Publication: LOW CALORIE DIET USING LIQUID MEAL REPLACEMENTS VERSUS CONVENTIONAL FOOD FOR WEIGHT LOSS IN OBESE MALAYSIAN ADULTS WITH TYPE 2 DIABETES IN AN OUTPATIENT CLINIC SETTING
Date
2017
Authors
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Journal ISSN
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Publisher
International Medical University
Abstract
Introduction: Little is known about the utility of meal replacements to manage obesity
in Malaysians with diabetes. This study investigated the use of a low calorie diet,
incorporating liquid meal replacements versus using conventional food, on weight loss
in Malaysian adults with Type 2 Diabetes and obesity in an outpatient clinic setting
over a period of 12 months.
Methods: In this single-centre non-blinded study, 70 subjects (women: 68.6%; mean
+ SD age: 47.5 + 9.5 years; mean + SD Body Mass Index: 32.7 + 3.6) were randomized
into one of three isocaloric low calorie diet groups: MR1 (n=20); MR2 (n=30); CD
(n=20). In Phase 1 (Baseline to 6-months), the intervention differed across groups by
use of MR: MR1 – one MR/day; MR2 – two MR/day; CD – conventional food only.
In Phase 2 (6-months to 12-months), all groups followed a conventional food only low
calorie diet. Primary outcomes were changes in weight and waist circumference.
Secondary outcomes were changes in glycaemic control, lipid profile, blood pressure,
and energy/macronutrient intake. Dietary challenges encountered in Phase 1 were also
assessed.
Results: Subjects who completed both Phase 1 and 2 (MR1: n=11; MR2: n=9; CD:
n=11) were included for analysis. There were significant baseline differences between
the study groups (body weight, BMI, waist circumference, and blood pressure) that
did not have significant effect on change in primary outcomes over time and
adjustments for these covariates were not preformed. From baseline to 6-months, mean
+ SE weight change (kg) (MR1: -1.6 + 0.6; MR2: -3.8 + 0.9; CD: -2.4 + 0.6) was not
significant between groups but significant within MR2 and CD. Mean + SE waist
circumference change (cm) (MR1: -1.9 + 0.9; MR2: -3.5 + 1.0; CD: -2.3 + 1.0) was not significant between groups but significant within MR2. The MR2 group had the
highest proportion of subjects who achieved a weight loss of > 5% from baseline
(MR1: 14.3%; MR2: 40.0%; CD: 16.7%). Among the meal replacers, the median +
IQR number of MR sachets consumed/day was significantly higher in subjects who
achieved (1.0 + 0.4) than subjects who did not achieve (0.6 + 0.9) > 5% weight loss.
Change in both fasting blood glucose and HbA1c was not significant between groups.
Mean + SE fasting glucose change (mmol/L) (MR1: 0.2 + 0.5; MR2: -2.8 + 0.7; CD:
-1.5 + 0.6) was significant within MR2, while HbA1c change (% point) (MR1: -0.5 +
0.2; MR2: -0.6 + 0.83; CD: -1.0 + 0.3) was significant within CD. No significant
change was seen in lipid profile and blood pressure between and within all groups.
Mean + SE energy intake change (kcal/day) (MR1: -426 + 112; MR2: -515 + 157; CD:
-463 + 129) was not significant between but significant within groups. No significant
macronutrient intake change was seen between groups. Mean + SE carbohydrate
intake change (g/day) (MR1: -61.7 + 13.0; MR2: -65.5 + 17.2; CD: -35.2 + 23.2) was
significant within MR1 and MR2 while fat intake change (g/day) (MR1: -20.1 + 7.5;
MR2: -24.8 + 9.2; CD: -31.8 + 6.4) was significant within CD. No significant change
was seen in protein intake within all groups. At 12-months, only MR2 maintained a
mean + SE weight change of -2.3 + 0.7 kg. Recidivism at 12-months was seen in all
other outcomes within all groups. Irrespective of groups, subjects faced similar
challenges with hunger, dietary deprivation, social support, need for constant care,
food planning, and life complications. Challenges specific to meal replacement use
were taste fatigue and unsuitability of the regimen or meal replacement product.
Conclusion: With low calorie diets in adults with obesity and Type 2 Diabetes, there
was no difference between the use of meal replacement and conventional food for
weight and energy intake reduction. However, subjects in the MR2 group had better weight loss (6-months) and weight maintenance (12-months) when compared to MR1
or CD. Among the meal-replacers, increased compliance to the meal replacement
regimen was associated with greater weight loss. During energy intake restriction, use
of meal replacement produced compensatory reductions in carbohydrate intake while
use of conventional food produced compensatory reductions in fat intake.
Description
Keywords
Obesity, Caloric Restriction, Weight Loss, Diabetes Mellitus, Type 2, Body Mass Index, Blood Glucose, Ambulatory Care Facilities, Adult