Long-term effects of a very low calorie diet (Nutrilett) in obesity treatment. A prospective, randomized, comparison between VLCD and a hypocaloric diet+behavior modification and their combination.

OBJECTIVES: To compare weight loss on a balanced hypocaloric diet to that of a Very Low Calorie Diet (VLCD) after two months of treatment and to further compare 26 months of weight maintenance and safety with or without VLCD assistance in obese patients. DESIGN: Prospective, randomized, controlled intervention trial, initially with two and later with three parallel groups. SETTING: Swedish University out-patient obesity clinic. SUBJECTS: Eighty-one obese patients of both gender with a BMI > or = 30 kg/m2 from the waiting list participated in a structured weight reduction + weight maintenance programme. INTERVENTION: Twenty-seven patients (group A) were randomized to a balanced diet of 6720 kJ/d (1600 kcal/d) during the whole treatment period. The other patients (n = 54) were randomized to VLCD (Nutrilett) 1764 kJ/d (420 kcal/d) diet during the first two months. The VLCD treated patients were rerandomized after the initial treatment to the well balanced hypocaloric diet (6720 kJ/d) with (group C) or without (group B) 1 MJ of VLCD to be taken during the evening. MAIN OUTCOME MEASURES: During the first two-month period, the mean body weight loss in the VLCD group was 18.9 +/- 7.1 kg compared to 7.2 +/- 4.8 kg in the diet treated group, with a similar relative fat loss assessed by bioimpedance of 68% and 76% respectively. The maintained weight loss in all groups after 28 months of treatment was 10.9 +/- 10.2 kg in the 52% who completed the programme. Weight losses and drop-out rates were similar in all three groups. CONCLUSIONS: Twenty-four months weight maintenance and drop out rates are independent of whether the initial treatment commences with VLCD or a hypocaloric diet. One MJ nutrition powder taken freely does not affect 24 months weight maintenance on a hypocaloric (6.7 MJ/d) diet.

Dietary fibres reduce blood pressure, serum total cholesterol and platelet aggregation in rats.

The effects of dietary fat and dietary fibres on blood pressure, serum lipids and platelet aggregation in spontaneously hypertensive and Wistar-Kyoto rats have been investigated. The systolic and diastolic blood pressure values were increased with increasing amounts of dietary fat and normalized by dietary fibre supplementation. The greatest reduction in blood pressure was obtained by a combination of reduced dietary fat and supplementary dietary fibre. Addition of dietary fibre when the amount of dietary fat was high or reduction of dietary fat when the amount of dietary fibre was low gave a smaller effect. In both rat strains the decreases in systolic and diastolic blood pressure values after reducing dietary fat and/or increasing dietary fibre were about 10-15 mmHg. Serum total cholesterol and serum HDL-cholesterol concentrations were reduced by reduction of dietary fat or a combination of dietary fat reduction and dietary fibre addition. A combination of dietary fat reduction and dietary fibre addition was the most effective dietary change for reducing serum triacylglycerol concentration and platelet aggregation. The present study demonstrates that in this experimental model it is possible to reduce risk indicators of coronary heart disease significantly by changing dietary habits.

Weight maintenance after a very low calorie diet (VLCD) weight reduction period and the effects of VLCD supplementation. A prospective, randomized, comparative, controlled long-term trial.

