5). In these obese patient’s adipose tissue release many inflammatory mediators. Many studies suggest that low grade inflammation is mitigated by a healthy diet. Among other health‐related behaviors, the association of obesity and inflammation is largely documented now. One of the most important diet connected with lower morbidity and mortality from chronic diseases like cardiovascular disease, diabetes, obesity, cancers, and lower all-cause mortality, is MedDiet. Greater adherence to a traditional MedDiet has good evidences on the protection of health effects [6,7].
The Mediterranean diet (MedDiet) is one of the most studied and used diet since 1960 by Ancel. It is based on the traditional foods that people used to eat in countries of the Mediterranean Sea region [8,9]. The MedDiet encourages plant-based foods and healthy fat and moderation consumption of red wine, by a high intake of plant foods (fruits, vegetables, breads and other cereals, potatoes, beans, nuts and seeds); minimally processed, seasonally fresh and locally grown foods; fresh fruits as typical dessert, with sweets containing sugars or honey a few times per week; a high intake of olive oil (especially virgin and extra-virgin olive oil) used as the principal source of fat; a moderate intake of dairy products (mostly as cheese and yoghurt); zero to four eggs a week; fish and poultry consumed in low to moderate amounts; red meat consumed in low amounts; and wine in moderation, consumed with meals (10–14). Following this pattern may help stabilize blood glucose levels and protect against type 2 Diabetes Mellitus. The MedDiet has also been shown to decrease insulin resistance, evidence from observational and intervention studies. Numerous studies have now shown that the Mediterranean diet can promote weight loss and help prevent heart attacks, strokes, type 2 Diabetes, and premature death (10,13,15-18).
Food intolerance is a reaction against food, but not immunological manner, and may be confused with real food allergies. According to the WHO, half of the world population has food intolerance (FI), and is associated with chronic systemic inflammation. The FIED is often helpful in discovering and eliminating foods associated with symptoms that may interfere with weight loss. Foods are commonly reintroduced after elimination to further assess individual sensitivity and tolerability (19-21). In the recent years has been concluded that obesity is an inflammatory disease and weight loss programs through different model of diets has been shown to decrease the inflammation (1,4,13,22).
Medical evidence is the keystone to sustaining and protecting the MedDiet and its beneficial clinical implications. Considering the value of the MedDiet in improving symptoms in patients with chronic diseases, we aimed to assess the immunomodulatory effect of the MedDiet combined with the FI in managing of inflammatory tests.
The aim of this study was to analyse the correlation between low grade marker of inflammation/cytotoxic such as C-Reactive Protein (CRP) and fibrinogen with metabolic profile: fasting glycemia, fasting insulin, Insulin Resistance (HOMA-IR), lipid profile, liver enzyme (ALT, AST, total bilirubin), in patient received only MedDiet and patient received MedDiet modified according the food intolerance test. All participants were with BMI>30kg/m2.
We enrolled 20 patients diagnosed with obesity (BMI >30kg/m2). Inclusion criteria were: Individuals over 18 years old
BMI >30kg/m2
For all of them, we calculated: BMI and WC (waist circumference), measured metabolic parameters and inflammatory marker. FI test were done in 10 of the 20 patients. We used stratified randomization, because we wanted that each group would have equal distribution of age, gender, BMI or other variables and divided them in two groups. The patients in the first group were given MedDiet. The patients in the second group were given MedDiet modified according the food intolerance test (MedDiet plus FI). The patients were monitored one month later for compliance with diet through self-recorded in a paper where the patients wrote all food diaries. The demographic data, calculated BMI, WC, venous blood collection, were measured before and at the end of the study, 8 weeks later. Physical activity during the study period was not promoted.
Mediterranean pattern consisted: ingestion of monounsaturated fats such as olive oil for cooking and dressing salad. Consumption of fresh fruit (4-6 servings/day), vegetables (2-3 servings/day), nuts (4-6 servings/week); legumes; moderate consumption of whole grains, moderate to high consumption of fish; fish meat instead of red meat or processed meat; Low to moderate consumption of dairy products (1-2 servings/day); moderate consumption of alcohol and only in form of red wine. It was recommended that during the period of the study the food to be consumed at home to be sure that they consume their accurate food cooked at home (7-12).
