HOME > EDICIONES > Año 2004, Volumen 54 - Número 4
Trabajos de Investigación
Impact of the hypocaloric diet using food substitutes on the body weight and biochemical profile
Mauro Fisberg, Cecilia Lacroix de Oliveira, Isa de Pádua Cintra, Gabriela Losso, Milena Baptista Bueno, Samantha Ottani Rhein, Priscila Maximino
Adolescent Center Federal University of Sao Paulo and Sao Marcos University- Brazil
|
SUMMARY
Impact of the hypocaloric diet using food substitutes on the body weight and biochemical profile
Recent studies using balanced hypocaloric diets with food substitutes in some meals, have presented positive results. There are no studies with the Brazilian population on the efficacy of using food substitute, together with a hypocaloric diet. Main objective of this study was to verify the effects of a hypocaloric diet using food substitutes as meal replacement on the body weight, lipid profile, and glucose and insulin plasma levels. Seventy eight subjects of both genders were selected, 20-50 years old, and a body weight index between 25 kg/m² and 35 kg/m². The study lasted for six months and it was divided in 2 phases of three months each- mass reduction for 3 months and 3 months for maintenance. The sample was randomly divided in two groups: Group A (control- 3 months of general nutritional and physical orientation followed by 3 months with 1 meal replacement) and Group B (intervention- 2 meals replacement a day plus nutritional and physical orientation for 3 months followed by 3 months with 1 meal replacement).Anthropometric measurements, percent body fat (%BF), biochemical profile and intake survey were performed at moments 0, 3 and 6 months. Both groups showed a significant decrease in %BF, weight, and consequently in their BMI, in the third and sixth month of follow up. However, weight loss in group B was higher than in group A. At the end of the treatment, 0 and 25.0% of the patients of the group A and B, respectively, presented a weight loss higher than 10% of the initial weight. Comparing the triglycerides, LDL-cholesterol and glucose levels, between the beginning and after the three and six months of treatment, there was a significant reduction in the individuals only in group B. In conclusion, the use of food substitutes as meal replacement, together with a balanced, hypocaloric diet, proved to be efficient in weight loss for Brazilian overweighed individuals.
Key words: Obesity, food substitutes, meal replacement, nutritional orientation.
RESUMO
Impacto de dieta hipocalórica utilizando substitutos alimentares sobre o peso corporal e perfil bioquímico
Estudos recentes usando dietas balanceadas e hipocalóricas utilizando substitutos alimentares em algumas refeições têm mostrado resultados positivos. Não existem estudos com a população brasileira sobre a eficiência de substitutos alimentares aliados a dietas hipocalóricas. O objetivo deste estudo foi o de verificar os efeitos desta intervenção com dieta utilizando substitutos alimentares em refeições, sobre o peso corporal, perfil lipídico, e níveis de glicose e insulina. Foram selecionados 78 adultos de 20 a 50 anos, ambos sexos com Índice de Massa Corporal (IMC) entre 25 e 35 kg/m². O estudo teve a duração de seis meses sendo três de intervenção e três de manutenção. A população foi dividida randomicamente em dois grupos: A ( controle, que recebeu 3 meses de orientação nutricional e de atividade física e 3 meses de substituto alimentar em uma refeição ) e B ( intervenção, que recebeu durante 3 meses substituto alimentar em 2 refeições e 3 meses com apenas uma refeição substituída ). Análises de consumo alimentar, bioquímica, antropométrica e percentagem de gordura corporal foram realizadas ao inicio, três e seis meses. Ambos grupos mostraram diminuição significativa do peso corporal, % gordura corporal e IMC aos 3 e 6 meses de intervenção. No entanto o grupo B perdeu significativamente mais peso. Ao final do tratamento, nenhum caso do grupo A e 25% do grupo B, apresentaram perda de peso superior a 10% dos valores iniciais. Em relação aos valores bioquímicos, triacilgliceróis, LDL colesterol e glicose foram significativamente inferiores aos valores iniciais somente para o grupo intervenção. Concluímos que o uso de substitutos alimentares dentro de um plano de redução calórica equilibrada pode ser uma ferramenta eficiente para a perda de peso corporal em adultos brasileiros com excesso de peso.
Palavras chave: Obesidade, sobrepeso, substitutos alimentares, orientação nutricional.
