VLCD by Enteral Route for Weight Loss
Condition: Severe Obesity
MeSH terms: Obesity; Obesity, Morbid
Study type: Observational

Summary: 
      Body weight excess, from overweight to overt obesity, is associated with adverse health
      outcomes. In view of the time-trends of the obesity epidemic and the related cost burden, the
      search for effective strategies for weight reduction and long-term maintenance of weight loss
      (WL) is at the top of the agenda of public health systems.

      The current first-line strategy includes several treatment options and dietary interventions
      to be implemented together with an exercise program. Unfortunately, compliance with
      intervention in the long-term is difficult. It is not infrequent to observe people following
      one diet after another and experiencing multiple failures which, in turn, lead to higher body
      weight and adverse consequences on body composition and fat distribution. The higher the
      number of attempts, the more difficult the adherence to further interventions. In the
      presence of severe (body mass index >40 kg/m2) or complicated obesity, bariatric surgery
      could be proposed. This therapeutic option is effective, but is not devoid of complications
      and may be irreversible. Obesity-related complications, such as diabetes, hypertension or
      sleep apnoea are likely to occur more frequently with increasing body mass index (BMI) and
      rapid and considerable WL is mandatory to curtail such risks.

      In this scenario, alternative treatment options are warranted. About 40 years ago, after the
      introduction of protein-sparing modified fasting (PSMF) achieved through the use of oral
      high-protein foods or liquid formula diets by Blackburn and Bistrian, several studies
      evaluated its effectiveness and safety. They showed that responsible and supervised very-low
      calorie diets (VLCDs) could be considered safe and appropriate therapy for obesity.

      The purpose of the present study was to investigate the potential role of a 2-week course of
      enteral treatment with a very low-calorie protein-based formula in the management of severe
      obesity.

      The rationale of this treatment option rests on the following considerations: 1) VLCDs appear
      to be able to reduce cardiovascular risk rapidly and effectively; 2) VLCDs induce
      considerable short and long-term WL; 3) optimal compliance with the intervention, as active
      participation of the patient is not required; 4) continuous administration of the
      intervention formula by enteral route enables the the maintenance of the body amino acid
      pool.

      Before being proposed for clinical use, a new WL program should be scientifically evaluated.
      Accordingly, in the present study, attention was focused not only on efficacy in terms of
      improving the cardiometabolic risk profile, but also on the feasibility and safety of the
      procedure.
    


Intervention name(s): NEP
Intervention type(s): Other
Intervention description(s): A homemade very low-calorie protein-based formula by enteral route (8-French nasogastric tube) for 14 days. The administration was continuous (h-24) by a feeding pump. The formula was made up of a fixed amount of aminoacids and a variable amount of high-quality proteins: 1.2 g/kg (ideal body weight). Other components were: pro-lipolytic substances (coenzyme Q10 and L-carnitine), linseed oil, policosanol, fructo-oligo saccharides, potassium, sodium and magnesium chloride. The intervention included also the daily oral administration of a multivitamin-multimineral supplement, alkalizing substances (calcium carbonate, 1500 mg; magnesium carbonate, 850 mg; potassium bicarbonate, 500 mg; sodium bicarbonate, 1500 mg; potassium citrate, 500 mg) and herbal remedies. All patients were also prescribed treatment with a proton pump inhibitor and ursodeoxycholic acid. A minimum intake of 2 liters/day of unsweetened fluids was recommended (3 litres in case of a history of kidney stones).
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Consecutive severly obese patients attending the Clinical Nutrition Unit of our institution
        for a weight loss program
      
Keywords: Enteral nutrition; very low-calorie diet; severe obesity; weight loss; ketosis