Efectos a Largo Término en Personas Obesas

7/21/2019 Efectos a Largo Trmino en Personas Obesas.

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Long-term effects of a ketogenic diet in obese patients

Hussein M Dashti,MD PhD FICS FACS,1Thazhumpal C Mathew, MSc PhD FRCPath,4Talib Hussein,MB ChB,Sami ! As"a#,MB ChB MD FRCS$% FACS,1Ab%ulla Behbahani,MB ChB FRCS FACSI PhDFICS FACS,1M&usa A !h&u#shee%,MB ChB FRCS FICS,1Hilal M Al'Sa(e#, MD PhD FICSFACS,1)&use" ) B&'Abbas,MD FRCPC,*an%+ai S Al'-ai%, BSc PhD.

Auth in"mati&n /C&p(#i0ht an% icense in"mati&n /

Obesity has become a serious chronic disease in both developing and developed countries.

Further

BACKGROUND:

Although various studies have examined the short-term efects o a !etogenicdiet in reducing "eight in o#ese $atients% its long-term efects on various

$h&sical and #iochemical $arameters are not !no"n'

OB()C*+,):

*o determine the efects o a .-"ee! !etogenic diet /consisting o 01 gcar#oh&drate% 2 g3!g #od& "eight $rotein% 14 saturated at% and 514$ol&unsaturated and monounsaturated at6 in o#ese $atients'

7A*+)N*8 AND 9)*OD8:

+n the $resent stud&% 50 o#ese $atients /0; men and .. "omen6 "ith a #od&mass index greater than 0< !g3m% and high glucose and cholesterol levels"ere selected' *he #od& "eight% #od& mass index% total cholesterol% lo" densit&li$o$rotein /=D=6 cholesterol% high densit& li$o$rotein /D=6 cholesterol%trigl&cerides% asting #lood sugar% urea and creatinine levels "ere determined#eore and ater the administration o the !etogenic diet' Changes in these$arameters "ere monitored ater eight% 2> and . "ee!s o treatment'

R)8U=*8:

*he "eight and #od& mass index o the $atients decreased signi?cantl&/7@1'11126' *he level o total cholesterol decreased rom "ee! 2 to "ee! .'D= cholesterol levels signi?cantl& increased% "hereas =D= cholesterol levels
http://www.ncbi.nlm.nih.gov/pubmed/?term=Dashti%20HM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Dashti%20HM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mathew%20TC%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mathew%20TC%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Hussein%20T%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Hussein%20T%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Asfar%20SK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Asfar%20SK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Asfar%20SK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Behbahani%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Behbahani%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Behbahani%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Khoursheed%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Khoursheed%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Sayer%20HM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Sayer%20HM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bo-Abbas%20YY%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bo-Abbas%20YY%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Zaid%20NS%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/http://www.ncbi.nlm.nih.gov/pubmed/?term=Mathew%20TC%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Hussein%20T%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Asfar%20SK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Behbahani%20A%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Khoursheed%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Sayer%20HM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bo-Abbas%20YY%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Zaid%20NS%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/http://www.ncbi.nlm.nih.gov/pubmed/?term=Dashti%20HM%5Bauth%5D


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signi?cantl& decreased ater treatment' *he level o trigl&cerides decreasedsigni?cantl& ollo"ing . "ee!s o treatment' *he level o #lood glucosesigni?cantl& decreased' *he changes in the level o urea and creatinine "erenot statisticall& signi?cant'

CONC=U8+ON8:

*he $resent stud& sho"s the #ene?cial efects o a long-term !etogenic diet' +tsigni?cantl& reduced the #od& "eight and #od& mass index o the $atients'urthermore% it decreased the level o trigl&cerides% =D= cholesterol and #loodglucose% and increased the level o D= cholesterol' Administering a !etogenicdiet or a relativel& longer $eriod o time did not $roduce an& signi?cant sideefects in the $atients' *hereore% the $resent stud& con?rms that it is sae touse a !etogenic diet or a longer $eriod o time than $reviousl& demonstrated'

