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October 2007 - Volume 1,
Issue 5
THE EFFECT OF A FIBRE RICH DIETARY
PRODUCT USED FOR THE DIETARY TREATMENT OF ADULT OBESE WOMEN
ON BLOOD LIPIDS AND SOME MINERAL LEVELS
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Aliye Ozenoglu, PhD:
Department of Psychiatry, Cerrahpasa Medical Faculty,
University of Istanbul, Istanbul, Turkey
Serdal Ugurlu, MD:
Department of Medicine, Cerrahpasa Medical Faculty,
University of Istanbul, Istanbul, Turkey
Erkan Caglar, MD:
Department of Medicine, Cerrahpasa Medical Faculty,
University of Istanbul, Istanbul, Turkey
Nurhan Caneroglu, MD :
Division of Endocrinology-Metabolism and Diabetes and
Department of Medicine, Cerrahpasa Medical Faculty,
University of Istanbul, Istanbul, Turkey
Fulya Akin, MD:
Division of Endocrinology-Metabolism and Diabetes and
Department of Medicine, Cerrahpasa Medical Faculty,
University of Istanbul, Istanbul, Turkey
Gunay Can, MD: Department of Public Health,
Cerrahpasa Medical Faculty,
University of Istanbul, Istanbul, Turkey
Hüsrev Hatemi, MD:
Professor of Medicine, Division of Endocrinology-Metabolism
and Diabetes and Department of Medicine, Cerrahpasa
Medical Faculty, University of Istanbul, Istanbul, Turkey
Correspondence to:
Aliye Özenoglu
Altimermer cad. Miralay Hasan Kazim sok. Ertan Apt.
No: 15/2
34280 Kocamustafapasa/Istanbul/ TURKEY
Tel: +90 212 4143130
Fax: +90 212 4143130
E-mail: aliyeozenoglu@yahoo.com
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| ABSTRACT
Background and aim: Obesity,
that can lead to diabetes and dislipidaemia, is a growing
health problem of modern life. Unhealthy nutritional
habits and consumption of too much refined food are
important factors contributing to this condition. This
study was performed to search for the effect of a Fibre
rich dietary product on blood lipids and some mineral
levels, used as a part of dietary treatment of obese
adult women.
Methods: A total of
25 adult women (12 in the study group and 13 in the
control group) were taken into this study in which patients
were selected randomly for both groups. At the beginning
of the study, height, weight, waist and hip circumferences
of all women were measured, and blood samples were taken
for some biochemical parameters (fasting blood glucose,
triglicerides, total cholesterol, HDL-C, LDL-C, VLDL-C,
and serum levels of calcium, phosphorus, iron and iron
binding capacity). Patients having some endocrinologic
and metabolic disturbances and that need to use anti-obesity
medications were not taken into this study. A low calorie
weight loss diet was planned for all women in both groups,
but women in the study group were also advised to use
a specific dietary product filled with inulin and oligofructose
including diabetic chocolate and rich in wheat fibre
as an exchange for one slice of bread every day. No
specific dietary product was advised to women in control
group. Patients were controlled once a month with respect
to weight loss and dietary adhesion until 3 months of
treatment were completed. Biochemical parameters were
repeated at the third month. Statistical analysis was
performed by a computer program with Mann-Whitney U
and Willcoxon tests.
Results: Although biochemical
parameters taken at the beginning of the study didn't
show any significant differences between groups, there
were significant decreases for trigliceride, total cholesterol
and VLDL-C levels in the study group after 3 months
of treatment, but not in the control group. No significant
differences were found with respect to the mineral levels
in either group or between basal and end findings between
study and control groups. Women in both groups lost
weight, and their waist and hip circumferences decreased
significantly.
Conclusion: We concluded
that this fibre rich, fat, sugar and salt free dietary
product can be useful for the dietary treatment of not
only obesity but also dislipidemia and insulin resistant
states.
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Key words: Obesity, diet,
fibre, blood lipids
INTRODUCTION
Obesity is a multifactorial disease
which is defined as increased fat tissue of the body to above
normal levels. It leads to an increase in risk for many diseases
some of which are diabetes, coronary heart disease, hypertension,
and also cancer. Aetiology of obesity includes genetic and
environmental factors; unbalanced, especially high in fat
diets; overeating; deficiency in physical activty; some disease
conditions that cause a decrease in exercise; and also socio-economical
status. Since it is impossible to change the genetic factors,
the most suitable way for the management of obesity seems
to control environmental factors. Nutritional modification
according to individual needs and increasing physical activty
are the most important environmental factors to be controlled.
