VLCD by Enteral Route for Weight Loss (NEP)
Body weight excess, from overweight to overt obesity, is associated with adverse health outcomes. In view of the time-trends of the obesity epidemic and the related cost burden, the search for effective strategies for weight reduction and long-term maintenance of weight loss (WL) is at the top of the agenda of public health systems.
The current first-line strategy includes several treatment options and dietary interventions to be implemented together with an exercise program. Unfortunately, compliance with intervention in the long-term is difficult. It is not infrequent to observe people following one diet after another and experiencing multiple failures which, in turn, lead to higher body weight and adverse consequences on body composition and fat distribution. The higher the number of attempts, the more difficult the adherence to further interventions. In the presence of severe (body mass index >40 kg/m2) or complicated obesity, bariatric surgery could be proposed. This therapeutic option is effective, but is not devoid of complications and may be irreversible. Obesity-related complications, such as diabetes, hypertension or sleep apnoea are likely to occur more frequently with increasing body mass index (BMI) and rapid and considerable WL is mandatory to curtail such risks.
In this scenario, alternative treatment options are warranted. About 40 years ago, after the introduction of protein-sparing modified fasting (PSMF) achieved through the use of oral high-protein foods or liquid formula diets by Blackburn and Bistrian, several studies evaluated its effectiveness and safety. They showed that responsible and supervised very-low calorie diets (VLCDs) could be considered safe and appropriate therapy for obesity.
The purpose of the present study was to investigate the potential role of a 2-week course of enteral treatment with a very low-calorie protein-based formula in the management of severe obesity.
The rationale of this treatment option rests on the following considerations: 1) VLCDs appear to be able to reduce cardiovascular risk rapidly and effectively; 2) VLCDs induce considerable short and long-term WL; 3) optimal compliance with the intervention, as active participation of the patient is not required; 4) continuous administration of the intervention formula by enteral route enables the the maintenance of the body amino acid pool.
Before being proposed for clinical use, a new WL program should be scientifically evaluated. Accordingly, in the present study, attention was focused not only on efficacy in terms of improving the cardiometabolic risk profile, but also on the feasibility and safety of the procedure.
|Study Design:||Observational Model: Case-Only
Time Perspective: Prospective
|Official Title:||A 2-week Course of Enteral Treatment With a Very Low-calorie Protein-based Formula for the Management of Severe Obesity|
- Weight loss [ Time Frame: 14 days ] [ Designated as safety issue: No ]Percentage of weight loss
- Feasibility [ Time Frame: 14 days ] [ Designated as safety issue: Yes ]Necessity to discontinue the intervention
- Safety [ Time Frame: 14 days ] [ Designated as safety issue: Yes ]Frequency of the following side effects: asthenia, headache, dizziness, fainting, orthostatic hypotension, heartburn, nausea, vomiting, palpitations, muscle cramps, hunger, constipation. evaluation of changes in the following hematological and biochemical parameters and, for those presenting with normal values, by the excursion outside of the reference ranges of our laboratory (new cases): hemoglobin, total lymphocyte count, urea, creatinine, uric acid, albumin, serum enzymes (cholinesterase, transaminases, γ-glutamyl-transferase, serum creatine phosphokinase and serum lactate dehydrogenase ) and electrolytes (sodium, potassium, magnesium, calcium and phosphorus).
- Anthropometric and biochemical parameters [ Time Frame: 14 days ] [ Designated as safety issue: No ]Changes (increase [high density cholesterol, apolipoprotein A-I and growth hormone] or more frequently reduction [all the others]) in the following study parameters: body mass index, waist circumference, hip circumference, waist-hip ratio, uric acid, glucose, insulin, insulin resistance, C-peptide, glycosylated hemoglobin, insulin-like growth factor 1, total cholesterol, high density cholesterol, low density cholesterol, triglycerides, triglyceride/high density cholesterol ratio, apolipoprotein B, apolipoprotein B/apolipoprotein A-I ratio, transaminases, γ-glutamyl-transferase.
|Study Start Date:||April 2010|
|Study Completion Date:||February 2013|
|Primary Completion Date:||February 2013 (Final data collection date for primary outcome measure)|
Patients undergoing the administration of a homemade very low-calorie protein-based formula (2000 mL per day) by enteral route for 14 days
A homemade very low-calorie protein-based formula by enteral route (8-French nasogastric tube) for 14 days. The administration was continuous (h-24) by a feeding pump. The formula was made up of a fixed amount of aminoacids and a variable amount of high-quality proteins: 1.2 g/kg (ideal body weight). Other components were: pro-lipolytic substances (coenzyme Q10 and L-carnitine), linseed oil, policosanol, fructo-oligo saccharides, potassium, sodium and magnesium chloride. The intervention included also the daily oral administration of a multivitamin-multimineral supplement, alkalizing substances (calcium carbonate, 1500 mg; magnesium carbonate, 850 mg; potassium bicarbonate, 500 mg; sodium bicarbonate, 1500 mg; potassium citrate, 500 mg) and herbal remedies. All patients were also prescribed treatment with a proton pump inhibitor and ursodeoxycholic acid. A minimum intake of 2 liters/day of unsweetened fluids was recommended (3 litres in case of a history of kidney stones).
|Clinical Nutrition Unit - A.O.R.N. "San Giuseppe Moscati"|
|Avellino, Italy, 83100|
|Principal Investigator:||Giuseppe Castaldo, MD||Clinical Nutrition Unit - A.O.R.N. "San Giuseppe Moscati", Avellino, Italy|