title: Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results.
abstract: OBJECTIVE
  To investigate the contribution of meal and snack replacements for long-term weight maintenance and risk factor reduction in obese patients.
  
  
  METHODS
  Prospective, randomized, two-arm, parallel intervention for 12 weeks followed by a prospective single-arm 4-year trial in a University Hospital clinic. One hundred patients, >18 years old and with a body mass index > 25 and < or = 40 kg/m2, were prescribed a 1,200 to 1,500 kcal/d control diet (Group A) or an isoenergetic diet, including two meal and snack replacements (vitamin- and mineral-fortified shakes, soups, and bars) and one meal high in fruits and vegetables (Group B). Following a 3 months of weight loss, all patients were prescribed the same energy-restricted diet (1,200 to 1,500 kcal) with one meal and one snack replacement for an additional 4 years.
  
  
  RESULTS
  All 100 patients were evaluated at 12 weeks. Mean percentage weight loss was 1.5 +/- 0.4% and 7.8 +/- 0.5% (mean +/- SEM) for Groups A and B, respectively. At 12 weeks systolic blood pressure, plasma triacylglycerol, glucose, and insulin concentrations were significantly reduced in Group B, whereas no changes occurred in Group A. After 4 years, 75% of the patients were evaluated. Total mean weight loss was 3.2 +/- 0.8% for Group A and 8.4 +/- 0.8% (mean +/- SEM) for Group B. Both groups showed significant improvement in blood glucose and insulin (p < 0.001), but only Group B showed significant improvement in triacylglycerol and systolic blood pressure compared to baseline values (p < 0.001).
  
  
  CONCLUSIONS
  Providing a structured meal plan via vitamin- and mineral-fortified liquid meal replacements is a safe and effective dietary strategy for obese patients. Long-term maintenance of weight loss with meal replacements can improve certain biomarkers of disease risk.
authors.affiliation: Department of Internal Medicine, University of Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Flechtner-Mors
authors.forename: H H
authors.initials: HH
authors.lastname: Ditschuneit
authors.forename: T D
authors.initials: TD
authors.lastname: Johnson
authors.forename: M A
authors.initials: MA
authors.lastname: Suchard
authors.forename: G
authors.initials: G
authors.lastname: Adler
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004038:Diet, Reducing; D004734:Energy Metabolism; D005260:Female; D005526:Food, Formulated; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D015431:Weight Loss
chemical_list: D015415:Biomarkers