While technological developments have improved the quality
of life, they have caused people to lessen their physical
activity as well. On the other hand, increase in the power
to buy goods have made people overeat especially preferring
'fast foods' which are high in fat, cholesterol, sodium and
energy, but low in fibre, vitamins and minerals. An unavoidable
result of this type of lifestyle is obesity and in turn leads
to other obesity related chronic diseases. For these reasons,
we conducted this study to investigate the effects of a fibre
rich, fat, salt and sugar free, dietary product for weight
loss and some biochemical parameters used for dietary treatment
of obese women.
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PATIENTS AND METHODS
A total of 25 obese women who attend
our Endocrinology Department and without any endocrinologic
and/or metabolic disturbances over 15 years old, were taken
into this study. Twelve subjects (mean age: 34.25±14.77
year) were in the study group and 13 (mean age: 37.51±11.71
year) in the control group. At the beginning of the study
blood samples were taken from all subjects for basal fasting
blood sugar (FBS), trigliceride (TG), cholesterol, HDL, LDL
and VLDL cholesterol and serum calcium (Ca), phosporus (P),
iron (Fe) and iron binding capacity (FeBC) levels. Anthropometric
measurements including height, weight, waist and hip circumferences,
and body composition anlyses with a Bioelectrical Impedance
Analyzer (BIA), were performed by a diet specialist. At least
3 days' food records were taken prepared by each patient to
predict their nutritional habits and also indepth interview
which is a qualitative method, was performed, taking at least
one hour for each patient. After that, low caloric and nutritionally
balanced diets were planned for all patients in both groups
according to patients nutritional and social conditions. Patients
in the study group were advised to intake a special dietary
product filled with inulin and oligofructose including diabetic
choclate and rich in wheat fibre, but free in fat, sugar and
salt, equivalent to the carbohydrate content of one slice
of bread (15 g), every day as bread exchange. This amount
of fibre rich dietary product (20 g) adds to the patient's
diet 5.5 g dietary fibre and 1.0 g cellulose every day. No
special dietary product was advised to the patients in the
control group.
All patients were seen once a month
by either an endocrinologist or dietitian. Patients' weight
reduction levels, waist and hip circumferences, and changes
in body compositions were measured and than recorded, and
their food intake was evaluated as to whether it was suitable
to be advised diet or not. Patients who didn't regulary use
special dietary products in the bstudy group were excluded
from the study. Pharmacological treatment advised patients
were not taken into this study. The results were statistically
analysed by a computer program with Mann Whitney-U and Willcoxon
tests.
RESULTS
Anthropometric measurements of both
groups at the beginning and the end of the study are shown
in Table 1.
Biochemical parameters taken at the
beginning for both groups were compared in Table
2a.
Biochemical parameters taken at the
end of the study are shown at Table
2b.
There were significant differences between only serum iron
binding capacities of the groups taken at the beginning of
the study. After 3 months of treatment, FBG levels showed
significant differences between groups.
Findings of the study group taken
at the beginning (basal) and the end of the study are shown
at Table 3a.
Weight, BMI, waist and hip circumferences
of women in the study group reduced significantly by the end
of the study. Trigliceride, cholesterol ve VLDL cholesterol
levels also showed significant decreases. But no significant
difference was found in mineral levels.
Findings of the control group belong to basal and the end
of the study, are given in Table
3b.
After 3 months of treatment, mean weight and BMI of the control
group showed a very significant decrease compared to the basal
values. Also, waist and hip circumferences decreased significantly.
There were not any significant differences in mineral levels.
DISCUSSION
The affluent western lifestyle is
associated with many chronic diseases including diabetes,
coronary heart disease (CHD) and cancer. The relationship
between lack of physical activity, excessive feeding and chronic
diseases is well known. The dietary Fibre hypothesis (1,2)
has drawn attention to the fact that these diseases are because
of a deficiency of dietary fibre. Many studies based on observation
have provided data that the consumption of whole-grain cereals
have a beneficial role in reducing CHD. In addition, it has
been suggested that consuming a lot of whole-grain food reduced
the risk of diabetes (3,4), hypertension and some types of
cancer (5).
