|Year : 2014 | Volume
| Issue : 1 | Page : 115-121
Effect of 3-month treatment of obesity by low-calorie diet on anthropometric, health, and nutritional status for obese female individuals
Olfat M Ibrahim Nassar
Department of Nutrition and Food Science, Faculty of Home Economics, Menoufia University, Shibin Al Kawm, Menoufia, Egypt
|Date of Submission||09-Oct-2013|
|Date of Acceptance||05-Nov-2013|
|Date of Web Publication||20-May-2014|
Olfat M Ibrahim Nassar
PhD, Department of Nutrition and Food Science, Faculty of Home Economics, Menoufia University, Shibin Al Kawm, Menoufia
Source of Support: None, Conflict of Interest: None
In the majority of obese patients, adjustment of the diet will be required to reduce calorie intake. In general, diets containing 1000-1200 kcal/day should be selected for obese patients.
The objective was to study the effect of treatment by low-calorie diet on obese female individuals for 3 months.
Forty obese female individuals (BMI40 kg/m 2 ) with ages ranging from 27 to 30 years were divided into two main groups: the nontreated group (n = 20) in which obese female individuals did not follow any diet and the treated group (n = 20) in which obese female individuals consumed low-calorie diet (LCD) containing 1200 kcal as 60 g protein, 165 g carbohydrate, and 33 g fats for 3 months.
Materials and methods
Food intakes, anthropometric measurements, follow-up weights, and blood samples were studied.
After weight-loss phase, the anthropometric measurements (weight, hips, waist circumference, and BMI) for the treated group (consumed LCD) were decreased significantly. The mean serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) in the treated group were decreased significantly (P < 0.001) at the end of weight-loss phase, whereas serum high-density lipoprotein (HDL) was increased but insignificantly when compared with the nontreated group.
Serum red blood cell, hemoglobin, hematocrit, and platelet in the treated group were decreased significantly at the end of weight-loss phase (P < 0.001 and P < 0.05), whereas in the nontreated group after the same time they were slightly increased (P < 0.01 and P < 0.001) except WBC and platelet, which decreased. The mean values of serum aspartate aminotransferase, alanine aminotransferase, glucose, uric acid, creatinine, and blood urea nitrogen in the treated group were decreased significantly (P < 0.001) compared with that in the nontreated group with slightly increased values, but the differences were insignificant. All obese patients (n = 40) before weight-loss phase (3 months) consumed a diet rich in energy, protein, and micronutrients (calcium, iron, vitamin A, C, D, B6, and B12). However, the weight-loss phase treated group (n = 20) (consumed LCD) consumed a diet that had reduced requirements (DRI) for energy, calcium, iron, vitamin A, vitamin C, vitamin D, and vitamin B6 by 54.5, 22.58, 36, 48.31, 83.33, 64.0, and 12.5%, respectively, whereas they consumed a diet that had increased requirements for total protein and vitamin B12. Hence, consumed LCD has a positive role in controlling body weight, anthropometric measurements, and health status but has a negative impact on nutritional status because it lacks some of the nutrients.
Body weight reduction after LCD has a positive impact on anthropometric measurements and health status but has a negative impact on nutritional status because it lacks some of the nutrients.
Keywords: Anthropometric measurements, health and nutritional statuses, low-calorie diet, obesity
|How to cite this article:|
Ibrahim Nassar OM. Effect of 3-month treatment of obesity by low-calorie diet on anthropometric, health, and nutritional status for obese female individuals. Menoufia Med J 2014;27:115-21
|How to cite this URL:|
Ibrahim Nassar OM. Effect of 3-month treatment of obesity by low-calorie diet on anthropometric, health, and nutritional status for obese female individuals. Menoufia Med J [serial online] 2014 [cited 2017 Oct 24];27:115-21. Available from: http://www.mmj.eg.net/text.asp?2014/27/1/115/132779
| Introduction|| |
Obesity is a medical condition in which excess body fat is accumulated to the extent that may have an adverse effect on health status. The most common definitions used were established by the WHO (2000) that classified obesity into three classes: class 1 has a BMI of 30-34.5, class 2 has a BMI of 35-39.9, and class 3 has a BMI of 40 or greater . Any BMI of 35-40 or greater is severe obesity, BMI of 40-44.9 or greater is morbid obesity, and finally BMI of 45-50 or greater is super obesity . The most common causes of obesity include individual variation and a combination of excessive food energy intake and lack of physical activity . A limited number of cases are primarily due to genetics, medical reasons, or psychiatric illness . In contrast, increasing rates of obesity at a social level are felt to be because of an easily accessible and palatable diet and increasing dependence on cars and mechanized manufacturing. Extra food energy came from an increase in carbohydrate consumption rather than fat consumption . The consumption of sweetened drinks is believed to be contributing to the rising rates of obesity . The association between fast-food consumption and obesity becomes more concerning . Obesity is associated with ischemic heart diseases, congestive heart failure, high blood pressure, abnormal cholesterol levels , diabetes mellitus, polycystic ovarian syndrome , depression in women and social stigmatization , gastroesophageal reflux disease, fatty liver disease, and gallstones .
