Macedonian Journal of Medical Sciences. 2011 Mar 15;
4(1):17-24.
doi:10.3889/MJMS.1857-5773.2011.0145
Basic Science
Impact of Balanced Caloric Diet and Physical
Activity on Body Composition and Fat Distribution of Obese Egyptian
Adolescent Girls
Nayera El-morsi Hassan1, Safaa T. Zaki2, Sahar
El-masry1, Manal A. Mohsen2, Eman Elashmawy2
1Biological Anthropology, National Research Centre, Cairo, Egypt;
2Child Health Departments, National Research Centre, Cairo, Egypt
Objective. The aim of this study was to evaluate the effects of 6
months of balanced caloric moderately deficit diet program combined with
individualized moderate Physical exercise on the body weight, body
composition and fat distribution of adolescent girls.
Subjects & Methods. It was a longitudinal survey comprised 1244
adolescent girls, aged from 14 to 18 years. Their body weight and height
were measured, and the BMI was calculated. Of the total sample, only one
hundred and eleven girls (8.9%), with mean age was 15.82 ± 0.75 years, were
suffering from obesity based on their body mass index; which is greater than
the 95th percentile for age and gender based Egyptian Growth Reference
Charts. These obese girls were undergoing nutritional intervention (specific
dietary program, nutritional education and exercise) for 6 months. At the
start of this program, the obese girls were assessed for their
anthropometric measures: the body weight, body height (or stature), body
mass index (BMI), waist and hip circumferences, waist/hip ratio, skin folds
thickness at 5 sites and, according to BIA, their body composition. This
assessment was repeated after 6 months. Only thirty eight girls completely
finished the program till the end.
Results. The current study showed that after following the dietary
program and physical activity, there were highly significant reduction in
waist circumference, the skin fold thickness at the 5 sites (triceps,
biceps, sub scapular, suprailiac and abdominal), peripheral and central
adiposity, and fat mass, and significant reduction in body weight, hip
circumference and fat%. The change in BMI was not significant. On the other
hand, there was a highly significant increase of the total body water and
Basal metabolic rate after following the dietary program and physical
activity.
Conclusion. The nutritional intervention program was succeeded in 38
obese adolescent girls. These girls show highly significant reduction in
body composition and body fat distribution. This revealed that the combined
program of diet restriction and exercise is necessary.
..................
Citation: Hassan NE, Zaki ST, El-masry S, Mohsen MA, Elashmawy E.
Impact of Balanced Caloric Diet and Physical activity on Body Composition
and Fat Distribution of Obese Egyptian Adolescent Girls. Maced J Med Sci.
2011 Mar 15; 4(1):17-24. doi.10.3889/MJMS.1957-5773.2011.0145.
Key words: Egyptian adolescents; obese girls; diet restriction;
exercise training; body composition; anthropometry.
Correspondence: Dr. Safaa Zaki. National Research Centre, Child
Health, El Behouth Street, Dokki. Giza 11441, Egypt. E-mail: safaa.zaki@hotmail.com
Received: 20-Jun-2010; Revised: 15-Aug-2010; Accepted: 05-Oct-2010; Online
first: 19-Jan-2011
Copyright: © 2011 Hassan NE. This is an open-access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.
Competing Interests: The author have declared that no competing
interests exist.
The prevalence of obesity has reached alarming levels. Obesity is affecting
virtually both developed and developing countries of all socioeconomic
groups including all age groups thereby posing an alarming problem,
described by the World Health Organization (WHO) as an “escalating global
epidemic” [1].
Worldwide, over 22 million children under the age of 5 are severely
overweight, as are 155 million children of school age. This implies that one
in 10 children worldwide is overweight [2]. The dramatic increase in
the prevalence of obesity in the past few decades can only be due to
significant changes in lifestyle influencing children and adults [3].
These obesity-promoting environmental factors are usually referred to
under the general term of obesogenic or obesigenic [4]. The current
changing nature of this obesogenic environment has been well described in a
WHO Technical Report as Changes in the world food economy have contributed
to shifting dietary patterns, for example, increased consumption of
energy-dense diets high in fat, particularly saturated fat, and low in
unrefined carbohydrates. These patterns are combined with a decline in
energy expenditure that is associated with a sedentary lifestyle [5].
