Obesity Surgery

, Volume 21, Issue 8, pp 1194–1202

Short-Term Carbohydrate-Restricted Diet for Weight Loss in Severely Obese Women

  • Andresa de Toledo Triffoni-Melo
  • Ingrid Dick-de-Paula
  • Guilherme Vannucchi Portari
  • Alceu Afonso Jordao
  • Paula Garcia Chiarello
  • Rosa Wanda Diez-Garcia
Clinical Research

Abstract

Background

Weight loss in bariatric pre-surgery period reduces surgical complications, surgery time, blood loss, and length of hospital stay. Carbohydrate-restricted diets have been used as an alternative for weight loss. We tested the efficacy of a low-calorie carbohydrate-restricted diet (RD) for short-term weight loss in women with severe obesity and evaluate its metabolic effects in relation to a conventional low-calorie diet (CD).

Methods

The subjects received a 1,200-kcal diet with or without carbohydrate restriction for a period of 1 week in the hospital. Nineteen obesity class III women were distributed into two groups: experimental (n = 10) and control (n = 9). The following variables were assessed at the beginning and end of the study: anthropometric measurements, body composition, resting energy expenditure, substrate oxidation, and biochemical tests.

Results

Compared with CD, RD led to larger weight loss (2.6 and 4.4 kg, respectively; p = 0.01) and waist circumference reduction (p < 0.01). Among the assessed biochemical indicators, only plasma and urine acetone levels were different (p < 0.01); higher values were found in the experimental group with no symptoms and other diet-related complaints. There was also a significant decrease in triglycerides and carbohydrate oxidation, as well as a significant enhancement in lipid oxidation in the RD group.

Conclusion

Short-term RD was more efficient than CD regarding quick weight loss and waist circumference reduction, which may favor gastroplasty. Also, RD did not lead adverse metabolic effects.

