The effect of orlistat versus metformin on body composition and insulin resistance in obese premenopausal women: 3-month randomized prospective open-label study

Abstract

IntroductionOur aim was to evaluate the effects of metformin and orlistat on body composition and glucose–insulin homeostasis in obese premenopausal women.Material and methodsSeventy-three obese premenopausal Caucasian women aged 32.4 ±8.3 years were treated with either metformin (1000 mg/day; n = 37) or orlistat (360 mg/day; n = 36). Anthropometric parameters were measured using dual-energy X-ray absorptiometry. Glucose tolerance, using the oral glucose tolerance test; insulin resistance, using the homeostasis model assessment (HOMA-IR); and insulin sensitivity, using the Matsuda insulin sensitivity index (ISI Matsuda), were assessed at the commencement of the study and after 3 months.ResultsThose treated with orlistat showed greater weight loss (−9.4 ±2.3 vs. –4.9 ±1.3 kg, p < 0.05) and decrease of fat mass (−5.4 ±3.0 vs. –3.5 ±0.7 kg, p < 0.05) than those treated with metformin. The percentage of android and gynoid fat deposits was reduced in both groups; however, a greater decrease in android fat was observed in those treated with metformin. Improvement in ISI Matsuda and post-load insulin were similar in both groups. High initial post-load insulin and low ISI Matsuda corresponded with reductions in total fat, trunk fat, and waist circumference in both groups, and a decrease in android fat in those treated with metformin.ConclusionsOrlistat treatment resulted in greater weight loss and improvement in body composition; metformin treatment resulted in a reduction of android fat. Both drugs produced a comparable improvement in insulin/glucose homeostasis. Overall, insulin-resistant women showed improvement with treatment, irrespective of which drug was used.

Effect of Orlistat Versus Metformin in Various Aspects of Polycystic Ovarian Syndrome: A Systematic Review of Randomized Control Trials

“…In view of Table 3, Jayagopal et al [6] showed that the reduction in weight and after treatment with orlistat was more significant than seen in the metformin-treated group (4.69 vs. 1.02%, p value -0.006). Similarly according to Kujawska-Łuczak et al [7], the percentage change of weight loss and BMI was more in orlistat-treated group than that of metformin (-3.2 ± 0.8 vs. -1.7 ± 0.4; p value \ 0.05 for weight loss and -4.9 ± 1.3 vs. -9.4 ± 2.3; p value\ 0.05 for BMI). On comparison, the difference between the above said groups was found to be statistically significant for the concerned parameters.…”

“…This fact indicates that the association of improvement of ovulation rate with either drug seems to be indirectly through weight loss and neither drug seems to have any direct effect on ovulation induction. As far as reduction in weight and BMI is concerned Jayagopal et al [6], Cho et al [8] and Kujawska-Łuczak et al [7] have found orlistat to be more effective than metformin. Although the weight losing effects of metformin have also been described in various studies [10], the metformin therapy is not associated with a smooth course as gastrointenstinal side effects are a major barrier to patient compliance.…”

“…At present, there is no guideline regarding the duration of use of orlistat for PCOS. However, based on the various randomized control trials that studied the various effects of orlistat, a treatment duration of minimum 3-6 month can be accepted as reasonable [3][4][5][6][7][8].…”

Efficacy of orlistat in non‑alcoholic fatty liver disease: A systematic review and meta‑analysis

“…The present results also indicated that orlistat treatment reduced plasma glucose levels compared to baseline in patients with NAFLD and NASH. Kujawska-Łuczak et al (30) observed similar results while examining the effect of orlistat on glucose/ insulin homeostasis in obese premenopausal women. Orlistat has been further indicated to improve glycemic control and insulin resistance, as well as reduce body weight gain and BMI, in patients with obesity and type 2 diabetes (31,32).…”

Effects of vitamin D supplementation on insulin resistance and dyslipidemia in overweight and obese premenopausal women

“…As a result of the correlation between hyperandrogenemia and NAFLD, bioavailable testosterone is independently associated with the fatty liver index in postmenopausal women [45]. Comparing the effect of orlistat versus metformin on body composition and insulin resistance in obese premenopausal women, it was found that orlistat and metformin produced similar improvement in insulin and glucose homeostasis [46]. Vitamin D deficiency is also associated with NAFLD and has even been correlated with the severity of the disease [47].…”