Dissertação de Mestrado Nutrição Humana e Metabolismo 2023 Faculdade de Ciências Médicas, Universidade NOVA de Lisboa

Background: Obesity increases cardiovascular risk through factors such as increased fasting plasma triglycerides and low high-density lipoprotein cholesterol, which represents metabolic manifestations of adiposopathy. Commercial weight loss programs that include interventions with evidence of efficacy in clinical trials have been considered effective alternatives for body weight management and to reduce the cardiovascular risk associated with obesity. In this regard, the Weight Loss Maintenance 3 Phases Program is a protocol treatment for overweight adults, which assumes a high-protein and low-carbohydrate diet, weekly consultations with a nutritionist, use of food supplements, motivational support, time-restricted eating, high-protein specific food and online platform monitoring, which makes it different from the standard low-carbohydrate approach. Objective: The aims were to evaluate the impact of the Weight Loss Maintenance 3 Phases Program on lipid profile (triglycerides, high-density lipoprotein cholesterol, and triglycerides/high-density lipoprotein cholesterol ratio), blood pressure, the cardiovascular risk with Systematic COronary Risk Evaluation2 and the correlation between nutritional intake and lipid profile at baseline and at 6 months, compared to a low-carbohydrate diet. Methodology: A total of 112 participants with obesity (Body Mass Index ≥ 30 kg/m2 and ≤ 39.9 kg/m2) were randomly assigned to the Weight Loss Maintenance 3 Phases Program or low-carbohydrate diet. Results: At 6 months the Weight Loss Maintenance 3 Phases Program resulted in a more pronounced increase in high-density lipoprotein cholesterol (mg/dL) compared to the low-carbohydrate diet [+7.9 (8.2) vs +4.9 (6.2); p=0.046]. The triglycerides/high-density lipoprotein cholesterol ratio at 6 months improved in both groups compared to baseline but without a statistical difference (p=0.267). No statistical differences were found in other outcomes between groups except weight loss and diastolic blood pressure (p<0.001 and p<0.021 respectively). The Weight Loss Maintenance 3 Phases Program had a lower total energy intake (kcal per day) [1313.8 (1167.5|1406.8) vs 1444.4 (1304.6|1573.6); p<0.001], a lower carbohydrate intake (% of total energy intake) [16.7 (14.4|24.6) vs 25.1 (22.1|28.6); p<0.001], a higher protein intake (% of total energy intake) [31.8 (28.6|34.2) vs 27.0 (24.6|29.4); p<0.001] and also higher fiber intake (g per day) [19.2 (15.5|21.3) vs 15.1 (12.9 to 18.8); p=0.040], compared to low-carbohydrate diet at 6 months. A positive correlation between triglycerides (r=0.38; p=0.011) and protein intake at 6 months in the low-carbohydrate diet and a positive correlation between triglycerides (r=0.53; p<0.001) and fiber intake at 6 months in the Weight Loss Maintenance 3 Phases Program were found. Conclusion: Our data showed that the Weight Loss Maintenance 3 Phases Program was more effective in increasing high-density lipoprotein cholesterol than a low-carbohydrate diet after 6 months of intervention for weight loss