Many studies have examined the body image, dissatisfaction with weight and shape, eating attitudes, and weight-loss behaviors including dieting, exercise, purging, smoking, and frequency of meals and snacks. Dieting is frequently used for weight loss, especially among female individuals, and is a significant health concern, as it may contribute to eating disorders in susceptible individuals (French et al., 1995). Low-calorie diets usually produce an energy deficit of 500-1000 calories/day, which can result in a 0.5-kg weight loss/week. The National Institutes of Health reviewed 34 randomized controlled trials to determine the effectiveness of low-calorie diets, and they found that these diets lowered the total body mass by 8% over 3-12 months .
| Participants and methods|| |
Sixty obese female individuals (BMI≥40 kg/m 2 ) with ages ranging 27-30 years were included in the study.
Participants were recruited from the Department of Physical Therapy for El Mowasah Hospital, Tala, Menoufia Governorate, Egypt. Our study was conducted between March and June 2012. After 10 and 30 days, 20 participants did not complete the experiment.
Female individuals who were not married and were within the age group of 27-30 years, who were employees in different places in Menoufia Governorate with higher educational level - studying postgraduate, and those living in Menoufia Governorate who agreed to participate were included in the study.
Patients who had chronic diseases such as cancer, renal failure, liver cirrhosis, and anemia and those who refused to participate were excluded from the study.
Forty obese female individuals were divided into two main groups:
The nontreated group included (n = 20) obese female individuals who did not follow any diet.
The treated group included (n = 20) obese female individuals who consumed low-calorie diet (LCD) - 1200 kcal for 3 months consecutively: 20% protein, 25% fat, and 55% carbohydrates.
0Food intake for each participant was estimated for 3 days/week by 24-h recall. The nutritive value of the consumed foods were calculated using Egyptian Food Composition tables (National Nutrition Institute, 1996). Intake from minerals and vitamins were compared with standards of WHO (2000). However, the requirements from energy were calculated by the equation given by Institute of Medicine and Food and Nutrition Board .
Weight and height were measured according to Al-Hazzaa  and waist and hip circumference were measured according to Weltman et al. (1987). The ratio of waist to hip, which represents a health hazard for women (<80 cm), was determined according to Bray and Gray .
Follow-up weights were obtained for 40 obese female individuals (with or without consumed LCD) every 2 weeks after completing the weight-loss phase.
The blood samples were collected and determined in the laboratory of the El Mowasah Hospital, Tala, Minoufia Governorate for the determination of hemoglobin (HGB), red blood cells (RBCs), HCT (hematocrit), and platelet (PLT) according to Dacie and Lewis . White blood cells (WBCs) was determined according to Koda et al. . Serum cholesterol, triglycerides, HDL cholesterol, LDL, and total lipids were determined according to Trinder and Ann , Wahlefeld , Richmond , Fruchart , and Friedwald et al. , respectively. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined according to Srivastava et al. . Serum glucose was determined according to Tietz . Serum uric acid and creatinine were determined according to Henery et al.  and Chary and Sharma , respectively.
Patients reported the following minor side effects at least once during the weight-loss phase: constipation, diarrhea, dizziness, fatigue, cold intolerance, and hair loss. These symptoms were managed as they occurred and did not require alteration of the usual weight-loss program.