INTRODUCTION
In the last decades, there was a quick increase in obesity prevalence both
in developed and in developing countries (1). In Brazil, there has been a
nutritional transition process, and between the years of 1974/75 and 1989, there
was a decrease in the prevalence of children malnutrition (from 19.8% to 7.6%)
and an increase in obesity prevalence in adults (from 5.7% to 9.6%) (2).
Since obesity presents a major association with metabolic
changes, such as dislipidemia, hypertension, hyperinsulinemia and glucose
intolerance(3-5), it is necessary to implement intervention and prevention
measures to fight against that nutritional disorder.
A decrease of 5 to 10% of the initial weight has been shown
to be effective in reducing the risk factors for cardiovascular diseases (6).
Changing life style by means of a hypocaloric and balanced
diet, together with physical activity, seems to be the most benefic strategy
(7). However, one of the major difficulties in weight loss programs is treatment
compliance and long-term weight maintenance.
Recent studies using balanced hypocaloric diets with food
substitutes in some meals, have presented positive results concerning those two
aspects (8,9). It is believed that those products have, in their formulation, an
adequate nutritional composition and that they facilitate the control of calorie
intake. There are no studies with the Brazilian population on the efficacy of
using food substitute, together with a hypocaloric diet, and its impact on the
body weight and metabolic profile of obese individuals.
ABESO, the regional branch of the IOTF (International Obesity
Task Force) has presented data showing that in Brazil, 40% of adult population
is overweight (19).
Nonetheless, obesity in Brazil is associated with high intake
of food and sedentarism, and morbid obesity is not as prevalent as it is in the
United States. Regional habits of food intake are, sometimes, maintained, using
the traditional combination of rice and beans, meat and salads instead of fast
food.
Therefore, the objective of the present study was to verify
the effects of a hypocaloric diet using food substitutes on the body weight,
lipid profile, and glucose and insulin plasma levels.
MATERIALS AND METHODS
Sample
The researchers selected 78 subjects of both genders (73 women and 5 men),
with ages between 20 to 50, and a body mass index (BMI=Weight (kg)/ Height (m2))
between 25 kg/m2 and 35 kg/m2. The subjects were recruited
through ads in the magazines and newspapers of the municipality of São Paulo.
The study excluded individuals with previous history or presence of chronic
diseases, endocrinal, psychiatric disorders, excessive use of alcohol, or under
drug or dietetic treatment for weight loss in the last six months, individuals
with changes in the lipid profile or lactose intolerant.
The study lasted for six months, and it was divided in 2
phases of three months each. During the first phase, the sample was randomly
divided in two groups with similar ages and genders:
Group A: control group, patients were submitted to a
hypocaloric diet with nutritional orientation.
Group B: study group, patients were submitted to a
hypocaloric diet, with the same calorie amount of the other group, and replacing
two meals, a major one (either lunch or dinner) and a small one (breakfast) with
a food substitute.
In the second phase, groups A and B were submitted to a
hypocaloric diet, replacing only one meal (either lunch or dinner) with a food
substitute.
Patients were assessed as to their lipid profile (total and
fraction cholesterol, triglycerides) and as to their glucose and insulin plasma
levels, at the beginning, and after three and six months after the beginning of
the study.
The study was conducted according to the research regulating
guidelines that involve human beings, which are in the CNS Resolutions, on
196/96, approved by the Ethics Committee of the Post Graduation and Research
Council of the Federal University of São Paulo, protocol # 1253/02. All
participants of the study were volunteers and had their consent inform taken and
signed. No financial compensation was established.
Anthropometric evaluation
In order to asses, the body weight a Filizola platform scale was used, with
a maximum load of 150 kg and 100 g accuracy. The scale was calibrated before
each measurement, and the patients were weighed standing up, with their back to
the measurement line of the scale, barefoot, and wearing a minimum amount of
clothes, with their arms down and their eyes looking at a fixed point ahead of
them to prevent oscillations in the measurement readings (11).
In order to measure their height, a stadiometer was used with
an accuracy scale of 0.1 cm. The patient was positioned on the basis of the
stadiometer, in an upright position, barefoot, with the upper limbs down at
their sides, feet together, trying to make the posterior surface of the heels,
pelvic waist, scapular waist, and occipital region touch the measuring scale. A
cursor helped to determine the measure that corresponded to the distance between
the plantar region and the vortex, being the assessed subject in aspiratory
apnea and with the head oriented to the Frankfurt plan parallel to the ground
(11).
In order to evaluate the body fat distribution, abdominal
circumference was used, measured from the middle point between the last costal
arch and the iliac crest, and the hip circumference, measured in the most
protuberant side of the glutei (11). Body fat was estimated based on equations
to predict body density. From this results % body fat can be calculed. Women
body density, was estimated with Jackson et al. (1980) equation (12).
