Department of General Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
Weight Management Center, Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, USA.
Diabetes Obes Metab. 2024 Sep;26 Suppl 4:28-38. doi: 10.1111/dom.15819. Epub 2024 Aug 7.
Obesity is a complex chronic disease with increasing prevalence across the globe. Medical nutrition therapy (MNT) is an important component of obesity treatment, and low-calorie diets (LCDs) and very-low-calorie diets (VLCDs) are part of the MNT toolbox. This narrative review focuses on the latest evidence and clinical guidelines regarding the use and impact of meal replacements (MRs) as part of LCDs/VLCDs for the treatment of obesity and some associated complications. MRs can be used in conjunction with food as partial diet replacement (PDR) or can be used exclusively to serve as the sole source of dietary energy (total diet replacement [TDR]). Use of MR may be associated with better control of cravings and hunger typically observed during reduced calorie intake through effects of ketosis or stimuli narrowing, although the exact mechanisms for these effects remain unclear. Several clinical guidelines have endorsed the use of MRs as a part of MNT for obesity, primarily based on evidence that shows an average weight reduction of ~10 kg or more with TDR over at least 12 months in large, randomized controlled trials. When compared to usual care controls, these effects are 6-8 kg greater, and when compared to food-based diets, the effects are nearly twice the effect of a food-based diet. MR-based diets have been found to be safe and associated with improvements in quality of life. These diets are also effective for improving key cardiometabolic health outcomes, including dysglycaemia, blood pressure, lipids, and metabolic associated fatty liver. The effectiveness, safety, and associated health improvement makes MRs use a valuable strategy for several higher risk clinical scenarios where weight reduction is indicated.
肥胖是一种复杂的慢性疾病，在全球范围内的患病率不断增加。医学营养疗法（MNT）是肥胖治疗的重要组成部分，低热量饮食（LCD）和极低热量饮食（VLCD）是 MNT 工具包的一部分。本叙述性综述重点介绍了关于使用代餐作为 LCD/VLCD 治疗肥胖症和一些相关并发症的最新证据和临床指南。代餐可以与食物一起作为部分饮食替代（PDR）使用，也可以单独用作膳食能量的唯一来源（总饮食替代 [TDR]）。使用代餐可能与更好地控制在减少热量摄入时通常观察到的渴望和饥饿有关，这可能是通过酮症或刺激变窄的影响，但这些影响的确切机制仍不清楚。几项临床指南都支持将代餐作为肥胖 MNT 的一部分，主要基于在大型随机对照试验中，TDR 在至少 12 个月内平均减轻 10 公斤或更多体重的证据。与常规护理对照相比，这些效果增加了 6-8 公斤，与基于食物的饮食相比，效果几乎是基于食物的饮食的两倍。基于代餐的饮食被发现是安全的，并能改善生活质量。这些饮食还能有效改善关键的心血管代谢健康结果，包括血糖异常、血压、血脂和代谢相关的脂肪肝。有效性、安全性和相关的健康改善使得代餐的使用成为几种需要减轻体重的高风险临床情况下的有价值的策略。