Statistical analysis was carried out using the SPSS software (SPSS Statistical Package for Social science Computer software, -2007-Ver.16, SPSS company London, UK) program for windows, version 13 . For descriptive data, anthropometric measurements, blood profiles before and after the use of LCD and without the use of LCD were presented as mean ± SD, T values, and significant differences. The level of statistical significance was set as: P value less than 0.001 was considered very highly significant, less than 0.01 was considered highly significant, and less than 0.05 was considered significant.
| Results|| |
[Table 1] shows that after the period of study (3 months) the anthropometric measurements (weight, hips, waist circumference, and BMI) in the nontreated group without consumed LCD were increased significantly (the change before and after the study was 9.39 kg, 5.86 cm, 5.16 cm, and 9.39 kg/m 2 , respectively). However, in the treated group (with consumed LCD) the above parameters were decreased significantly (the change before and after the study was −19.32 kg, −21.56 cm, −22.59 cm, and −19.26 kg/m 2 , respectively).
|Table 1: Anthropometric measurements of obese patients with and without consumed low-calorie diet|
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[Table 2] shows the results of dietary intake; all obese patients (n = 40) before weight−loss phase (3 months) consumed a diet rich in energy, total protein, calcium, total iron, vitamin A, vitamin C, vitamin D, vitamin B6, and vitamin B12 when compared with Dietary Reference Intake . The percentage of reduction was 82, 192, 62, 70.1, 240.93, 179.77, 31.60, 20.63, and 175.75%, respectively. However, in the weight−loss phase treated group (n = 20) (consumed LCD), the diet satisfied only 54.5, 120.0, −77.42, −64.0, −51.69, 16.67, −38, −87.5, and 185% of the requirements for energy, total protein, calcium, total iron, vitamin A, vitamin C, vitamin D, vitamin B6, and vitamin B12, respectively.
|Table 2: Mean food intake of obese patients before and after consumed LCD|
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[Table 3] shows the results of mean serum total cholesterol (TC), triglycerides (TG), and LDL in the treated group (consumed LCD), which were decreased significantly by 29, 13, and 20%, respectively, (P < 0.001) at the end of weight-loss phase. However, serum HDL was slightly increased but not significantly by 2%. Moreover, the mean values of TC and TG in the nontreated group (without consumed LCD) were increased significantly by 5 and 2%, respectively (P < 0.001).
|Table 3: Mean ± SD of lipid profiles of obese patients with and without consumed low-calorie diet|
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Results from [Table 4] indicated that serum RBC, HGB, HCT, and PLT in the treated group were decreased significantly (the change before and after the study was 1.02, -2.46, 0.26, and 0.28, respectively) at the end of weight-loss phase (P < 0.001 and P < 0.05). However, in the nontreated group after the same time the above parameters were slightly increased (the change before and after the study was 0.59, 0.99, and 0.21, respectively) (P < 0.01 and P < 0.001) except WBC and PLT, which were decreased (the change before and after the study was 0.80 and 0.08, respectively).
Results from [Table 5] revealed that mean serum AST, ALT, glucose, uric acid, creatinine, and blood urea nitrogen in the treated group (with used LCD) decreased significantly (the change before and after the study was 14.38, 16.67, 5.95, 32.28, 27.17, and 23.71, respectively) compared with that in the nontreated group (without used LCD) in which the above parameters were increased slightly but insignificantly (the change before and after the study was 0.93, 2.45, 3.71, 0.63, 0.52, and 6.29, respectively) by the end of the study period.