Dietary prescription
Patients were submitted to a dietary program with a meal plan, between 1300
kcal for those with BMI lower than 30 kg/m2 and 1500 kcal for those
with BMI higher than 30 kg/m2. The diet was balanced with 50-55% of
carbohydrate, up to 30% of total fat and 20-25% of protein regarding the total
energetic value of the diet.
Individualized meal plans were developed with the help of a
list of food substitutes, divided in groups and portions with same calorie
amount. Patients were told to have at least 4 to 5 daily meals, to eat larger
amounts of food rich in vitamins, minerals, and fibers, such as fruit,
vegetables, grains, lean meats and low-fat dairy products and to reduce the
intake of saturated fat, fried food, sweets, candies and soft drinks. All the
patients had a follow up every fifteen days in an individual appointment with a
nutritionist.
The food substitute that was used was a "shake"
offered in a liquid form (325 ml per meal) or in powder (33g of powder in 235ml
of skim milk), enriched with vitamins and minerals. Nutritional composition of
macronutrients is shown in tables # 1 and 2.
TABLE 1
Nutritional composition of the
product 33g
of powder product added to skim milk
|
|
Energy value (kcal)
|
220
|
|
Total fat (g)
|
2.5
|
|
Carbohydrate (g)
|
40
|
|
Protein (g)
|
10
|
|
TABLE 2
Nutritional composition ready-to-feed
version product
|
|
Energy value (kcal)
|
200
|
|
Total fat (g)
|
1.5
|
|
Carbohydrate (g)
|
36
|
|
Protein (g)
|
11
|
|
Biochemical tests
Total and fraction cholesterol, triglycerides, glucose and insulin were
tested at the beginning of the intervention and then after three and six months
later.
All the tests were done when patients were fasting for 12
hours. Glucose, total and fraction cholesterol, and triglycerides were analyzed
by the colorimetric enzymatic test, whereas insulin was analyzed by
electrochemical luminescence.
Statistical Analysis
The changes in the value of the anthropometric and biochemical
variables, according to treatment group, were assessed by Generalized Estimating
Equation (GEE) method (13). T-Student tests were conducted to compare changes of
those measurements at each specific time point with the initial value. The test
was deemed significant when p value was lower than 0.05. The statistical pack
Stata version 7.0 was used for the analysis.
RESULTS
After six months of treatment, 56 subjects continued with the program. Out
of the 22 that abandoned the research (all female), 2 became pregnant, 1 moved
out of the State and 1 had to go through a major surgery. The demographic,
social and economical characteristics and the study group among those who
abandoned the study were similar to those of the subjects that remained (data
not shown).
Out of the total number of subjects that were in the
beginning of the study, 5 were male (3 in group A and 2 in group B). The mean
age of the subjects between the control and intervention groups was 35.36 (7.85)
and 36.59 (7.31) years, respectively.
Initially, the groups did not present differences as to the
anthropometric and biochemical variables. Both groups showed a significant
decrease in weight, and consequently in their BMI, in the third and sixth month
of follow up. However, weight loss in group B was higher than in group A (Table
3). Upon analyzing the mean values of the waist circumference, it was verified
that group A presented a significant reduction only in the sixth month, while
group B showed that reduction already in the third month. Fatty mass percentage
results, showed only for female group, were signicantly reduced for both groups
( p<0,05) . Group B presented higher reduction of fat, but no clinical or
estatistical signifance was achieved.
TABLE 3
Mean (SD) changes in
anthropometric measures at beginning,
after three and six months of treatment
|
|
|
Initial
|
Third Month
|
Sixth Month
|
|
Nº of patients
|
Group A
Group B
|
36
42
|
31
36
|
28
28
|
|
Weight (kg)
|
Group A
Group B
|
78.11 (11.29)
80.53 (13.34)
|
75.61 (12.91)*
74.71 (11.98)*
|
74.62 (12.28)*
73.11 (12.93)*
|
|
Weight loss (kg) §
|
Group A
Group B
|
---
---
|
-2.72 (2.10)
-4.32 (3.51)
|
-3,69 (3.10)
-7,16 (4.85)
|
|
IMC (kg/m2)
|
Group A
Group B
|
29.77 (3.03)
29.55 (3.20)
|
28.82 (3.36)*
27.93 (3.10)*
|
28,42 (3.16)*
26,94 (3.12)*
|
|
Waist (cm)
|
Group A
Group B
|
89.96 (11.42)
92.31 (11.74)
|
88.01 (10.31)
84.61 (8.82)*
|
86.14 (10.19)*
83.41 (9.18)*
|
|
Hip (cm)
|
Group A
Group B
|
108.46 (6.78)
111.39 (7.97)
|
104.51 (7.15)*
104.03 (7.79)*
|
104.77 (6.76)*
104.03 (8.77)*
|
|
Body Fat (%)
|
Group A
Group B
|
37.57 (5.35)
37.55 (5.52)
|
35.96 (6.25)*
33.81 (6.01)*
|
34.80 (6.31)*
33.42 (5.37)*
|
|
|
Data are represented by means and
standard deviation N(SD)
* T-student test compared with first observation.