Ke&"ords: Diet% Ketosis% O#esit&

O#esit& has #ecome a serious chronic disease in #oth develo$ing anddevelo$ed countries' urthermore% it is associated "ith a variet& o chronicdiseases /2.6' +t is estimated that in the United 8tates alone a$$roximatel&011%111 $eo$le die each &ear rom o#esit&-related diseases /6' Diferentmethods or reducing "eight using reduced calorie and at inta!e com#ined"ith exercise have ailed to sho" sustained long-term efects /;6' Recentstudies rom various la#oratories /21%226% including our o"n /26% have sho"nthat a high at diet rich in $ol&unsaturated att& acids /!etogenic diet6 is uiteefective in reducing #od& "eight and the ris! actors or various chronicdiseases' *he !etogenic diet "as originall& introduced in 2;1 /206' +n this diet%the at to car#oh&drate ratio is


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mammals' Although most o the changes in the $h&siological $arametersinduced ollo"ing exercise revert #ac! to their normal values ra$idl&% the levelo circulating !etone #odies increases or a e" hours ater muscular activit&ceases /26' +t has #een ound that in trained individuals% a lo" #lood !etonelevel $rotects against the develo$ment o h&$ogl&cemia during $rolongedintermittent exercise /6' +n addition% !etosis has a signi?cant inIuence onsu$$ressing hunger' *hus% a !etogenic diet is a good regulator o the #od&scalorie inta!e and mimics the efect o starvation in the #od&+t is generallelieved that high at diets ma& lead to the develo$ment o o#esit& and severalother diseases such as coronar& arter& disease% dia#etes and cancer' *his vie"%ho"ever% is #ased on studies carried out in animals that "ere given a high atdiet rich in $ol&unsaturated att& acids' +n contrast% our la#orator& has recentl&sho"n that a !etogenic diet modi?ed the ris! actors or heart disease in o#ese$atients /26'

Although various short-term studies examining the efect o a !etogenic diet inreducing the "eight o o#ese $atients have #een carried out /216% its long-termefects in o#ese su#Fects are not !no"n /2


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*AB=) 2

*AB=) 2

7atient data at #aseline #eore treatment "ith the !etogenic diet

7rotocol or !etogenic diet-induced #od& "eight reduction

All 50 su#Fects received the !etogenic diet consisting o 1 g to 01 g ocar#oh&drate in the orm o green vegeta#les and salad% and 51 g to 211 g o$rotein in the orm o meat% ?sh% o"l% eggs% shell?sh and cheese'7ol&unsaturated and monounsaturated ats "ere also included in the diet'*"elve "ee!s later% an additional 1 g o car#oh&drate "ere added to the mealo the $atients to total .1 g to th and .th "ee! "ere ;2'21J'> !g% 5;'0;J0'. !g

and 5>'>J0'1 !g% res$ectivel& /igure 26' 8imilar to the loss in #od& "eight% asigni?cant decrease "as o#served in the B9+ o the $atients ollo"ing theadministration o the !etogenic diet' *he initial B9+% and the B9+ ater theeighth% 2>th and .th "ee! "ere 0'J1'; !g3m% 00';1J1'50 !g3m%00'.J2'11 !g3m and 0'1>J2'20 !g3m% res$ectivel& /igure 6'

igure 26


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igure 26

Reduction in #od& "eight at eight% 2> and . "ee!s ollo"ing theadministration o the !etogenic diet in o#ese $atients' *he "eights areex$ressed as mean J 8)9

igure 6igure 6

Decrease in #od& mass index at eight% 2> and . "ee!s during theadministration o a !etogenic diet in o#ese $atients' *he values are ex$ressedas mean J 8)9