OBJECTIVES: To evaluate the efficacy of a structured very low calorie diet (VLCD) weight reduction/weight maintenance behaviour programme on weight maintenance in obese patients (BMI > or = 30 kg/m2). DESIGN: Prospective, randomized, controlled intervention trial. SETTING: University out-patient obesity clinic. SUBJECTS: A total of 114 obese patients from the waiting list were invited to participate in the structured weight reduction/weight maintenance programme lasting for 64 weeks. Sixty patients agreed to participate. INTERVENTION: All 60 patients were placed on a Cambridge 330 kcal day-1 diet during the first 12 weeks. Fifty-two were subsequently randomized to either a well balanced hypocaloric diet (1600 kcal day-1), of which 220 kcal were provided by two sachets of Cambridge diet (group 1), or the same energy provided by the same principal diet (group 2) during the following 52-week weight maintenance period. MAIN OUTCOME MEASURES: During the VLCD period, the mean body weight decreased significantly from 112.4 +/- 19.8 to 91.6 +/- 17.7 kg (P < 0.0001). Seventy-one per cent of the weight loss was fat. During the weight maintenance period the average body weight increased significantly in group 1: 8.0 +/- 8.2 vs. 12.3 +/- 9.7 kg in group 2 (P < 0.0001). After the 64-week treatment period the mean body weight in group 1 was 93.7 +/- 18.1 kg and significantly lower compared to 109.9 +/- 23.8 kg in group 2 (P = 0.008). Compliance was high: 87% completed the VLCD period and 75% completed the whole 64-week treatment programme. CONCLUSION: Very low calorie diet as part of the dietary allowance during the weight maintenance programme partly prevents weight regain. This finding can be translated into practical treatment recommendations.

A dietary fibre supplement in the treatment of mild hypertension. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To study the effects of a dietary fibre supplement given as monotherapy upon blood pressure in mildly hypertensive patients. DESIGN: The investigation was performed as a prospective randomized, double-blind, placebo-controlled trial for 3 months. SETTING: Patients attending an outpatient hypertension clinic in a hospital. PATIENTS: Hypertensive patients with a minimum of two diastolic blood pressure (DBP) readings greater than 90 mmHg during a 2-week run-in period were included. Of the 65 patients enrolled, 63 were randomized (32 fibre, 31 placebo). Six patients did not complete the trial. INTERVENTION: Patients were treated with either fibre (7 g/day) or matching placebo. MAIN OUTCOME MEASURE: Based on previous studies, the a priori hypothesis was that dietary fibre supplementation could reduce blood pressure in hypertensive patients. RESULTS: Body weight was significantly reduced in the fibre group. Dietary fibre significantly reduced DBP and fasting serum insulin. However, no correlation between changes in body weight and systolic blood pressure or DBP was found. CONCLUSION: A dietary fibre supplement can lower DBP in mildly hypertensive patients independent of changes in body weight.

Overweight treated with energy restriction and a dietary fibre supplement: a 6-month randomized, double-blind, placebo-controlled trial.

Fifty-two (41 females, 11 males) overweight patients, mean body mass index (BMI) = 29.3, were treated for 6 months in a randomized, double-blind, placebo-controlled, parallel group design. The treatment consisted of an energy restricted diet and a dietary fibre supplement amounting to 7 g/day. After treatment the weight reduction in the fibre-treated group, 5.5 +/- 0.7 kg, was significantly higher than that of the placebo group, 3.0 +/- 0.5 kg (P = 0.005). Both groups were normotensive and comparable commencing treatment, 126.5/75.6 +/- 2.0/1.3 mm Hg versus 126.7/78.7 +/- 2.5/1.6 mm Hg. The treatment changed blood pressure non-significantly. Hunger feelings using visual analogue scales (VAS) were significantly reduced from 139.8 +/- 8.2 cm to 118.3 +/- 7.0 cm in the fibre-treated group, whereas a significant increase from 129.5 +/- 6.9 cm to 146.9 +/- 8.8 cm (P less than 0.02) was seen in the placebo group. Side-effects were predominantly gastrointestinal and equally distributed in the two groups. It is concluded that a dietary fibre supplement is of value in the management of overweight, enhancing weight loss and decreasing hunger feelings.

The effect of a soluble dietary fibre supplement on 24-hour energy expenditure during a standardized physical activity programme.

Twenty-four hour energy expenditure during a standard physical activity programme was investigated in 19 healthy volunteers in a randomized, double-blind, cross-over design, after supplementation with a soluble dietary fibre amounting 7 g/day for 2 weeks. Energy intake and food fibre intake were kept constant during the treatment period. Twenty-four hour energy expenditure decreased insignificantly during fibre treatment (1.3 +/- 1.7 per cent). The dietary fibre supplement also had no significant effect on body weight, faecal energy loss or heart rate. Systolic blood pressure was insignificantly reduced during both placebo and fibre treatment (P = 0.09). There was, however, no difference between the groups after treatment.