Keywords

Low-carbohydrate diet Weight loss Ketosis Morbid obesity 

Abbreviations

RD

low-calorie carbohydrate-restricted diet

CD

conventional low-calorie diet

HCFMRP-USP

Clinical Hospital, School of Medicine of Ribeirão Preto, University of São Paulo

BMI

body mass index

AC

arm circumference

WC

waist circumference in the navel

WC1

waist circumference 10 cm above the WC

WC2

waist circumference 20 cm above the WC

HOMA-IR

homeostasis model assessment-insulin resistance

SD

standard deviation

REE

resting energy expenditure

FM

fat mass

LM

lean mass

RQ

respiratory quotient

TEV

total energy value

References

  1. 1.
    Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii, 1-253Google Scholar
  2. 2.
    World Health Organization. Obesity and overweight. What are overweight and obesity? Fact sheet no. 311; September 2006. http://www.who.int/mediacenter/factsheets/fs311/en/print.html. Accessed 08 Aug 2009.
  3. 3.
    IBGE Fundação Instituto Brasileiro de Geografia e Estatística / Ministério do Planejamento, Orçamento e Gestão, Ministério da Saúde. Pesquisa de Orçamentos Familiares 2002-2003. Análise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. Rio de Janeiro, Brasil: IBGE; 2004.Google Scholar
  4. 4.
    Santos LMP, Oliveira IV, Peters LR, et al. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system. Obes Surg; 2008.Google Scholar
  5. 5.
    Pardela M, Wiewióra M, Sitkiewicz T, et al. The progress in bariatric surgery. J Physiol Pharm. 2005;56 Suppl 6:35–44.Google Scholar
  6. 6.
    World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: WHO; 1998.Google Scholar
  7. 7.
    Fandiño J, Benchimol AK, Coutinho WF, et al. Cirurgia bariátrica: aspectos clinico-cirúrgicos e psiquiátricos. Rev Psiquiatr Rio Gd Sul. 2004;26:47–51.CrossRefGoogle Scholar
  8. 8.
    Segal A, Fandiño J. Indicações e contra-indicações para realização das operações bariátricas. Rev Bras Psiquiatr. 2002;24(Supl 3):68–72.CrossRefGoogle Scholar
  9. 9.
    Cartagena R. Preoperative evaluation of patients with obesity and obstructive sleep apnea. Anesthesiol Clin North America. 2005;23:463–78.PubMedCrossRefGoogle Scholar
  10. 10.
    Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3:141–5. discussion 145-6.PubMedCrossRefGoogle Scholar
  11. 11.
    Ali MR, Baucom-Pro S, Broderick-Villa GA, et al. Weight loss before gastric bypass: feasibility and effect on postoperative weight loss and weight loss maintenance. Surg Obes Relat Dis. 2007;3:515–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Tarnoff M, Kaplan LM, Shikora S. An evidenced-based assessment of preoperative weight loss in bariatric surgery. Obes Surg. 2008;18:1059–61.PubMedCrossRefGoogle Scholar
  13. 13.
    Volek JS, Sharman MJ, Gómez AL, et al. Comparison of a very low-carbohydrate and low-fat diet on fasting lipids, LDL subclasses, insulin resistance, and postprandial lipemic responses in overweight women. J Am Coll Nutr. 2004;23:177–84.PubMedGoogle Scholar
  14. 14.
    Astrup A, Larsen TM, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet. 2004;364:897–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Clifton PM. Dietary treatment for obesity. Nat Clin Pract Gastroenterol Hepatol. 2008;5:672–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Yancy Jr WS, Foy M, Chalecki AM, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005;2:34.CrossRefGoogle Scholar
  17. 17.
    Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949;109:1–9.PubMedGoogle Scholar
  19. 19.
    Frayn KN. Calculation of substrate oxidation rates in vivo from gaseous exchange. J Appl Physiol. 1983;55:628–34.PubMedGoogle Scholar
  20. 20.
    Schutz Y. The basis of direct and indirect calorimetry and their potentials. Diabetes Metab Rev. 1995;11:383–408.PubMedCrossRefGoogle Scholar
  21. 21.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.PubMedGoogle Scholar
  22. 22.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Portari GV, Marchini JS, Jordão AA. Validation of a manual headspace gas chromatography method for determining volatile compounds in biological fluids. Lab Med. 2008;39:42–5.CrossRefGoogle Scholar
  24. 24.
    AOAC. Association of Official Analytical Chemists. Official methods of analysis, 16 ed. Washington 1995; 1 (cap12): 7.Google Scholar
  25. 25.
    Schall R. Estimation in generalized linear models with random effects. Biometrika. 1991;78:719–27.CrossRefGoogle Scholar
  26. 26.
    R Development Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2008.Google Scholar
  27. 27.
    Noble CA, Kushner RF. An update on low-carbohydrate, high-protein diets. Curr Opin Gastroenterol. 2006;22:153–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778–86.PubMedGoogle Scholar
  29. 29.
    Last AR, Wilson SA. Low-carbohydrate diets. Am Fam Physician. 2006;73:1942–8.PubMedGoogle Scholar
  30. 30.
    Erlanson-Albertsson C, Mei J. The effect of low carbohydrate on energy metabolism. Int J Obes (Lond). 2005;29 Suppl 2:S26–30.CrossRefGoogle Scholar
  31. 31.
    Volek JS, Westman EC. Very low-carbohydrate weight-loss diets revisited. Cleve J Med 2002; 69: 849, 853, 856-8 passim.Google Scholar
  32. 32.
    Westerterp-Plantenga MS. The significance of protein in food intake and body weight regulation. Curr Opin Clin Nutr Metab Care. 2003;6:635–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Alnasir FA, Fateha BE. Low carbohydrate diet. Its effects on selected body parameters of obese patients. Saudi Med J. 2003;24:949–52.PubMedGoogle Scholar
  34. 34.
    Daly ME, Piper J, Paisey R, et al. Efficacy of carbohydrate restriction in obese type 2 diabetes patients (Abstr. A98). Diabet Med. 2006;23 Suppl 2:26–7.Google Scholar
  35. 35.
    Denke MA. Metabolic effects of high-protein, low-carbohydrate diets. Am J Cardiol. 2001;88:59–61.PubMedCrossRefGoogle Scholar
  36. 36.
    Das SK, Roberts SB, McCrory MA, et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr. 2003;78:22–30.PubMedGoogle Scholar
  37. 37.
    Adam-Perrot A, Clifton P, Brouns F. Low-carbohydrate diets: nutritional and physiological aspects. Obes Rev. 2006;7:49–58.PubMedCrossRefGoogle Scholar
  38. 38.
    VanItallie TB, Nufert TH. Ketones: metabolism’s ugly duckling. Nutr Rev. 2003;61:327–41.PubMedCrossRefGoogle Scholar
  39. 39.
    Tay J, Brinkworth GD, Noakes M, et al. Metabolic effects of weight loss on a very low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol. 2008;51:59–67.PubMedCrossRefGoogle Scholar
  40. 40.
    Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859–73.PubMedCrossRefGoogle Scholar
  41. 41.
    Volek JS, Sharman ML, Forsythe CE. Modification of lipoproteins by very low-carbohydrate diets. J Nutr. 2005;135:1339–42.PubMedGoogle Scholar
  42. 42.
    Grieb P, Klapcinska B, Smol E, et al. Long-term consumption of a carbohydrate-restricted diet does not induce deleterious metabolic effects. Nutr Res. 2008;28:825–33.PubMedCrossRefGoogle Scholar
  43. 43.
    Al-Zaid NS, Dashti HM, Mathew TC, et al. Low carbohydrate ketogenic diet enhances cardiac tolerance to global ischaemia. Acta Cardiol. 2007;62:381–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84:304–11.PubMedGoogle Scholar
  45. 45.
    Meckling KA, O’sullivan C, Saari D. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab. 2004;89:2717–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Andresa de Toledo Triffoni-Melo
    • 1
  • Ingrid Dick-de-Paula
    • 2
  • Guilherme Vannucchi Portari
    • 3
  • Alceu Afonso Jordao
    • 4
  • Paula Garcia Chiarello
    • 4
  • Rosa Wanda Diez-Garcia
    • 4
  1. 1.Department of Internal Medicine, School of Medicine of Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil
  2. 2.Clinical Hospital, School of Medicine of Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil
  3. 3.Faculty of NutritionFederal University of Triangulo MineiroUberabaBrazil
  4. 4.Nutrition and Metabolism, Department of Internal Medicine, School of Medicine of Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil

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