An increase in body weight contributes
to the risk of diabetes and CHD in addition to causing insulin
resistance. Because of this reason, it is suggested that it
would be beneficial for obese subjects to eat fibre. In addition
to studies showing a positive effect of water-soluble viscous
fibre and low-glycemic index diets on the risk factors of
diseases associated with insulin resistance, there are also
studies which prove that serum lipids, carbohydrate tolerance
and glycemic control improve with insoluble wheat bran (6).
In our study, we used a specific dietary product rich in wheat,
oat and apple fibre (%28) and filled with diabetic choclate
including inulin, isomalt and oligofructose. When some parameters
of the groups before and three months after therapy were compared,
it was seen that triglyceride (TG), cholesterol and VLDL cholesterol
levels decreased significantly after therapy in the study
group (Table-3a); no such change was observed in the control
group (Table-3b). In both groups, weight, BMI, waist and hip
circumferences decreased significantly after 3 months (Table-3a,b).
Mineral levels didn't show any significant difference in both
groups. We thought that inulin and oligofructose which have
prebiotic properties, might effect positively for absorption
of these minerals.
It is said that when inulin and oligofructose
which are non-absorbable carbohydrates, are added to a diet,
they cause a significant increase in the colonic bifidobacteria
population(7). Inulin and oligofructose are fermented totally
by colonic microflora to produce acetat and other short chain
fatty acids. Together with dietary fibre and other non-absorbable
carbohydrates, they play important roles in decreasing blood
cholesterol, postprandial hypoglycaemia, immune stimulation,
and vitamin synthesis (7-9). Studies on rats showed that inulin
and oligofructose intake to nearly 10% of a diet, cause a
decrease in hepatic trigliceride synthesis and serum VLDL
levels (10-12).
According to the results of our study
which was compatible with the literature, we can say that
this dietary product rich-in-fibre and free in fat, salt and
sugar might be useful for not only weight reduction diets;
but, also in the presence of diabetes, dyslipidemia, and obesity.
It is also evident that foods rich-in-fibre will help to prevent
constipation which is an important problem in subjects of
almost all ages from different parts of the community.
As a result of the advances in technology,
the consumption of ready to eat refined fast-foods has increased,
leading to an increase in the frequency of diseases like obesity,
diabetes, dyslipidemia and cancer. We can say that this fibre-rich
dietary product which has a similar constitution to natural
foods can be used not only for the treatment of some diseases,
but also can be included in healthy nutritional programmes
to help prevent chronic degenerative diseases.
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Table 1:
Comparison of anthropometric measurements of both groups.
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Parameter Study
group Control group
p
Mean SD Mean
SD
Age
(year) 34.25 14.77
37.31 11.71 0.611
Height
(cm) 155.50 6.61
158.08 7.71 0.503
Weight 1 (kg) 90.83
30.42 96.77 17.41
0.087
Weight 4 (kg) 82.38
28.30 89.19 14.44
0.087
BMI 1 (kg/m2) 37.57
11.38 39.04 8.50
0.186
BMI 4 (kg/m2) 34.19
10.71 35.99 7.26
0.137
Waist cir. 1 (cm) 99.92
21.19 104.15 10.41
0.186
Waist cir. 4 (cm) 93.46
22.32 99.15 8.68
0.077
Hip cir. 1 (cm) 122.83
20.27 127.31 13.67
0.186
Hip cir. 4 (cm) 117.38
19.56 121.31 11.49
0.186
WHR 1 0.81
0.05 0.82 0.06
0.769
WHR 4 0.79
0.06 0.81 0.05
0.270
BMI: Body mass index
WHR: Waist/hip ratio
1: Measures taken at the beginning of the study
4: Measures taken at the end of the study.
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Table 2a.
Comparison of basal biochemical parameters of the
groups.
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Parameter Study
group Control group
Mean SD Mean
SD p
FBG
(mg/dl) 91.92 13.15
97.77 12.14 0.247
Trigliceride (mg/dl) 117.33
30.17 138.46 78.84
0.574
Cholesterol
(mg/dl) 213.42 45.31 201.85
29.77 0.503
LDL-C.
(mg/dl) 137.17 39.39
126.77 27.43 0.728
HDL-C
(mg/dl) 52.66 15.61
46.60 10.02 0.186
VLDL-C.
