[Management of obesity--zero diet or calorie-reduced diet? Calorie-reduced diet].
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The influence of a 4-weeks carbohydrate-reduced, fat-rich diet on 9 slightly overweighted men was investigated. Caloric and protein intake remained unchanged. 70% were fat, 20% carbohydrates. Glucose, cholesterol, triglycerids, serumproteins, urea, uric acid, sodium and potassium were measured in rest. At a 60 minutes bicycle ergometer test glucose, triglycerids, free fatty acids and glycerol were registrated before and after 20 and 60 minutes work. The intensity was 70% of the maximal oxygen uptake. These were the most important results: (1) Body weight decreased continuously. One of the causes is an elevated heat production. (2) Serum-protein and -glucose remained unchanged. Cholesterol and triglycerides were reduced. Serum-urea, -sodium and -potassium diminished continually. On the contrary, uric acid raised over the normal range. (3) Work performance was reduced for 20%. (4) Hypoglycemic values did not appear. The oxidation of fat by the working muscles, and fat mobilisation increased by a fat-rich diet.
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Groups of 15 rats each (I--non-reduced diet; II--non-reduced diet and physical stress; III--diet reduced by 40%; IV--reduced diet and physical stress) were examined after 20 and 140 days, respectively. The electron microscopic examination revealed that the most important changes had occurred in group III; there exists an excess of autophagolysosomes. The biochemical examinations show that the reduced diet (group III) also produces a considerable increase in activity of most of the lysosome enzymes in the liver. The occurrence of autophagy evidences that this is either physiologically induced or the manifestation of a beginning pathological process.
The effect of calorifically reduced diet No 8e on the lipoproteinic composition of the blood serum in patients with metabolic-alimentary adiposity was studied. Most of the patients examined demonstrated hyperlipoproteinemia, basically of the IIb type, more seldom of the IIa and IV types. Following a course of the reduced diet the frequency of hyperlipoproteinemia of the II, III and IV types declines and the content of atherogenid lipoprotein fractions in the serum goes down. In young patients the effect of a reduced diet on the lipoprotein composition of the blood serum proved most effective.
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It must be readily understood that the only possibility of fighting obesity is by bringing about a reversal in the energy balance so that inputs are smaller than outputs. At least theoretically, then, obesity's special quality is that it does not present any therapeutic problem. Restriction in food intake is currently the treatment of choice; to be effective, food intake must be cut so that the energy provided is below the obese person's daily consumption, on average below 1200 calories per day, while at the same time holding a comparatively high intake of indispensable elements (proteins, vitamins, certain minerals and oligo-elements). The physician has a choice of various possibilities represented by fasting, a variety of free or controlled diets, protein diets or diets with low carbohydrate content and with a variable fat content; dissociated, zig-zag, one food diets etc. Substantially all these tend to limit the total quantity of glycides and boost the feeling of satiety by increasing the total volume of good while keeping total calories unvaried. It is clear that each of them has specific indications and clear-cut contraindications. The aim is to produce a calory shortfall, not cause denutrition. The diet must therefore be suited to the individual directed during subsequent stages of weight loss in relation to the patient's specific requirements (number of meals, etc.).
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A method of measuring body density is presented which allows much greater precision in calculating the fat content of the human body than the usual methods of under-water weighing. Using this method, body fat was determined for three groups: normal weight, moderately overweight, and obese subjects. In spite of vast amounts of energy stored in the obese patient, no advantages for the pre- or post-surgical phase result. The explanation for this paradoxical situation is seen in two factors: 1. The cardiovascular system is not capable of delivering more energy because mobilisation of fat depends on corresponding oxygen intake. 2. Aside from this, a metabolic limiting factor exists in the mobilisation of protein reserves for the production of glucose, which leads to a considerable protein loss the first few weeks of a period of abstinence. In posttraumatic or post-operative situations, this protein mobilisation is particularly strong, especially when connected with a high metabolic intake. The high nitrogen loss and/or the high metabolic rate, is illustrated on the basis of severe skull and brain traumas. The differences between absolute fasting and a 200kcal-protein formula diet were experimentally investigated. The nitrogen loss under the protein diet was decisively less. An anabolic phase even reappeared after three weeks of the diet. The 200kcal-diet therefore represents a means of pre-operative weight reduction without protein loss. The alterations in body composition are almost exclusively the results of reduction in excess fat. This is demonstrated by means of clinical examples.
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