*he level o total cholesterol sho"ed a signi?cant decrease rom "ee! 2 to"ee! . /igure 06' *he level o D= cholesterol signi?cantl& increased /igure.6% "hereas =D= cholesterol levels signi?cantl& decreased "ith treatment/igure J1'05 mmol3=% and . "ee!s during the administration o a !etogenicdiet

igure .6

igure .6

Changes in the level o high densit& li$o$rotein /D=6 cholesterol in o#ese$atients during treatment "ith a !etogenic diet or a $eriod o . "ee!s' Dataare ex$ressed as mean J 8)9

igure


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igure >6

Changes in the level o trigl&cerides in o#ese $atients during treatment "ith a!etogenic diet over a $eriod o . "ee!s' *he values are ex$ressed as mean J8)9

igure 6igure 6

Decreased levels o #lood glucose /ex$ressed as mean J 8)96 in o#ese$atients at eight% 2> and . "ee!s during the administration o a !etogenicdiet

igure 56

igure 56

Changes in the level o urea in o#ese $atients during a .-"ee! !etogenic diet'*he level o urea is ex$ressed as mean J 8)9

igure ;6

igure ;6

Changes in the level o creatinine in o#ese $atients during a .-"ee! !etogenicdiet' ,alues are ex$ressed as mean J 8)9

Go to:

D+8CU88+ON

Until recentl&% !etosis "as vie"ed "ith a$$rehension in the medical "orldL

ho"ever% current advances in nutritional research have discounted thisa$$rehension and increased $u#lic a"areness a#out its avoura#le efects' +nhumans% !etone #odies are the onl& additional source o #rain energ& aterglucose /0%.6' *hus% the use o !etone #odies #& the #rain could #e asigni?cant evolutionar& develo$ment that occurred in $arallel "ith #raindevelo$ment in humans' e$atic generation o !etone #odies during asting isessential to $rovide an alternate uel to glucose' *his is necessar& to s$are thedestruction o muscle rom glucose s&nthesis'

A !etogenic diet is clinicall& and ex$erimentall& efective in antie$ile$tic and

antio#esit& treatmentsL ho"ever% the molecular mechanisms o its actionremain to #e elucidated' +n some cases% a !etogenic diet is ar #etter thanmodern anticonvulsants /


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those "ho sufer rom de$ression or mania /56' +t has also #een ound that a!etogenic diet afects signal transduction in neurons #& inducing changes in the#asal status o $rotein $hos$hor&lation /;6' +n another stud& /016% it "assho"n that a !etogenic diet induced gene ex$ression in the #rain' *hesestudies $rovide evidence to ex$lain the actions o a !etogenic diet in the #rain'

One o the mechanisms o a !etogenic diet in e$ile$s& ma& #e related toincreased availa#ilit& o #eta-h&droxut&rate% a !etone #od& readil&trans$orted through the #lood-#rain #arrier' +n su$$ort o this h&$othesis% it "asound that a !etogenic diet "as the treatment o choice or glucose trans$orter$rotein s&ndrome and $&ruvate deh&drogenase de?cienc&% "hich are #othassociated "ith cere#ral energ& ailure and seiHures />6'

One argument against the consum$tion o a high at diet is that it causes

o#esit&' *he maFor concern in this regard is "hether a high $ercentage odietar& at $romotes "eight gain more than a lo" $ercentage o at inta!e'Because at has a higher caloric densit& than car#oh&drate% it is thought thatthe consum$tion o a high at diet "ill #e accom$anied #& a higher energ&inta!e /026' On the contrar&% recent studies rom our la#orator& /26 and man&other la#oratories /.%00.6 have o#served that a !etogenic diet can #e usedas a thera$& or "eight reduction in o#ese $atients'

+t has #een ound that a sugar& diet is the root cause o various chronicdiseases o the #od&' A recent stud& /06% it "as sho"n that the ris! odietar& gl&cemic load rom re?ned car#oh&drates "as inde$endent o other!no"n ris! actors or coronar& diseases'

+t is no" evident that high car#oh&drate diets increase asting $lasmatrigl&ceride concentrations /.


