Efeito da dieta com restrição de carboidrato vs. dieta recomendada na composição corporal e capacidade funcional muscular de indivíduos com obesidade
Data
2021-12-10
Autores
Mortareli, João Henrique Fabiano [UNIFESP]
Orientadores
Izar, Maria Cristina de Oliveira [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A redução da massa corporal (MC) em indivíduos com obesidade se mostra como um fator de risco modificável na morbimortalidade por doenças cardiovasculares (DCV). No entanto, os potenciais benefícios da redução da MC induzida por restrição calórica podem ser comprometidos devido a redução de massa magra (MM) e força muscular (FM) que podem afetar inadvertidamente a capacidade funcional muscular (CFM) do indivíduo. Objetivo: Avaliar as alterações da composição corporal e da CFM em pacientes com obesidade inativos fisicamente submetidos a uma entre duas distintas dietas hipocalóricas ao longo de 6 meses. Métodos: Foram incluídos 25 pacientes inativos fisicamente com obesidade grau I ou II, de ambos os sexos, com média de idade de 40 anos, acompanhados durante 6 meses por meio de atendimento médico e nutricional periódico, alocados entre grupo Dieta Dukan (DD) (n=11), que receberam as recomendações nutricionais estipuladas pela metodologia Dukan ou a Dieta Recomendada (DR) (n=14), que receberam orientações nutricionais baseadas no Guia Alimentar para População Brasileira de 2014. Utilizou-se Raio-x de dupla absorbância (DEXA) (Lunar DPX GE Health Care, Software Encore) para análise da MM, e gordura corporal (GC) junto a medidas antropométricas de circunferência da cintura (CC), quadril (CQ) e abdome (CABD); dinamômetro isocinético Biodex® Multi-joint System 3 (Biodex Medical Systems Inc, Shirley, NY, USA) para análise da CFM dos músculos extensores do joelho (Pico de torque a 60º/s - PT e sua variável corrigida pela MC - PT/MC). Quantificou-se a ingestão alimentar via recordatório alimentar de 3 dias. As análises foram realizadas no momento Basal, 05 dias, 30 dias e 180 dias. Resultados: Consumo significativamente maior de proteínas e menor de carboidratos e fibras (com exceção do tempo 180 dias para as fibras) foi observado no grupo DD em comparação a DR. Ao final do estudo, observou-se que ambas as intervenções promoveram reduções significativas da MC (DD
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P<0,001; DR P<0,001) e GC (DD P<0,001; DR P<0,001), porém, somente a DD apresentou reduções significativas de MM (P<0,031), PT (P<0,001) e PT/MC P<0,001) e em todas as medidas de circunferência (CC P<0,001, CABD P<0,001 e CQ P<0,001) enquanto a DR apresentou redução somente da CC (P<0,001). A comparação entre grupos no momento 180 dias apresentou valores significativamente menores para as medidas de CC (P<0,033), CABD (P<0,039), CQ (P<0,036) e GC (P<0,031) no grupo DD. Conclusão: A DD promoveu reduções mais expressivas de MC, GC, MM e medidas de circunferência às custas de prejuízo da CFM mesmo diante de um elevado consumo proteico. Estudos de mais longo prazo são necessários para compreender se a redução da CFM poderá acarretar em prejuízos funcionais e/ou aumento do risco para DCV nesta população em decorrência da prática desta dieta.
