Toubro S, Astrup A
Research Department of Human Nutrition, Royal Veterinary and Agricultural University, Copenhagen, Denmark.
BMJ. 1997 Jan 4;314(7073):29-34. doi: 10.1136/bmj.314.7073.29.
To compare importance of rate of initial weight loss for long term outcome in obese patients and to compare efficacy of two different weight maintenance programmes.
Subjects were randomised to either rapid or slow initial weight loss. Completing patients were re-randomised to one year weight maintenance programme of ad lib diet or fixed energy intake diet. Patients were followed up one year later.
University research department in Copenhagen, Denmark.
43 (41 women) obese adults (body mass index 27-40) who were otherwise healthy living in or around Copenhagen.
8 weeks of low energy diet (2 MJ/day) or 17 weeks of conventional diet (5 MJ/day), both supported by an anorectic compound (ephedrine 20 mg and caffeine 200 mg thrice daily); one year weight maintenance programme of ad lib, low fat, high carbohydrate diet or fixed energy intake diet (< or = 7.8 MJ/day), both with reinforcement sessions 2-3 times monthly.
Mean initial weight loss and proportion of patients maintaining a weight loss of > 5 kg at follow up.
Mean initial weight loss was 12.6 kg (95% confidence interval 10.9 to 14.3 kg) in rapid weight loss group and 12.6 (9.9 to 15.3) kg in conventional diet group. Rate of initial weight loss had no effect on weight maintenance after 6 or 12 months of weight maintenance or at follow up. After weight maintenance programme, the ad lib group had maintained 13.2 (8.1 to 18.3) kg of the initial weight loss of 13.5 (11.4 to 15.5) kg, and the fixed energy intake group had maintained 9.7 (6.1 to 13.3) kg of the initial 13.8 (11.8 to 15.7) kg weight loss (group difference 3.5 (-2.4 to 9.3) kg). Regained weight at follow up was greater in fixed energy intake group than in ad lib group (11.3 (7.1 to 15.5) kg v 5.4 (2.3 to 8.6) kg, group difference 5.9 (0.7 to 11.1) kg, P < 0.03). At follow up, 65% of ad lib group and 40% of fixed energy intake group had maintained a weight loss of > 5 kg (P < 0.07).
Ad lib, low fat, high carbohydrate diet was superior to fixed energy intake for maintaining weight after a major weight loss. The rate of the initial weight loss did not influence long term outcome.
比较肥胖患者初始体重减轻速度对长期预后的重要性，并比较两种不同体重维持方案的疗效。
将受试者随机分为初始体重快速减轻组或缓慢减轻组。完成减重的患者再随机分为自由饮食或固定能量摄入饮食的一年体重维持方案。一年后对患者进行随访。
丹麦哥本哈根的大学研究部门。
43名（41名女性）肥胖成年人（体重指数27 - 40），居住在哥本哈根及其周边地区，身体健康。
8周低能量饮食（2兆焦耳/天）或17周常规饮食（5兆焦耳/天），均辅以一种食欲抑制剂（麻黄碱20毫克和咖啡因200毫克，每日三次）；自由饮食、低脂高碳水化合物饮食或固定能量摄入饮食（≤7.8兆焦耳/天）的一年体重维持方案，两种方案每月均有2 - 3次强化课程。
平均初始体重减轻情况以及随访时体重减轻超过5千克的患者比例。
快速减重组的平均初始体重减轻为12.6千克（95%置信区间10.9至14.3千克），常规饮食组为12.6（9.9至15.3）千克。初始体重减轻速度对体重维持6个月或12个月后或随访时的体重没有影响。体重维持方案后，自由饮食组在初始体重减轻13.5（11.4至15.5）千克的基础上维持了13.2（8.1至18.3）千克，固定能量摄入组在初始体重减轻13.8（11.8至15.7）千克的基础上维持了9.7（6.1至13.3）千克（组间差异3.5（-2.4至9.3）千克）。随访时固定能量摄入组的体重反弹比自由饮食组更大（11.3（7.1至15.5）千克对5.4（2.3至8.6）千克，组间差异5.9（0.7至11.1）千克，P < 0.03）。随访时，自由饮食组65%的患者和固定能量摄入组40%的患者体重减轻超过5千克（P < 0.07）。
在大幅减重后，自由饮食、低脂高碳水化合物饮食在维持体重方面优于固定能量摄入饮食。初始体重减轻速度不影响长期预后。
