Multidisciplinary treatment of obesity with a protein-sparing modified fast: results in 668 outpatients.

Palgi, Aviva; Read, John; Greenberg, Isaac; Hoefer, Martha A.; Bistrian, Bruce R.; Blackburn, George L.

doi:10.2105/ajph.75.10.1190

Cited by 72 publications

(50 citation statements)

References 33 publications

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“…In one study [15], weight loss after 17 weeks of treatment was 21 kg versus 10.2 kg in 3.5 weeks in the present study. Another smaller study [34] found results are closer to ours: 15 patients lost 14.4 kg after 6 weeks of PSMF with lactalbumin-derived protein dosed at 60 g/day.…”

Section: Discussionmentioning

confidence: 39%

“…With regard to the complications of KEN treatment including asthenia and mild lightheadedness, which have also been reported with the PSMF diet [15], the symptoms were easily relieved by increasing salt intake [15]. …”

Section: Discussionmentioning

confidence: 99%

“…This effect could be due to the protein infusion [37,38] or it could be connected with the mild metabolic acidosis [39] that occurs in ketonemic diets [40]. Constipation is also commonly reported during ketonemic diets [15,40], probably due to the lack of fibers in the protein solution. This issue can be resolved by increasing polyethylene glycol (PEG) administration.…”

Section: Discussionmentioning

confidence: 99%

“…They invented a very low calorie protein diet [15], the protein sparing modified fast (PSMF), but their subsequent studies on obese patients were based on an oral protein diet which had two main drawbacks: (1) glucose intake could not be reduced to zero and (2) protein intake stopped during the night. Normally overnight fasting does not entail muscle catabolism because hepatic glycogen sustains the patient’s energy requirement [16-18], but after one day of a high protein diet glycogen deposits are greatly reduced [16] and overnight fasting will entail muscle catabolism.…”

Section: Introductionmentioning

confidence: 99%

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Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

et al. 2012

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BackgroundOnly protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion.Methods19,036 patients (age 44.3 ± 13, M:F = 2:5) with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50–65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females.ResultsAfter an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%.ConclusionKetogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

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Section: Discussionmentioning

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

et al. 2012

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“…Additionally, enteral feeding often fails to provide an adequate amount of calories and nutrients in the critically ill population due to patient intolerance of appropriate tube feeding volumes; this is especially true among obese patients, who are at increased risk for having conditions (see above) predisposing to enteral feeding failure. These are examples of unintentional failure to provide adequate nutrition, whereas ‘hypocaloric feeding’, refers specifically to permissive underfeeding of a patient and is derived from the classical protein-sparing modified fast [58]. There is no standard method for hypocaloric feeding, but generally involves providing 30–70% estimated daily caloric needs in conjunction with a higher proportion of protein calories (often 50–60% of total calories) in order to minimize glucose loads while sparing lean body mass from catabolism.…”

Section: Hypocaloric Feedingmentioning

confidence: 99%

Metabolic support of the obese intensive care unit patient: a current perspective

Port¹,

Apovian

2010

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Obesity is a widespread condition associated with a variety of mechanical, metabolic, and physiologic changes that affect both health outcomes and delivery of care. Nutrition support is a key element of management during critical illness known to improve outcomes favorably, but is likewise complicated in the presence of obesity. This review serves to discuss the challenges unique to management of critically ill obese patients and an evidence-based approach to nutrition support in this patient population. Recent findings High-protein, hypocaloric feeding has emerged as a nutrition support strategy capable of reducing hyperglycemia and protein catabolism, while promoting favorable changes in body composition and fluid mobilization. Recent data have shown a protective effect of mild-moderate obesity (BMI 30–39.9 kg/m2), with improved morbidity and mortality outcomes in this subgroup. Therefore, it is unclear whether hypocaloric feeding represents an inferior approach in this subgroup in which weight maintenance may be preferable. Summary There are many obstacles that limit provision of nutrition support in the obese ICU patient. Calculating energy needs accurately is extremely problematic due to a lack of reliable prediction equations and a wide variability in body composition among the obese patients. Further research is needed to determine a better approach to estimating energy needs in this population, in addition to validating hypocaloric feeding as the standard approach to nutrition support in the obese patients.

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A Multicenter Evaluation of a Proprietary Weight Reduction Program for the Treatment of Marked Obesity

Wadden

Foster²,

Letizia³

et al. 1992

Arch Intern Med

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Multidisciplinary treatment of obesity with a protein-sparing modified fast: results in 668 outpatients.

Cited by 72 publications

References 33 publications

Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

Metabolic support of the obese intensive care unit patient: a current perspective

A Multicenter Evaluation of a Proprietary Weight Reduction Program for the Treatment of Marked Obesity

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