Effect of a very-low-calorie diet on body composition and resting metabolic rate in obese men and women

Very-low-calorie diets (VLCDs) provide a rapid decrease in total body weight, but limited data are available regarding the extent of fat loss and whether body fat distribution is altered. The purpose of this study was to investigate body composition, body fat distribution, and resting metabolic rate in obese men and women and to compare bioelectrical impedance analysis (BIA) with hydrodensitometry before and after 12 weeks of treatment in a VLCD program. Body composition was assessed by hydrodensitometry and BIA. Circumference measures were used to determine waist:hip and waist:thigh ratios. Seventeen subjects lost a mean of 24.2 kg. A mean of 75.5% of the weight loss was adipose tissue as measured by hydrodensitometry. BIA underestimated body fat percentage compared with hydrodensitometry in this obese population. Waist:hip and waist:thigh ratios showed a small but significant decrease, implying a decreased risk for diabetes and cardiovascular disease after weight loss. Resting metabolic rate, as measured by oxygen consumption, dropped 23.8% during the 12 weeks of the VLCD. The findings indicate that a VLCD can provide a rapid weight loss of more than 75% fat and a concomitant decrease in waist:hip and waist:thigh ratios. The findings also indicate that BIA may not be a useful tool in assessing fat loss in obese subjects. Finally, it appears that the decrease in resting metabolic rate that occurs during treatment with VLCD does not correlate with changes in lean body mass.     

Efficacy and safety of very-low-calorie diet in Taiwanese: A multicenter randomized, controlled trial

ObjectiveVery-low-calorie diets (VLCDs) are an effective method for weight reduction in Caucasians. This study investigated the efficacy and safety of two different VLCDs (450 or 800 kcal/d) in obese Taiwanese.Methods132 participants with BMI ≥30 kg/m² were randomized to two VLCD groups for body weight reduction for 12 weeks. Each group had 66 participants. Anthropometric and metabolic parameters were measured.ResultsThe intention-to-treat analysis revealed that the percentage change in body weight over the 12-week treatment period was –9.14% in the VLCD-450 group and –8.98% in the VLCD-800 group. A total of 27 (40.9%) participants in the VLCD-450 group and 29 (43.9%) participants in the VLCD-800 group achieved 10% or more weight loss at the end of treatment. The body weight, waist circumference, hip circumference, fat mass, blood pressure, triglycerides, and blood glucose were statistically improved from baseline but not between the two groups. The improvement rate of nonalcoholic fatty liver disease (NAFLD) was 41.5% in the VLCD-450 group and 50.0% in the VLCD-800 group. The incidence of adverse events did not differ significantly between the groups and no serious adverse events were reported in either group.ConclusionBoth the VLCD-450 and 800 kcal/d can effectively and safely reduce body weight and improve NAFLD in 12 weeks in obese Taiwanese participants. However, there is no additional benefit in prescribing the more restrictive diet intervention in Taiwanese.     

Effects of a very-low-calorie diet on metabolic control and cardiovascular risk factors in the treatment of obese non-insulin-dependent diabetics

Ten obese non-insulin-dependent diabetics (six men, four women) with secondary drug failure were treated with a hypocaloric diet only (2100-3350 kJ/d) for 3 mo to assess the effects of weight reduction on metabolic control, energy production rate, and cardiovascular risk factors. During the 3 mo of follow-up the mean body weight decreased from 101.0 +/- 7.2 (means +/- SEM) to 87.2 +/- 5.5 kg (p less than 0.001). Basal energy production rate (kJ/min) decreased by 8.5%. Fasting blood glucose declined from 12.3 +/- 0.4 to 10.5 +/- 0.7 mmol/L (p less than 0.05) but mean diurnal glucose and glycosylated hemoglobin A1c did not change significantly. Serum total cholesterol was decreased at 2 wk but at 3 mo it did not differ significantly from the baseline value. A marked reduction was observed in serum triglycerides after 3 mo (4.57 +/- 1.0 vs 2.18 +/- 0.26 mmol/L, p = 0.012). The high-density lipoprotein (HDL) cholesterol increased after weight reduction (0.96 +/- 0.06 vs 1.11 +/- 0.05 mmol/L, p = 0.009). A significant decline was found in both systolic (152 +/- 6 vs 133 +/- 3 mm Hg, p = 0.004) and diastolic blood pressure (92 +/- 3 vs 81 +/- 3 mm Hg, p = 0.007). There was no evidence of linoleic acid deficiency after this diet.     