|Table 4: Mean ± SD of blood count of obese patients with and without consumed low-calorie diet|
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|Table 5: Mean ± SD of liver function, kidney function, and glucose level of obese patients with and without consumed low-calorie diet|
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| Discussion|| |
Results from [Table 1] were in agreement with those obtained by Anderson et al.  who found that patients lost a mean weight of 35.1 ± 1.9 kg over an average of 26 ± 1.7 weeks (P < 0.001). The mean BMI was reduced to 12.4 U (P < 0.001). In addition, Tokunaga and Furubayashi  found that the diets containing 1000-1200 kcal/day should be selected for obese patients. Very low-calorie diet (VLCD) is below 600 kcal/day. VLCD should not be used routinely for weight-loss therapy because it requires special monitoring and supplementation. The differences in the effectiveness between the weight-loss methods were similar when we analyzed waist circumference and percentage body weight as outcome variables . Patients consumed significantly lower (P < 0.05) total kcal during the carbohydrate-restricted diet compared with a habitual diet; body mass decreased significantly (P < 0.05). Despite a reduction in body mass, strength and power outputs were maintained for male and female individuals during the carbohydrate-restricted diet Sawyer et al.  who found that patients on low-carbohydrate diet had lost more weight than patients on the conventional diet at 3 months (mean ± SD), −6.8 ± 5.0 versus −2.7 ± 3.7% of body weight loss, respectively (P ≤ 0.001) . Finally, Pedro et al.  reported that dietary adherence is strongly associated with the rates of weight loss and is adversely affected by the severity of caloric restriction. The weight-loss programs should consider moderate caloric restriction with respect to estimates of energy requirements rather than generic LCDs.
[Table 2] shows the results of dietary intake; these results were in agreement with those of Zaghloul et al.  who reported that nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients, and decreased intakes of fiber and micronutrients. Scali et al.  suggested that overweight and obesity appear as two different entities. Energy imbalance induced by various lifestyle factors plays a major role in the development of overweight, whereas obesity represents a more complex entity where psychological and genetic factors that are difficult to assess may be more important. General nutritional guidelines appear more adapted to the prevention of overweight than of obesity and to individual counseling for the prevention of obesity. In addition, a high daily-eating frequency is associated with a healthy lifestyle and dietary pattern in both men and women and with a reduced likelihood of general and central obesity in men. Holmbδck et al.  suggested that there is a need for prospective studies investigating the association between eating frequency, diet, and body composition. In the majority of obese patients, adjustment of the diet will be required to reduce calorie intake. In general, diets containing 1000-1200 kcal/day should be selected for obese patients according to Tokunaga and Furubayashi . Low-carbohydrate high-protein diets (LCHP) are seriously deficient in several micronutrients and dietary fiber, thus creating a need for nutritional supplements . Consuming a low-carbohydrate (approximately <47% energy) diet is associated with greater likelihood of being overweight or obese among healthy, free-living adults. The lowest risk may be obtained by consuming 47-64% energy from carbohydrates as reported by Merchant et al. .
Results from [Table 3] were in agreement with those of Lofgren et al.  who suggested that waist circumference (WC) is a stronger predictor for coronary heart disease risk compared with BMI and is more closely associated with the level of exercise in premenopausal women, measured plasma LDL, and TG. They found that women with a BMI of 30 kg/m 2 or greater or with WC greater than 88 cm had significantly higher plasma TG and LDL concentrations compared with women having a BMI less than 30 kg/m 2 or a WC of 88 cm or less (P < 0.05). In addition, stable weight loss and significant improvement in cardiovascular risk profile were observed in morbidly obese patients, 10 years after laparoscopic adjustable gastric banding. A significant reduction in total cholesterol and triglycerides was observed in the short-term evaluation and was confirmed in the long-term evaluation .
Wood et al.  concluded that weight loss induced by carbohydrate restriction favorably alters the secretion of plasma LDL cholesterol and triglycerides (TG), significantly reduced by 8.9 and 38.6%, respectively. In contrast, plasma HDL cholesterol concentrations were increased by 12%. In addition, they were associated with decreased risk for atherosclerosis and coronary heart disease.
It has been suggested that low-carbohydrate high-protein diets (LCHP) and their potential impact on the practice of cardiology, which were introduced originally as weight-loss regimens, also have a significantly beneficial effect on a variety of cardiovascular risk factors. It is clear that people who consume such diets have a reduced intake of calories, resulting in a predictable degree of weight loss. These diets induce a moderate level of ketosis and, in some studies, have been shown to improve the lipid profile overall. In addition, there is a reduction in the number of LDL particles. However, these trends also have been observed over the periods of 24 weeks or less with LCDs that already have an established record of safety and efficacy .