(mg/dl) 23.50 6.12
28.62 15.77 0.406
Fe
(mic/dl) 74.29 19.14
81.89 36.86 0.837
FeBC
(mic/dl) 342.29 31.83
383.00 31.79 0.031*
Calcium
(mg/dl) 10.16 0.53
9.93 0.30 0.383
Phosphorous
(mg/dl) 3.90 0.77 2.53
0.39 0.057
Hemoglobin
(g/dl) 12.69 1.01
13.24 1.35 0.232
Hematocrit
(%) 36.89 1.62
38.30 3.61 0.536
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Table 2b:
Comparision of biochemical parameters taken after
3 months of the study.
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Parametre
Study group Control group
Mean SD Mean
SD p
FBG (mg/dl) 89.50
14.04 100.00 9.97
0.005**
Trigliserid (mg/dl) 94.25
35.90 135.15 62.89
0.060
Cholesterol (mg/dl) 191.83
36.13 201.92 30.75
0.470
LDL -C (mg/dl) 125.83
28.25 131.08 29.49
0.689
HDL -C (mg/dl) 47.16
8.92 44.56 11.19
0.406
VLDL-C (mg/dl) 18.93
7.32 26.38 12.97
0.123
Fe
(mic/dl) 73.63 31.88
63.64 22.51 0.492
FeBC (mic/dl) 321.50
39.14 338.55 44.22
0.542
Calcium (mg/dl) 9.87
0.51 9.81 0.45
0.852
Phosporus (mg/dl) 3.07
0.21 2.60 0.60
0.400
Hgb (g/dl) 12.90
1.09 12.63 0.94
0.836
Hct (%)
37.01 2.91 36.86
2.17 0.836
**: highly significant
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Table
3a: Comparison of basal and the end findings of
the study group.
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Parameter At
the beginning After 3 months
Mean SD Mean
SD p ______
Weight (kg) 90.83
30.42 82.38 28.30
0.002**
BMI (kg/m2) 37.57
11.38 34.19 10.71
0.002**
Waist cir. (cm) 99.92
21.19 93.46 22.32
0.002**
Hip cir. (cm) 122.83
20.27 117.38 19.56
0.002**
WHR
0.81 0.05 0.79
0.06 0.066
FBG (mg/dl) 91.92
13.15 89.50 14.04
0.184
Trigliceride (mg/dl) 117.33
30.17 94.25 35.90
0.019*
Cholesterol (mg/dl) 213.43
45.31 191.83 36.13
0.019*
LDL C (mg/dl) 137.17
39.39 125.83 25.25
0.117
HDL -C. (mg/dl) 52.66
15.61 47.16 8.92
0.062
VLDL-C. (mg/dl) 23.50
6.12 18.93 7.32
0.026*
Fe
(mic/dl) 74.29 19.14
73.63 31.88 1.000
FeBC
(mic/dl) 342.29 31.83
321.50 39.14 0.138
Calcium
(mg/dl) 10.16 0.53
9.87 0.51 0.414
Hgb
(g/dl) 12.69 1.01
12.90 1.09 0.588
Hct (%)
36.89 1.62 37.01
2.91 0.500
Hgb: Hemoglobin
Hct:
Hematocrit
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Table 3b:
Comparision of the findings of control group taken at
the beginning and the end of the study.
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Parameter
At the beginning After 3 months
Mean SD Mean
SD p
Weight
(kg) 96.77 17.41
89.19 14.44 0.001***
BMI
(kg/m2) 39.04 8.50
35.99 7.26 0.001***
Waist
cir. (cm) 104.15 10.41
99.15 8.68 0.002**
Hip
cir. (cm) 127.31 13.67
121.31 11.49 0.002**
WHR
0.82 0.06 0.81
0.05 0.843
FBG
(mg/dl) 97.77 12.14
100.00 9.97 0.624
Trigliserid
(mg/dl) 138.46 78.84 135.15
62.89 0.972
Cholesterol
(mg/dl) 201.85 29.77 201.92
30.75 0.727
LDL
-C (mg/dl) 126.77 27.43
131.08 29.49 0.600
HDL -C
(mg/dl) 46.60 10.02 44.56
11.19 0.308
VLDL-C.
(mg/dl) 28.62 15.77 26.38
12.97 0.583
Fe
(mic/dl) 81.89 36.86
63.64 22.51 0.176
FeBC
(mic/dl) 383.00 31.79
338.55 44.22 0.063
Calcium
(mg/dl) 9.93 0.30
9.81 0.45 1.000
Hgb
(g/dl) 13.24 1.35
12.63 0.94 0.593
Hct
(%) 38.30 3.61
36.82 2.17 0.715
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