Exclusion criteria were:
Laboratory examination
For all individuals blood was obtained from an antecubital vein from 8 to 10 a.m. after 8-12h of fasting. First in the beginning of the study and the second time eight weeks later from the first evaluation. Blood was centrifuged and the serum was sent for analyses at the central laboratory. Biochemical markers (blood glucose levels, serum insulin concentrations, C-reactive protein, fibrinogen, liver enzyme, lipid profile) were measured. Hypercholesterolemia was defined as total serum cholesterol levels greater than 200 mg/dl or the use of lipid lowering agents. Insulin resistance was assessed by the approach involving calculation of a homeostasis model assessment (HOMA). Fasting plasma glucose (mmol/l) × fasting plasma Insulin (μU/ml) / 22.5.
CRP was measured by an ultrasensitive competitive immunoassay was considered positive >0.5mg/dL.
Fibrinogen was measured in citrated plasma with a modified clot-rate assay was considered positive > 400 mg/dl.
All lipids (triglycerides, cholesterol, LDL and HDL) was analyzed using photometry with Cobas 8000 (Roche).
| Variables | Reference interval |
| Glucose | 70-110 mg/dl |
| Fasting Insulin | 2.6-24.9 uU/mL |
| HOMA-IR | <2> 2-2.5 borderline high >2.5 high |
| Fibrinogen | 200-400 mg/dl |
| CRP | 0-0.5 mg/dl |
| Total-Cholesterol | 0-200 mg/dl |
| LDL-Cholesterol | 0-100 mg/dl |
| HDL-Cholesterol | >65 mg/dl |
| Triglyceride | 0-200 mg/dl |
Table 1: Reference interval according ALNET (Albanian Laboratory Network at American Hospital).
We used the CYTOTEST® to detect foods that the patients were intolerant. The principle of the test is modification of leukocytes caused by the reaction antigen-antibody. There are four degree of reaction first degree of reaction - Stacking of red blood cells, normal - Normochromic red blood cells - Leukocytes do not have assumed any structural deformation - The membrane of leukocytes is well preserved, second degree of reaction - Swollen leukocytes - Stacking of red blood cells, normal - Normochromic red blood cells - Vacuolated leukocytes with a slight alteration of the membrane, third degree of reaction - Vacuolated leukocytes - Not stacking of red blood cells - Red blood cells tend to hypochromia - Vacuolated leukocytes with a partial rupture of the membrane followed by a loss of cytoplasmic granules, fourth degree of reaction - Leukocytes in disintegration - Stacking of red blood cells increasingly less evident - The red blood cells are hypochromic - Leukocytes are disintegrating with a total rupture of the membrane. According the grade result we recommended abstinence period. After the test result the reaction of the participants were identified for each food. The food that showed reaction was eliminated from the diet for 8 weeks.
The Windows SPSS 17.0 Statistics Package Program was used for statistical analysis of study data. Pearson correlation test and binary linear regression were used for evaluation of data. The P value calculated in the analyses p <0>
In this study were included 20 patients. Female were 14 (75%) and male 6 (25%). Mean age was 42.4 years’ old, SD±13.1 years. Minimum and maximum ages were 18 and 66 years old respectively. The groups were homogeneous for all variables (P> 0.05) and they have similar baseline demographic, anthropometric, metabolic, and inflammatory characteristics.
