Parretti H M, Jebb S A, Johns D J, Lewis A L, Christian-Brown A M, Aveyard P
Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
Obes Rev. 2016 Mar;17(3):225-34. doi: 10.1111/obr.12366. Epub 2016 Jan 18.
Guidelines suggest that very-low-energy diets (VLEDs) should be used to treat obesity only when rapid weight loss is clinically indicated because of concerns about rapid weight regain. Literature databases were searched from inception to November 2014. Randomized trials were included where the intervention included a VLED and the comparator was no intervention or an intervention that could be given in a general medical setting in adults that were overweight. Two reviewers characterized the population, intervention, control groups, outcomes and appraised quality. The primary outcome was weight change at 12 months from baseline. Compared with a behavioural programme alone, VLEDs combined with a behavioural programme achieved -3.9 kg [95% confidence interval (CI) -6.7 to -1.1] at 1 year. The difference at 24 months was -1.4 kg (95%CI -2.6 to -0.2) and at 38-60 months was -1.3 kg (95%CI -2.9 to 0.2). Nineteen per cent of the VLED group discontinued treatment prematurely compared with 20% of the comparator groups, relative risk 0.96 (0.56 to 1.66). One serious adverse event, hospitalization with cholecystitis, was reported in the VLED group and none in the comparator group. Very-low-energy diets with behavioural programmes achieve greater long-term weight loss than behavioural programmes alone, appear tolerable and lead to few adverse events suggesting they could be more widely used than current guidelines suggest.
指南建议，仅在临床上因担心体重快速反弹而有快速减重指征时，才应使用极低能量饮食（VLEDs）治疗肥胖症。检索了从起始至2014年11月的文献数据库。纳入的随机试验中，干预措施包括VLED，对照为无干预或在成年超重人群的普通医疗环境中可采用的干预措施。两名研究者对研究人群、干预措施、对照组、结局进行了描述并评估了质量。主要结局是自基线起12个月时的体重变化。与单纯行为方案相比，VLED联合行为方案在1年时体重减轻了-3.9 kg [95%置信区间（CI）-6.7至-1.1]。24个月时的差异为-1.4 kg（95%CI -2.6至-0.2），38 - 60个月时为-1.3 kg（95%CI -2.9至0.2）。VLED组19%的患者提前终止治疗，对照组为20%，相对危险度0.96（0.56至1.66）。VLED组报告了1例严重不良事件，即因胆囊炎住院，对照组无不良事件报告。极低能量饮食联合行为方案比单纯行为方案能实现更大程度的长期体重减轻，似乎耐受性良好且不良事件较少，这表明其使用范围可比当前指南所建议的更广泛。