In addition, Anderson et al.  concluded that VLCD program enabled obese patients to lose an average weight of 35.1 kg in 26 weeks. The mean BMI was decreased by 12.4 U, with 53% of patients losing more than 10 BMI units. These weight losses were accompanied by clinically significant decreases in obesity-related risk factors, including a 15% reduction in serum total cholesterol and 17% reduction in LDL cholesterol.
Thakur and Bisht  reported that obese patients had higher total cholesterol and triglycerides and lower HDL-C compared with nonobese patients (P < 0.05). At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total cholesterol [58 mg/dl (1.50 mmol/l)], LDL [50 mg/dl (1.30 mmol/l)], VLDL [8 mg/dl (0.21 mmol/l)], non-HDL cholesterol [63 mg/dl (1.63 mmol/l)] (P < 0.001 vs. baseline for each), triglycerides [58 mg/dl (0.66 mmol/l)] (P < 0.001), and total ApoB (49 mg/dl) (P < 0.001). Mean HDL cholesterol decreased significantly (P < 0.001), although ApoA-I increased (4 mg/dl) (P = 0.23). Significant but less marked changes persisted in children after 12 and 24 months. Kwiterovich et al.  and Ma et al.  reported that cross-sectional analysis of the results from this study suggest that higher total carbohydrate intake, percentage of calories from carbohydrate, glycemic index (GI), and/or glycemic load (GL) are related to lower high-density lipoprotein cholesterol (HDL-C) and higher serum triacylglycerol levels, whereas higher total carbohydrate intake and/or GL are related to lower total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels. In a 1-year longitudinal analysis, GL was positively associated with total cholesterol and LDL-C levels, and there was an inverse association between percentage of calories from carbohydrate and HDL-C levels.
Results from [Table 4] indicated the levels of serum RBC, HGB, HCT, and PLT. These results are in agreement with those obtained by Ausk and Ioannou  who found that all other higher BMI categories did not have a significant change in HGB concentration after adjustment for the above-mentioned confounders. Overweight and obesity were associated with changes in serum iron, TS (transferrin saturation), and ferritin that would be expected to occur in the setting of chronic, systemic inflammation. However, overweight and obese persons were less likely to be anemic compared with normal-weight persons.
Results from [Table 5] revealed mean serum AST, ALT, glucose, uric acid, creatinine, and blood urea nitrogen. Strauss et al. (2000) indicated that overweight and obesity are the most common findings in adolescents with elevated ALT levels. Besides, Purkins et al.  reported that blood transaminase activity increased significantly when patients consumed a high-carbohydrate high-calorie diet compared with patients who consumed a balanced normal-calorie diet. The results by Marchesini et al.  indicated that liver disease of metabolic origin, associated with obesity, is now recognized as the most prevalent liver disease in western countries. Strategies are needed to approach obesity-associated liver disease by conducting behavior programs and motivating people to adopt a healthier lifestyle. Such programs should be coupled with public policies at a social level to obtain the maximum effects in lifestyle changes. Carbohydrate overfeeding increased patient's weight and liver fat and enzymes according to Sevastianova et al. , whereas hypocaloric diet reduced their weight and liver fat content.
Gasteyger et al.  indicated that LCD led to an immediate significant decrease in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). However, in women, these enzymes increased significantly.
Oyama et al.  suggested that, in adults, serum uric acid levels are positively correlated with BMI, and hyperuricemia is considered to be a common lifestyle disorder related to obesity. In addition, obesity has been correlated to increase the overall risk for hyperuricemia within the blood. Individuals with a BMI that indicates obesity are much more likely to develop higher uric acid levels as reported by Smart Living Network . Omar et al.  found that the elevation in serum uric acid is more prevalent in obese individuals. Obesity, calories from dietary protein ≥16.5% and serum creatinine are the dominant risk factor for elevated serum uric acid. Data obtained by Yamashita et al.  suggest that hyperuricemia in obese people is mainly attributed to an impaired renal clearance of uric acid rather than overproduction; hyperuricemia associated with obesity can be treated very well only with appropriate diet therapy and in most cases there is no need for drug therapy. In addition, other investigators [54-59] indicated that body weight reduction has a positive impact on renal hemodynamics, decreasing urinary albumin excretion as well as significantly reducing creatinine clearance.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]