sicurezza ed efficacia del digiuno



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Sicurezza ed efficacia del digiuno e della restrizione calorica.

Efficacy and safety of very-low-calorie diet in Taiwanese: A multicenter randomized, controlled trial.
Lin WY, Wu CH, Chu NF, Chang CJ.  Nutrition. 2009 Jul 8.
OBJECTIVE: Very-low-calorie diets (VLCDs) are an effective method for weight reduction in Caucasians. This study investigated the efficacy and safety of two different VLCDs (450 or 800kcal/d) in obese Taiwanese. 
METHODS: 132 participants with BMI >/=30kg/m(2) were randomized to two VLCD groups for body weight reduction for 12 weeks. Each group had 66 participants. Anthropometric and metabolic parameters were measured. 
RESULTS: The intention-to-treat analysis revealed that the percentage change in body weight over the 12-week treatment period was -9.14% in the VLCD-450 group and -8.98% in the VLCD-800 group. A total of 27 (40.9%) participants in the VLCD-450 group and 29 (43.9%) participants in the VLCD-800 group achieved 10% or more weight loss at the end of treatment. The body weight, waist circumference, hip circumference, fat mass, blood pressure, triglycerides, and blood glucose were statistically improved from baseline but not between the two groups. The improvement rate of nonalcoholic fatty liver disease (NAFLD) was 41.5% in the VLCD-450 group and 50.0% in the VLCD-800 group. The incidence of adverse events did not differ significantly between the groups and no serious adverse events were reported in either group. 
CONCLUSION: Both the VLCD-450 and 800kcal/d can effectively and safely reduce body weight and improve NAFLD in 12 weeks in obese Taiwanese participants. However, there is no additional benefit in prescribing the more restrictive diet intervention in Taiwanese.

Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study.
J Altern Complement Med. 2005 Aug;11(4):601-7.
Michalsen A, Hoffmann B, Moebus S, Backer M, Langhorst J, Dobos GJ.
Department of Integrative and Internal Medicine V, Kliniken Essen-Mitte, and Complementary and Integrative Medicine of the Alfred Krupp von Bohlen und Halbach Foundation, University Duisburg-Essen, Essen, Germany.
Objectives: The aim of this study was to implement fasting therapy in an inpatient integrative medicine ward and to evaluate safety, acceptance, and effects on health-related outcomes and lifestyle adherence. 
Design: This was a prospective observational study with consecutive inpatients over 13 years. Inclusion and exclusion criteria for fasting therapy were checked by treating physicians and recommendations given. After receiving full information patients decided whether they would participate in fasting. Outcomes were assessed on admission, at discharge, and 3 and 6 months after discharge. 
Setting: The study took place in an integrative medicine department of an academic teaching hospital. Subjects: Subjects were newly admitted inpatients with chronic internal diseases and chronic pain syndromes, with lengths of hospital stay of >3 days. Interventions: All patients received intensive integrative treatments including Mind/Body Medicine, acupuncture, nutritional/lifestyle education, and hydrotherapy. Fasting patients participated in a 7-day juice fast (intake <350 kcal/day) with accompanying bowel cleansing, 2 prefasting relief days, and 3 days with stepwise reintroduction of food. Outcome measures: Outcomes were assessed based on rate of participation in fasting, severity of main complaint, quality of life (QOL, MOS 36-Item Short-Form Health Survey), safety, lifestyle adherence to recommendations given (relaxation, diet, exercise).
Results: Of 2121 patients with complete discharge questionnaires, 952 patients participated in fasting, 873 had a normocaloric vegetarian diet, and 296 patients had other diets and were excluded. Response rates were 71% and 56% at 3- and 6-month follow-up. The main disease-related complaint at discharge was significantly greater improved in fasters versus nonfasters (p < 0.01). Patient QOL increased significantly and comparably from baseline to discharge in both groups. Fasting was well tolerated and no serious fasting-related adverse effects were reported. In all, 743 (78%) of fasting patients reported improvement of their health through fasting. Descriptors of lifestyle adherence showed higher levels of related activities in the 3 and 6 months of follow-up. Conclusions: Fasting can safely and successfully be implemented in an inpatient integrative medicine concept and is perceived as a health-promoting method by the majority of patients. Potential effects on disease-related complaints and lifestyle adherence should be further evaluated in randomized trials.

Nonphysician supervision of a very-low-calorie diet. Results in over 200 cases.
Int J Obes. 1981;5(3):237-41.
Atkinson RL, Kaiser DL.
Nonphysician nutritional therapists treated 234 obese patients with a 12-week behavioral modification, nutrition education program followed by up to 12 weeks on a very-low-calorie diet (VLCD). Mean weight decreased from 104.5 kg to 85.8 kg after 12 weeks on VLCD. Mean maximal weight loss for all patients was 17.2 kg. Blood pressure decreased from 133/86 to a low of 111/70 during VLCD. In 91 hypertensive patients, blood pressure fell from 145/95 to 128/81 after 12 weeks of VLCD. No serious side effects of VLCD were noted, although two patients developed mild cases of gout and one patient was taken off the fast when premature ventricular contractions were noted on ECG. Cost analysis reveals that physician care is almost three times as expensive as care by non-physician nutritional therapists. We conclude that the treatment of obesity should be performed by nutritional therapists under physician supervision using a comprehensive program of behavioral modification and VLCD.

Features of a successful therapeutic fast of 382 days' duration.
Postgrad Med J. 1973 Mar;49(569):203-9. Stewart WK, Fleming LW.

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