E f f e c t o f a tr a diti o n a l k o re an v e ry - l o w - c al o rie die t on ob e s e p atie n t s

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1 : ,,, * =A b s t r a c t = E f f e c t o f a tr a diti o n a l k o re an v e ry - l o w - c al o rie die t on ob e s e p atie n t s Won Il Park, M.D., Jong Hyup Lee, M.D., Shim Hyun Jo, M.D., Bong Luck Paik, M.D., Chung Keung Choi, M.D., Seung Geun Lee, M.D., Han Kyu Moon, M.D., Young Mee Choi, R.D., Yoon Sok Jung, M.D., Kw an Woo Lee, M.D., Hyeon Man Kim, M.D., Mi Kyung Kim, R.D., Ji Hyun Lee, R.D. and Sun Jeung Choi, Ph.D. Departments of Internal M edicine and F ood, N utrition, Dong E ui M edical Center, B usan, K orea; Departments of Endocrinology, M etabolism and F ood, N utrition, Aj ou University College of M edicine, Suwon, K orea B ackg round : T here is increasing interest in the use of a very low calorie diet (VLCD) as a treatment regimen for weight loss in obese subjects. This study was designed to investigate the effects and safety of a traditional Korean very- low - calory diet Meth ods : T welve hospitalized obese patients at Dong Eui hospital in Busan city from May 1998 to December 1998 were selected. Height, body weight, blood lipids, blood insulin level, body fat, lean body mass, subcutaneous fat and visceral fat were measured. A traditional Korean VLCD was supplied for 14 days. Re s ult s : Patient 's body weight was significantly decreased from 83.8 kg to 78.6 kg, body fat from 32.2 kg to 28.6 kg, lean body mass from 32.2 kg to 28.6 kg, and BMI from 31.4 to 29.5, respectively (p <0.05). T otal fat was significantly decreased from 807 cc to 659 cc, subcutaneous fat from 567 cc to 473 cc, visceral fat from 273 cc to 185 cc, respectively. However there were no significant changes in minerals. After VLCD intervention, total cholesterol was significantly decreased from 199 mg/ dl to 166 mg/ dl, HDL- cholesterol from 42 mg/ dl, to 35 mg/ dl, triglyceride from 158 mg/ dl, to 75 mg/ dl (p <0.05). T he insulin area under the curve was also significantly decreased from 205 IU/ ml2hr to 168 IU/ ml2hr (p <0.05). Conclus ion : Above findings suggested that a traditional Korean VLCD is effective and safe for short term use in terms of reducing body fat and improving insulin resistance in obese patients.(korean J Med 62: , 2002) Key W ords : VLCD, Insulin resistance, HDL- cholesterol : : :, 245-1, ( ) E -mail : pw

2 Won Il Park, et al : Effect of a traditional korean very- low - calorie diet on obese patients (VLCD, very- low calory diet) Kcal,,., (BMI, body mass index )30 kg/ m 2 1 ). 3050%, % 2-6 ) 5 2 ),,,, (behavior therapy) 7 ).,,.,,, ,,,,, (BMI, body mass index) 30 kg/ m 2, 28 kg/ m , 8, 34 11, kg, kg/ m 2 (1). T able 1. B as eline characteris tic s of s tudy s ubjects Characteristics Numbers 12 Age (years) 3411 Sex (male/ female) 4/ 8 Body weight (kg) BMI (kg/ ) (kg/ ) Data are meanssd T able 2. Nutritional components of v ery - low calory diet and 1000 Kcal low calory diet Diet T otal calory Carbohydrate Protein Fat Carbohydrate : protein : fat (Kcal) (g) (g) (g) (calory %) VLCD : 33.8 : : 34.9 : 12.7 LCD : 28.1 :

