‘Caution is necessary’ with severe energy restriction diet for postmenopausal women
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Severe energy restriction with a total meal replacement diet among postmenopausal women with obesity induced greater weight loss and approximately 1.5-fold as much loss of whole-body lean mass and thigh muscle area compared with moderate energy restriction over 12 months; however, researchers also observed a greater decrease in hip bone mineral density with severe energy restriction, according to findings published in JAMA Network Open.
“Despite being an effective and affordable dietary obesity treatment, a number of prominent clinical obesity treatment guidelines from around the world show limited support for the use of total meal replacement diets, and these diets are not routinely used by health care professionals,” Radhika V. Seimon, PhD, a researcher with the Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, at the University of Sydney in Camperdown, New South Wales, Australia, and colleagues wrote in the study background. “This may be because of reported adverse effects (eg, hair loss, constipation, headaches, dizziness, fatigue, and cholelithiasis), the lack of training and resources available for pretreatment evaluation and monitoring during these diets, and possibly also concerns that severe energy restriction may adversely affect body composition (ie, lean mass and BMD) compared with moderate energy restriction.”
Seimon and colleagues analyzed data from 101 postmenopausal women aged 45 to 65 years with a BMI between 30 kg/m² and 40 kg/m² participating in the Type of Energy Manipulation for Promoting Optimum Metabolic Health and Body Composition in Obesity (TEMPO) diet trial, a 12-month, single-center study (mean age, 58 years; mean BMI, 34.4 kg/m²). Participants, recruited between October 2018 and August 2019, reported fewer than 3 hours weekly of structured physical activity. Researchers randomly assigned women to 12 months of moderate (25%-35%) energy restriction with a food-based diet or 4 months of severe (65%-75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for an additional 8 months. Both interventions had a prescribed protein intake of 1 g/kg of actual body weight per day. Physical activity was encouraged but not supervised. Primary outcome was whole-body lean mass at 12 months. Secondary outcomes were body weight, thigh muscle area and muscle function (strength), BMD, and fat mass and distribution, measured at baseline, 4, 6 and 12 months.
Compared with women assigned to moderate energy restriction, women in the severe energy restriction group lost more weight (effect size, –6.6 kg; 95% CI, –8.2 to –5.1) more whole-body lean mass (effect size, –1.2 kg; 95% CI, –2 to –0.4) and more thigh muscle area (effect size, –4.2 cm2; 95% CI, –6.5 to –1.9). The researchers noted that observed decreases in whole-body lean mass and thigh muscle area were proportional to total weight loss. There were no between-group differences in muscle strength as measured by handgrip test.
Women in the severe energy restriction group had lower total hip BMD vs. the moderate energy restriction group at 12 months (effect size, –0.017 g/cm2; 95% CI, –0.029 to –0.005); however, there were no between-group differences in lumbar spine BMD or whole-body BMD.
“After adjusting our analyses for weight at each point, there was still a significantly lower total hip BMD in the severe group compared with the moderate group at 12 months,” the researchers wrote.
At 12 months, the researchers also observed an increase in the number of women with osteopenia, defined as a T-score between –1 and –2.5, at the femoral neck among women in the severe energy restriction group vs. the moderate energy restriction group (39.1% vs. 28.9%). There were no women with osteoporosis at 12 months in either group.
“While these losses of lean tissues were proportional to the amount of weight lost and while muscle strength (ie, handgrip strength) was unaffected by severe vs. moderate energy restriction, there was an approximately 2.5-fold greater loss of total hip BMD with severe compared with moderate energy restriction, a difference not accounted for by the greater weight loss,” the researchers wrote. “Therefore, caution is necessary when implementing severe energy restriction in postmenopausal women with obesity, especially in those with osteopenia or osteoporosis, for whom concurrent bone-strengthening treatments (eg, muscle strengthening exercises) are recommended.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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