Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity.

OBJECTIVE: To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets. DESIGN: Randomized dietary intervention study over six months comparing two ad libitum fat reduced diets (30% of total energy) strictly controlled in composition: High-carbohydrate (HC, protein 12% of total energy) or high-protein (HP, protein 25% of total energy). SETTING AND PARTICIPANTS: Subjects were 65 healthy, overweight and obese subjects (50 women, 15 men, aged 18-55 y) randomly assigned to HC (n = 25), HP (n = 25) or a control group (C, n = 15). All food was provided by self-selection in a shop at the department, and compliance to the diet composition was evaluated by urinary nitrogen excretion. MAIN OUTCOME MEASURE: Change in body weight, body composition and blood lipids. RESULTS: More than 90% completed the trial. Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group (difference 3.7 kg, 95% confidence interval (CI)(1.3-6.2 kg) P < 0.001), and fat loss was 4.3 kg and 7.6 kg, respectively (difference 3.3 kg (1.1-5.5 kg) P < 0.0001), whereas no changes occurred in the control group. More subjects lost > 10 kg in the HP group (35%) than in the HC group (9%). The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly. CONCLUSIONS: Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet, improves weight loss and increases the proportion of subjects achieving a clinically relevant weight loss. More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products, and hence improve adherence to low-fat diets in weight reduction programs.     

Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects

BACKGROUND: Due to the high satiating effect of protein, a high-protein diet may be desirable in the treatment of obesity. However the long-term effect of different levels of protein intake on renal function is unclear. OBJECTIVE: To assess the renal effects of high vs low protein contents in fat-reduced diets. DESIGN: Randomized 6 months dietary intervention study comparing two controlled ad libitum diets with 30 energy (E%) fat content: high-protein (HP; 25 E%) or low-protein, (LP, 12 E% protein). All food was provided by self-selection in a shop at the department, and high compliance to the diet composition was confirmed by measurements of urinary nitrogen excretion. SUBJECTS: 65 healthy, overweight and obese (25相似文献   

Effect of calcium and dairy foods in high protein, energy-restricted diets on weight loss and metabolic parameters in overweight adults

OBJECTIVE: To compare the effects two high-protein (HP) diets that differ in dietary calcium and protein source on weight loss, body composition, glucose and lipid metabolism, markers of liver function, fibrinolysis and endothelial function and blood pressure. DESIGN: Randomized, parallel study (12 wk of energy restriction, 4 wk of energy balance) of high dairy protein/high-calcium (DP, 2400 mg Ca/d) and high mixed protein/moderate calcium (MP, 500 mg Ca/d) diets (5.5 MJ/d, 34% protein, 41% carbohydrate, 24% fat). SUBJECTS: In all, 50 healthy, overweight (age 25-64 y; body mass index 25-35 kg/m(2);) males (n=20) and females (n=30). RESULTS: Loss of total weight (-9.7+/-3.8 kg), fat mass (-8.3+/-0.4 kg) and lean mass (-1.6+/-0.3 kg) were independent of dietary group. Improvements in fasting insulin, lipids, systolic/diastolic blood pressure, and markers of liver function, fibrinolysis and endothelial function were independent of dietary intervention. CONCLUSIONS: Increased dietary calcium/dairy foods in an energy-restricted, HP diet does not affect weight loss or body composition. Weight reduction following increased protein diets is associated with beneficial metabolic outcomes that are not affected by protein source.     

Effect of a high-protein, energy-restricted diet on weight loss and energy expenditure after weight stabilization in hyperinsulinemic subjects