A dietary fibre supplement and weight maintenance after weight reduction: a randomized, double-blind, placebo-controlled long-term trial.

Ninety-seven mildly obese females (BMI = 27.4 kg/m2) were in a randomized, double-blind, placebo-controlled trial treated for 52 weeks. The treatment consisted of a hypocaloric diet providing 5000 kJ/day (1200 kcal) and a dietary fibre supplement of 7 g/day for 11 weeks, (part I), followed by a diet providing 6720 kJ/day (1600 kcal) and a dietary fibre supplement of 6 g/day for 16 weeks (part II). Finally placebo was withdrawn and all still adhering subjects were given a dietary fibre supplement of 6 g/day and an ad libitum diet for the rest of the period (part III). Initial body weights were comparable, 76.9 +/- 0.8 kg in the fibre group versus 77.7 +/- 1.3 kg in the placebo group. During part I the weight reduction in the fibre group of 4.9 kg was significantly higher compared to that of 3.3 kg in the placebo group (P = 0.05). Accumulated weight reduction during part II was still significantly higher in the fibre group, 3.8 kg, compared to 2.8 kg in the placebo group (P less than 0.05). Total weight loss in the fibre group after 52 weeks was 6.7 kg. Probability of adherence to the treatment regimen was significantly higher in the fibre group from week 13 and onwards (P less than 0.01). Initial blood pressures were comparable. A significant reduction of systolic blood pressure occurred in both groups. A significant reduction of diastolic blood pressure occurred in the fibre group only, from 85.4 +/- 1.2 mmHg to 81.7 +/- 1.1 mmHg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of a high-fibre diet on body weight, serum lipids and blood pressure in slightly overweight persons. A randomized, double-blind, placebo-controlled investigation with diet and fibre tablets (DumoVital).

Sixty slightly overweight women were treated with a weight-reducing diet for 12 weeks in a randomized, double-blind, placebo-controlled study. In addition to the diet 30 women received dietary fibre tablets, whereas the remaining 30 women received identical-looking placebo tablets. During the trial both groups experienced a significant reduction in body weight (P less than 0.01). The mean weight loss 8.5 kg (7.5-9.5 kg) in the fibre group was significantly higher than that of the placebo group 6.7 kg (4.8-8.0 kg) (P less than 0.01). Both serum triglyceride and serum cholesterol concentrations were significantly lowered (P less than or equal to 0.02) after treatment in both groups. No significant differences were detected between the groups. Both systolic and diastolic blood pressure were significantly reduced (P less than 0.01) in the fibre group. No significant reduction in blood pressure was found in the placebo group. Side-effects, which were gastrointestinal in nature, were of low frequency. We conclude that supplementation with dietary fibre of the form used in this study is useful in the treatment of overweight women.

Effects of a moderate dietary fibre supplement on hunger rating, energy input and faecal energy output in young, healthy volunteers. A randomized, double-blind, cross-over trial.

The effects of moderate dietary-fibre supplementation on satiety, energy intake and faecal energy excretion were studied in 20 young healthy volunteers of normal body weight, mean body mass index 20.9, receiving a dietary fibre supplement of 7.3 g per day in a randomized, double-blind, cross-over study. Hunger feeling, energy intake, and defaecation pattern, were recorded daily during a 2-week control period and then, during two 4-week treatment periods. Furthermore, faecal energy output was determined during the last week of each treatment period. The fibre treatment, as compared to placebo, resulted in a significantly higher faecal energy excretion: 173 kcal/d (163-183 kcal/d) vs 153 kcal/d (135-171 kcal/d), respectively (P less than 0.05); a decrease in hunger rating (using a visual analogue scale) (P less than 0.05); an increase in number of bowel movements (P less than 0.05), and a softer consistency of the stools (P less than 0.05). There was no significant difference in mean energy intake between the two treatment periods. This study demonstrated that moderate dietary fibre supplementation in normal man increases faecal energy excretion with simultaneously decreased hunger feeling. These beneficial effects may have therapeutic value in the management of obesity.