Effects of a very-low-calorie diet and physical-training regimens on body composition and resting metabolic rate in obese females

Sixty-nine obese females received 90 d of a liquid diet providing 2184 kJ/d in clinical trials. Groups were diet only (C), diet plus endurance exercise (EE), diet plus weight training (WT), or diet plus endurance exercise and weight training (EEWT). Changes in body weight, percent fat, fat weight, and fat-free mass were not different between groups. Declines in resting metabolic rate (RMR) were approximately 7% to approximately 12% of baseline values with no differences among groups. A significant increase in work capacity (approximately 16%) was shown for EEWT. Strength index showed declines of approximately 6% for C and EE and gains of approximately 3% and approximately 10% for EEWT and WT, respectively. These clinical trials did not show advantages of any exercise regimen over diet alone for weight loss, body-composition changes, or declines in RMR. Improvements in work capacity were limited and strength improved in groups that participated in strength training.     

Getting comfortable with disability: The short- and long-term effects of a clinical encounter

BackgroundPhysicians report discomfort when interacting with patients with disabilities, which can negatively impact the quality of healthcare they provide.Objective/HypothesisAn intervention structured around a formative clinical encounter was assessed for its effectiveness in changing comfort towards treating patients with disabilities. It was predicted that this encounter would have a positive short- and long-term impact on medical students.MethodDuring the 2017–2018 academic year, 169 third-year medical students conducted a patient encounter with a person who had a disability. Students met individually with the “patient” and completed a brief social and medical history as if they were meeting a new patient to establish care. A measure of perceived comfort caring for patients with disabilities was administered to students before and after the encounter. One year after the patient encounter, 59 students were surveyed about their satisfaction and the impact of the patient encounter.ResultsThe impact of encountering people with disabilities in a clinical setting was positive, with statistically significant improvements across all items on the measure of perceived comfort. Students were highly satisfied with the experience and anticipated feeling more confident, more comfortable, less awkward, and more skilled and efficacious when encountering a person with a disability in their future practice. A thematic analysis of the one year follow-up data suggest that students valued the encounter and desired more content on disability throughout their education.ConclusionsMedical education should include dedicated exposure to persons with disabilities and a simulated patient experience allowing for a safe environment to gain skills and confidence.     

Energy-metabolism adaptation in obese adults on a very-low-calorie diet

In this study, six obese women received a very-low-calorie diet (VLCD) for 3 wk. At day 0, body composition was assessed with a bioelectric impedance analyzer. The evolution in lean body mass (LBM) during the VLCD was estimated from nitrogen balance, measuring urine and fecal losses and taking into account skin, nitrate, and menstrual losses to avoid underestimation bias that could explain the decreased ratio of resting metabolic rate (RMR) to LBM previously reported. RMR was measured at days 0, 3, 5, and 21. The RMR-LBM ratio declined significantly during the VLCD period and decreased faster during the first week; the day 3, day 5, and day 21 ratio values were 94%, 91%, and 82%, respectively, of the original. The RMR-LBM ratio decrease after 21 d of a VLCD was near that found in chronic undernutrition. Results of previous studies that did not find any drop in the RMR-LBM ratio in obese adults on VLCDs might be explained by their LBM-assessment methods.     

Self-reported short- and long-term respiratory effects among PVC-exposed firefighters

Firefighters exposed to burning polyvinyl chloride (PVC) were studied to assess respiratory effects at 5-6 wk post-incident and again 22 mo following the fire. Exposed subjects reported significantly more frequent and severe respiratory symptoms at both time points than did firefighter controls. In longitudinal analyses, a number of symptoms persisted over time, and acute symptom scores were significantly correlated with chronic scores. At Time 2, approximately 18% of exposed firefighters, compared with none of the controls, reported that since the time of the PVC exposure, a physician had told them that they had either asthma and/or bronchitis.     