With changing food habits and increasingly sedentary lifestyles, a potential
deluge is evident across the globe with obesity rates increasing more than
two fold over the past 25 years in the U.S., almost threefold in the past 10
years in England, and almost fourfold over a similar time frame in Egypt
[6]. Recently, in Egypt research of National Survey for Diet,
nutrition and non-communicable diseases DNPCNCD by National Nutrition
Institute (2008) [7] stated that the prevalence of overweight and obesity
among adolescents aged 10-18 years was 20.5 %.
Obesity in children and adolescents is associated with several metabolic and
hemodynamic abnormalities: dyslipidemia, high blood pressure (BP), impaired
glucose tolerance, insulin resistance and assorted cardiovascular risk
factors [8]. In addition, atherosclerosis reportedly begins in childhood
[9].
So, the need for evidence-based treatment recommendations is a critical
health care issue, because obese children and adolescents are at risk for
developing many of the co-morbidities seen in obese adults. Studies
demonstrated that fasting serum glucose, insulin, and triglyceride levels
and the prevalence of impaired glucose tolerance and systolic hypertension
increase significantly as children become obese (BMI of 95th percentile)
[10]. Even children and adolescents who are overweight (BMI of 85th to 94th
percentile) are at risk for co-morbidities. Therefore, interventions using
dietary modifications, increased physical activity, and behavioral therapy
may be beneficial for overweight children and adolescents, with
more-aggressive intervention directed toward obese children and adolescents
[11].
Health care professionals, however, may find it difficult to determine which
interventions will be most efficacious for their patients. Clinical trials
have failed to determine whether specific dietary modifications alone
without behavioral interventions and increased physical activity are
effective in reducing childhood overweight and obesity rates. Comprehensive
interventions that include behavioral therapy along with changes in
nutrition and physical activity are the most closely studied and seem to be
the most successful approaches to improve long-term weight and health status
[12]. However, the clinical trials testing these interventions often are
limited in their ability to determine the relative efficacy of individual
strategies. Ultimately, children and adolescents (and adults, for that
matter) become overweight or obese because of an imbalance between energy
intake and expenditure. Dietary patterns, television viewing and other
sedentary activities, and an overall lack of physical activity play key
roles in creating this imbalance and therefore represent opportunities for
intervention.
The aim of this study was to evaluate the effects of 6 -month of balanced
caloric moderately deficit diet program combined with individualized
moderate physical exercise on the weight, body composition and fat
distribution of adolescent girls.
This study was conducted by the National Research Centre, Egypt, to estimate
the prevalence of obesity among secondary school adolescent girls. It was a
longitudinal survey, comprised 1244 adolescent girls, with age ranged from
14 to 18 years. They were recruited from “Gamal Abd-El-Naser Secondary
Public School”, in Giza governorate, for a whole studying year from October,
2008 to April 2009. Girls were excluded if they had a prior major illness,
including type 1 or 2 diabetes, took medications or had a condition known to
influence body composition, insulin action or insulin secretion (e.g.
glucocorticoid therapy, hypothyroidism and Cushing’s disease).
Permission to perform the study was granted by the Ministry of Education,
and the director of the school included in the research. Parents were
informed about the purpose of the study and their permission in the form of
written consent was obtained. Another assent from the student’s involved in
the research was obtained. The protocol was approved by the Ethical
Committee of the National Research Centre .
Each girl underwent a complete physical examination, including
anthropometric measures which are following the recommendations of the
International Biological program [13]. The body height was measured to the
nearest 0.1 cm on a Holtain portable anthropometer, and the body weight was
determined to the nearest 0.01 kg on a Seca scale Balance with the subject
wearing minimal clothing and no shoes. Body mass index (BMI) was calculated
as body weight (in kilograms) divided by body height (in meters) squared.
Of the total sample, only one hundred and eleven girls or 8.9% with mean age
15.82 ± 0.75 years, were suffering from obesity based on their body mass
index; which is greater than the 95th percentile for age and gender based on
the Egyptian Growth Reference Charts [14]. These obese girls were undergoing
nutritional intervention (specific dietary program, nutritional education
and exercise) for 6 months. At the start of this program, the obese girls
were assessed for following anthropometric measures and calculated
parameters: the body weight and body height; waist and hip circumferences;
five skin fold thickness; BMI; waist/hip ratio; and body composition
according to BIA. This assessment was repeated after 6 months.