Introduction: The reduction of body mass (BM) in obese individuals has been considered a modifiable risk factor for cardiovascular diseases (CVD) morbidity and mortality. However, the potential benefits of caloric restriction-induced BM reduction may be compromised due to the reduction in lean mass (LM) and muscle strength (MS), which may inadvertently affect the individual's muscular functional capacity (MFC). Objective: To evaluate changes in body composition and MFC in physically inactive obese patients undergoing one of two different low-calorie diets over a 6-month period. Methods: We included 25 physically inactive patients with grade I or II obesity, of both genders, with a mean age of 40 years, followed for 6 months through periodic medical and nutritional care, allocated to the Dukan´s Diet (DD) group (n=11) who received the nutritional recommendations specified by the Dukan Diet or the Recommended Diet (RD) methodology (n=14), who received nutritional guidelines based on the 2014 Food Guide for the Brazilian Population. Double absorbance x-ray (DEXA) (Lunar DPX GE Health Care, Encore Software) was used for analysis of LM, and Body Fat (BF) along with anthropometric measurements of waist (WC), abdomen (AC) and hip (HC) circumferences; Biodex® Multi-joint System 3 isokinetic dynamometer (Biodex Medical Systems Inc, Shirley, NY, USA) was used for MFC analysis of the knee extensor muscles (Peak torque at 60º / s - PT and its variable corrected by BM - PT / BM). Food intake was quantified via 3-day dietary recall. Analyzes were performed at baseline, 05, 30, and 180 days. Results: Significantly higher consumption of protein and lower consumption of carbohydrates and fiber (with the exception of 180 days for fiber) were observed in the DD group compared to RD. At the end of the study, it was observed that both interventions promoted significant reductions in BM (DD P<0.001; DR P<0.001) and BF (DD P<0.001; RD P<0.001), however, only DD presented significant reductions of LM (P<0.031), PT (P<0.001), PT/BM xi (P<0.000) and in all circumference measures (WC P<0.000, AC P<0.000 and HC P<0.000) while RD showed a reduction only on WC (P<0.001). Comparison between groups at 180 days showed significantly lower measures for WC (P<0.033), AC (P<0.039), HC (P<0.036) and BF (P<0.031) in the DD group. Conclusion: DD promoted more expressive reductions in BM, BF, LM and circumference measures at the expense of a loss of MFC even with a high protein intake. Longer-term studies are needed to understand whether the reduction in MFC could lead to functional impairment and/or increased risk for CVD in this population as a result of the practice of this diet.
Introduction: The reduction of body mass (BM) in obese individuals has been considered a modifiable risk factor for cardiovascular diseases (CVD) morbidity and mortality. However, the potential benefits of caloric restriction-induced BM reduction may be compromised due to the reduction in lean mass (LM) and muscle strength (MS), which may inadvertently affect the individual's muscular functional capacity (MFC). Objective: To evaluate changes in body composition and MFC in physically inactive obese patients undergoing one of two different low-calorie diets over a 6-month period. Methods: We included 25 physically inactive patients with grade I or II obesity, of both genders, with a mean age of 40 years, followed for 6 months through periodic medical and nutritional care, allocated to the Dukan´s Diet (DD) group (n=11) who received the nutritional recommendations specified by the Dukan Diet or the Recommended Diet (RD) methodology (n=14), who received nutritional guidelines based on the 2014 Food Guide for the Brazilian Population. Double absorbance x-ray (DEXA) (Lunar DPX GE Health Care, Encore Software) was used for analysis of LM, and Body Fat (BF) along with anthropometric measurements of waist (WC), abdomen (AC) and hip (HC) circumferences; Biodex® Multi-joint System 3 isokinetic dynamometer (Biodex Medical Systems Inc, Shirley, NY, USA) was used for MFC analysis of the knee extensor muscles (Peak torque at 60º / s - PT and its variable corrected by BM - PT / BM). Food intake was quantified via 3-day dietary recall. Analyzes were performed at baseline, 05, 30, and 180 days. Results: Significantly higher consumption of protein and lower consumption of carbohydrates and fiber (with the exception of 180 days for fiber) were observed in the DD group compared to RD. At the end of the study, it was observed that both interventions promoted significant reductions in BM (DD P<0.001; DR P<0.001) and BF (DD P<0.001; RD P<0.001), however, only DD presented significant reductions of LM (P<0.031), PT (P<0.001), PT/BM xi (P<0.000) and in all circumference measures (WC P<0.000, AC P<0.000 and HC P<0.000) while RD showed a reduction only on WC (P<0.001). Comparison between groups at 180 days showed significantly lower measures for WC (P<0.033), AC (P<0.039), HC (P<0.036) and BF (P<0.031) in the DD group. Conclusion: DD promoted more expressive reductions in BM, BF, LM and circumference measures at the expense of a loss of MFC even with a high protein intake. Longer-term studies are needed to understand whether the reduction in MFC could lead to functional impairment and/or increased risk for CVD in this population as a result of the practice of this diet.