| Variables | MedDiet (nr=10) | MedDiet plus FI (nr=10) | P Sig. (2-tailed) | Mean Difference |
Mean Difference (%) |
| Age (years | 42±11.4 | 42.8±15.3 | 0.896 | -0.80 | -1.9 |
| Weight (kg) | 101.3±12.2 | 101.8±11.7 | 0.932 | -0.46 | -0.5 |
| Height (cm) | 164.5±8.4 | 163.5±7.9 | 0.839 | 0.75 | 0.5 |
| BMI | 37.5±4.1 | 38.1±4.7 | 0.784 | -0.55 | -1.5 |
| WC (cm) | 106.3±8.3 | 105.9±11.7 | 0.931 | 0.40 | 0.4 |
| ALT (<35> | 28.6±11.7 | 48.6±36.1 | 0.114 | -19.96 | -69.8 |
| AST (<43> | 23.2±5.9 | 35.5±20.1 | 0.080 | -12.31 | -53.1 |
| Glucose (74-106 mg/dL) | 100.5±6.8 | 102.0±10.4 | 0.705 | -1.52 | -1.5 |
| Insulin (2.6-24.9 mIU/L) | 24.3±9.7 | 23.1±8.3 | 0.762 | 1.24 | 5.1 |
| HOMA-IR | 6.0±2.4 | 5.7±1.8 | 0.772 | 0.28 | 4.7 |
| CRP (< 0> | 0.6±0.2 | 0.7±0.4 | 0.598 | -0.07 | -10.7 |
| Fibrinogen (200-400 mg/dL) | 403.1±42.0 | 405.5±55.5 | 0.914 | -2.40 | -0.6 |
| T-Chol (0-200 mg/dL) | 239.2±39.8 | 239.2±39.8 | 0.393 | -15.33 | -6.8 |
| LDL-Chol (0-100 mg/dL) | 170.7±44.3 | 174.2±58.1 | 0.880 | -3.54 | -2.1 |
| HDL-Chol (>50 mg/dL) | 46.8±10.0 | 47.1±12.8 | 0.946 | -0.35 | -0.7 |
| TG (0-150 mg/dL) | 223.1±77.5 | 248.8±87.8 | 0.496 | -25.70 | -11.5 |
Table 2. Baseline demographic, anthropometric, metabolic, and inflammatory characteristics between two groups. Date is presented as mean and SD.
Abbreviations: BMI, body mass index; WC, waist circumference; Homa-IR, Homeostasis model assessment-Insulin Resistant; HDL, high-density lipoprotein, LDL, low-density lipoprotein; CRP, C-reactive protein.
Participants generally displayed high levels of CRP. CRP as it’s shown on table 3. was elevated in 15 participants (75%) from them 9 were female and 6 males. Eight patients were from the group with only MedDiet and 7 from the group with MedDiet plus FI. Fibrinogen was elevated in 5 patients (25%), 3 female and 2 males and 4 of them were in MedDiet and 1 was on MedDiet plus FI group respectively see table 3.
| CRP | Male | Female | Sum |
| Med diet | 3 | 5 | 8 |
| Med diet plus FI | 3 | 4 | 7 |
| Fibrinogen | |||
| DM | 2 | 2 | 4 |
| DM plus FI | 0 | 1 | 1 |
Table 3. Distribution of cases with elevated CRP level and fibrinogen according to gender.
HOMA-IR was elevated in all 20 participants.
When we use Linear logistic regression, fibrinogen showed a stronger association with BMI (5.4%, p=0.005 and with WC (r=3.4% p=0.001), wheras HOMA-IR showed a stronger association with BMI (3.6%, p=0.041) see table nr 4.
| Dependent Variable | Independent Variable | R2 (%) | P | ||
| HOMA-IR | BMI | 3.6 | 0.041 | ||
| HOMA-IR | WC (cm) | 0.1 | 0.329 | ||
| CRP (mg/dL) | BMI | 7.0 | 0.969 | ||
| CRP (mg/dL) | WC (cm) | 5.1 | 0.990 | ||
| Fibrinogen (g/L) | BMI | 5.4 | 0.005 | ||
| Fibrinogen (g/L) | WC (cm) | 3.4 | 0.001 |
Table 4. Linear logistic regression between different variables.
.95% confidence intervals as a measure of the precision of their estimates, as well as the coefficient of determination (R2). HOMA-IR: Homeostasis Model Assessment of Insulin Resistance BMI body mass index R2 (%).
| Measurement | Period | Mean | Std. Deviation | Mean Difference | Mean Diffe (%) | P value |
| Weight (kg) | Beginning | 101.6 | 11.6 | 5.58 | 5.5 | 0.129 |
| After 8 weeks | 96.0 | 11.1 | ||||
| BMI | Beginning | 37.8 | 4.3 | 2.03 | 5.4 | 0.142 |
| After 8 weeks | 35.8 | 4.2 | ||||
| WC (cm) | Beginning | 106.1 | 9.8 | 4.30 | 4.1 | 0.139 |
| After 8 weeks | 101.8 | 8.1 | ||||
| ALT (U/L) | Beginning | 38.6 | 28.1 | 12.17 | 31.5 | 0.074 |
| After 8 weeks | 26.4 | 9.5 | ||||
| AST (U/L) | Beginning | 29.3 | 15.7 | 4.46 | 15.2 | 0.264 |
| After 8 weeks | 24.9 | 7.6 | ||||
| Glucose (mg/dL) | Beginning | 101.2 | 8.6 | 4.28 | 4.2 | 0.097 |
| After 8 weeks | 96.9 | 7.2 | ||||
| INSULINEMI (mIU/L) | Beginning | 23.7 | 8.8 | 7.60 | 32.1 | 0.003 |
| After 8 weeks | 16.1 | 5.7 | ||||
| HOMA-IR | Beginning | 5.9 | 2.1 | 2.24 | 38.1 | 0.000 |
| After 8 weeks | 3.6 | 1.3 | ||||
| CRP (mg/dL) | Beginning | 0.7 | 0.3 | 0.30 | 44.1 | 0.000 |
| After 8 weeks | 0.4 | 0.1 | ||||
| Fibrinogen (g/L) | Beginning | 404.3 | 47.9 | 50.75 | 12.6 | 0.001 |
| After 8 weeks | 353.6 | 36.6 | ||||
| T-Chol (mg/dL) | Beginning | 231.5 | 38.9 | 57.74 | 24.9 | 0.000 |
| After 8 weeks | 173.8 | 38.1 | ||||
| LDL-Chol (mg/dL) | Beginning | 172.5 | 50.3 | 57.87 | 33.6 | 0.000 |
| After 8 weeks | 114.6 | 40.7 | ||||
| HDL-Chol (mg/dL) | Beginning | 47.0 | 11.2 | 5.74 | 12.2 | 0.102 |
| After 8 weeks | 41.2 | 10.5 | ||||
| TG (mg/dL) | Beginning | 236.0 | 81.7 | 102.77 | 43.6 | 0.000 |
| After 8 weeks | 133.2 | 70.8 |
Table 5. Comparison between time periods; from baseline to 8 weeks results concerning the indicators of body composition (BMI, WC), biochemical parameters and inflammatory markers of all 20 patients.
Body weight was reduced from mean value 101.6 kg in the beginning to 96.0 kg, after 8 weeks p= 0.129. The average level of BMI was 37.8 in the beginning and after 8 weeks it was reduced to 35.8 kg, p=0.142 and mean difference was 5.4%. Mean WC was 106.1 cm in the beginning and after 8 weeks it was reduced to 101.8 cm, p= 0.139 and mean difference was 4.1%. Mean glucose level was 101.2 mg/dl in the beginning and after 8 weeks it was reduced to 96.9 mg/dl p= 0.097 and mean difference was 4.2%. Mean Insulin level was 23.7 mIU/L in the beginning and after 8 weeks it was reduced to 16.1 mIU/L) p= 0.003 mean difference was 7.6% and reached a statistical significance after the diet the same results were also for HOMA-IR, CRP fibrinogen and lipid profile.
