Applied nutritional investigationEfficacy and safety of very-low-calorie diet in Taiwanese: A multicenter randomized, controlled trial
Introduction
Obesity is associated with a high comorbidity rate and all-cause mortality [1], [2]. Nonpharmacological intervention of obesity can never be overemphasized, but is often discouraged by the high attrition rate [3]. Because the effect of a conventional low-calorie diet (LCD) treatment in moderate to severely obese subjects is often minimal [4], very-low-calorie diets (VLCDs) were developed [5]. A VLCD was defined as a hypocaloric diet containing 800 kcal or fewer per day. VLCDs have been used successfully by obese Caucasian persons who failed to lose weight with a conventional LCD [5], [6], [7], [8]. The imbalance between food intake and energy expenditure is the major factor that can lead to obesity. In the weight reduction program, dietary intervention is always the first and major step in weight loss, not the physical activity [9]. It would be expected that lower energy intake contributes to greater weight reduction. Previous studies in Caucasians, however, have found that weight loss does not significantly differ between dietary interventions of 240 kcal/day and 800 kcal/day [10], [11]. In Taiwan, obesity has become a pervasive problem [12]. According to national surveys, the prevalence of obesity has increased steadily from 1980 to 2000, especially in children and in men [12], [13]. Many intervention programs have been tried but the results have been disappointing. There have been no well-designed studies of a VLCD in Taiwanese subjects. On the other hand, racial differences with obesity have been found previously. Obesity-related complications have been found to occur at a lower body mass index (BMI) in Asians than in Caucasians [14]. For a given BMI, Asians have greater body fat accumulation than do Caucasians [15]. Furthermore, racial differences may exist in the treatment of obesity. For example, Harvin et al. and Capella et al. reported that Caucasian women lost more weight than African-American or Hispanic females after obesity surgery [16], [17]. Therefore, in this study we investigated the efficacy and safety of two different VLCDs (450 or 800 kcal/day) in obese patients in Taiwan.
Section snippets
Subjects
Obese Taiwanese subjects (BMI ≥30 kg/m2) aged 18–65 y who visited the obesity special outpatient clinics of three tertiary hospitals located in northern, central, and southern Taiwan were recruited. Exclusion criteria included participants: with concomitant diseases including type 1 or 2 diabetes mellitus; severe infection; insufficient renal function (serum creatinine >133 μmol/L); insufficient liver function (transaminases: alanine transaminase [ALT] or aspartate transaminase [AST] >2 X upper
Subjects
There were 164 participants recruited in the screening, 132 of whom (BMI = 34.2 ± 3.7 kg/m2) were randomized to the two treatment groups (each group = 66; Table 1). The other 32 participants who failed to meet inclusion criteria were excluded. There were no significant differences in demographic characteristics and laboratory tests between the two VLCD treatment groups. Of the 132 participants, 95 (72%) completed the study (71.2% in VLCD-450 and 72.7% in VLCD-800).
Treatment efficacy
The percentage change from baseline
Discussion
In this study, we demonstrated that both VLCD-450 kcal/d and VLCD-800 kcal/d are efficacious and safe in obese Taiwanese participants. Consistent with a previous report in African-American and Caucasian obese women [19], our results showed that participants on both the VLCD-450 and the VLCD-800 treatment not only lost about 9% of BW on average after 12 weeks of treatment, but also had an average reduction of nearly 20% in fat mass percentage. Although the average weight loss was about 9% in our
Conclusion
Both the VLCD-450 and VLCD-800 kcal/d programs can effectively and safely reduce BW 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. Finally, considering that the weight reduction was not enhanced using the greater energy deficit, aberrant physiological compensatory responses must be considered.
Acknowledgments
We thank Professor Tsai-Chung Li and Miss Chia-Ing Li for their kindly help in the statistical analysis and thank Dr. F. Xavier Pi-Sunyer for his kindly revised the paper. We thank Nestle Taiwan Ltd. to provide the study materials. We also thank that National Science Council of Taiwan (NSC 93-2314-B-006-110, NSC 94-2314-B-006-119) and China Medical University Hospital (DMR-92-016, DMR-97-149) to provide the study grants.
References (34)
- et al.
Effectiveness of a soy-based compared with a traditional low-calorie diet on weight loss and lipid levels in overweight adults
Nutrition
(2007) - et al.
A controlled comparison of three very-low-calorie diets: effects on weight, body composition
symptoms. Am J Clin Nutr
(1992) - et al.
Prevalence of obesity and metabolic syndrome in Taiwan
J Formos Med Assoc
(2006) - et al.
Diet-induced thermogenesis: variations among three isocaloric meal-replacement shakes
Nutrition
(2005) Effect of a very-low-calorie diet on body composition and resting metabolic rate in obese men and women
J Am Diet Assoc
(1991)- et al.
High-fat diet: a trigger of non-alcoholic steatohepatitis? Preliminary findings in obese subjects
Nutrition
(2008) - et al.
Effect of changes on body weight and lifestyle in nonalcoholic fatty liver disease
J Hepatol
(2005) - et al.
Body weight and mortality among men and women in China
JAMA
(2006) Health implications of obesity
Am J Clin Nutr
(1991)- et al.
Conservative treatment of obesity in an academic obesity unit. Long-term outcome and drop-out
Eat Weight Disord
(2006)
National Institutes of Health: very low-calorie diets
JAMA
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—The Evidence Report. National Institutes of Health
Obes Res
Treatment of obesity by very-low-calorie diet. Behaviour therapy and their combination: a five year perspective
Int J Obes Relat Metab Disord
Very-low-calorie diets and sustained weight loss
Obes Res
Role of physical activity in preventing and treating obesity
J Appl Physiol
Weight loss outcome and health benefits associated with the Optifast program in the treatment of obesity
Int J Obes Relat Metab Disord
Prevalence of obesity in Taiwan
Obes Rev
Cited by (38)
Nutrition in liver disease
2023, Comprehensive Guide to Hepatitis AdvancesESPEN practical guideline: Clinical nutrition in liver disease
2020, Clinical NutritionCitation Excerpt :Likewise, a reduction in the consumption of fructose sweetened soft drinks should be considered. In a multi-center randomized study, low-calorie diets were effective and safe in reducing body weight and improving NAFLD within twelve weeks [107]. Likewise, a low-calorie diet was effective in achieving weight loss of at least 5% and improvement of NAFLD [102,108,109].
ESPEN guideline on clinical nutrition in liver disease
2019, Clinical NutritionCitation Excerpt :The authors of this umbrella review of meta-analyses correctly point out that robust randomized controlled trials are needed to understand whether the observed associations are causal [253]. In a multi-center randomized study, very-low-calorie diets were effective and safe in reducing body weight and improving NAFLD within twelve weeks [254]. Likewise, a low-calorie diet was effective in achieving weight loss of at least 5 % and improvement of NAFLD [242,246,255].
Nutrition Interventions for Chronic Liver Diseases and Nonalcoholic Fatty Liver Disease
2016, Medical Clinics of North AmericaOne size does not fit all; practical, personal tailoring of the diet to NAFLD patients
2022, Liver International
The study was funded by Nestle Taiwan Ltd., by grants from National Science Council of Taiwan (NSC 93-2314-B-006-110, NSC 94-2314-B-006-119), and by grants from China Medical University Hospital (DMR-92-016, DMR-97-149).