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Original Article  

Effects of Lifestyle Modification Program, KOHNODAI Program, on Metabolic Parameters in Japanese Obese People

Akiko Kawaguchi, MD, Hisayuki Katsuyama, MD, PhD, Hidekatsu Yanai, MD, PhD*
1Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan

*Corresponding author: Dr. Hidekatsu Yanai, M.D., Ph.D., F.A.C.P. Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, 1-7-1 Kohnodai, Chiba, 272-8516, Japan.
E-mail: dyanai@hospk.ncgm.go.jp

Submitted: 10-15-2015 Accepted: 10-20-2015  Published: 10-27-2015

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Article

 
Abstract

Background

We developed the program to support obese patients to change their lifestyle related with obesity, KOHNODAI program. Here we studied effects of KOHNODAI program on metabolic parameters in 19 Japanese obese people. Mean body weight significantly decreased to 79.9 kg immediately after the KOHNODAI program, and at 3 (79.7 kg) and 6 months (77.3 kg) after the program as compared with body weight before the program (81.7 kg). Serum high-density lipoprotein-cholesterol levels significantly increased, and alanine aminotransferase tended to decrease 6 months after the program. Lower BMI tended to achieve weight reduction ≧ 3% at 6 months after the program. Frequency of participants who take anti-psychotic drugs was significantly lower in the group that achieved weight reduction ≧ 3% as compared with the group that could not achieve weight reduction ≧ 3%. In conclusion, our KOHNODAI program significantly reduced body weight, and ameliorated dyslipidemia and liver function in obese people.
 
Keywords: Anti-psychotic drugs, Body weight reduction, HDL-cholesterol, Lifestyle, Obesity

Introduction

Obesity, especially abdominal obesity, has been known to be frequently associated with metabolic disorders, such as glucose intolerance, hypertension and dyslipidemia [1-7].

The mission of our institute, National Center for Global Health and Medicine (NCGM), is to provide the best general healthcare services to overcome diseases and improve health with the aim of contributing to society. Prevention of obesity-related metabolic abnormalities is one of important missions for NCGM. We developed the program to support obese patients to change their lifestyle related with obesity, and named this program KOhnodai Hospital NCGM Obesity-related Diet and Physical Activity Improvement (KOHNODAI) program [8]. Here we studied effects of the KOHNODAI program on metabolic parameters in Japanese
obese people.

Subjects and Methods

Subjects

We studied 19 patients who participated in the KOHNODAI Program. Clinical characteristics were shown in Table 1. After 5 days admission, the participants visit our outpatient clinic and receive guidance about diet every month. Almost 40 patients were screened to participate in the KOHNODAI program, and almost half of screened patients rejected the participation.

Methods
 
The summary of KOHNODAI program was shown in Table 2. Briefly, this program is scheduled to be completed for 5 days, and start on Friday and finish on next Tuesday for a busy businessman. On Day 1, we perform a medical check-up to understand that obese patients can take diet therapy and exercise safely. We measure the markers of atherosclerosis, and also visceral and subcutaneous fat, which can motivate patients to participate actively in this program. Physical therapists make an individual exercise program which depends on age, exercise capacity and endurance, cardiopulmonary function of each patient, and instructed patients to do exercise. Our diet therapy includes the small restriction of calorie intake [25 kcal/kg (ideal body weight) /day]. On Day 2 and Day 3, patients take diet therapy and exercise. On Day 4, we measure serum metabolic parameters, and basal metabolic rate which influence on changes in body weight. In the afternoon of Day 4, patients receive the instruction of nutrition therapy by the registered dietitians individually. On Day 5, each patient reflects on the KOHNODAI program and their lifestyle.
 
Diabetes Table 10.1
 
To understand effects of the KOHNODAI program on metabolic parameters, we studied clinical and biochemical data and medical history before and immediately after the KOHNODAI program, and at 3 and 6 months after the program.

Measurements

Height and weight were measured with a rigid stadiometer and calibrated scale (seca 764, seca Co., Ltd, Birmingham, United Kingdom). Body mass index (BMI) was calculated as body weight (kg) divided by the square of height (m). Waist circumference was measured in a standing posture at the umbilical level while breathing out.

We determined visceral fat area (VFA) and subcutaneous fat area by using the abdominal computed tomography.

Venous blood samples were taken after a 12-h overnight fast. Fasting plasma glucose (FPG) was measured using an enzymatic method. Glycated hemoglobin (HbA1c) was measured by high-performance liquid chromatography (HPLC).
 
Triglyceride and high-density lipoprotein (HDL)-cholesterol were measured enzymatically using commercially available kits. Low-density lipoprotein-cholesterol was obtained by the Friedwald formula [9].
 
Diabetes Table 10.2
 
Statistical Analysis

All statistical analyses were performed using SPSS version 19 (IBM Co., Ltd, Chicago, IL). We analyzed the difference in values between two groups by paired T test, and analyzed the difference in frequency between two groups by chi-square test. A P value of < 0.05 was considered statistically significant.

Results

Body weight significantly decreased immediately after the KOHNODAI program, and at 3 and 6 months after the program as compared with body weight before the program (Figure 1).
 
Diabetes Fig 10.1
 
Changes in clinical and metabolic parameters at 6 months after the KOHNODAI program were shown in Table 3. Serum HDL-cholesterol levels significantly increased, and alanine aminotransferase (ALT) tended to decrease 6 months after the program.
 
Diabetes Table 10.3
 
Clinical differences between the group that achieved weight reduction ≧ 3% and the group could not achieve weight reduction ≧ 3% at 6 months after the KOHNODAI program was shown in Table 4. Lower BMI tended to achieve weight reduction ≧ 3% at 6 months after the program.
 