| Parameter | Baseline | 8 weeks | Absolute change (%) | p value | Mean Difference (%) | ||
| Intolerance | Mean | Std. Deviation | Mean | Std. Deviation | |||
| Weight (kg) | |||||||
| MedDiet | 101.3 | 12.1 | 97.5 | 11.7 | 3.8 | 0.485 | 3.75 |
| MedDiet plus FI | 101.8 | 11.7 | 94.5 | 10.9 | 7.4 | 0.163 | 7.22 |
| BMI | |||||||
| MedDiet | 37.5 | 4.1 | 36.1 | 3.9 | 1.4 | 0.443 | 3.76 |
| MedDiet plus FI | 38.1 | 4.7 | 35.4 | 4.7 | 2.6 | 0.224 | 6.94 |
| WC (cm) | |||||||
| MedDiet | 106.3 | 8.3 | 102.7 | 8.2 | 3.6 | 0.343 | 3.39 |
| MedDiet plus FI | 105.9 | 11.7 | 100.9 | 8.2 | 5.0 | 0.282 | 4.72 |
| ALT (U/L) | |||||||
| MedDiet | 28.6 | 11.7 | 23.5 | 10.5 | 5.1 | 0.321 | 17.73 |
| MedDiet plus FI | 48.6 | 36.1 | 29.3 | 7.8 | 19.3 | 0.116 | 39.66 |
| AST (U/L) | |||||||
| MedDiet | 23.2 | 5.9 | 21.7 | 4.9 | 1.5 | 0.540 | 6.51 |
| MedDiet plus FI | 35.5 | 20.1 | 28.1 | 8.6 | 7.4 | 0.305 | 20.85 |
| Glucose (mg/dL) | |||||||
| MedDiet | 100.5 | 6.8 | 97.9 | 7.5 | 2.6 | 0.430 | 2.58 |
| MedDiet plus FI | 102.0 | 10.4 | 96.0 | 7.2 | 6.0 | 0.153 | 5.85 |
| INSULINEMI (mIU/L) | |||||||
| MedDiet | 24.3 | 9.7 | 17.8 | 6.0 | 6.5 | 0.089 | 26.79 |
| MedDiet plus FI | 23.1 | 8.3 | 14.4 | 5.1 | 8.7 | 0.011 | 37.64 |
| HOMA-IR | |||||||
| MedDiet | 6.0 | 2.4 | 4.3 | 1.3 | 1.8 | 0.062 | 29.12 |
| MedDiet plus FI | 5.7 | 1.8 | 3.0 | 1.1 | 2.7 | 0.001 | 47.47 |
| CRP (mg/dL) | |||||||
| MedDiet | 0.6 | 0.2 | 0.4 | 0.2 | 0.3 | 0.004 | 39.78 |
| MedDiet plus FI | 0.7 | 0.4 | 0.4 | 0.1 | 0.3 | 0.015 | 48.01 |
| Fibrinogen (g/L) | |||||||
| MedDiet | 403.1 | 42.0 | 352.5 | 34.1 | 50.6 | 0.008 | 12.55 |
| MedDiet plus FI | 405.5 | 55.5 | 354.6 | 40.7 | 50.9 | 0.031 | 12.55 |
| T-Chol (mg/dL) | |||||||
| MedDiet | 223.9 | 38.6 | 184.3 | 20.0 | 39.6 | 0.012 | 17.68 |
| MedDiet plus FI | 239.2 | 39.8 | 163.3 | 49.1 | 75.9 | 0.001 | 31.73 |
| LDL-Chol (mg/dL) | |||||||
| MedDiet | 170.7 | 44.3 | 130.9 | 25.4 | 39.8 | 0.024 | 23.32 |
| MedDiet plus FI | 174.2 | 58.1 | 98.3 | 47.5 | 75.7 | 0.005 | 43.58 |
| HDL-Chol (mg/dL) | |||||||
| MedDiet | 46.8 | 10.0 | 46.2 | 10.1 | 0.6 | 0.896 | 1.26 |
| MedDiet plus FI | 47.1 | 12.8 | 36.3 | 8.7 | 10.9 | 0.039 | 23.10 |
| TG (mg/dL) | |||||||
| MedDiet | 223.1 | 77.5 | 126.9 | 57.3 | 96.3 | 0.278 | 43.14 |
| MedDiet plus FI | 248.8 | 87.8 | 139.5 | 84.8 | 109.3 | 0.011 | 43.92 |
Tab 6. Comparison between groups (MedDiet vs MedDiet plus FI) and between time periods for all variables.
