Skip to main content
Top
Published in: Nutrition Journal 1/2014

Open Access 01-12-2014 | Research

Very low calorie diet without aspartame in obese subjects: improved metabolic control after 4 weeks treatment

Authors: Erik Norén, Henrik Forssell

Published in: Nutrition Journal | Issue 1/2014

Login to get access

Abstract

Background

Very low calorie diet (VLCD) is routinely used in programs for treatment of obesity and before bariatric surgery in order to reduce risk of postoperative complications. Aspartame, an artificial sweetener, is commonly used in VLCD and is well approved as a food additive without any adverse effects. The development of a new fructose containing VLCD formula without aspartame raises questions as to effects on glucose and lipid control.

Methods

As part of an ongoing study of a novel bariatric surgery procedure, twenty-five obese subjects with mean body mass index (BMI) 39.8 kg/m2 and mean age of 48.8 years enrolled in a single center observational study. Seven subjects presented with type 2 diabetes mellitus. The subjects underwent four weeks dietary treatment with VLCD Slanka (Slanka®). Blood samples including fasting plasma glucose, HbA1c, cholesterol and triglycerides were performed at start and after four weeks of diet. Blood pressure and weight were noted.

Results

All subjects completed the diet without any adverse events. Mean weight reduction was 8.2 kg with 95% confidence interval 7.1–9.2 kg (p = 0.001). Excess weight (i.e. proportion of weight exceeding BMI 25) loss decreased by median 19.5% (inter quartile range (IQR) 16,8-24,2). Median fasting plasma glucose was at inclusion 5,6 mmol/l (IQR 5,3-6,8) and after diet 4.8 mmol/l (IQR 4,6-5,2) (p = 0.001). Median HbA1c changed from 39 mmol/mol (IQR 37–44) to 37 mmol/mol (IQR 35–43) (p = 0.001). There was also significant reduction in cholesterol and triglyceride levels as well as in systolic blood pressure. Changes in other monitored blood chemistry values were without clinical importance.

