Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss

OBJECTIVE: To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS: We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS: The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS: The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.

Fatores determinantes de perda de peso em adultos submetidos a intervenções dietoterápicas / Determinant factors associated with weight loss in adults on diet interventions

OBJETIVO: Analisar os fatores determinantes da perda de peso (> 5%) resultante de atendimento ambulatorial individual. SUJEITOS E MÉTODOS: Estudo de coorte retrospectivo com 318 pacientes com sobrepeso/obesidade em atendimento individual para perder peso. RESULTADOS: Quinze por cento dos pacientes não perderam peso, 35,1% apresentaram perda < 5%, 35,4% entre 5-10% e 13,9% perda > 10%. Os pacientes que perderam > 5% de peso (-7,6 ± 3,3 kg; n = 156) tiveram maior número e menor intervalo entre consultas e maior frequência de atendimentos particulares, acompanhamento por nutricionista e atendimentos multidisciplinares. Ainda, houve neste grupo menor prescrição de medicamentos antiobesidade e o valor calórico total da dieta foi maior do que nos demais pacientes. Em análises multivariadas de regressão de Cox apenas o intervalo entre consultas e o número total de consultas permaneceram inversamente associados à perda de peso. CONCLUSÕES: Os determinantes de perda de peso > 5% foram um menor número de consultas com um menor intervalo entre os atendimentos.

OBJECTIVE: To analyze the determinants for weight loss (> 5%) resulting from outpatient individual appointments. SUBJECTS AND METHODS: A retrospective cohort study was conduct in 318 overweight/obese patients seeking individual care to lose weight. RESULTS: Fifteen percent of the patients did not lose weight; 35.1% had lost < 5%; 35.4% had lost between 5 and 10%; and 13.9% had lost > 10%. Patients who lost > 5% body weight (-7.6 ± 3.3 kg, n = 156) had a greater number of visits at a shorter interval, and greater frequency of visits with a registered dietitian and multidisciplinary care. This group had a lower prescription of anti-obesity drugs and their total calorie intake was higher than the other patients. In multivariate Cox regression, only the interval between appointments and the total number of visits remained inversely associated with weight loss. CONCLUSIONS: The determinants of > 5% weight loss were fewer visits with a shorter interval between appointments.

Prevalence of weight-loss strategies of young adults from the 1982 birth cohort in Pelotas, RS / Prevalencia de estrategias para perder peso de jovens adultos da coorte de nascimentos de 1982 de Pelotas, RS

The objective of this article was to identify, among the members of the 1982 birth cohort in Pelotas, those who were trying to lose weight at the age of 23, and which strategies they used. From 2004 to 2005, 4,297 individuals from the 1982 cohort were interviewed. The effects of demographic, socioeconomic and behavioral factors on the prevalence of any strategy to lose weight in the past year were assessed in a cross-sectional analysis with the Poisson regression. Out of all the youngsters interviewed, 28.5% reported having used some strategy to lose weight. In the adjusted analysis, gender, schooling, family income, body mass index and smoking were associated with the use of some strategy. The strategy used by most of the young people was diet followed by physical activity. The results showed that appropriate preventive measures and body weight control are necessary, along with public policies aimed at encouraging healthy habits among young people, including physical and dietary education.

O objetivo deste artigo é identificar, entre os membros da Coorte de Nascimentos de 1982 de Pelotas, aqueles que estavam tentando perder peso aos 23 anos e quais as estratégias utilizadas por eles. Entre 2004 - 2005, foram entrevistados 4.297 indivíduos da Coorte de 1982. Os efeitos das variáveis demográficas, socioeconômicas e comportamentais sobre a prevalência do uso de estratégia para emagrecer no último ano foram analisados em uma análise transversal utilizando regressão de Poisson. Do total de jovens entrevistados, 28,5% referiram ter utilizado alguma estratégia para perder peso. Na análise ajustada o sexo, a escolaridade, a renda familiar, o índice de massa corporal e o tabagismo estiveram associados ao uso de alguma estratégia, sendo que a mais utilizada pela maioria dos jovens foi dieta seguida de exercício físico. Os resultados mostraram que medidas adequadas de prevenção e de controle do peso corporal são necessárias, com políticas públicas voltadas para a população jovem, incentivando hábitos saudáveis como atividade física e educação alimentar.

Serum endothelin-1 in obesity: the effect of weight reduction

Recent studies have shown that endothelin-1 [ET-1] is implicated in avariety of pathological conditions including obesity, diabetes mellitus, essential hypertension and astherosclerosis. The aim of the present work was to examine the relationship between ET-1 with some anthropometric and metabolic variables characteristic of insulin resistance syndrome The effects of energy restriction either alone or in combination with metformin on serum ET-1, some anthropometric and metabolic variables characteristic of insulin resistance syndrome were also studied. The study included 40 obese female patients with age ranging from 47 to 53 years. They were divided into two groups. Group I included 30 obese female patients with either IGT or newly diagnosed type 2 diabetes with insulin resistance syndrome, group II included 10 obese females without IRS and were taken as a control. Both groups were matched in age, and BML. Patients in group I was divided into two groups. Group I received LCD [1200 kcal/day] alone, Group 2 received low calorie diet plus metformin ,[850mg twice daily]. The study continued for 6 months. All patients were subjected to thorough history taking and clinical examination stressing on weight, height, BMI, WHR and blood pressure. Fasting 2 hour postprandial plasma glucose, HBAIc, HOMA-IR lipogram and ET-1 were also assessed. These parameters were also evaluated after dietary intervention and metformin treatment. From this study, we found that patients with IRS were obese, BMI [33.57 +/- 1.7] with significant increase in WHR compared to obese controls, Also there was significant increase in SBP, DBP, fasting postprandial plasma glucose, fasting insulin insulin, HOMA-IR, total cholesterol, LDL-C, TG and significant reduction in HDL-C in obese patients with IRS in comparison with obese controls. Also resum ET-1 were significantly increased in obese patients with IRS compared to controls. Also, there was significant correlations between serum ET-1 and some parameters present in IRS e.g. BMI, WHR, SBP, DI3P, fasting and postprandial plasma glucose, HbAlc, fasting insulin, HOMA-IR and lipid profile. The following results were obtained after dietary intervention and metformin treatment: Significant decrease in BMI, WHR, blood pressure, fasting, postprandial blood glucose, HbAlc, HOMA-IR, total cholesterol, LDL-c in both groups with more reduction in LCD+metformin group HDL-C also significantly increased in both groups with more significant increase in LCD+metformin group. ET-1 were significantly reduced in LCD metformin group. We can conclude that insulin resistance syndrome is a constellation of clinical and biochemical anomalies clustering in subjects with upper body fat distribution. ET-1 also may be involved in. the pathogenesis of many components of IRS e.g. insulin resistance, hypertension dyslipidaemia. Insulin ET-1 production and ET-1 decreased insulin sensitivity so, ET-1 may play another key underlying role in IRS through its close relation with insulin resistance. LCD and metformin are effective and safe measures in the management of obese patients with IRS as they improve many components of this syndrome. Their effects may be explained partly by their effect on insulin resistance and plasma ET-1