Diabetes Table 10.4
 
Differences in biochemical data and medical history between the group that achieved weight reduction ≧ 3% and the group that could not achieve weight reduction ≧ 3% at 6 months after the KOHNODAI program was shown in Table 5. Frequency of participants who take anti-psychotic drugs was significantly lower in the group that achieved weight reduction ≧ 3% as compared with the group that could not achieve weight reduction ≧ 3%.
 
Diabetes Table 10.5
 
 
Discussion

Present study showed effectiveness of our KOHNODAI program to obtain a significant reduction of body weight in a short period (5 days), and also prolonged significant effects on body weight reduction. The KOHNODAI program has two characteristic contents. First, the patients measure and record body weight four times a day by themselves on Days 1-5, which make patients discover what increase or decrease their body weight, and how their body weight change. Secondly, patients and nurses discuss on their lifestyle for one hour on Days 1-5. Nurses make patients discover their problems and remedy, and encourage patients to modify their lifestyle. These characteristic contents of our program may help obese people to reduce their body weight.

Visceral fat accumulation leads to insulin resistance, which induces dyslipidemia such as hypertriglyceridemia and low HDL-C [10]. In Japan, the number of metabolic disorders was greater than 1.0 at 100 cm2 of VFA and the best combination of the sensitivity and specificity for determining subjects with multiple risk factors was 100 cm2 of VFA [11]. The regression line obtained from simple correlation analyses indicated that the waist circumference corresponding to 100 cm2 of VFA is defined as abdominal obesity in the Japanese diagnostic criteria for metabolic syndrome [11]. The mean±SD of VFA in our participants was 199±78 cm2, which was significantly higher than the upper limit of VFA defined as the metabolic syndrome. Present study showed a significant increase in HDL-C at 6 months after the program, suggesting that our program improved insulin resistance and ameliorated insulin resistance-related dyslipidemia.

Non-alcoholic fatty liver disease (NAFLD) is now the most frequent chronic liver disease, and is associated with obesity and insulin resistance and is considered the hepatic manifestation of the metabolic syndrome [12]. Current treatment relies on weight loss and exercise [12]. The KOHNODAI program tended to reduce ALT, proposing the effectiveness of our program for the treatment of NAFLD.

In the analyses of differences in clinical, biochemical data and medical history between the group that achieved weight reduction ≧ 3% and the group could not achieve weight reduction ≧ 3% at 6 months after the KOHNODAI program, we found that frequency of participants who take anti-psychotic drugs was significantly lower in the group that achieved weight reduction ≧ 3% as compared with the group that could not achieve weight reduction ≧ 3%. Recently, a growing interest has been observed on weight gain, which is now a well-known adverse effect of many anti-psychotics [13], supporting our results.

We have to mention the limitation of our study. The most findings were statistically nonsignificant. We should increase the number of participants to prove the valid effects of the KOHNODAI program. We should also mention the possibility that the participants of this 5 days admission program were likely already highly motivated before the start of program.

Conclusion

The KOHNODAI program significantly reduced body weight in a short period, and also showed prolonged significant effects on body weight reduction. Our program ameliorated dyslipidemia and liver function in obese people. Present study also indicated that patients who take anti-psychotic drugs are unlikely to reduce body weight by our program.

Conflict Interests

The authors declare that they have no competing interests.

References

 References

1.Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, Adams PW. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab. 1982, 54(2):254-260.

2.Hartz AJ, Rupley DC Jr, Kalkhoff RD, Rimm AA. Relationship of obesity to diabetes: influence of obesity level and body fat distribution. Prev Med. 1983,12(2):351-357.

3.Krotkiewski M, Björntorp P, Sjöström L, Smith U. Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest. 1983,72(3):1150-1162.

4.Evans DJ, Murray R, Kissebah AH. Relationship between skeletal muscle insulin resistance, insulin-mediated glucose disposal, and insulin binding. Effects of obesity and body fat topography. J Clin Invest. 1984,74(4):1515-1525.

5.Evans DJ, Hoffmann RG, Kalkhoff RK, Kissebah AH. Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women. Metabolism. 1984,33(1):68-75.

6.Ohlson LO, Larsson B, Svärdsudd K, Welin L, Eriksson H, et al. The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes. 1985, 34(10):1055-1058.

7.Kalkhoff RK, Hartz AH, Rupley D, Kissebah AH, Kelber S. Relationship of body fat distribution to blood pressure, carbohydrate tolerance, and plasma lipids in healthy obese women. J Lab Clin Med. 1983, 102(4):621-627.

8.Yanai H. Lifestyle Modification Program, KOHNODAI Program. J J Diab Endocrin. 2014, 1(1): 005.

9.Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972, 18(6):499-502.

10.Després JP. The insulin resistance-dyslipidemic syndrome of visceral obesity: effect on patients’ risk. Obes Res. 1998, 6(Suppl )1: 8S-17S.

11.Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity. New criteria for ‘obesity disease’ in Japan. Circ J. 2002, 66(11): 987-992.

12.Abd El-Kader SM, El-Den Ashmawy EM. Non-alcoholic fatty liver disease: The diagnosis and management. World J Hepatol. 2015, 7(6):846-858.

13.Tardieu S, Micallef J, Gentile S, Blin O. Weight gain profiles of new anti-psychotics: public health consequences. Obes Rev. 2003, 4(3):129-138.

Cite this article: Hidekatsu. Effects of Lifestyle Modification Program, KOHNODAI Program, on Metabolic Parameters in Japanese Obese People. J J Diab Endocrin. 2015, 1(1): 010.

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