Vogels N, Westerterp-Plantenga M S
Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
Int J Obes (Lond). 2005 Jul;29(7):849-57. doi: 10.1038/sj.ijo.0802984.
The aim of this study was to investigate the effect of categorical strategies based on subject-specific characteristics of dietary restraint and physical activity, on weight maintenance (WM) in overweight and obese subjects, after a very low calorie diet (VLCD). Furthermore, find predictors of WM that can be important in the context of obesity treatment.
In all, 120 subjects (age: 49.0+/-9.8 y, BMI 31.0+/-3.8 kg/m(2)) followed a VLCD (2.1 MJ/day) for 6 weeks in a free-living situation, followed by a period of 1 y WM. Body weight (BW), body composition, leptin concentration, dietary restraint and physical activity were determined right before (t0) and after (t1) the VLCD, after 3 months (t2) and after 1 y (t3). During WM, subjects were divided into four categories of WM guidelines (dietary, activity, diet+activity, placebo), taking their capability measured during weight loss and their preference for particular guidelines into account.
BW loss during VLCD was 7.0+/-3.1 kg. After 1 y follow-up, BW regain was 56.3+/-55.0%, without significant differences between the four groups. With respect to measured capability during weight loss, subjects with an increased dietary restraint (F1 of the Three Factor Eating Questionnaire) had less BW regain than subjects with an increased physical activity (Baecke questionnaire) (35.5+/-53.2 vs 68.5+/-46.4%, P<0.05). Moreover, activity guidelines promoted WM in dietary disciplined subjects compared to activity-related disciplined subjects (% regain: 25.2 vs 74.3%, P<0.05). Subjects receiving guidelines that were opposite to their preference showed a better WM than subjects receiving preferred guidelines. After 1 y WM, 21 subjects were successful (<10% BW regain) and 99 unsuccessful (> or =10% BW regain). At baseline, these groups were significantly different in BMI (resp. 32.7+/-4.9 vs 30.7+/-3.5 kg/m(2), P<0.05), waist circumference (106.5+/-14.0 vs 100.6+/-11.2 cm, P<0.05) and fat mass (FM) (35.2+/-10.6 vs 32.1+/-6.6%, P=0.06). Finally, successful subjects appeared to spare fat-free mass (FFM) to a greater extent than unsuccessful subjects.
After weight loss, type of guidelines (dietary, activity, placebo) is not related to the magnitude of WM, whereas guidelines opposite to the subject's capability and preference are related. These only reach successful WM (>90%) in originally dietary disciplined subjects who are supported by characteristics such as a relatively high baseline BMI, waist circumference and FM, together with the ability to spare FFM.
本研究旨在探讨基于饮食节制和身体活动的个体特征的分类策略对极低热量饮食（VLCD）后超重和肥胖受试者体重维持（WM）的影响。此外，找出在肥胖治疗背景下对体重维持至关重要的预测因素。
总共120名受试者（年龄：49.0±9.8岁，BMI 31.0±3.8kg/m²）在自由生活环境中进行了为期6周的极低热量饮食（2.1MJ/天），随后是1年的体重维持期。在极低热量饮食前（t0）和后（t1）、3个月后（t2）以及1年后（t3）测定体重（BW）、身体成分、瘦素浓度、饮食节制和身体活动。在体重维持期间，根据受试者在减肥期间测量的能力以及他们对特定指导方针的偏好，将受试者分为四类体重维持指导方针（饮食、活动、饮食+活动、安慰剂）。
极低热量饮食期间体重减轻7.0±3.1kg。随访1年后，体重反弹为56.3±55.0%，四组之间无显著差异。就减肥期间测量的能力而言，饮食节制增加的受试者（三因素饮食问卷的F1）体重反弹比身体活动增加的受试者（贝克问卷）少（35.5±53.2%对68.5±46.4%，P<0.05）。此外，与活动相关自律的受试者相比，活动指导方针促进了饮食自律受试者的体重维持（反弹百分比：25.2%对74.3%，P<0.05）。接受与他们偏好相反指导方针的受试者比接受偏好指导方针的受试者体重维持得更好。体重维持1年后，21名受试者成功（体重反弹<10%），99名受试者失败（体重反弹≥10%）。在基线时，这些组在BMI（分别为32.7±4.9对30.7±3.5kg/m²，P<0.05）、腰围（106.5±14.0对100.6±11.2cm，P<0.05）和脂肪量（FM）（35.2±10.6对32.1±6.6%，P=0.06）方面有显著差异。最后，成功的受试者似乎比失败的受试者在更大程度上保留无脂肪体重（FFM）。
减肥后，指导方针的类型（饮食、活动、安慰剂）与体重维持的幅度无关，而与受试者的能力和偏好相反的指导方针有关。这些指导方针仅在最初饮食自律的受试者中实现成功的体重维持（>90%），这些受试者具有相对较高的基线BMI、腰围和FM等特征，以及保留无脂肪体重的能力。