§ GEE: treatment effect (p<0.001)
|
Figure 1 shows the percentage mean of weight loss according
to treatment group. In the first treatment month there was no difference in the
percentage of weight loss between the groups. As of the second month, group B
presents a more enhanced weight loss. As of the fourth month this difference
shows to be significant (p<0.05).
FIGURE 1
Percentage average of initial
weight change during 6 months
of treatment, in group A (control) and group B (intervention)
There was a significant change of relative loss weight
throughout time, in the GEE model (p<0.05).
At the end of the treatment, 25.0% of the patients of the
group B presented a weight loss higher than 10% of the initial weight, whereas
in group A none of the patients presented a percentage of weight loss equal or
higher than 10%. In both groups, 35.7% of the patients lost between 5 and 10% of
the initial weight and 32.1% of the study group and 50.0% of the control group
lost between 0 and 5%. Four patients of group B gained, in average, 1.37% (0.78)
and two patients of group A gained, in average 0.75% (0.64).
There was a higher reduction in the biochemical variables in
the first three months, in both treatment groups (Table 4). Comparing the
triglycerides, LDL-cholesterol and glucose levels, between the beginning and
after the three and six months of treatment, there was a significant reduction
in the individuals only in group B. It is observed that as to insulin, group B
was the only one to present a significant reduction in the third month.
TABLE 4
Biochemical measures at beginning, and after three and six months of
treatment
|
|
|
Initial
|
Third Month
|
Sixth Month
|
|
|
Cholesterol
|
Group A
Group B
|
201.53 (43.20) 193.81 (33.03)
|
174.46 (36.04)*
168.14 (31.38)*
|
187.96 (33.07)* 179.39 (26.79)*
|
|
HDL-cholesterol
|
Group A
Group B
|
53.72 (14.94) 54.12 (13.40)
|
50.71 (13.75) 49.69 (10.66)*
|
53.39 (13.60) 54.68 (13.26)
|
|
LDL-cholesterol
|
Group A
Group B
|
123.39 (42.20) 114.34 (31.05)
|
107.00 (31.95)* 99.25 (29.33)*
|
114.46 (31.38) 107.14 (21.36)*
|
|
VLDL-cholesterol
|
Group A
Group B
|
25.61 (15.82) 22.19 (10.26)
|
20.22 (10.25)* 17.61 (7.95)*
|
20.11 (9.34)* 17.57 (10.50)*
|
|
Triglycerides
|
Group A
Group B
|
117.61 (64.37) 110.61 (51.54)
|
100.83 (51.13)* 88.19 (39.83)*
|
101.00 (46.74) 87.82 (52.09)*
|
|
Glucose
|
Group A
Group B
|
90.97 (8.91) 88.57 (8.54)
|
10.53 (4.65) 10.47 (6.52)
|
84.09 (9.36)* 84.61 (8.46)
|
|
Insulin
|
Group A
Group B
|
10.21 (5.22) 7.43 (3.27)*
|
89.96 (13.39) 85.10 (7.38)*
|
9.45 (4.23)
8.33 (4.60)
|
|
Data are
represented by means and standard deviation N(SD)
* paired t-student test with initial data.
|
DISCUSSION
Obesity treatment, by means of dietetic intervention and physical exercises,
not always presented positive results, due to a high rate of individuals that
either give up or do not comply with the several treatments. Another aspect that
has drawn attention in weight loss programs is the difficulty that many
individuals experiment in keeping their weight for a long period (14). This fact
seems to be connected to lack of encouragement a low self-esteem.