A controlled study of the short- and long-term effects of a Train the Trainers course

Objectives  This study aimed to establish the longterm effects of a 3-day 'Training for Trainers' course (TTC) on doctors' knowledge, teaching behaviour and clinical learning climate.
Methods  The study was designed as an intervention study with pre-, post- and long-term measurements. The intervention group (I-group) included 118 doctors from the departments of internal medicine and orthopaedic surgery at one university hospital. The control group (C-group) consisted of 125 doctors from the corresponding departments at another university hospital. Gains in knowledge about teaching skills were assessed by a written test. Teaching behaviour and learning climate were evaluated by questionnaires.
Results  In the I-group, 98.4% of doctors, both specialists and trainees, participated in a TTC. Response rates on the written test varied from 90% at baseline to 70% at 6 months after the intervention. Knowledge about teaching skills increased in the I-group by 25% after the TTC and was sustained at 6 months. Questionnaire response rates varied from 98.4% at baseline to 84.8% at 6 months. Post-course, the teaching behaviour of the I-group significantly changed and its learning climate improved compared with the C-group. Scores for use of feedback and supervision in the I-group increased from 4–5 to 6–7 (maximum score = 9). This was significantly higher than in the C-group.
Conclusions  A 3-day residential TTC has a significant impact in terms of gains of knowledge concerning teaching skills, teaching behaviour and learning climate after 6 months. The positive effects demonstrated in this study were rooted in both the specialists and trainees who attended the course.     

Focus on the short- and long-term effects of ghrelin on energy homeostasis

The endogenous ligand for the growth hormone secretagogue receptor, ghrelin, is a 28–amino-acid peptide acylated with an octanoyl group at the serine in position 3. Most of the circulating ghrelin results from its synthesis and secretion by the X/A-like endocrine cells from the stomach and proximal small intestine. Besides its potent growth hormone secretory action, ghrelin is a highly pleiotropic hormone, contributing significantly to the regulation of appetite and food intake control, gastrointestinal motility, gastric acid secretion, endocrine and exocrine pancreatic secretions, cell proliferation, glucose and lipid metabolism, and cardiovascular and immunologic processes. The purpose of this review is to consider the orexigenic effects of ghrelin on short-term regulation of food intake and long-term regulation of body weight, the implications of genetic ghrelin and growth hormone secretagogue receptor polymorphism, and the use of antagonists and agonists of ghrelin in pathophysiological conditions.     

Increased muscle dynamic endurance associated with weight reduction on a very-low-calorie diet

To assess muscle function after a period of negative energy balance, 32 obese women were placed on a 544-kcal/d, high-protein diet for 4 wk. Weight loss was associated with a decrease in the waist-to-hip-circumference ratio (WHR) and significantly higher emptying of abdominal than gluteal fat cells. The low-calorie regimen was associated with a significant increase in isokinetic muscle endurance, a decrease in glycogen concentration, and an increase in glycogen synthase (GS) activity and its fractional velocity (FV). The GS activity and its FV were negatively correlated with the WHR before treatment whereas their subsequent increase was correlated with the decrease in WHR. Dietary treatment produced a decrease in the isokinetic muscle strength, which was correlated with the reduction in lean body mass. The improvement in dynamic endurance observed after energy restriction parallels not only the increase in GS activity in muscle but also the decrease in glycogen stores and glucose oxidation, and most probably depends on the increased utilization of fatty acids.     

A comparison of two very-low-calorie diets: protein-sparing-modified fast versus protein-formula-liquid diet

This study investigated the acceptability of two very-low-calorie diets in 16 moderately overweight persons participating in a weight reduction program. Subjects were prescribed a 1000-1200 kcal balanced diet the first month and asked to complete appetite and mood scales on a weekly basis. They were then randomly assigned to either a protein-sparing-modified fast (PSMF) or a protein-formula-liquid diet, each of which provided about 400 kcal daily. Analysis of the appetite data showed that PSMF subjects reported significantly less hunger and preoccupation with eating than did liquid diet subjects during 2 of the 4 weeks on a very-low-calorie diet. Subjects in both conditions reported significant reductions in anxiety. Results are discussed in terms of possible advantages of PSMF.     

