Basic nutritional investigationWeight Loss Associated With a Daily Intake of Three Apples or Three Pears Among Overweight Women☆
Introduction
Although fruit intake is considered a protective factor for many chronic diseases1 and dietary guidelines have recommended increased intakes of fruits and vegetables,2, 3 there is no intervention study of adding fruits to diet as a weight-loss treatment. Testing whether increased intake of fruits contributes to weight loss requires a population with a low intake of fruits, a frequent dietary pattern in the low-income population in Brazil.
The rationale for such a hypothesis of weight loss with increased intake of fruits is based on three premises: the low-energy density of most fruits, their higher fiber composition, and a less striking variation of diets high in fruit. In support of this hypothesis, a recent review indicated that, under fixed energy intake, soluble or insoluble fiber intake increases postmeal satiety and decreases subsequent hunger. In addition, this review suggested, at least for short-term follow-up, that high-fiber diets decrease energy intake and body weight.4 High-fiber content also can be a marker for lower palatability or a monotonous diet. Dietary variety within food groups and palatability were shown to be important predictors of body fatness.5 Because individuals tend to consume a fixed amount of food,6, 7 a large intake of a low-energy food, such as fruits, makes excessive energy intake more difficult. Findings from several investigations have shown that low-energy density foods reduce total energy intake,6, 8, 9 and US women consumed 20% less energy in a low-energy compared with a high-energy density diet.8 Therefore, we carried out a clinical trial among hypercholesterolemic, overweight women to test primarily the effect on serum cholesterol with the addition of three apples, three pears, or three oat cookies (with the same amount of fruit fiber) to the daily diet. For the present analysis, the pear and apple groups were combined to verify the effect of fruit intake on body weight.
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Materials and methods
Overweight (body mass index > 25 kg/m2), hypercholesterolemic, non-smoking women, 30 to 50 y of age, were randomized to receive, free of charge, one of three dietary supplements for 12 wk: apples, pears, or oat cookies. Women were instructed to eat one of each supplement three times a day as snacks between meals. The overall intake of supplements per day was 300 g of apple (variety Fuji), 300 g of pear (William), or 60 g of oat cookies (Table I).
During a run-in period of 2 wk and the 12-wk
Results
Of the 49 subjects initially recruited, 40 were followed for 6 wk and 35 were followed for 12 wk. Baseline characteristics of the fruit and oat groups were not statistically different, and both treatment groups did not differ from those lost to follow-up (Table II). After 12 wk of follow-up, the fruit group lost 1.21 kg (95% confidence interval = 0.44–1.85), whereas the oat group lost 0.88 kg (0.37–2.13). The fruit group, but not the oat group, had a statistically significant reduction of
Discussion
Results indicated that overweight, hypercholesterolemic women have important changes in their body weights and metabolic profiles by adding fruits to their diets. The serum increase of triacylglycerol with fruit supplementation was in accordance to the literature. Several intervention dietary studies found an increase on triacylglycerols due to fructose intake.14, 15, 16, 17 In the present study daily fructose intake reached 22.8 g in the apple group and 19.2 g in the pear group. Chronic intake
Acknowledgements
The authors gratefully acknowledge the assistance of Associação Brasileira de Produtores de Maçã for providing the supplements; the Policlinica Piquet Carneiro, Instituto de Medicina Social, UERJ, and Hospital Universitário Pedro Ernesto for their technical support, and the Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior.
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This research was supported by the Associação Brasileira de Produtores de Maçã and the Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior.