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Transcript of LCD-vlcd
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LCD and VLCD
Norman Hardi UtamaRendy Andika
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Weight-Reducing Diets
• ↓calorie intake↑energy deficit, ↑weight
loss
• Reducing diets based on calorie content:
– Balanced-deficit diets
– Low-calorie diet
– very-low-calorie diets
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Low-Calorie Diets
• Low-calorie diets (LCDs) contain 800 to 1500 kcal/day
• indicated for people with: – BMI ≥ 30
– OR {[BMI 25 to 29.9 OR waist circumference > 35inch in (F) > 40 inch(M)] AND ≥ 2 risk factors}.
• The risk factors: – cigarette smoking
– hypertension
– high-risk low-density lipoprotein (LDL) cholesterol
– low high-density lipoprotein (HDL) cholesterol
– impaired fasting glucose – family history of premature coronary heart disease
– Age ≥ 45 years for men or age ≥ 55 years for women (orpostmenopausal).
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Contraindications
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• >30 randomized trials have shown that LCDsproduce losses of approximately 8 to 10% ofinitial weight in 16 to 26 weeks of treatment
• Benefit: – helps prevent stroke, heart disease, hypertension,
and high blood pressure, lowers cholesterol levels,decreases risk of Type 2 diabetes
• Adverse effects:
– fatigue, constipation, nausea, diarrhea and theformation of gallstones (less food consumption → ↓gall bladder contraction)
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LCD in practice
• Traditional LCD diet of self selected foods
Failed?
• Portion controlled LCD
fixed amount of food• Liquid meal replacement LCD2 meals and 2
snack replaced with liquid shake and bars
both produce more significant weight loss(obese persons underestimate their calorie
intake up to 50%)
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Very Low Calorie Diet
• An option for those failed with LCD
• Preparation for bariatric surgery
• By definition <800calorie/day• Alternative definition: <50% of REE
• Induces approx. 15-20% loss of initial weight
in 12 weeks
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Risk vs Benefit vs Cost
• The National Task Force on the Prevention and
Treatment of Obesity,34recommend that
VLCDs are restricted to those:
– With a BMI of >30
– Who are well motivated
– Who have failed at more conservative approaches
– Have a medical condition that would be
immediately improved with rapid weight loss e.g.
severe obstructive sleep apnoea.
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Contraindications
• Unstable cardiac or cerebrovascular disease
• Acute and chronic renal failure
• Severe or end stage liver disease• Psychiatric disorder that could interfere with
compliance
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• 1988: Oprah winfrey lost 67 pounds(30KG)
• 1990: all weight loss regained, announced
would “ never diet again”
• 2004: >200.000 Amerricans used VLCDs
• Except France, VLCD is available over the
counter in EU nations.• Total food cost:
3000-3500USD
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Baseline Predictors for Greater Weight
Loss Through VLCD
Women
• Having more children
• Lower education
• Better perceived physicalhealth
• R2=12.7%
Men
• Better ambulation capacity
• Living w/partner or children
• Snacking on ice cream moreoften
• R2=39.4%
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VLCD
• 100% RDA essential vitamins and minerals
• 70-100g protein/daypreserve lean bodymass
• Source of protein: – milk, soy, or egg-based powder mixed with water
– Lean meat, fish, fowl
• +2L/d non-caloric fluid• Followed by 12-14 weeks of refeeding and
weight stabilization
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Rapid Weight Loss Period
• Monitored at least every 2 weeks
• ↑ risk of gallstones, cold intolerance, hair loss,
headache, fatigue, dizziness, volume depletion
(with electrolyte abnormalities), muscle cramps,and constipationussually mild
• Gallstones25% patients during 8 weeks VLCD,
6% required cholecystectomy. +12% developasymptomatic gallstones within 6 months, half
eventually required cholecystectomy
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• The risk can be decreased by
– ursodeoxycholic acid – Moderate amount of fat in the diet(>7g)
– Limitting the rate of weight loss to 1.5kg/wk
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Safety
• 60 recorded deaths in US, most developed
cardiac complications after an average of 4
months diet.
• No death were reported in <8weeks
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Efficacy for weight loss
• Short term:
– VLCD>LCD: 16.1 + 1.6% vs 9.7 + 2.4%
– Mean difference: 6.4 + 2.7% (p=0.0001)
• Long term(2 years): – Comparable, about 6%
– VLCD and LCD patients regained 62% and 41% of
lost weight, respectively.• Ketotic and non ketotic VLCD have comparable
hunger level and weight loss
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References
• Gripeteg L, Karlsson J, Torgerson J, Lindroos AK. Predictorsof Very Low Energy Diet Outcome in Obese Women andMen. Obes Facts 2010;3: 159-65
• National Heart, Lung, and Blood Institute and NorthAmerican Association for the Study of Obesity (NAASO).Practical Guide to the Identification, Evaluation, andTreatment of Overweight and Obesity in Adults. Bethesda,M D: National Institute of Health, 2000.
• Shils, Maurice E, Shike, et al. Modern Nutrition in Healthand Disease. 10th edition. Lippincott Williams & Wilkins2006. Ch64: Obesity:Management.
• Tsai AG, Wadden TA. The Evolution of Very Low CalorieDiets: An Update and Meta-analyses. Obes
2006;14(8):1283-93