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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

Documents

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