OBJECTIVE: To determine the effect of replacing some dietary carbohydrate with protein, during energy restriction, on weight loss, total energy expenditure (TEE), resting energy expenditure (REE), respiratory quotient (RQ), and the thermic effect of feeding (TEF) in subjects with hyperinsulinemia. DESIGN: Parallel, clinical intervention study of 12 weeks energy restriction (6.5 MJ/day) and 4 weeks energy balance (8.2 MJ/day) in two groups of subjects randomly assigned to either a high-protein (HP) diet (27% of energy (%E) as protein, 45%E as carbohydrate) or a lower-protein (LP) diet (16%E as protein, 57%E as carbohydrate). SUBJECTS: A total of 36 obese nondiabetic volunteers with hyperinsulinemia (10 males/26 females, aged 34-65 y, BMI 28-43 kg/m(2), fasting insulin 12-45 mU/l). MEASUREMENTS: Body weight and composition, TEE, REE, and RQ were measured at baseline and at week 16. In addition, the TEF to an HP or LP meal was determined for 3 h, at baseline and at week 16. RESULTS: After 16 weeks, weight loss was similar in response to each diet; the overall decrease was 7.9+/-0.6 kg (P<0.001), of which 6.8+/-0.5 kg was fat (P<0.001). REE fell similarly with each diet; the overall decrease was 719+/-106 kJ/day (P<0.001). The TEF was 2% greater after the HP than after the LP meal at baseline (P<0.01) and 0.8% greater at week 16 (P=0.35). After 16 weeks, the TEF was not reduced in either dietary group. There was no change in TEE after 16 weeks. CONCLUSION: In subjects with hyperinsulinemia an energy-restrictive diet containing an increased protein-to-carbohydrate ratio does not enhance weight loss or significantly affect energy expenditure. Caloric restriction, rather than the macronutrient composition of the diet, is the most important determinant of weight loss.     

Predictors of weight loss and maintenance during 2 years of treatment by sibutramine in obesity. Results from the European multi-centre STORM trial. Sibutramine Trial of Obesity Reduction and Maintenance

BACKGROUND: In this report we assess pre-treatment determinants of weight loss and maintenance outcome in The Sibutramine Trial of Obesity Reduction and Maintenance (STORM), a 2 y randomized, double-blind, placebo-controlled, European multicenter study examining the effect of sibutramine (Sib) on inducing and maintaining weight loss in obese subjects. MATERIAL: A total of 605 obese patients (BMI: 30-45 kg/m2) of both gender were included from eight European centers and treated for 24 months. The patients were treated for the initial 6 months by Sib (10 mg/day) and a low-fat low-energy, individualized diet (600 kcal/day deficit). The 467 patients who achieved >5% weight loss after 6 months were randomized 3∶1 to Sib (10 mg/day) (Sib/Sib) and placebo (Sib/Pla) for weight maintenance over a further 18 months. MAIN OUTCOME AND ANALYSES: Pre-treatment individual characteristics were assessed as predictors of 6 months weight loss (kg) and 24 months weight maintenance using simple and multivariate correlation and regression analyses. RESULTS: In univariate analyses, the 6 month weight loss (n=505) was positively associated with pre-treatment body weight (r=0.27), height (r=0.18), fat-free mass (r=0.21) (all P<0.001), fat mass (r=0.13, P<0.03), and resting metabolic rate (r=0.13, P<0.003). However, no relation was found with age, gender, smoking status, age at onset of obesity, or number of previous slimming attempts. The same predictors were found for weight change to endpoint in the Sib/Sib group (n=350), while no predictors were identified in the Sib/Pla (n=114). In the multivariate regression analysis only pre-treatment body weight predicted weight loss at 6 months (P<0.001). Weight change (kg) to 24 month was predicted by: 4.34+0.07*body weight (kg)-4*treatment (Sib=1, Pla=0)-0.06*age (y), (r2=8%, P<0.001). CONCLUSION: Only pre-treatment body weight seems to be an important independent predictor of 6 months weight loss and 24 month weight maintenance in this study on diet and Sib. As only 8% of the variation in 24 months weight change could be explained by the predictors, the clinical value of this information is limited.     

A randomized controlled trial of a moderate-fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults.