Anthropometric measures: Body weight was measured as previously
mentioned. Waist circumference was measured at the level of the umbilicus
with the subject standing and breathing normally, hip circumference at the
level of the iliac crest, using non-stretchable plastic tape to the nearest
0.1 cm. Skin fold thickness were taken at five sites: triceps, biceps, sub
scapular, suprailiac and abdominal. Each skin fold was measured three times
on the left side of the body with Holtain skinfold caliper to the nearest
0.2 mm, and the mean was recorded. The following indices were calculated:
- Body mass index (Kg/mІ)
- Waist/ Hip ratio (cm/ cm).
- Peripheral adiposity: as the sum of triceps and biceps skin fold
thickness.
- Central adiposity: as the sum of subscapular, suprailiac and abdominal
skin fold thickness.
Body Composition: Whole body resistance and reactance
(capacitance) were measured using a Bioelectrical Impedance Analyzer (HOLTAIN
LIMITED). As specified by the manufacturer, the unit was calibrated before
testing using 400-ohm resistor, and electrodes were placed on right wrist
and ankle. By using girlґs sex, age, body weight and body height
approximated to the nearest unit, the percentage body fat (Fat %), fat mass
(FM), fat free mass (FFM), total body water and basal metabolic rate (kcal)
were derived.
Nutritional intervention (specific dietary program, nutritional
education and exercise):
A balanced caloric moderate deficit diet (BCDD), is a reduced-energy diet (–
500 kcl/day) was established by a dietician. The diet was selected from the
usual 4 food groups in quantities thought to meet basic requirements of all
macronutrients and micronutrients in a healthy proportion: (25-30% of total
calories from fats, 8-10% from saturated fats, up to 15% of total calories
from monounsaturated fatty acids, up to 10% from polyunsaturated fats, <300
mg/d cholesterol, approximately 15% of total calories from protein, 55% from
CHO, 20—30 gm/d fiber ,no more than 1.5 gm/d Na, water not less than 2.5
liter /d, 1000—15000 mg/d calcium). These diet regimen supplies enough
calories to enable the patients to proceed normally in their life & not feel
hungry nor lacking energy. Also, it can be adherent to and safe in long and
short time, the diet design was individualized, flexible allowing the
patients to exchange items, so as not to be boring, and produce 1 Ib or 0.5
kg loss per week. We spread the food through the day to meet the energy
needs, avoiding long periods of no food or hunger. The foods were selected
according to the girl’s dietary habits. PowerPoint presentations and
role-play scripts were designed for trainers to be used during the
educational program.
Exercise: moderate Physical activity in the form of unsupervised
walking for an hour daily or at least 5 times /week, starting by half an
hour then gradually increase the duration to an hour after 3 days. This was
encouraged and motivated by grouping teams of students.
The anthropometric measurements and body composition were remeasured after 6
months from the start of the dietary program to assess the effect of the
nutritional modifications.
Statistical Analysis: Graphic presentation of the % of girls with
different effect of the program, according to the reduction of the % body
fat was drawn. Evaluation of the statistical distribution of the variables
was done using Kolmogorov - Smirnov Goodness of Fit Test. Most the variables
have asymmetric distribution (p<0.05); except skin fold thickness at the
triceps and suprailiac crest, fat free mass and total body water; where they
have normal distribution (p>0.05). All values are reported as the mean ± SD
(the range). The changes in the used parameters before and after the dietary
program were calculated. WILCOXSON non parametric t- test was used to
examine the differences before and after the dietary program for the
variables which had asymmetric distribution, while Paired sample t test
(d-statistics) was used for the variables which had normal statistic
distribution. The level of significance was set at a probability of less
than 5% (p<0.05). Statistical evaluation of the results was performed with
the SPSS 9.05 computer program.
The nutritional intervention program started with 111 girls; but
unfortunately; 38 girls only continued strictly with the program for the 6
months. All of them undergo weight reduction, except 3 girls showed very
minimal changes in weight but significant changes in body fat distribution
and body composition. Their ages ranged between 15 to 16 years (with mean
age 15.45 ± 0.50).
Percentage of the girls with different effect of the program, according to
the reduction in % body fat are presented in Figure 1. It was noticed that
38.6% (14 girls) had no effect on the % body fat; inspite of the reduction
in their weight;26.3% (10 girls) had reduction less than 5%, 18.4% (7 girls)
had reduction between 5 - 10%,and 18.4% (7 girls) had reduction between 10 -
20%.
Figure 1: Percentage of the girls with different effect of
the program, according to the reduction in % body fat.