In the present study, two groups (study and control groups)
were followed up for six months. Both received the same dietetic guidance, but
the study group was oriented to use a food substitute in the breakfast and in
other meal during three months. From the third to the sixth month both groups
started to use food substitutes in one of the major meals. It was observed that
in the first month of treatment, that both groups presented similar decrease of
body mass, an average of 3% of the initial values. It was concluded that all
patients were highly motivated and eager to reduce energy intake. After this
initial observation, treatment group presented a significant decrease of weight
and after three months, this was a two fold decrease as compared to control
group: (-2.72 (2.1) x -4.32 (3.5)). As of the second intervention period, the
percentage of weight loss was significantly higher in the study group than in
the control group (Figure 1). These results confirm those of other studies that
evaluated the effect of a hypocaloric diet combined with the use of food
substitutes for different periods.
Ditschuneit et al. (8) in a research conducted with a
protocol with very similar design as ours, but with larger follow up, showed
similar data. The average of weight loss in the first three months in the weight
of the group that used food substitute was 7.1 (3.5) kg and in the control group
was 1.3 (2.2) kg. An analysis conducted on studies on the efficacy of food
substitutes use in weight loss programs showed that individuals that used food
substitutes presented a more significant weight loss than those that only had a
conventional nutritional guidance, and the average difference was 2.54 to 3.01
kg between the two groups in the first three months (15).
One of the advantages of using food substitutes is the
control of caloric intake, once the individual only consumes a certain amount of
calories. Another benefit is the composition of those products, because besides
vitamins and minerals, they also have fibers that increase the feeling of being
satisfied.
The emphasis is the program proposed in this study. Both
groups had nutritional follow up every fifteen days, by nutritionists and were
encouraged to carry out frequent physical activities. Therefore, the proposal is
to adopt a healthy life style, by means of a balanced and hypocaloric diet and
physical exercises, using food substitutes.
Upon analyzing the biochemical profile, both groups presented
positive results. This can be seen as a result of the significant weight loss,
once a weight loss of 5 to 10% of the initial weight is associated with
improvement in metabolic profile (16). The difference in the lipid profile
between the two groups was that in the study group there was a significant
difference between the levels at the beginning and at the end of the six months
for triglycerides and LDL-cholesterol, whereas in the control group this
difference was observed only in the third month. This result might be a result
of the mean values relatively normal of the lipid profile variables presented by
both groups at the beginning of the study.
Ditschuneit et al. (17) evaluated the impact of the caloric
restriction using food substitute on the lipid profile and verified that there
was a significant reduction in triglycerides, only in the group that used food
substitute in the third intervention month. The mean weight loss in this group
was 7.8 (3.7) % of the initial weight. Another study that evaluated the
metabolic profile of individuals that used food substitutes showed that the
improvement of the lipid profile took place mainly in those individuals with
total cholesterol higher or equal to 220 mg/dL and that presented weight loss of
more than 5% of the initial weight (9).
As to insulin, it was verified that the study group was the
only one to present a decrease in the mean values in the first three month. This
result might be associated to a larger reduction in the waist circumference,
also observed in this group, in the third month (control group: -1.95 cm; study
group: -7.7 cm). Rice et al. (18) in a study conducted with
obese men observed that abdominal fat reduction was critical to improve
sensitivity and reduce insulin plasma levels.
Throughout the study, the only manifestation of side effects
that could be associated to product use was a transitory elimination of flatus,
which discontinued after two weeks of drug usage. Both in the control and in the
study group there was a significant change of life styles, with a gradual
increase of physical activity and reduction of body measures. In an individual
and qualitative analysis of attitude changes, all the patients mentioned
incorporation of new types of food to their diet, reduction in fried food,
chocolate and sweets consumption, and, at the same time, they mentioned a major
change in the family dynamics. Even with not much significant weight loss, there
was a change in the type of clothing, social and sexual activity, with more
acceptance by the family and social group, regardless of the analysis group.
Nutritional guidance programs, with logistics and situational support for daily
situations are essential for those attitude changes
As seen in many developed and developing countries, Brazil is
going through a nutritional transition, with a wide increase in obesity
prevalence.
Nonetheless, obesity treatment presents high rates of lack of
commitment, with patients continuingly dropping of. Using a food substitute,
helping them to daily plan their meals, has proved to be very satisfactory
during this study, with a high acceptance of product and of the entire
nutritional program.