3 : T able 3. Contents of Korean v ery - low calory and 1000 Kcal low calory diet 450 Kcal 710 Kcal 1000 Kcal * 2 (option menu) : 46 g (1/ 4, 20 g) * 3 (option menu) : 70 g (1/ 3, 30 g) * 4 (option menu) : 93 g (2/ 5 ) 1 (20 g) 1 (30 g) 1 (40 g) 90 g 130 g 173 g 2(35 g) 3 (20 g) 3(50 g) 5 (30 g) 4(67 g) 6 (40 g) ( ) : 40 : 1/ 2 ( ) (1/ 2 ) : 60 : 1 (1/ 2 ) : 60 : 1 ( ) (1/ 2 ) 100 ml (1/ 2 ) (1 ) ( ) (40) (1 ) ( ) (1/ 2 ) (60) (1 ) (1/ 2 ) (60) (1 ) ( ) ( 1/ 2 ) 100 ml (1/ 2 ), ( ) ( 1/ 2 ) ( ) (1/ 2 ) ( 1 ) (1/ 2 ) ( 1 ) (1.0 ) * : ( 5 g) 2. Howard 1 ). 2.,, (3) Kcal/ day, 1000 Kcal/ day, 710 Kcal/ day, 450 Kcal/ day, 710 Kcal/ day, 1000 Kcal/ day 2, 2, 2, 10, 2 2, 204, 710 Kcal/ day, 450 Kcal/ day, 710 Kcal/ day Kcal/ day, Kcal/ day

4 13:.. 4. (Anthropometry, Biospace. InBody 2.0),. autoanalyser (Beckman X- 7).,, - (HDL- cholesterol)heparin- Mn, C- peptide (EIA) urine stick, (nitrogen balance).,, BUN, creatinine, 2 5. SPSS PC (mean) (SD, standard deviation) paired t- test kg kg, (lean body mass) kg kg, kg kg, kg/ m kg/ m 2 (p <0.05) ( 1). 2., cc 659 Fig ure. 1 Anthropometric changes before and after treatment (N=12, *p <0.05, LBM : lean body mass) Fig ure 2 Comparison of fat volume before and after treatment by abdominal fat CT (* : p <0.05) (Total, Subcutaneous, Visceral fat) T able 4. Chang es of serum electroly tes after treatment Na (meq/ L) K (meq/ L) Cl (meq/ L) Mg Ca P Before After Mean SD

5 Korean Journal of Medicine : Vol. 62, No. 3, 2002 T able 5. Chang es of heart rate, QT c interv al, amy lase and renal function before and after treatment Heart rate (bpm) QT c interval (msec) Amylase (U/ L) BUN Creatinine Before After MeanSD T able 6. Chang es of blood chemistry before and after treatment AST (U/ L) ALT (U/ L) Bilirubin Protein (g/ dl) T otal cholesterol HDL- cholesterol Triglyceride Before After 248 * 2813 * * * * 354 * 7515 * MeanSD *p < cc, cc cc, cc cc (p <0.05) ( 2). 3. Na, K, Cl, Mg, Ca. P (4). QT c, BUN Creatinine (5). AST, ALT,,,, -, (p <0.05) (6) g (75 g OGT T )0, 60, IU/ ml, IU/ ml, IU/ ml IU/ ml, IU/ ml, IU/ ml (p <0.05), - (insulin- area under the curve) IU/ ml2hr IU/ ml 2hr (p <0.05) ( 3, 4) (7). Fig ure. 3 Insulin secretion during 75 g OGT T before and after treatment (*p <0.05) Fig ure 4. Insulin AUC during 75 g OGTT before and after treatment (*p <0.05)

6 Won Il Park, et al : Effect of a traditional korean very- low - calorie diet on obese patients T able 7. Nitrog en balance before and after treat - ment and then 1 w eek after discharg e Nitrogen balance (g/ day) MeanS.D 8 ).,., 1)..,,. 47 Na, K, Ca, Mg. Before After After discharge How ardrössner 9 ), hydroxy- - methylglutaryl coenzyme A reductase (HMG- CoA reductase), lipoprotein lipase (LPL) - LPL - 10 )., 11). Hellström 12 ) - 2 adrenoceptor sensitivity. 13 )., (glycogen synthase) (pyruvate dehydrogenase). / (waist/hip ratio),,,. TNF- (overexpression) 14). Rotella., Niskanen 15 ), Bryson 16 ) nonoxidative glycolysis, (hepatic gluconeogenesis) lactatealanine reesterification. 17 ). Bastard 18 ) Interleukin 6 Leptin. QT c