Conclusion

Four weeks treatment with fructose containing VLCD of obese subjects preparing for bariatric surgery gave a substantial weight reduction without any significant negative metabolic effects.
Appendix
Available only for authorised users
Literature
1.
go back to reference Flegal K, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012, 307: 491-497.CrossRefPubMed Flegal K, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012, 307: 491-497.CrossRefPubMed
2.
go back to reference Freedman DM, Ron E, Ballard-Barbash R, Doody MM, Linet MS: Body mass index and all-cause mortality in a nationwide US cohort. Int J Obes (Lond). 2006, 30: 822-829.CrossRef Freedman DM, Ron E, Ballard-Barbash R, Doody MM, Linet MS: Body mass index and all-cause mortality in a nationwide US cohort. Int J Obes (Lond). 2006, 30: 822-829.CrossRef
3.
go back to reference Sjöström L, Narbo K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM: Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007, 357: 741-752.CrossRefPubMed Sjöström L, Narbo K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM: Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007, 357: 741-752.CrossRefPubMed
4.
go back to reference Marsk R, Näslund E, Freedman J, Tynelius P, Rasmussen F: Bariatric surgery reduces mortality in Swedish men. Br J Surg. 2010, 97: 877-883.CrossRefPubMed Marsk R, Näslund E, Freedman J, Tynelius P, Rasmussen F: Bariatric surgery reduces mortality in Swedish men. Br J Surg. 2010, 97: 877-883.CrossRefPubMed
5.
go back to reference Colles SL, Dixon JB, Marks P, Strauss BJ, O'Brien PE: Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006, 84: 304-311.PubMed Colles SL, Dixon JB, Marks P, Strauss BJ, O'Brien PE: Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006, 84: 304-311.PubMed
6.
go back to reference Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, van Dielen F, Wiezer R, Janssen I, Kramer M, Thorell A: Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011, 146: 1300-1305.CrossRefPubMed Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, van Dielen F, Wiezer R, Janssen I, Kramer M, Thorell A: Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011, 146: 1300-1305.CrossRefPubMed
7.
go back to reference Butchko HH, Stargel WW, Comer CP, Mayhew DA, Benninger C, Blackburn GL, de Sonneville LM, Getha RS, Herelendy Z, Koestner A, Leon AS, Liepa GU, McMartin KE, Mendenhall CL, Munro IC, Novotny EJ, Renwick AG, Schiffman SS, Schomer DL, Schaywitz BA, Spiers PA, Tephly TR, Thomas JA, Trefz FK: Aspartame: review of safety. Regul Toxicol Pharmacol. 2002, 35: 1-93.CrossRef Butchko HH, Stargel WW, Comer CP, Mayhew DA, Benninger C, Blackburn GL, de Sonneville LM, Getha RS, Herelendy Z, Koestner A, Leon AS, Liepa GU, McMartin KE, Mendenhall CL, Munro IC, Novotny EJ, Renwick AG, Schiffman SS, Schomer DL, Schaywitz BA, Spiers PA, Tephly TR, Thomas JA, Trefz FK: Aspartame: review of safety. Regul Toxicol Pharmacol. 2002, 35: 1-93.CrossRef
8.
go back to reference Curtius HC, Endres W, Blau N: Effect of high-protein meal plus aspartame ingestion on plasma phenylalanin concentrations in obligate heterozygotes for phenylketonuria. Metabolism. 1994, 43: 413-416.CrossRefPubMed Curtius HC, Endres W, Blau N: Effect of high-protein meal plus aspartame ingestion on plasma phenylalanin concentrations in obligate heterozygotes for phenylketonuria. Metabolism. 1994, 43: 413-416.CrossRefPubMed
9.
go back to reference SW R: Health implications of fructose consumption: A review of recent data. Nutr Metab (Lond). 2010, 7: 82-CrossRef SW R: Health implications of fructose consumption: A review of recent data. Nutr Metab (Lond). 2010, 7: 82-CrossRef
10.
go back to reference Ahn Y, Park SJ, Kwack HK, Kim MK, Ko KP, Kim SS: Rice-eating pattern and the risk of metabolic syndrome especially waist circumference in Korean Genome and Epidemiology Study (KoGES). BMC Public Health. 2013, 13: 61-CrossRefPubMedPubMedCentral Ahn Y, Park SJ, Kwack HK, Kim MK, Ko KP, Kim SS: Rice-eating pattern and the risk of metabolic syndrome especially waist circumference in Korean Genome and Epidemiology Study (KoGES). BMC Public Health. 2013, 13: 61-CrossRefPubMedPubMedCentral
11.
go back to reference Chiu S, Sievenpiper JL, de Souza RJ, Cozma A, Mirrahimi A, Carleton AJ, Ha V, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Don-Wauchope AC, Beyene J, Kendall CW, Jenkins DJ: Effect of fructose on markers of non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr. 2014, 68: 416-423.CrossRefPubMedPubMedCentral Chiu S, Sievenpiper JL, de Souza RJ, Cozma A, Mirrahimi A, Carleton AJ, Ha V, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Don-Wauchope AC, Beyene J, Kendall CW, Jenkins DJ: Effect of fructose on markers of non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr. 2014, 68: 416-423.CrossRefPubMedPubMedCentral
