Page 492 - fbkCardioDiabetes_2017

468 Nutrient Manipulation for Obesity
Metabolic Syndrome and Diabetes

ic dyslipidemia at lower body mass index and waist 500-1000 gram/week. To sustain weight loss energy
circumference(2,3). deficit should be maintained(12). Dietary fat restric-
tion and carbohydrate (CHO) restriction have been
Nutrition & Causes: tried and studied in different populations across the
world. The conventional weight reduction diet had
Obese people have higher energy requirements when
compared to normal weight individuals for a given 15% proteins, <30% fats and 50-55% carbohydrates;
physical activity(12). Reducing energy intake in obese with lesser fat and increased fiber. This was effective
individuals will eventually cause weight loss. Symonds in short term weight loss due to low satiety and poor
et al review have suggested that nutritional fluctua- adherence over long period of time. Low CHO diet
tions in pregnancy may act via changes in maternal were useful in short term weight loss and their long
body composition and hormonal insulin sensitivity term benefit not established well(7).
to determine feto-placental adaptations and these The satiating ability of the various dietary compo-
determine the offspring’s relative risk for developing nents are used to cause a spontaneous reduction
obesity and metabolic syndrome(4). The current obe- in energy intake; this is the principle of ad libitum
sity epidemic is due to the obesogenic environment diet(12). Different nutritional treatments with varying
- calorie dense foods and a very sedentary life style. nutritional composition have been used like incorpo-
But not all become obese and the variability is due rating fiber or flavonoids, manipulating the glycemic
to the inheritance of the obesity susceptibility genes index, Omega 3 Fatty Acids and of minerals like
and its interaction with the obesogenic environment calcim and selenium(7). Low GI diets have shown
leading to positive energy balance and weight gain. to cause rapid weight loss, better management of
Sedentary behaviour and reduced physical activity glucose, insulin levels and decrease in triglycerides
together promotes over consumption of fats and re- and blood pressure. Recent evidence suggests that
fined carbohydrates (dietary macronutrients). Dietary diet moderately high in protein and modestly restrict-
pattern, food frequency, breakfast consumption all ed in carbohydrates and fat show benefits on body
have an impact on body weight. Role of gut microbi- homeostasis and metabolic parameters. Diet rich in
ota, energy homeostasis and inflammation also con- omega 3 fatty acids(FA) positively affects weight loss
tribute to obesity and related disorders(5). and weight maintenance by affecting satiety regula-
tion. Diet with moderately high proteins (30-35%), low
Weight Loss Advantages: GI carbohydrates (40%) and specific omega 3 fatty
Weight loss has significant role in treating obesi- acids (30%) creates satiety and contributes to weight
ty, metabolic syndrome, dyslipidemia, hyperten- loss and weight control(7).
sion, insulin resistance and hyperglycemia. Modest Options for weight loss diets:
weight loss can reduce the prevalence of obesity
and metabolic syndrome. 5-10% weight loss reduc- Several regimens of therapeutic weight loss diet ex-
es triglycerides and increases HDL-C and for every ists. Low-energy diets (LED) provides 800-1500 Kcal/
kilogram of weight loss the risk of diabetes mellitus day uses food with reduced fat and carbohydrate.
development reduces by 16%. Studies have shown Very-low-energy diets (VLED) are modified fasts pro-
that low calorie diet along with physical activity is the viding 200-800 Kcal/day and replace normal food.
most effective strategy to improve insulin resistance Ad libitum low fat diets restricts fat intake by 20-
and obesity(6). 30% of total energy intake, increased protein intake
because of the satiating power and modest carbo-
Nutritional Modifications in Obesity, hydrate intake leading to a modest weight loss(12).
Metabolic Syndrome & Diabetes Mellitus: Very-low-energy diets (VLED):
Different strategies were used in nutritional therapy. Earlier starvation was the ultimate treatment for obe-
Reducing the energy intake of a obese individual to sity, but it is no longer used due to the associated
that of a normal weight individual inevitably causes complications. This has been replaced by VLED (200-
weight loss, about 75% fat and 25% lean tissue(12). 800 Kcal/day) which provides very less energy but all
Diet composition doesn’t affect energy absorption essential nutrients, This diet should have increased
and energy expenditure but it reduces hunger, cre- nutrient density and it is difficult to get this from nat-
ates satiety and reduces energy intake. Larger the ural foods leading to commercial production of VLED
energy deficit the more rapid the weight loss. A defi- supplemented with all nutrients in RDA quantities.
cit of 300-500 Kcal/day reduces 300-500 gram/ VLED providing 800Kcal/day is safe and effective.
week and a deficit of 500-1000 Kcal/day reduces

GCDC 2017