Effects of cardiac stress during a very-low-calorie diet and exercise program in obese women

To assess the safety of very-low-calorie diets (VLCDs), stress tests known to induce arrhythmias in susceptible patients were performed in 24 obese women on a VLCD (660-720 kcal/d) for 6 wk. Half of the subjects had diet only (DO) and half underwent supervised exercise (DE) four times weekly. Five control subjects ate a balanced, moderately low-calorie diet (approximately 1400 kcal/d). Stress tests included maximal and submaximal (85%) exercise, psychological stress, and isometric handgrip tests, all with constant electrocardiogram (ECG) monitoring. Twenty-four-hour Holter monitors at weeks 0 and 6 and weekly resting ECGs were obtained. DO and DE lost similar amounts of weight. There were no changes in QT intervals or in voltage or width of the QRS complex on resting ECG and no arrhythmias on Holter monitoring. These data support the safety of VLCDs containing greater than or equal to 650 kcal/d and adequate amounts of high-quality protein, vitamins, and minerals for use for periods of at least 6 wk in normal, healthy obese women.     

The long-term effect of dietary advice on the diet of men with angina: the diet and angina randomized trial

Introduction The long‐term effects on diet of dietary advice to eat fruit and vegetables or fatty fish are not well described. Materials and methods From 1990 to 1996 3114 men aged 37–70 with treated angina were recruited from general practices in South Wales. A dietitian randomly allocated the eligible men to receive advice to eat more fruit and vegetables, or advice to eat more fatty fish, or both these types of advice or neither. In 2000, a brief self‐completion questionnaire was sent to a sample of 1191 of the men known to be alive at the end of March 1999. Results The questionnaire was returned by 944 of the 1036 men alive at the time the questionnaire was sent. Those given fish advice were consuming more fatty fish but the difference was modest 21.9 g day^?1 vs. 14.0 g day^?1 (P < 0.01). The differences in fruit and vegetables intake between those given fruit advice and those not given fruit advice were small 373.2 g day^?1 vs. 351.7 g day^?1 (P = 0.05). Discussion Men of this age group may be particularly resistant to fruit and vegetables advice; population‐based interventions or interventions targeted at women might be more effective.     

Binge eating disorder affects outcome of comprehensive very-low-calorie diet treatment

To determine the effects of binge eating disorder (BED) on weight loss and maintenance in women undergoing treatment for obesity, we studied the weight changes of 38 women (body mass index > 30 kg/m2), 21 of whom met proposed criteria for BED and 17 of whom reported few problems with binge eating, during and after a 26-week comprehensive very-low-calorie diet (VLCD) treatment program. All 17 subjects without and 16/21 subjects with BED returned for four follow-up visits over 12 months (p = 0.05). While a similar proportion of subjects with and without BED reported absolute adherence to both the modified fast and refeeding, those with BED showed a significantly different distribution in energy intake from those without BED, with fewer small and more large lapses among those who deviated from the diet (p < 0.05). There was no significant difference in mean weight loss over the 26 weeks of treatment, but subjects with BED showed significantly diminished weight loss during the middle third of treatment (p < 0.05). Black subjects, regardless of the presence of BED, lost significantly less weight during treatment than white subjects (p < 0.005). Although there was no significant difference in mean weight loss at any of the four follow-up visits between subjects with and without BED, 25% of subjects with BED had regained > 50% of their lost weight by three-month follow-up, vs. no subjects without the disorder (p < 0.05). One year after completing treatment, approximately half of BED (+) and BED (-) subjects had a good outcome, maintaining a weight loss > or = 10% of initial body weight. However, 35% of subjects with BED, and none of the subjects without BED, had a poor outcome (p < 0.05). We conclude that many individuals with BED will respond well to a medically supervised comprehensive VLCD program, attaining medically significant weight loss. However, this subgroup appears to be at risk for early major regain of lost weight and for poor outcome one year following weight-loss treatment.