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Vol. 52. Núm. S1.
Nutrición basada en la evidencia
Páginas 102-109 (Mayo 2005)
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Vol. 52. Núm. S1.
Nutrición basada en la evidencia
Páginas 102-109 (Mayo 2005)
Nutrición basada en la evidencia
Acceso a texto completo
Medicina basada en la evidencia: nutrición en la obesidad
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M.A. Rubio herreraa,
Autor para correspondencia
marubio@futurnet.es

Correspondencia: Dr. M.A. Rubio. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario San Carlos. Martín Lagos, s/n. 28040 Madrid. España.
, C. Moreno loperab
a unidad De Nutrición Clínica Y Dietética. Servicio De Endocrinología Y Nutrición. Hospital Clínico Universitario San Carlos. Madrid. España
b Centro de Salud. Villaviciosa de Odón. Madrid. España
Este artículo ha recibido
Información del artículo

El tratamiento dietético hipocalórico es la piedra angular del planteamiento terapéutico de la obesidad. En la mayoría de los estudios controlados la distribución de macronutrientes de la dieta no parece marcar la diferencia en términos de pérdida de peso. Así, por ejemplo, las dietas bajas en hidratos de carbono consiguen pérdidas significativas de peso frente a las dietas bajas en grasa, en períodos cortos de tiempo (6 meses), pero no hay diferencias tras un seguimiento a más largo plazo (12 meses). Existe un consenso general acerca de que una reducción energética comprendida entre 500 y 1.000 kcal diarias, respecto a la dieta habitual, consigue pérdidas promedio de 0,5 a 1 kg a la semana durante los primeros 6 meses de tratamiento, lo que representa una reducción entre el 5-10% del peso corporal, una proporción suficiente para atenuar el impacto de las comorbilidades asociadas con la obesidad. Pero los resultados a largo plazo (más de un año) con las dietas bajas en grasas son desalentadores (promedio de 0-3 kg), mientras que la seguridad de las dietas bajas en hidratos de carbono está pendiente de demostrar. En esta revisión se analizan los niveles de evidencia que diferentes tipos de dieta (incluidas las de muy bajo contenido calórico) tienen sobre el peso corporal a medio y largo plazo, poniendo de relieve que, posiblemente, los planteamientos terapéuticos de pérdida de peso deban ser diferentes de aquellos dirigidos al mantenimiento del peso perdido. Por último, cualquiera que sea el planteamiento dietético de la obesidad, no cabe duda de que el refuerzo a través de un programa estructurado de cambios en el estilo de vida y de actividad física constituye una herramienta esencial para asegurar un éxito a largo plazo.

Palabras clave:
Dieta baja en grasa
Dieta baja en hidratos de carbono
Dieta hipocalórica
Obesidad
Índice glucémico
Dieta cetogénica
Dieta de muy bajo contenido calórico
Lipoproteínas
Densidad energética
Abstract

The mainstay of the therapeutic approach to obesity is the low calorie diet. In most controlled studies the distribution of micronutrients in the diet does not seem to influence weight loss. Thus, for example, low carbohydrate diets achieve significant weight loss compared with low-fat diets in short periods (6 months), but there are no differences after longer follow-up (12 months). There is general consensus that a reduction of between 500 and 1,000 kcal daily with respect to the normal diet achieves an average weight loss of 0.5 to 1 kg per week for the first 6 months of treatment, representing a reduction of 5-10% of body weight, a proportion that is sufficient to attenuate the impact of obesity-related comorbidities. However the long-term results (more than 1 year) with low-fat diets are discouraging (0-3 kg), while the safety of low carbohydrate diets remains to be demonstrated. The present review analyzes the levels of evidence for the effect of distinct types of diet (including very low calorie diets) on body weight in the medium and long term, highlighting that possibly the therapeutic approaches to weight loss should differ from the strategies used to maintain weight loss. Lastly, whatever the dietary approach to obesity, there is no doubt that reinforcement through a structured program of lifestyle changes and physical activity is an essential tool to ensure longterm success.

Keywords:
Low-fat diet
Low carbohydrate diet
Low calorie diet
Very low calorie diet
Lipoproteins
Energy density
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