Anthropometric measurements at the beginning and the end of the nutritional
intervention were summarized in Table 1. The main baseline of BMI was 32.39
+ 3.13 Kg/mІ, which indicates that; on average; these girls were obese at
the beginning of the nutritional intervention. After the 6 months
nutritional intervention, highly significant reduction in body weight and
waist circumference, and significant reduction in hip circumference were
recorded after following the dietary program, nutritional education and
physical activity. However, the change in BMI was insignificant.
Table 1: Anthropometric measurements before and after the
6 months nutritional intervention.
|
Before
Mean
±
SD
(Range) |
After
Mean
±
SD
(Range) |
Changes
Mean
±
SD
(Range) |
Weight
(kg) |
86.01
± 6.79
( 76.00
~ 94.00) |
82.93
±
5.93**
(73.80
~ 92.10) |
3.08
± 2.92
(- 1.60
~ 8.60) |
BMI
(kg/m˛) |
32.39
± 3.13
(28.50
~ 37.80) |
32.36
± 2.14
(30.30
~ 36.40) |
0.029
± 1.48
(- 1.90
~ 1.40) |
Waist C
(cm) |
85.55
±
6.70
( 77.00
~ 97.00) |
80.79
± 8.08**
(74.00
~ 95.00) |
4.76
± 2.87
( 2.00~
10.00) |
Hip C
(cm) |
105.84
± 9.39
(93.00
~ 120.00) |
100.45
±
9.01*
(89.00
~ 116.00) |
5.39
± 2.88
(3.00 ~
11.00) |
N.B.: The significance was tested using
WILCOXON non parametric test; *,
Significant (p < 0.05);
**,
Highly significant (p < 0.01).
Body fat distribution at the beginning and the end of the nutritional
intervention program were summarized in Table 2.Highly significant reduction
in all the skin fold thickness at the 5 sites (triceps, biceps, sub
scapular, suprailiac and abdominal), peripheral and central adiposity, waist
circumference and waist-hip ratio was recorded.
Table 2: Fat distribution before and after the 6 months
nutritional intervention.
Skinfold Thickness |
Before
Mean
±
SD
(Range) |
After
Mean
±
SD
(Range) |
Changes
Mean
±
SD
(Range) |
|
+Triceps |
32.68
± 6.79
(22.050
~ 42.00) |
26.87
±
6.65**
( 18.00
~ 35.00) |
5.82
± 1.65
(4.00 ~
8.50) |
|
#Biceps |
24.74
± 5.82
( 17.00
~ 32.00) |
19.62
± 5.76**
(12.00
~ 27.00) |
5.12
± 1.65
( 1.80
~ 7.00) |
|
#Subscapular |
31.26
± 5.59
(23.00
~ 41.00) |
25.68
± 6.51**
(18.00
~ 37.00) |
5.58
± 2.21
(3.00 ~
10.00) |
|
+Suprailiac |
26.89
±
7.24
(19.00
~ 40.00) |
21.95
± 6.19**
(15.00
~ 33.00) |
4.95
± 1.29
( 2.00
~ 7.00) |
|
#Abdominal |
27.32
± 7.95
(17.00
~ 38.00) |
21.99
± 7.16**
(15.00
~ 32.00) |
5.33
± 1.54
( 1.00
~ 6.50) |
|
#Peripheral Adiposity |
57.42
± 11.72
(44.50
~ 74.00) |
46.49
± 11.99**
(32.00
~ 61.00) |
10.93
± 2.95
(7.00 ~
15.50) |
|
#Central Adiposity |
85.47
± 18.74 |
69.62
± 18.44** |
15.86
± 3.48 |
|
(70.00
~ 119.00) |
(51.00
~ 102.00) |
( 6.00
~ 20.00) |
|
#Waist
Circumference (cm) |
85.55
±
6.70
( 77.00
~ 97.00) |
80.79
± 8.08**
(74.00 ~ 95.00) |
4.76
± 2.87
( 2.00 ~ 10.00) |
#Waist-Hip Ratio (cm/cm) |
0.81
± 0.05
( 0.76
~ 0.91) |
0.81
± 0.06**
(0.74 ~ 0.91) |
0.005
± 0.01
( - 0.01 ~ 0.02) |
N.B.: # The
significance was tested using WILCOXON non parametric test; +, The
significance was tested using Paired sample t-test; *, Significant (p
< 0.05); **, Highly significant (p < 0.01).