CONTEXT: Long-term success in weight loss with dietary treatment has been elusive. OBJECTIVE: To evaluate a diet moderate in fat based on the Mediterranean diet compared to a standard low-fat diet for weight loss when both were controlled for energy. DESIGN: A randomized, prospective 18 month trial in a free-living population. PATIENTS: A total of 101 overweight men and women (26.5-46 kg/m(2)). INTERVENTION: (1) Moderate-fat diet (35% of energy); (2) low-fat diet (20% of energy). MAIN OUTCOME MEASUREMENTS: Change in body weight. RESULTS: After 18 months, 31/50 subjects in the moderate-fat group, and 30/51 in the low fat group were available for measurements. In the moderate-fat group, there were mean decreases in body weight of 4.1 kg, body mass index of 1.6 kg/m(2), and waist circumference of 6.9 cm, compared to increases in the low-fat group of 2.9 kg, 1.4 kg/m(2) and 2.6 cm, respectively; P < or = 0.001 between the groups. The difference in weight change between the groups was 7.0 kg. (95% CI 5.3, 8.7). Only 20% (10/51) of those in the low-fat group were actively participating in the weight loss program after 18 months compared to 54% (27/50) in the moderate-fat group, (P<0.002). The moderate-fat diet group was continued for an additional year. The mean weight loss after 30 months compared to baseline was 3.5 kg (n = 19, P = 0.03). CONCLUSIONS: A moderate-fat, Mediterranean-style diet, controlled in energy, offers an alternative to a low-fat diet with superior long-term participation and adherence, with consequent improvements in weight loss.     

Laparoscopic gastric banding and body composition in morbid obesity

BACKGROUND AND AIM: Gastric banding induced considerable and rapid weight loss in morbid obesity. Nevertheless data on changes in body composition following gastric banding are scanty. In this study, we evaluated the 2-year changes in body composition in a small group of morbidly obese women treated by laparoscopic adjustable gastric banding (LAGB) associated with a well balanced low-calorie diet. METHODS AND RESULTS: We studied 20 premenopausal morbid obese women with BMI ranging from 35 to 57 (kg/m2) before, and 6, 12 and 24 months after laparoscopic adjustable gastric banding (LAGB). A well balanced 5.4 MJ/day hypocaloric diet was prescribed after surgery. Total body water (TBW), fat-free mass (FFM) and fat mass (FM) were investigated using conventional bioelectrical impedance analysis (BIA). Tissue hydration was also assessed by impedance vector analysis and the RXc graph method. The subjects showed a total weight loss of 28% of baseline body weight. In the first 6 months after surgery, patients lost 18.5+/-5.9 kg of body weight (17.6+/-6.2 kg of FM and 0.7+/-1.4 kg of FFM). From 6 to 12 months, a further 12.5+/-7.5 kg of body weight was lost (10.5+/-8.2 kg of FM and 2.2+/-3.8 kg of FFM). During the last 12 months, weight loss was 3.0+/-2.3 kg (1.9+/-3.7 kg of FM and 1.1+/-2.9 kg of FFM). The weight loss observed after LAGB was mainly due to a decrease in FM, whereas TBW, FFM and BCM were only slightly and non-significantly reduced. No changes in body hydration status were observed after surgery. CONCLUSIONS: LAGB associated with a well balanced low-calorie diet achieved a satisfactory 2-year weight loss, while sparing FFM and not causing body fluid alterations.     

Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects

OBJECTIVE: To compare the long-term compliance and effects of two low-fat diets differing in carbohydrate to protein ratio on body composition and biomarkers of cardiovascular disease risk in obese subjects with hyperinsulinemia. DESIGN: Outpatient, parallel, clinical intervention study of two groups of subjects randomly assigned to either a standard protein (SP; 15% protein, 55% carbohydrate) or high-protein (HP; 30% protein, 40% carbohydrate) diet, during 12 weeks of energy restriction (approximately 6.5 MJ/day) and 4 weeks of energy balance (approximately 8.3 MJ/day). Subsequently, subjects were asked to maintain the same dietary pattern for the succeeding 52 weeks with minimal professional support. SUBJECTS: A total of 58 obese, nondietetic subjects with hyperinsulinemia (13 males/45 females, mean age 50.2 y, mean body mass index (BMI) 34.0 kg/m2, mean fasting insulin 17.8 mU/l) participated in the study. MEASUREMENTS:: Body composition, blood pressure, blood lipids, fasting glucose, insulin, CRP and sICAM-1 were measured at baseline and at weeks 16 and 68. Urinary urea/creatinine ratio was measured at baseline, week 16 and at 3 monthly intervals thereafter. RESULTS: In total, 43 subjects completed the study with similar dropouts in each group (P=0.76). At week 68, there was net weight loss (SP -2.9+/-3.6%, HP -4.1+/-5.8%; P<0.44) due entirely to fat loss (P<0.001) with no diet effect [corrected]. Both diets significantly increased HDL cholesterol concentrations (P<0.001) and decreased fasting insulin, insulin resistance, sICAM-1 and CRP levels (P<0.05). Protein intake was significantly greater in HP during the initial 16 weeks (P<0.001), but decreased in HP and increased in SP during 52-week follow-up, with no difference between groups at week 68, indicating poor long-term dietary adherence behaviour to both dietary patterns. CONCLUSION: Without active ongoing dietary advice, adherence to dietary intervention is poor. Nonetheless, both dietary patterns achieved net weight loss and improvements in cardiovascular risk factors.     