Data were expressed as means± SD, comparison between groups done by Pearson Correlation
We found a reduction in average values for BMI and WC between time periods (8 weeks), at the two interventions, without any statistical significance but the reduction of weight was greater in the MedDiet plus FI from 101.8 to 94.5 kg compared 101.3 kg to 97.5 kg (7.4%vs3.8%) the reduction of BMI was greater in the group with MedDiet plus FI than only MedDiet intervention 6.94% vs3.76% respectively. The percentage of variation in WC for the group MedDiet plus FI was -4.72% whereas MedDiet alone showed a reduction of -3.39%. The biochemical assessment showed a significant decrease in values of triglycerides, total-Cholesterol, HDL-cholesterol; LDL-cholesterol (43.92% ,43.14%, 23.1% and – 43.58%, respectively; P <0 p=0.011), p=0.001>
A comparison of inflammatory markers, shown at table 6. revealed a significant decrease in the average value of fibrinogen and CRP in both groups MedDiet plus FI and MedDiet alone corresponding to 12.55% vs 12.52 % (p=0.031 vs p= 0.008) for fibrinogen reduction of 48.01% MedDiet plus FI vs 39.78% MedDiet alone. There were no significant variations in the other markers.
Food intolerances is also one of the probable causes of low-grade inflammation because increase the calories may contribute to the onset of obesity (3,21,23,24). In our study the groups were homogeneous for all variables (P> 0.05). They have similar baseline demographic, anthropometric, metabolic, and inflammatory characteristics. Those were some strong points for this study. In the recent years has been concluded that obesity is an inflammatory disease and weight loss programs through different model of diets has been shown to decrease the inflammation (1- 26). As shown in our analyses, an increase in severity of obesity corresponded to higher concentrations of blood glucose, fasting plasma insulin, total-cholesterol and triglycerides. A higher BMI was associated with higher values for insulin resistance (HOMA-IR). Acute phase proteins such as CRP was increased in patients with obesity, CRP was elevated in 75% of patients (15) from them 9 were female and 6 males. The value of CRP usually isn’t high then two-fold of normal value. These data are founded in this study. In previous study CRP level correlated with degree of adiposity which is consistent with our findings that an increase in severity of obesity corresponded to higher CRP level, so our study demonstrates a positive correlation between BMI and serum CRP. These findings suggest a state of low-grade systemic inflammation in obese individuals [5,27-29]. Higher BMI is associated with higher CRP concentrations, even among young adults aged 17 to 39 years. These findings suggest a state of low-grade systemic inflammation in overweight and obese persons [2,14,30]. Fibrinogen was elevated in 5 patients (25%), 3 female and 2 males. The prevalence of insulin resistance is increased in obese individuals, also in our study HOMA-IR was elevated in all 20 participants. When we use Linear logistic regression fibrinogen showed a stronger association with BMI (5.4%, p=0.005 and with WC (r=3.4% p=0.001), HOMA-IR showed a stronger association with BMI (3.6%, p=0.041). The prevalence of insulin resistance is increased in obese individuals [28,31-34].
From our study it was identified that there was statistically significant improvement in the metabolic parameters and inflammatory marker after the food intolerance elimination diet compared with only MedDiet. The same result came from the study of Gubur et al [19]. A recent clinical study by Madsen and colleagues investigated the effects of short-term and long-term weight loss on levels of CRP and fibrinogen among obese subjects and founded that long-term weight loss was associated with decreased CRP and fibrinogen concentrations [35].
One of the most important limitations in this study was the patient’s number. We will be preferred to have more patients, but financial support was crucial.
Obesity is a major health problem concerning public health all over the world and is associated with much health risk with increased morbidity and mortality rate. The most effective way to reduce weight in obesity is the proper diet and continued regularly. One of the methods is through elimination diet after identification and removing of the food that are reactive in the food intolerance test. The result of our study suggests that food intolerance elimination diet gave positive changes on body composition and metabolic parameters in obese people. Even the sample size of our study was small we can consider such a diet as a potential treatment of medical nutrition therapy for obesity.
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As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
