Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective
Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective
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DOI：
10.1093/ajcn/85.2.346
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发表时间：
2007-02-01
影响因子：
7.1
通讯作者：
Pietrobelli, Angelo
中科院分区：
文献类型：
--
作者：
Heymsfield, Steven B.;Harp, Joyce B.;Pietrobelli, Angelo
低热量饮食（LCD）研究中观察到的最大体重减轻往往较小，并且导致这种低治疗效果的机制尚未阐明。 LCD 减重效果低于预期可能是由于能量吸收分数 (FEA) 的增加、能量消耗的调整或患者饮食依从性不完全造成的。我们系统地回顾了分别对采用 LCD 减肥的肥胖患者和肥胖减轻 (RO) 患者进行 FEA 和总能量消耗 (TEE) 的研究。该信息用于支持能量平衡模型，然后应用该模型来检查患者对规定的 LCD 治疗计划的依从性。在有限的现有文献中，在 LCD 短期（< 12 周）治疗研究中，FEA 与基线相比没有变化；没有发现长期（26 周）研究。对双标记水和呼吸室研究的回顾发现了 10 份关于长期体重减轻的 RO 患者 (n = 150) 的 TEE 报告。这些体重稳定的患者的 TEE 与非肥胖受试者的测量值或预测值几乎相同（加权平均差：1.3%；范围：-1.7-8.5%）。经审查的 FEA 和 TEE 研究支持的能量平衡建模表明，参加 LCD 计划的肥胖受试者的体重减轻程度不到预测值的一半。因此，通过 LCD 治疗观察到的小幅最大体重减轻可能不是由于胃肠道适应，而是可能归因于患者依从性困难，或者在较小程度上归因于当前模型未捕获的负能量平衡引起的代谢适应。
Maximal weight loss observed in low-calorie diet (LCD) studies tends to be small, and the mechanisms leading to this low treatment efficacy have not been clarified. Less-than-expected weight loss with LCDs can arise from an increase in fractional energy absorption (FEA), adaptations in energy expenditure, or incomplete patient diet adherence. We systematically reviewed studies of FEA and total energy expenditure (TEE) in obese patients undergoing weight loss with LCDs and in patients with reduced obesity (RO), respectively. This information was used to support an energy balance model that was then applied to examine patient adherence to prescribed LCD treatment programs. In the limited available literature, FEA was unchanged from baseline in short-term (< 12 wk) treatment studies with LCDs; no long-term (26 wk) studies were found. Review of doubly labeled water and respiratory chamber studies identified 10 reports of TEE in RO patients (n = 150) with long-term weight loss. These patients, who were weight stable, had a TEE almost identical to measured or predicted values in never-obese subjects (weighted mean difference: 1.3%; range: -1.7-8.5%). Modeling of energy balance, as supported by reviewed FEA and TEE studies, suggests that obese subjects participating in LCD programs have a weight loss less than half of that predicted. The small maximal weight loss observed with LCD treatments thus is likely not due to gastrointestinal adaptations but may be attributed, by deduction, to difficulties with patient adherence or, to a lesser degree, to metabolic adaptations induced by negative energy balance that are not captured by the current models.