7 : QT c. Seim 19 ), ST - T, QT c (p <0.05). 807 cc 659 cc, 567 cc 473 cc, 273 cc 185 cc (p <0.05) mg/ dl 166 mg/ dl, - 42 mg/ dl 35 mg/ dl, 158 mg/ dl 75 mg/ dl (p <0.05). - (insulin- area under the curve) 205 IU/ ml2hr168 IU/ ml2hr(p <0.05). :..,. :. : , 1200 Kcal, 1000 Kcal, 710 Kcal, 450 Kcal, 710 Kcal, 1000 Kcal 2, 2, 2, 10, 22.,,,,,. : 83.8 kg 78.6 kg, 51.6 kg 50.0 kg, 32.2 kg 28.6 kg, R E F E R E N C E S 1) Howard AN. The historical development, eff icacy and safety of very low calorie diets. Int J Obes 5: , ) Wing RR, Marcus MD, Salata R, Epstein LH, Miaskiewicz S, Blair EH. Eff ects avery- low- calorie diet on long - term glycemic control in obese type 2 diabetic subj ects. A rch Intern M ed 151: , ) Wadden T A, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD. Treatment of obesity by very low caloric diet, behavior therapy, and their combination: a f ive-year p ersp ective. Int J Obes 13:39-46, ) Anderson T, Backer OG, Stokholm DH, Quaade F. Randomized trial of diet and gastroplasty compared with diet alone in morbid obesity. N Engl J M ed 310: , ) Miura J, Arai K, T sukahara S, Ohno M, Ikeda Y. The long term eff ectiveness of combined therapy by behavior modif ication and very low caloric diet: 2 years f ollow- up. Int J Obes 13:73-77, ) Sikand G, Kondo A, Foreyt JP, Jones PH, Gotto AM Jr. Two year f ollow- up of patients treated with a very low calorie dieting and exercise testing. J A m Diet A ssoc 88: , ) Ayyad C, Andersen T. Long- term eff icacy of dietary treatment of obesity: a systematic review of studies published between 1931 and Obes R ev 1: , ) Kissebah AH, Vydelingum N, Murray R, Evans DJ,

8 13: Hartz AJ, Kalkhoff RK, Adams PW. R elation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol M etab 54: , ) Rössner S, Flaten H. VL CD versus L CD in longterm treatment of obesity. Int J Obes R elat M etab Disord 21:22-26, ) Dattilo AM, Kris- Etherton PM. Eff ects of weight reduction on blood lip ids and lip op roteins: a metaanalysis. A m J Clin N utr 56: , ).. p ,, ) Hellström L, Rössner S, Hagström- T oft E, Reynisdottir S. Lip olytic catecholamine resistance linked to alpha 2-adrenoceptor sensitivity: a metabolic p redictor of weight loss in obese subj ects. Int J Obes R elat M etab Disord 21: , ) Matsuzawa Y, Simomura I, Nakamura T, Keno Y, Kotani K, T okunaga K. Pathophysiology and pathogenesis of visceral fat obesity. Obes R es(supp l 2), , ) Halle M, Berg A, Northoff H, Keul J. Imp ortance of TN F -alpha and leptin in obesity and insulin resistance: a hyp othesis on the impact of physical exercise. Exerc Immunol R ev 4:77-94, ) Niskanen L, Uusitupa M, Sarlund H, Siitonen O, Paljarvi L, Laakso M. The effects of weight loss on insulin sensitivity, skeletal m uscle comp osition and cap illary density in obese nondiabetic subj ects. Int J Obes R elat M etab Disord 20: , ) Bryson JM, King SE, Burns CM, Baur LA, Swaraj S, Caterson ID. Changes in glucose and lip id metabolism following weight loss produced by a very low caloric diet in obese subj ects. Int J Obes R elat M etab Disord 20: , ) Kelly DE, Wing R, Buonocore C, Sturis J, Polonsky K, Fitzsimmons M. R elative eff ects of calorie restriction and weight loss in noninsulin- dep endent diabetes mellitus. J Clin Endocrinol M etab 77: , ) Bastard JP, Jardel C, Bruckert E, Blondy P, Capeau J, Laville M, Vidal H, Hainque B. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adip ose tissue of obese women af ter weight loss. J Clin Endocrinol M etab 85: , ) Seim HC, Mitchell JE, Pomeroy C, de Zwaan M. E lectrocardiographic findings associated with very low calorie dieting. Int J Obes R elat M etab Disord 19: ,