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Research Notes: Modified Protein-sparing FastingN Engl J Med. 1977 Apr 7. Four adolescents or young adults with the Prader-Willi syndrome (hypotonia, mental retardation, hypogonadism and obesity) received a protein-sparing modified fast consisting of 1.5 g of meat protein per kilogram of ideal body weight and meeting vitamin, mineral and fluid requirements. Evaluation of nitrogen and energy metabolism revealed the development of starvation ketosis and a positive nitrogen balance. Serial whole-body potassium measurements in two patients confirmed preservation of lean tissue despite continuing loss of weight. Clinical diabetes mellitus in two subjects was rapidly ameliorated by the regimen. Short-term weight loss greater than 18 kg occurred in three of the four subjects, and reduced weight persisted during observation periods of 26 to 44 months. This degree of outpatient diet adherence by mentally deficient subjects, who do not normally experience satiety, suggests that hunger is eliminated or at least reduced by modified, protein-sparing fasting. Am J Public Health. 1985 Oct. Six hundred sixty-eight obese outpatients, 71 per cent (+/- 34) in excess of ideal weight, were enrolled in a multidisciplinary weight control program. The major components of the program included nutrition, education, behavior modification, and exercise. Rapid weight loss was accomplished using a very low calorie (less than 800 kcal) ketogenic diet. Patients adhered to the protein sparing modified fast (PSMF) for 17 +/- 12 weeks and averaged 9 +/- 17 weeks in a refeeding/maintenance program. Mean weight loss was 47 +/- 29 lb (21 +/- 13 kg) at the point of minimum weight and 41 +/- 29 lb (19 +/- 13 kg) at the end of the maintenance period. Systolic and diastolic blood pressure and serum triglycerides fell significantly in men and women. Success in weight loss was greatest in the heaviest patients, those who adhered the longest to the PSMF, and those who stayed the longest in the maintenance program. J Am Diet Assoc. 1985 Apr. When severe, obesity in adolescence demands effective treatment, thus justifying use of a protein-sparing, low-energy diet for periods of 3 to 4 months. When properly planned and supervised, this diet is safe and effective, even if only to maintain a functional body weight. The regimen used at the Hospital for Sick Children, Toronto, provides 2.0 to 2.5 gm protein per kilogram ideal body weight, plus adequate fluid and nutrient supplements. The amounts of meat, poultry, and fish that supply this allocation of protein are determined using a protein equivalency system developed for the diet. The system allows both dietitians and patients to plan meals that minimize energy intake while maintaining protein adequacy and dietary variety. With prolonged use of the diet, limited carbohydrate may be added in the form of selected vegetables measured using a similar carbohydrate equivalency system. Recent use of the diet for 21 patients, 8 to 20 1/2 years old and averaging 211% ideal body weight, resulted in acceptable weight control. J Am Diet Assoc. 1980 Apr. Forty-five grossly obese patients (averaging 64.1 kg. above ideal body weight) were treated as in-patients with a modified protein-sparing fast. Twenty-seven of these patients had diabetes, sixteen of them requiring insulin. In-patient treatment with PSMF ranged from three days to two years. The dietary regimen provided 1.2 gm. protein per kilogram ideal body weight, with no added fat or carbohydrates; this generally amounted to 270 to 430 gm. meat, distributed in three meals (about 500 to 800 kcal per day). Generous vitamin and mineral supplements were provided. Concomitant psychotherapy was also part of the treatment. Before discharge, the patients had lost from 0.45 to 93.2 kg., depending on compliance, length of hospitalization, and amount of exercise. After discharge, compliance fell, despite provision of group therapy with a psychologist and bi-weekly appointments with the physician and dietitian. The more committed patients who attended group therapy regularly have been more successful in continuing to lose weight. Int J Obes. 1980. Nitrogen balance has been measured in 25 (16 f, 9m) patients with severe obesity submitted for four weeks to total fasting (TF) or different versions of protein-sparing modified fast (PSMF). The hospitalized patients, divided into four age-matched groups, were treated as follows:Group 1, were submitted to TF; Group 2 were treated by 80 kcal-PSMF (17 g protein=2.6 g N, traces of fat and carbohydrate); Group 3 were submitted to 180 kcal-PSMF (40 g protein = 6.4 g N, 2 g fat, traces carbohydrate) and Group IV, to 80/180 kcal-PSMF (80 kcal during the 1st and 2nd week and 180 kcal during the 3rd and 4th week of treatment). Weight loss was similar (-11 kg) in Gps 1, 2 and 4; lower (-8 kg) in Gp 3. Mean daily Nitrogen loss was significantly lower (P < 0.05) in Gps 3 and 4 than in Gps 1 and 2. Nitrogen loss was significantly reduced from the 3rd week onward in Gps 1 (P < 0.005), 2 (P < 0.05) and 4 (P < 0.002). During 180 kcal-PSMF nitrogen loss was significantly lower (P < 0.005) only when this dietary regimen was preceded by 80 kcal-PSMF for two weeks (Gp 4). These observations suggest a new approach to the treatment of severe obesity by PSMF and show that is is possible to further reduce the early catabolic phase which commonly arises during this type of therapy. Int J Obes. 1978. Thirty-six obese adults received a protein-sparing modified fast (PSMF) consisting of 1.5 g of meat protein per kilogram of ideal body weight and meeting vitamin, mineral, and fluid requirements. These studies were conducted as short-term inpatient metabolic studies followed by a program of outpatient obesity treatment. Thirty-one patients were contacted from one to 4 1/2 years from initial assessment. Significant weight loss of greater than 9 kg (20 lb) occurred in more than half the patients, and of greater than 40 lb in one-third of patients over the study period. A PSMF for weight reduction, accompanied by instruction in behaviour modification, nutrition, and exercise for maintenance of weight loss may be helpful in the management of obesity. Diabetes. 1976 Jun. A protein-sparing modified fast (PSMF), which is a total fast modified by the intake of 1.2-1.4 gm. protein per kilogram ideal body weight (IBW), fluids ad libitum, and vitamin and mineral supplementation, allows effective control of carbohydrate metabolism and hunger. It reduces serum glucose and insulin concentrations in obese diabetic patients and increases free fatty acid and ketone body concentrations; ketonuria appears within 24-72 hours. When this fast was applied to seven obese adult-onset diabetics who were receiving 30-100 units of insulin per day, insulin could be discontinued after 0-19 days (mean, 6.5). In the three patients who had extensive nitrogen-balance studies, balance could be maintained chronically by 1.3 gm. protein per kilogram IBW, despite the gross caloric inadequacy of the diet. The PSMF was tolerated well in an outpatient setting after the initial insulin-withdrawal phase had occurred in the hospital. Significant improvements in blood pressure, lipid abnormalities, parameters of carbohydrate metabolism, and cardiorespiratory, symptoms were associated with weight loss and/or the PSMF. For diabetics with some endogenous insulin reserve, the PSMF offers significant advantages for weight reduction, including preservation of lean body mass (as reflected in nitrogen balance) and withdrawal of exogenous insulin. |