The Protein-Sparing Modified Fast Diet

Bakhach, Marwan; Shah, Vaishal; Harwood, Tara; Lappe, Sara; Bhesania, Natalie; Mansoor, Sana; Alkhouri, Naim

doi:10.1177/2333794x15623245

Cited by 14 publications

(15 citation statements)

References 15 publications

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“…The largest declines in weight loss were at 3 and 6 months, with some weight regain occurring by 12 months. This pattern of weight loss is similar to other PSMF studies in adolescents [15,16]. Interestingly, the recommended daily carbohydrate intake was increased from 40 to 60 g at 6 months.…”

Section: Discussionsupporting

confidence: 88%

“…In addition, children and adolescents with severe obesity tend to do poorly with adherence in traditional pediatric weight management interventions [8,30,32]. In a clinic-based study of the PSMF for adolescents, the dropout rate was as high as 50% across 12 months [15]. Even with the challenges with retention and adherence, the children/adolescents in this study also experienced significant improvements in weight loss.…”

Section: Discussionmentioning

confidence: 99%

“…Extant literature on the PSMF in both adults and adolescents is encouraging [9,13,14,15,16,17,18,19,20], yet studies on the use of the PSMF in children and adolescents to treat obesity are limited. In a study of adolescents with severe obesity who previously failed at conventional lifestyle modification, the PSMF produced a clinically significant mean decrease of 9.8% of body weight over 6 months [15]. A case series using a revised PSMF protocol with carbohydrate intake limited to 20 g per day in both an inpatient and outpatient setting reported an average weight loss of 1–2 pounds a week and improvement in comorbidities [19].…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, the PSMF is categorized as a very low-calorie diet (VLCD), with significant calorie restriction, sometimes as low as 500–800 kcal per day [20,21]. However, VLCDs (when provided mostly as liquid meal replacements) have raised safety concerns in the past [18,22]; so recent studies using the PSMF have been less stringent with caloric restriction and have demonstrated improved safety profiles [15,16,19].…”

Section: Introductionmentioning

confidence: 99%

“…Most of the studies in the pediatric population have been hampered by small sample sizes, follow up periods of 6 months or less and low retention rates [15,17,23]. In addition, not much is known about the relationship between varying levels of adherence with the diet and weight-related outcomes or quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study

Eneli

Tindall

et al. 2019

IJERPH

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Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200–1800 calories, 40–60 g of carbohydrate/day and 1.2–1.5 g protein/kg of ideal bodyweight was implemented over 12 months. Twenty-one participants enrolled in the study. Mean age 16.2 ± 1.4 years, females (76.2%) and mean weight at baseline was 119 ± 19.9 kg. Regardless of adherence to the rPSMF, the mean weight change at 1 month was −3.7 ± 3.5 kg, (range −13.5 kg to 0.9 kg); at 3 months was −5.5 ± 5.1 kg, (range −19.3 kg to 1.8 kg) and at 6 months was −4.7 ± 6.6 kg, (range −18.3 kg to 8.6 kg). At 12 months, the mean weight change was −1.3 ± 10.6 kg (range −17.7 kg to 14.8 kg). Parent and child-reported physical and psychosocial quality of life (HRQOL) improved. Despite limited adherence, the rPSMF diet resulted in clinically significant weight loss and improved HRQOL for children and adolescents with severe obesity.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study

Eneli

Tindall

et al. 2019

IJERPH

View full text Add to dashboard Cite

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The Effect of Starting the Protein-Sparing Modified Fast on Weight Change over 5 years

et al. 2020

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BACKGROUND: Ketogenic diets have been highlighted as a way to lose weight while experiencing reduced hunger. The protein-sparing modified fast (PSMF) induces ketosis but may be difficult to maintain. OBJECTIVE: To track weight loss for individuals initiating PSMF versus all other diets (e.g., balanced, high protein) for up to 5 years. DESIGN: Retrospective cohort study PARTICIPANTS: Adults who discussed the PSMF with a clinician between 2007 and 2014 INTERVENTION: Initiating the PSMF diet versus other diets MEASURES: The main outcome was percent weight change up to 5 years. Demographic and health data were collected using electronic health records. We fit regression models including age, sex, race, insurance, new medication prescriptions, and specialist visit to identify the effect of PSMF diet on percent weight change. We grouped patients by percent weight change at each year (≥ 5% loss, 4% loss to 4% gain, ≥ 5% gain) and used Pearson χ 2 tests to compare proportions. RESULTS: Of 1,403 eligible patients, 879 (63%) started the PSMF. The PSMF group was slightly younger (52 vs. 54 years, p < 0.01) and had a higher body mass index (41.9 kg/m 2 vs. 40.4 kg/m 2 , p < 0.001). In the adjusted analysis, the PSMF group averaged 3% more weight loss than the other group over the 5-year follow-up (95% CI − 3.5, − 2.0, p < 0.001). PSMF patients lost more weight initially, but by year 4, there was no difference between diets (1.6% versus 1.3%, PSMF versus other diets, p = 0.12). Patients starting the PSMF were more likely to experience ≥ 5% weight loss at 1 year (55% vs 20%, p < 0.001) and 3 years (33% vs. 23% p < 0.05), but not 5 years (34% vs 29%, p = 0.16, PSMF versus other diets, respectively). CONCLUSIONS: In clinical practice, the PSMF achieves rapid weight loss in the first 6 months, but only a small percentage of patients maintained significant weight loss long term.

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