Long-term effects of popular dietary approaches on weight loss and features of insulin resistance

OBJECTIVE: High-carbohydrate (HC)-high-fibre diets are recommended for weight loss and for treating and preventing diseases such as diabetes and cardiovascular disease. We report a randomised trial comparing high-fat (HF) and high-protein (HP) diets with the conventional approach. RESEARCH DESIGN AND METHODS: A total of 93 overweight insulin-resistant women received advice following randomisation to HF, HP or HC dietary regimes, to achieve weight loss followed by weight maintenance over 12 months. Weight, body composition and measures of carbohydrate and lipid metabolism were investigated. RESULTS: Retention rates were 93% for HP and 75% for HC and HF. Features of the metabolic syndrome improved in all groups during the first 6 months, to a greater extent on HF and HP than an HC. During the second 6 months the HF group had increases in waist circumference (mean difference 4.4 cm (95% CI 3.0, 5.8)), fat mass (2.3 kg (1.5, 3.1)), triglycerides (0.28 mmol/l (0.09, 0.46)) and 2 h glucose (0.70 mmol/l (0.22, 1.18)). Overall there was substantial sustained improvement in waist circumference, triglycerides and insulin in the HP group and sustained but more modest changes on HC. Dietary compliance at 12 months was poor in all groups. CONCLUSIONS: HP and HC approaches appear to be appropriate options for insulin-resistant individuals. When recommending HP diets appropriate composition of dietary fat must be ensured. HC diet recommendations must include advice regarding appropriate high-fibre, low glycaemic index foods.     

NIA0005Long-term weight maintenance: does diet composition matter? A randomized, prospective trial

Background:  High protein diets confer weight loss and metabolic advantages over high carbohydrate diets in the short-to-medium term. Little has been published on long-term use of high protein diets, especially in the context of weight maintenance following significant weight loss.
Methods:  The study consisted of two phases. The first phase saw patients provided with a very low energy diet for 12 weeks. Patients who lost > 10% of their body weight progressed to the second phase in which they were randomly allocated to a high carbohydrate (HC) (55% carbohydrate) or high protein (HP) diet (30% protein) to maintain their weight loss. Patients were followed up monthly for 12 months. Anthropometric and cardiovascular risk factors were measured.
Results:  A total of 173 overweight or obese people (88 males, 85 females) aged 43 years (SD = 10.6); weight 112.2 kg (±24.6); Body Mass Index 39.2 kg/m² (±7.7) were enrolled. 151 patients (87.3%) completed phase I and entered phase II. There was no significant difference between the weight loss recorded during phase I for each group after randomization (mean weight loss 18.5 kg ±6.9 kg and 17.7 ± 5.0 respectively). On average, patients from both groups were reasonably successful in maintaining their weight loss at completion of phase II (HC 14.7 ± kg 12.5 vs. HP 14.8 kg ± 9.7), with no significant difference between the groups.
Conclusion :   Although a high protein diet compares favourably to a high carbohydrate diet in the short-to-medium term, in this study a high protein diet exhibited no advantage over a higher carbohydrate diet in achieving weight maintenance over a 12 month period.     

