| Research BackgroundObesity is defined as a chronic metabolic disease caused by the combined effect of both heredity and environment.Obesity is a well-estabilshed global epidemic.The prevalence of overweight and obesity has been increasing dramatically in China over the past more than ten years because of the rapid economic development and lifestyle changes which included increased calorie diet intake and reduced physical activity.According to the diagnostic criteria established by the Working Group on Obesity in China(WGOC),the prevalence of overweight and obesity in China was 31.4%and 12.2%respectively.It has been shown that obesity is not only a kind of insanitary chronic disease,it can also lead to type 2 diabetes,metabolic syndrome,cardiovascular disease,osteoarthritis,depression and other diseases.It is important,therefore,to treat obesity safely and effectively.There are many ways to lose weight,including diet,exercise,medical drugs and surgical treatment.Each method has its advantages and disadvanges.However,lifestyle intervention combining proper nutrition with exercise is still the safest and most effective way to reduce weight.With more and more studies focus on mechanism of endocrine function and pathophysiology of adipose tissue,it has been proved that micro-inflammatorry state in obese people caused by imbalance of adipocytokines and oxidative stress is the major cause of obesity related complications.So we hope to have a way to reduce weight at the level of adipocytokine which may effectively improve glycolipid metabolism and alleviate inflammatory state in obese patients.Numerous evidence has accumulated in the literature,suggesting that very low-carbohydrate ketogenic diets could have a therapeutic role in lots of diseases.It became popular in the 1970s for weight loss-especially as the 'Atkins diets'.In addition,it had been proved that VLCD could decrease blood glucose,improve serum lipids and alleviate insulin resistance yet little is known regarding the effects on the obesity related complications and adipocytokines.Few clinical trials about VLCD in China.Therefore,we designed the clinical trial and observed the effect of an 8-week short time diet intervene of VLCD for overweight and obesity patients on body,metabolism,adipokines and obesity related complication for providing a more feasible,effective and safer way to reduce weight,alleviate imbalance of adipocytokines and micro-inflammatorry state improve the life quality of obese patients.Obejective(1)to investigate the effect of VLCD on body and metabolic parameters;(2)to explore the impact of VLCD on obesity related complications and adipokines.MethodsThis is a case control study and prospective self pre-and post-control clinical study.A number of 41 overweight or obeses(OW/OB)participants were recruited in the study from January 2016 to October 2016 from Obesity Clinic or inpatient department of Zhujiang Hospital and 38 normal weight(NW)control subjects with age-and sex-matched were enroll as normal group from the physical examination center of Zhujiang Hospital.The subjects of overweight/obese group were treated for 8-weeks VLCD recipes under the guidance of specialists and qualified dieticians,with a telephone follow-up everyday to supervise patients self-monitoring and adherence,every 4 weeks for an outpatient follow-up.Weight,height,waist circumference and hip circumference were measured.Body fat mass(BFM),visceral fat area(VFA),skeletal muscle mass(SMM),percentage of body fat(PBF)were detected by bioelectrical impedance analysis.Fasting blood glucose,fasting insulin,creatinine,total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),uric acid,alanine aminotransferase(ALT),aspartate aminotransferase(AST)were tested on an empty stomach,body mass index(BMI),waist-to-hip ratio(WHR),estimated glomerular filtration rate(eGFR),HOMA-%? and HOMA-IR were calculated.Body composition measurement was conducted by bioelectrical impedance and non-alcoholic fatty liver disease(NAFLD)were diagnosed by B ultrasound examination of liver.5.0ml venous blood were collected and separated for serum,which was reserved at-80 ? low temperature refrigerator and detected for levels of adiponectin(ADP),leptin,interleukin 8(IL-8),tumor necrosis factor-alpha(TNF-a),transforming growth factor betal(TGF-?1).All data were analyzed by IBM SPSS version 20.0 software.Normally distributed and continuous variables were presented as x ± s and non-normally distributed variables as median and interquartile spacing.Comparisons between groups were assessed by independent sample t-test and Chi-square test.Comparisons of pre-and post-treatment were assessed by paired samples t-test.Two tailed P<0.05 was considered statistically significant.ResultsA total of 41 OW/OB patients and 38 NW were assessed in our study and 1 patient in OW/OB group withdrew from study because of impaired liver function during VLCD intervention.Compared with baseline in the OW/OB patients who followed the VLCD treatment,body mass(-10.62±3.59kg)?waist circumference(-8.72±5.5 7cm)and visceral fat area(-33.79±27.89cm2)were significantly decreased at week 8.Blood biochemical results showed there were significant decreases in FPG,Fins,HOMA-IR,TG,UA levels and prevalence of NAFLD.Compared with baseline,serum leptin,TNF-a,IL-8 concentrations were significantly lower after VLCD(Leptin:17.38±3.08 to 11.57±2.65ng/mL,TNF-a:5.24±0.60 to 4.12±0.49 pg/mL,IL-8:1.07±0.32 to 0.66±0.20ng/mL,P<0.05),serum ADP were increased significantly at the end of VLCD(15.34±8.86 to 21.28±9.14 mg/L,P<0.01).There were no significant changes in serum TC,LDL-C,HDL-C,eGFR,CysC and TGF-?1 throughtout the study.ConclusionFor overweight and obese subjects,(1)8-weeks VLCD is an effective intervention which could reduce weight and visceral fat area and improve body posture;(2)VLCD can effectively decrease blood glucose and triglyceride level,improve insulin resistance;(3)VLCD can adjust the level of adipokines and improve obesity related complications. |
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