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Effect of Weight Loss via Severe vs Moderate Energy Restriction on Lean Mass and Body Composition Among Postmenopausal Women With Obesity: The TEMPO Diet Randomized Clinical Trial

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Seimon, RV, Wild-Taylor, AL, Keating, SE, McClintock, S, Harper, C, Gibson, AA, Johnson, NA, Fernando, HA, Markovic, TP, Center, JR, Franklin, J, Liu, PY, Grieve, SM, Lagopoulos, J, Caterson, ID, Byrne, NM ORCID: 0000-0001-5310-6640 and Sainsbury, A 2019 , 'Effect of Weight Loss via Severe vs Moderate Energy Restriction on Lean Mass and Body Composition Among Postmenopausal Women With Obesity: The TEMPO Diet Randomized Clinical Trial' , JAMA Network Open, vol. 2, no. 10 , pp. 1-19 , doi: 10.1001/jamanetworkopen.2019.13733.

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Abstract

Importance:Severely energy-restricted diets are the most effective dietary obesity treatment.However, there are concerns regarding potential adverse effects on body composition.Objective: To compare the long-term effects of weight loss via severe vs moderate energyrestriction on lean mass and other aspects of body composition.Design, setting, and participants: The Type of Energy Manipulation for Promoting OptimumMetabolic Health and Body Composition in Obesity (TEMPO) Diet Trial was a 12-month, singlecenter, randomized clinical trial. A total of 101 postmenopausal women, aged 45 to 65 years withbody mass index (calculated as weight in kilograms divided by height in meters squared) from 30 to40, who were at least 5 years after menopause, had fewer than 3 hours of structured physical activityper week, and lived in the Sydney metropolitan area of New South Wales, Australia, were recruitedbetween March 2013 and July 2016. Data analysis was conducted between October 2018 andAugust 2019.Intervention: Participants were randomized to either 12 months of moderate (25%-35%) energyrestriction with a food-based diet (moderate intervention) or 4 months of severe (65%-75%) energyrestriction with a total meal replacement diet followed by moderate energy restriction for anadditional 8 months (severe intervention). Both interventions had a prescribed protein intake of 1.0g/kg of actual body weight per day, and physical activity was encouraged but not supervised.Main outcomes and measures: The primary outcome was whole-body lean mass at 12 monthsafter commencement of intervention. Secondary outcomes were body weight, thigh muscle areaand muscle function (strength), bone mineral density, and fat mass and distribution, measured at 0,4, 6, and 12 months.Results: A total of 101 postmenopausal women were recruited (mean [SD] age, 58.0 [4.2] years;mean [SD] weight, 90.8 [9.1] kg; mean [SD] body mass index, 34.4 [2.5]). Compared with themoderate group at 12 months, the severe group lost more weight (effect size, −6.6 kg; 95% CI, −8.2to −5.1 kg), lost more whole-body lean mass (effect size, −1.2 kg; 95% CI, −2.0 to −0.4 kg), and lostmore thigh muscle area (effect size, −4.2 cm2; 95% CI, −6.5 to −1.9 cm2). However, decreases inwhole-body lean mass and thigh muscle area were proportional to total weight loss, and there was nodifference in muscle (handgrip) strength between groups. Total hip bone mineral density (effect size, −0.017 g/cm2; 95% CI, −0.029 to −0.005 g/cm2), whole-body fat mass (effect size, −5.5 kg; 95% CI,−7.1 to −3.9 kg), abdominal subcutaneous adipose tissue (effect size, −1890 cm3; 95% CI, −2560 to−1219 cm3), and visceral adipose tissue (effect size, −1389 cm3; 95% CI, −1748 to −1030 cm3) losswere also greater for the severe group than for the moderate group at 12 months.Conclusions and relevance: Severe energy restriction had no greater adverse effect onrelative whole-body lean mass or handgrip strength compared with moderate energy restriction andwas associated with 2-fold greater weight and fat loss over 12 months. However, there wassignificantly greater loss of total hip bone mineral density with severe vs moderate energy restriction.Therefore, caution is necessary when implementing severe energy restriction in postmenopausalwomen, particularly those with osteopenia or osteoporosis.

Item Type: Article
Authors/Creators:Seimon, RV and Wild-Taylor, AL and Keating, SE and McClintock, S and Harper, C and Gibson, AA and Johnson, NA and Fernando, HA and Markovic, TP and Center, JR and Franklin, J and Liu, PY and Grieve, SM and Lagopoulos, J and Caterson, ID and Byrne, NM and Sainsbury, A
Keywords: weight loss, obesity, postmenopausal, women with obesity, energy restriction
Journal or Publication Title: JAMA Network Open
Publisher: American Medical Association
ISSN: 2574-3805
DOI / ID Number: 10.1001/jamanetworkopen.2019.13733
Copyright Information:

© 2019 Seimon RV et al. Licensed under Creative Commons Attribution under the terms of CC-BY.

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