A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months

OBJECTIVE: To investigate the effect of an 8-week group-based cognitive behaviour therapy lifestyle intervention with monthly follow-up to 6 months and further follow up at 12 months on change in weight and other weight-related variables, change in physical activity and change in health and well being compared to individualised dietetic treatment or giving an information booklet only (BO). DESIGN: A randomised controlled trial of two intervention groups, a group-based cognitive behaviour therapy lifestyle intervention, Fat Booters Incorporated--(FBI) and individualised dietetic treatment (IDT) and control group receiving an information booklet only (BO). The intervention groups involved weekly contact for 8 weeks with monthly follow-up to 6 months and further follow-up at 12 months, conducted in real practice setting. SUBJECTS: A total of 176 adults with body mass index (BMI)>27 kg/m2, mean (+/-s.d.) age 48+/-13 years, mean BMI 34+/-5.5 kg/m2. MAIN OUTCOME MEASURES: Weight, percent body fat, waist circumference, physical activity, health status, self-efficacy and satisfaction with life were measured at baseline, 3, 6 and 12 months. RESULTS: A statistically significant difference between groups was observed for weight change over time (P=0.05). The change in weight (mean+/-s.e.) for the FBI group was significantly greater than the BO group at 3 and 12 months (-2.8+/-0.7 compared to -1.0+/-0.6 kg, P<0.05 and -2.9+/-0.9 compared to +0.5+/-0.9 kg, P<0.005, respectively). Change in weight in the IDT group did not differ from the FBI group at any time point. For all groups, waist circumference was significantly less than baseline at all time points (P<0.001). Significant differences in self-efficacy were observed over time (P=0.02), with both intervention groups having greater self-efficacy than the BO group. Significant drop-outs occurred over time for all three groups. CONCLUSIONS: A cognitive behaviour-based lifestyle intervention was more effective than providing an information booklet alone and as effective as intensive individualised dietetic intervention in weight loss and improvements in self-efficacy.     

Metformin and carbohydrate-modified diet: a novel obesity treatment protocol: preliminary findings from a case series of nondiabetic women with midlife weight gain and hyperinsulinemia

The authors conducted a retrospective analysis of a new obesity treatment protocol, metformin and hypocaloric, carbohydrate-modified diet, in high-risk, nondiabetic hyperinsulinemic women with progressive midlife weight gain (refractory to diet and exercise). Thirty consecutive nondiabetic women with glucose-mediated area-under-the-curve (AUC) insulin elevations (>or=100 microU/mL) in two body mass index (BMI) categories (group I: 25 to 32.9 kg/m(2) and group II: 33 to 41.7 kg/m(2)) participated in a 1-year treatment program of metformin (mean daily doses of 1,500 mg/day [group I] and 2,000 mg/day [group II]) and carbohydrate-modified dietary regimens. Follow-up body weight (at 3, 6, and 12 months), percentage of patients meeting goal weight attainment (10% reduction in body weight or BMI normalization), and fasting insulin levels (as available) are reported in 26 women (18/18 in group I and 8/12 in group II) who returned for one or more follow-up visits. Significant weight loss was observed at 3, 6, and 12 months in both group I (3.47 [SE 0.68], 6.41 [0.72], and 8.06 [0.96] kg, P < 0.0001) and group II (4.4 [0.8], 9.7 [2.3], 15.1 [3.3], P = 0.001, 0.004, 0.011). Twenty-five of 26 (96%) patients lost >or=5% of their body weight at 6 months and 21/26 (81%) patients lost >or=10% of their body weight at 12 months. Posttreatment fasting insulin decrement (-35.5 [8.2]%) was the most significant predictor of 1-year weight loss (R(2)=0.656, regression coefficient = 0.810, P = 0.005). Following completion of the 1-year intervention study, weight stabilization (within 1 kg) was observed at a 6-month surveillance in 8/9 patients who attained goal weight and continued metformin without additional nutritional counseling, in contrast to weight gain (>or=4 kg or 50% of lost weight) in 5/6 patients who discontinued metformin. The authors concluded that metformin and carbohydrate-modified hypocaloric diet could be an effective novel treatment for long-term weight management in nondiabetic, hyperinsulinemic women.     

Consumption of a controlled low-fat diet containing olestra for 9 months improves health risk factors in conjunction with weight loss in obese men: the Ole' Study