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levels o vitamin )% thus reducing the amount o antioxidants in the #od&' +t has#een $roven% #e&ond a dou#t% that disru$ting the oxidant-antioxidant status othe cell "ill lead to various diseases o the #od& /26' 8ugar consum$tion is $ositivel&associated "ith cancer in humans and test animals /26' *his o#servation isuite logical #ecause tumours are !no"n to #e enormous sugar a#sor#ers' +t

has also #een ound that the ris! o #reast cancer decreases "ith increases intotal at inta!e /2>6' urther studies on the role o a !etogenic diet inantineo$lastic thera$& are in $rogress in our la#orator&'

A lin! #et"een lo" at diets and osteo$orosis has #een suggested' ,er& lo" atdiets are considered to #e lo" in calcium content' Eomen on lo" at dietsexcrete most o the calcium the& consumeL thereore% the& are more $rone toosteo$orosis' o"ever% a high at diet can recti& this situation />6'

+n the $resent stud&% a control $o$ulation on a lo" at diet "as not includeddue to the diMculties in recruiting su#Fects or a control grou$' o"ever%several studies />0%>.6 "ith a$$ro$riate control grou$s that com$ared theefect o a lo" at diet "ith a lo" car#oh&drate !etogenic diet have recentleen $u#lished' +n this regard% these t"o recent studies are com$ara#le "iththe $resent stud&' Brehm et al /06 sho"ed that o#ese "omen on a lo"car#oh&drate !etogenic diet lost 5'< !g over six months com$ared "ith .' !glost #& those in the lo" at diet grou$ /7@1'1126' *"ent&-t"o su#Fects rom thelo" car#oh&drate !etogenic diet and 1 su#Fects rom the lo" at dietcom$leted the stud&% "ith #oth grou$s reducing their energ& inta!e #&a$$roximatel& .


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CONC=U8+ON8

*he data $resented in the $resent stud& sho"ed that a !etogenic diet acted asa natural thera$& or "eight reduction in o#ese $atients' *his is a uniue stud&monitoring the efect o a !etogenic diet or . "ee!s' *here "as a signi?cantdecrease in the level o trigl&cerides% total cholesterol% =D= cholesterol and

glucose% and a signi?cant increase in the level o D= cholesterol in the$atients' *he side efects o drugs commonl& used or the reduction o #od&"eight in such $atients "ere not o#served in $atients "ho "ere on the!etogenic diet' *hereore% these results indicate that the administration o a!etogenic diet or a relativel& long $eriod o time is sae' urther studieselucidating the molecular mechanisms o a !etogenic diet are in $rogress in ourla#orator&' *hese studies "ill o$en ne" avenues into the $otential thera$euticuses o a !etogenic diet and !etone #odies'

Go to:

R))R)NC)8

2' Bra& GA' 9edical conseuences o o#esit&' ( Clin )ndocrinol 9eta#'11.L5;:' 7u#9edP

;' 7eni 9G' +m$roving maintenance o "eight loss ollo"ing treatment #& dietand liest&le modi?cation' +n: Eadden *A% ,an +tallie *B% editors' *reatment othe 8eriousl& O#ese 7atient' Ne" Sor!: GuilordL 2;;' $$' .'


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21' 8ondi!e 8B% Co$$erman N% (aco#son 98' )fects o a lo"-car#oh&drate dieton "eight loss and cardiovascular ris! actors in over"eight adolescents' (7ediatr' 110L2.:>' 7u#9edP

2>' ranceschi 8% avero A% Decarli A% et al' +nta!e o macronutrients and ris! o#reast cancer' =ancet' 2;;>L0.:20' 7u#9edP

2' =iu 8% 9anson ()% 8tant$er 9(% et al' Dietar& gl&cemic load assessed #&ood-reuenc& uestionnaire in relation to $lasma high-densit&-li$o$roteincholesterol and asting $lasma triac&lgl&cerols in $ostmeno$ausal "omen' Am (Clin' 112L0:1>' 7u#9edP

25' GaHiano (9% enne!ens C% ODonnell C(% Breslo" (=% Buring ()' asting

trigl&cerides% high-densit& li$o$rotein and ris! o m&ocardial inarction'Circulation' 2;;L;>:


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05' =iu 8% Eillett EC% 8tam$er 9(% et al' A $ros$ective stud& o dietar&gl&caemic load% car#oh&drate inta!e% and ris! o coronar& heart disease in U8"omen' Am ( Clin Nutr' 111L2:2.