12.
go back to reference Wikstrand I, Torgerson J, Boström KB: Very low calorie diet (VLCD) followed by a randomized trial of corset treatment for obesity in primary care. Scand J Prim Health Care. 2010, 28: 89-94.CrossRefPubMedPubMedCentral Wikstrand I, Torgerson J, Boström KB: Very low calorie diet (VLCD) followed by a randomized trial of corset treatment for obesity in primary care. Scand J Prim Health Care. 2010, 28: 89-94.CrossRefPubMedPubMedCentral
13.
go back to reference Case CC, Jones PH, Nelson K, O'Brian Smith E, Ballantyne CM: Impact of weight loss on the metabolic syndrome. Diabetes Obes Metab. 2002, 4: 407-414.CrossRefPubMed Case CC, Jones PH, Nelson K, O'Brian Smith E, Ballantyne CM: Impact of weight loss on the metabolic syndrome. Diabetes Obes Metab. 2002, 4: 407-414.CrossRefPubMed
14.
go back to reference Gu Y, Yu H, Li Y, Ma X, Lu J, Yu W, Xiao Y, Bao Y, Jia W: Beneficial effects of an 8-week, very low carbohydrate diet intervention on obese subjects. Evid Based Complement Alternat Med. 2013, 2013: 760804-PubMedPubMedCentral Gu Y, Yu H, Li Y, Ma X, Lu J, Yu W, Xiao Y, Bao Y, Jia W: Beneficial effects of an 8-week, very low carbohydrate diet intervention on obese subjects. Evid Based Complement Alternat Med. 2013, 2013: 760804-PubMedPubMedCentral
15.
go back to reference Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, McMahon DJ, Korner J: Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell function in type 2 diabetic patients. Diabetes. 2013, 62: 3027-3032.CrossRefPubMedPubMedCentral Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, McMahon DJ, Korner J: Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell function in type 2 diabetic patients. Diabetes. 2013, 62: 3027-3032.CrossRefPubMedPubMedCentral
16.
go back to reference Lips MA, de Groot GH, van Klinken JB, Aarts E, Berends FJ, Janssen IM, Van Ramshorst B, Van Wagensveld BA, Swank DJ, Van Dielen F, van Dijk W, Pijl H: Calorie restriction is a major determinant of the short-term metabolic effects of gastric bypass surgery in obese type 2 diabetic patients. Clin Endocrinol (Oxf). 2013, epub ahead of print Lips MA, de Groot GH, van Klinken JB, Aarts E, Berends FJ, Janssen IM, Van Ramshorst B, Van Wagensveld BA, Swank DJ, Van Dielen F, van Dijk W, Pijl H: Calorie restriction is a major determinant of the short-term metabolic effects of gastric bypass surgery in obese type 2 diabetic patients. Clin Endocrinol (Oxf). 2013, epub ahead of print
17.
go back to reference Jazet IM, Pijl H, Frölich M, Schoemaker RC, Meinders AE: Factors predicting the blood glucose lowering effect of a 30-day very low calorie diet in obese Type 2 diabetic patiens. Diabet Med. 2005, 22: 52-55.CrossRefPubMed Jazet IM, Pijl H, Frölich M, Schoemaker RC, Meinders AE: Factors predicting the blood glucose lowering effect of a 30-day very low calorie diet in obese Type 2 diabetic patiens. Diabet Med. 2005, 22: 52-55.CrossRefPubMed
18.
go back to reference Jazet IM, de Craen AJ, van Schie EM, Meinders AE: Sustained beneficial metabolic effects 18 months after a 30-day very low calorie diet in severely obese, insulin-treated patients with type 2 diabetes. Diabete Res Clin Pract. 2007, 77: 70-76.CrossRef Jazet IM, de Craen AJ, van Schie EM, Meinders AE: Sustained beneficial metabolic effects 18 months after a 30-day very low calorie diet in severely obese, insulin-treated patients with type 2 diabetes. Diabete Res Clin Pract. 2007, 77: 70-76.CrossRef
19.
go back to reference Shaw KA, O'Rourke P, Del Mar C, Kenardy J: Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2005, 2: CD003818 Shaw KA, O'Rourke P, Del Mar C, Kenardy J: Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2005, 2: CD003818
20.
go back to reference Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, Jung RT, Smith WC: What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. J Hum Nutr Diet. 2004, 17: 317-335.CrossRefPubMed Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, Jung RT, Smith WC: What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. J Hum Nutr Diet. 2004, 17: 317-335.CrossRefPubMed
Metadata
Title
Very low calorie diet without aspartame in obese subjects: improved metabolic control after 4 weeks treatment
Authors
Erik Norén
Henrik Forssell
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Nutrition Journal / Issue 1/2014
Electronic ISSN: 1475-2891
DOI
https://doi.org/10.1186/1475-2891-13-77

Other articles of this Issue 1/2014

Nutrition Journal 1/2014 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.