OBJECTIVE: To compare the effects of a standard American diet, a traditional low-fat diet, and a low-fat diet containing the fat substitute olestra on risk factors for heart disease and diabetes. DESIGN: A 9-month, double-blind, randomized, parallel-arm, feeding study comparing three diets: (1). control (33% fat), (2). fat-reduced (FR; 25% fat), and (3). fat-substituted (FS) where olestra replaced 1/3 of dietary fat (33% lipid and 25% digestible fat). Subjects were allowed to adjust their total energy intake as desired, allowing weight to fluctuate. SUBJECTS: A total of 37 healthy, obese men (age 36.7+/-1.3 y; body mass index 30.8+/-0.4 kg/m(2)). MEASUREMENTS: Body weight and composition by dual-energy X-ray absorptiometry, blood pressure, serum lipids, lipoproteins, hemostatic factors, glucose, insulin, and leptin at baseline and every 3 months. RESULTS: The FS group lost 6.27 kg of body weight by 9 months vs 4.0 kg in the control and 1.79 kg in the FR groups. There was a significant diet main effect on cholesterol (P=0.002), low-density lipoprotein cholesterol (P=0.003), and triglycerides (P=0.01), all of which decreased in the FS group but not the other groups by 9 months. Apolipoprotein B (ApoB) increased in the FR and control groups but was unchanged in the FS group (diet main effect P=0.04). High-density lipoprotein (HDL) cholesterol increased in all groups over 9 months (time main effect P=0.0001). Time main effects were also observed for cholesterol, ApoA1, ApoB, Factor VII, diastolic blood pressure, and glucose. After adjustment for % fat loss at 9 months, the effects of diet on change in risk factors remained significant only for triglycerides. DISCUSSION: Consumption of a low-fat diet containing olestra for 9 months produced significant improvement in cardiovascular risk factors, an effect largely explained by weight loss. Long-term low-fat diet consumption with or without olestra does not decrease HDL cholesterol.     

Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines

OBJECTIVE: To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss >/=2.5 kg during a 4 week dietary lead-in period, and weight losses of >/=5% after 12 weeks and >/=10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years. DESIGN: A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design. SETTING: Twenty-nine centres throughout Europe. PARTICIPANTS: Two hundred and twenty men and women (BMI 28-43 kg/m(2)) who completed 2 years of treatment. INTERVENTION: After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two. MAIN OUTCOME MEASURES: Weight loss and obesity-related risk factor changes. RESULTS: Weight loss >/=5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of >/=2.5 kg during the 4 week lead-in and >/=10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost >/=5% of their weight at 12 weeks (n=104, 47.3%) lost significantly more weight after 2 years than others: -11.9% (95% confidence interval (CI) -13.4% to -10.3%) vs -4.7% (-5.7% to -3.7%) (P=0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved >/=5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose >/=10% body weight at 6 months compared with those who did not achieve >/=10% weight loss by month 6. CONCLUSIONS: Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of >/=5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2 years, while other suggested criteria are less useful.     

Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial

BACKGROUND: Weight loss medications are recommended as an adjunct to diet and exercise modification but seem to be prescribed as a monotherapy by many physicians. This practice is likely to be associated with suboptimal weight loss. METHODS: This 1-year, randomized trial compared the effects of sibutramine hydrochloride used alone (ie, the drug-alone group) to sibutramine plus group lifestyle modification, prescribed with either a 5021- to 6276-kJ/d diet (1200-1500-kcal/d diet) (ie, the drug-plus-lifestyle group) or, for the first 4 months, a 4184-kJ/d diet (1000-kcal/d diet (ie, drug-plus-lifestyle with a portion-controlled diet [the combined treatment] group). Participants were 53 women with a mean (+/-SD) age of 47.2 +/- 9.8 years and weight of 101.3 +/- 9.7 kg. At baseline, they reported the number of pounds they expected to lose at the end of treatment. RESULTS: At month 12, patients treated with the drug alone lost (mean +/- SD) 4.1% +/- 6.3% of their initial body weight compared with significantly (P<.05) larger losses in the drug-plus-lifestyle group of 10.8% +/- 10.3% and the combined treatment group of 16.5% +/- 8.0%. Women in the 2 lifestyle groups achieved a significantly (P<.05) greater percentage of their expected weight loss than those in the drug-alone group and were significantly more satisfied with the medication and with changes in weight, health, appearance, and self-esteem (P<.05 for all). Significant reductions were observed at 12 months in triglyceride and low-density lipoprotein cholesterol levels but systolic and diastolic blood pressure both increased significantly (P<.05 for all). CONCLUSION: The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients' satisfaction with treatment outcome.     