In conclusion, the use of food substitutes together with a
balanced, hypocaloric diet, and the change in food habits proved to be efficient
in weight loss for Brazilian, overweighed individuals, being a good alternative
for overweight and obesity follow up.
aCKNOWLEDGEMENTS
Our gratitude to the dietitians that were part of the team throughout
the intervention: Samantha Cesar, Samantha Rhein, Maria Aparecida Passos, Sofia
Boschetti, Eliana Almeida and Priscila Maximino, for an outstanding job. For our
secretary, Luciana Pires. To Unilever Brazil, for giving us the food
substitutes, and for Sao Marcos University for the support.
REFERENCES
-
Popkin BM, Doak CM. The obesity epidemic is a world
phenomenon. Nutr Rev 1998; 56:106-14.
-
Monteiro CA, Mondini L, Medeiros SAL, Popkin BM. The
nutrition transition in Brazil. Eur J Clin Nutr 1995; 49:105-113.
-
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH.
Long-term morbidly and mortality of overweight adolescents: a follow-up of
the Harvard Growth Study 1922 to 1935. N Engl J Med 1992; 327:1350-55.
-
Bao W, Srinivasan SR, Berenson GS. Persistent elevation
of plasma insulin Levels is associated with increased cardiovascular risk in
children and young adults. Circulation 1996; 93:54-59.
-
Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Smith GD.
Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study
based on the Boyd Orr cohort. Am J Clin Nutr 1998; 67:1111-18.
-
Willett WC, Dietz WH, Colditz GA. Guidelines for healthy
weight (review). N Engl J Med 1999; 341:427-34.
-
Van Dale D, Saris WHM, Schoffelen PFM, Ten Hoor F. Does
exercise give an additional effect in weight reduction regimens? Int J Obes
1987; 11:367-75.
-
Ditschuneit HH, Flechtner-Mors M, Johnson TD, Alder G.
Metabolic and weight-loss effects of a long-term dietary intervention in
obese patients. Am J Clin Nutr 1999; 69:198-204.
-
Ashley JM, Jeor ST, Schrage JP, Perumean-Chaney SE,
Gilbertson MC, McCall NL, Bovee V. Weight Control in the Physician's Office.
Arch Intern Med 2001; 161: 1599-604.
-
Brasil – Instituto Nacional de Câncer, Ministério da
Saúde (Secretaria de Vigilância em Saúde). Inquérito domiciliar sobre
comportamentos de risco e morbidade referida de doenças e agravos não
transmissíveis. Available in http://www.inca.gov.br
em 27/10/2004.
-
Lohman TG, Roche AF, Martorrel R. Anthropometric
Standardization Reference Manual. Champaign, Illinois, Human Kinetics; 1988.
-
Jackson, AS; Pollock, ML, Ward, A. Generalized equations
for predicting body density of women. Medicine and Science in Sports and
Exercise. 1980; 12:175-82.
-
Twiski, JWR. Applied longitudinal data analysis for
epidemiology practical guide. United Kingdom: Cambridge University Press,
2003.
-
Goodrick GK, Foreyt JP. Why treatments for obesity don't
last. J Am Diet Assoc 1991; 91: 1243-47.
-
Heymsfield SB, van Mierlo CAJ, van der Knaap HCM, Heo M,
Frier HI. Weight management using a meal replacement strategy: meta and
pooling analysis from six studies. Int J Obes 2003; 27:537-49.
-
Janssen I, Fortier A, Hudson R, Ross R. Effects of an
energy-restrictive diet with or without exercise on abdominal fat,
intramuscular fat, and metabolic risk factors in obese women. Diabetes Care
2002;25:431-38.
-
Ditschuneit HH, Frier HI, Flechtner-Mors M. Lipoprotein
responses to weight loss and weight maintenance in high-risk obese subjects.
Eur J Clin Nutr 2002; 56:264-70.
-
Rice B, Janssen I, Hudson R, Ross R. Effects of aerobic
or resistance exercise and/or diet on glucose tolerance and plasma insulin
levels in obese men. Diabetes Care 1999; 22:684-91.
Recibido: 16/07/2004
Aceptado: 22/12/2004
 |
PRIVACIDAD | ACCESIBILIDAD
ALAN-VE ISSN 0004-0622 - Depósito Legal: pp 199602DF83
Sociedad Latinoamericana de Nutrición
Producción editorial en Venezuela: Capítulo Venezolano - RIF: J-30843129-0
Urbanización Santa María, primera transversal, No. 417-214, Planta Alta
Tele-Fax: (+58-212) 283.8618
E-mail info@alanrevista.org
Código Postal: 1070
Caracas - Venezuela |
|
|
Ir al principio