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.1' Gola& A% DeronHo RA% errannini )% et al' Oxidative and non-oxidativeglucose meta#olism in non-o#ese t&$e /non-insulin de$endent6 dia#etic$atients' Dia#etologia' 2;55L02:0:;0;.>' 79C reearticleP 7u#9edP

.0' ollen#ec! B% S-Di Chen% Reaven G9' A com$arison o the relative efects oo#esit& and non-insulin de$endent dia#etes mellitus on in vivo insulin-stimulated glucose utiliHation' Dia#etes' 2;5.L00:>>' 7u#9edP

..' Kolterman OG% Gra& R8% GriMn (% et al' Rece$tor and $ostrece$tor deectscontri#ute to the insulin resistance in noninsulin-de$endent dia#etes mellitus' (

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N=9 N+ D8 U8A'gov

C79C ull text:

)x$ Clin Cardiol' 11. allL ;/06: 111J2' 2'J1'12 21'.J0' 0 2'>J1'12 ;;'5J'; 0;'.J2'1

All data are mean J 8)9o$&right W Disclaimer W 7rivac& W Bro"sers WAccessi#ilit& W Contact

*AB=A

*AB=)

Com$osition o the ca$sule

7ara-amino#enHoic acid /76 01 mg

,itamin B2 /thiamin mononitrate6 /B762< mg

,itamin B /ri#oIavin6 /B76 0 mg

,itamin B< /nicotinamide6 /B76 < mg

,itamin B0 /calcium $antothenate6 /76 0 mg

,itamin B> /$&ridoxine C+6 /B76 < mg

,itamin B2 /c&anoco#alamin6 /B76 21 Yg

Biotin /76 < Yg

olic acid /B76 211 Yg

,itamin C /ascor#ic acid6 B7 >1 mg

,itamin A /retinol6 /U87L 111 +U6 1'> mg


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,itamin D /calcierol6 /+NNL 11 +U6 < Yg

,itamin ) /toco$herol acetate6 /U8N6 21 mg

=ecithin /76.1 mg

Eheat germ oil 211 mg

=&sine /76 .1 mg

9ethionine /DAB6 >1 mg

Rutin /DAB6 /rutoside6 /+NN6 21 mg

+ron /as umarateL B76 2 mg

Calcium /as dicalcium $hos$hate6 /B76


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Copyright&'icense ()e*uest permission to reuse

Figure 1)

)eduction in body +eight at eight, - and 24 +ee/s ollo+ing the administration o the

/etogenic diet in obese patients. 1he +eights are expressed as mean 3

PMC full

text:

)x$ Clin Cardiol' 11. allL ;/06: 111


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Decrease in #od& mass index at eight% 2> and . "ee!s during theadministration o a !etogenic diet in o#ese $atients' *he values are ex$ressedas mean J 8)9

PMC full

text:

)x$ Clin Cardiol' 11. allL ;/06: 111


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Changes in the level o high densit& li$o$rotein /D=6 cholesterol in o#ese$atients during treatment "ith a !etogenic diet or a $eriod o . "ee!s' Dataare ex$ressed as mean J 8)9

Figure 5)

Changes in the level o lo" densit& li$o$rotein /=D=6 cholesterol duringtreatment "ith a !etogenic diet in o#ese $atients at eight% 2> and . "ee!s'*he values are ex$ressed as mean J 8)9


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Figure 6)

Changes in the level o trigl&cerides in o#ese $atients during treatment "ith a!etogenic diet over a $eriod o . "ee!s' *he values are ex$ressed as mean J8)9

Figure 7)

Decreased levels o #lood glucose /ex$ressed as mean J 8)96 in o#ese$atients at eight% 2> and . "ee!s during the administration o a !etogenicdiet


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Figure 8)

Changes in the level o urea in o#ese $atients during a .-"ee! !etogenic diet'*he level o urea is ex$ressed as mean J 8)9

Images in this article

Figure 9)

Changes in the level o creatinine in o#ese $atients during a .-"ee! !etogenicdiet' ,alues are ex$ressed as mean J 8)9

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Efectos a Largo Término en Personas Obesas