多学科减重联合门诊对中国肥胖患者减重效果的研究

目的探讨多学科联合减重门诊对肥胖的减重效果及减重成功率的影响因素。方法多学科减重门诊团队由2名内分泌科医师、2名营养师、2名康复科运动指导师、1名普外科医师、1名中医科医师以及多名健康教育护士组成。本团队自2015年6月至2017年6月共纳入在北京大学第一医院多学科减重门诊就诊的患者445例,平均年龄(37.6±12.5)岁,其中女性293例(65.8%),男性152例(34.2%)。在首诊后的3、6、12、18和24个月进行复诊,同时随访其体重及异常的代谢指标,并应用Logistic回归分析和χ2检验分析影响减重成功率的因素。结果多学科减重门诊患者每次随访体重均较基线体重显著下降(P<0.01)。此外,随访第6和12个月时的体重均较上一次随访体重显著下降[6个月比3个月:(87.2±20.2)比(87.8±19.8)kg,P<0.01;12个月比6个月:(86.7±19.0)比(87.2±20.2)kg,P<0.01]。定义体重较基线下降超过5%为减重成功时,多学科减重门诊患者中减重成功率达40.9%(179/438)~50.9%(110/216)。定义体重较基线下降超过10%为减重成功时,减重成功率逐渐由13.2%(58/438)升高至26.9%(14/52)。女性性别、基线体质指数(BMI)、腰围和减重治疗早期体重下降与减重成功率有关(P<0.01或P<0.05),应用二甲双胍与减重成功率无关(P>0.05)。结论多学科减重团队对肥胖患者的减重治疗具有显著效果。女性性别、基线BMI、腰围和减重治疗早期体重出现下降与减重成功率有关。     

Weight change and blood coagulability and fibrinolysis in healthy obese women.

OBJECTIVES: To study the effect of weight loss and subsequent weight maintenance or weight regain on the activities of FVII and plasminogen activator inhibitor 1 (PAI-1) and the concentration of fibrinogen over 12 months in obese women consuming a hypoenergetic, low-fat diet with or without orlistat. In addition, the relation between the changes of the activities of PAI-1 and FVII with the changes of other cardiovascular risk factors were examined. METHODS AND PROCEDURES: Design-a 12-month randomized double-blind weight reduction trial of placebo and orlistat. Subjects-51 healthy obese women (age 44+/-0.7 y, BMI 36.2+/-0.5 kg/m(2), mean+/-s.e.m.) Treatment-the participants were on a hypoenergetic diet (-600 kcal daily). The diet was adjusted for actual body weight (-300 kcal) at 6 months. Women were randomized to receive either orlistat 120 mg three times daily (n=25) or placebo three times daily (n=26) for 12 months according to a double-blind protocol after a 1 month run-in period. Measurements-changes of body weight, body composition, haemostatic and other cardiovascular risk factors were measured at 3-6 month intervals. The activity of plasma PAI-1 was measured by a chromogenic method, fibrinogen by the PT-derived method and the activity of FVII by the one-stage method. RESULTS: The changes in body weight between orlistat and placebo groups were not statistically significantly different. Orlistat did not influence haemostatic factors beyond its effect on weight loss. Therefore, the results of the orlistat and placebo groups were pooled. The average weight loss at 3, 6 and 12 months was 7.6, 9.5 and 10.0 kg, respectively (P<0.001). Between 6 and 12 months, 35% of women regained weight, 24% had stable weight and 41% continued to lose weight. No changes in the mean plasma fibrinogen concentration were observed at any time point during the trial. During the first 3 months the activities of PAI-1 and FVII decreased. The decline depended on the magnitude of weight loss. Between months 6 and 12 the changes of PAI-1 and FVII activities paralleled the changes of body weight. The activities rose with weight rebound but remained below the 6-month values if weight loss was sustained or continued. The changes of serum insulin were significantly correlated with the changes of both PAI-1 and FVII at 6 months and with PAI-1 at 12 months. CONCLUSIONS: The maintenance of modest weight loss is associated with long-term benefits in PAI-1 and FVII in obese women. The change of serum insulin is associated with the changes of PAI-1 activities. Fibrinogen is not affected by modest weight loss.     

X-PERT: weight reduction with orlistat in obese subjects receiving a mildly or moderately reduced-energy diet: early response to treatment predicts weight maintenance

AIM: To determine the effect of two different levels of energy deficit on weight loss in obese patients treated with orlistat. METHODS: Patients (n=430) were randomized in a 1-year, multicentre, open-label, parallel group study conducted at 23 hospital centres and university medical departments worldwide. Obese outpatients (body mass index 30--43 kg/m(2)) aged 18--70 years with a body weight of >or=90 kg and a waist circumference of >or=88 cm (women) or >or=102 cm (men) were treated with orlistat 120 mg three times daily plus a diet that provided an energy deficit of either 500 or 1,000 kcal/day for 1 year. Orlistat treatment was discontinued in patients who did not achieve >or=5% weight loss after assessment at 3 and 6 months. The primary outcome measure was change in body weight from baseline at week 52. RESULTS: Reported mean difference in energy intake between the two groups (500-1,000 kcal/day deficit) at weeks 24 and 52 was actually 111 and 95 kcal/day respectively. Of the 430 patients involved in the study, 295 achieved >or=5% weight loss at both 3 and 6 months. In this population, at week 52, weight loss from baseline was similar for patients randomized to either the 500 or the 1,000 kcal/day deficit diet (-11.4 kg vs. -11.8 kg, respectively; p=0.778). After 12 months of treatment with orlistat, 84% (n=118/141) and 85% (n=131/154) of patients in the 500 and 1,000 kcal/day deficit groups, respectively, achieved >or=5% weight loss, and 50% (n=70/141) and 53% (n=82/154) of patients, respectively, achieved >or=10% weight loss. Patients in both the diet treatment groups showed similar significant improvements in blood pressure, lipid levels and waist circumference at week 52. CONCLUSIONS: Treatment with orlistat was associated with a clinically beneficial weight loss, irrespective of the prescribed dietary energy restriction (-500 or -1000 kcal/day). Patients who achieved >or=5% weight loss at 3 months achieved long-term, clinically beneficial weight loss with orlistat plus either diet. Therefore, identifying patients who lose at least 5% weight after 3 months and who maintain this weight loss up to 6 months is a valuable treatment algorithm to select patients who will benefit most from orlistat treatment in combination with diet.     

Level of dietary protein impacts whole body protein turnover in trained males at rest

The current investigation examined the effect of variations in protein intake on Whole body protein turnover (WBPTO) at rest in endurance-trained males. Whole body protein turnover is influenced by both diet and exercise. Whether endurance athletes require more protein than the non-exerciser remains equivocal. Five male runners (21.3 +/- 0.3 years, 179 +/- 2 cm, 70.6 +/- 0.1 kg, 8.7% +/- 0.4% body fat, 70.6 +/- 0.1 VO(2)max) participated in a randomized, crossover design diet intervention where they consumed either a low-protein (LP; 0.8 g/kg), moderate-protein (MP; 1.8 g/kg), or high-protein (HP; 3.6 g/kg) diet for 3 weeks. Whole body protein turnover (Ra, leucine rate of appearance; NOLD, nonoxidative leucine disposal; and Ox, leucine oxidation), nitrogen balance, and substrate oxidation were assessed at rest following each dietary intervention period. The HP diet increased leucine Ra (indicator of protein breakdown; 136.7 +/- 9.3, 129.1 +/- 7.4, and 107.8 +/- 3.1 micromol/[kg . h] for HP, MP, and LP diets, respectively) and leucine Ox (31.0 +/- 3.6, 26.2 +/- 4.3, and 18.3 +/- 0.6 micromol/[kg . h] for HP, MP, and LP diets, respectively) compared with LP diet (P < .05). No differences were noted in nonoxidative leucine disposal (an indicator of protein synthesis) across diets. Nitrogen balance was greater for HP diet than for MP and LP diets (10.2 +/- 0.7, 1.8 +/- 0.6, and -0.3 +/- 0.5 for HP, MP, and LP diets, respectively). Protein oxidation increased with increasing protein intake (54% +/- 6%, 25% +/- 1%, and 14% +/- 2% for HP, MP, and LP diets, respectively). Findings from this study show that variations in protein intake can modulate WBPTO and that protein intake approximating the current recommended dietary allowance was not sufficient to achieve nitrogen balance in the endurance-trained males in this investigation. Our results suggest that a protein intake of 1.2 g/kg or 10% of total energy intake is needed to achieve a positive nitrogen balance. This is not a concern for most endurance athletes who routinely consume protein at or above this level.