Body composition at the beginning and the end of the nutritional
intervention program were summarized in Table 3. It was observed that there
were highly significant reduction in fat % and fat mass, while, total body
water and basal metabolic rate showed highly significant increase. However,
the fat free mass was not significantly increased or even not changed.
Table 3: Body Composition before and after the 6 months
nutritional intervention.
Skinfold
Thickness |
Before
Mean
±
SD
(Range) |
After
Mean
±
SD
(Range) |
Changes
Mean
±
SD
(Range) |
|
+Triceps |
32.68 ±
6.79
(22.050 ~
42.00) |
26.87 ±
6.65**
( 18.00 ~
35.00) |
5.82 ±
1.65
(4.00 ~
8.50) |
|
#Biceps |
24.74 ±
5.82
( 17.00 ~
32.00) |
19.62 ±
5.76**
(12.00 ~
27.00) |
5.12 ±
1.65
( 1.80 ~
7.00) |
|
#Subscapular |
31.26 ±
5.59
(23.00 ~
41.00) |
25.68 ±
6.51**
(18.00 ~
37.00) |
5.58 ±
2.21
(3.00 ~
10.00) |
|
+Suprailiac |
26.89 ±
7.24
(19.00 ~
40.00) |
21.95 ±
6.19**
(15.00 ~
33.00) |
4.95 ±
1.29
( 2.00 ~
7.00) |
|
#Abdominal |
27.32 ±
7.95
(17.00 ~
38.00) |
21.99 ±
7.16**
(15.00 ~
32.00) |
5.33 ±
1.54
( 1.00 ~
6.50) |
|
#Peripheral Adiposity |
57.42 ±
11.72
(44.50 ~
74.00) |
46.49 ±
11.99**
(32.00 ~
61.00) |
10.93 ±
2.95
(7.00 ~
15.50) |
|
#Central
Adiposity |
85.47 ±
18.74 |
69.62 ±
18.44** |
15.86 ±
3.48 |
|
(70.00 ~
119.00) |
(51.00 ~
102.00) |
( 6.00 ~
20.00) |
|
#Waist
Circumference (cm) |
85.55 ±
6.70
( 77.00 ~
97.00) |
80.79 ± 8.08**
(74.00 ~ 95.00) |
4.76 ± 2.87
( 2.00 ~ 10.00) |
#Waist-Hip
Ratio (cm/cm) |
0.81 ±
0.05
( 0.76 ~
0.91) |
0.81 ± 0.06**
(0.74 ~ 0.91) |
0.005 ± 0.01
( - 0.01 ~ 0.02) |
N.B.: # The significance was tested using WILCOXON non parametric test; +,
The significance was tested using Paired sample t-test; *, Significant (p
< 0.05); **, Highly significant (p < 0.01).
The nutritional intervention program was succeeded in 38 obese adolescent
girls. These girls show highly significant reduction in body composition and
body fat distribution.
Adolescents who are overweight or obese are more likely to remain so in
adulthood than pre-adolescents aged 10–14 [15], unless the latter obtain
treatment.
Treatment for children and adolescents who are overweight or obese seems
easy, that is, just counsel children, adolescents and their families to eat
less and to exercise more. In practice, however, treatment of childhood
obesity is time-consuming, frustrating, difficult, and expensive. In fact,
choosing the most effective methods for treating overweight and obesity in
children is complex at best. This is especially true for primary care
providers, who have limited resources to offer interventions within their
offices or programs. The paucity of providers to whom they can refer
patients adds to the problem.
A multi-factorial approach has been in use for the treatment of obesity,
including dietary modification, exercise, psychotherapy and medication.
There are several reports in the literature about exercise programs for
adolescents with obesity [16, 17]. However, the focus of most programs is on
long-lasting endurance activities, which in our opinion are boring for the
pediatric population. Furthermore, most programs are not easily reproducible
due to lack of detail or requirement of special equipment. Therefore, our
aim was to encourage adolescents to do a simple, cheap, cost effective
activity which is accessible to everyone and motivates adolescents by
walking with their colleagues.
Low physical activity levels may be as important as excess energy intake
[18]. Although data from previous studies were equivocal, Swinburn et al.
(2006) [19] found energy intake was a more important determinant of high
body weight than low physical activity. TES, 2008 [20] stated that in the
absence of caloric restriction, moderate exercise does not generally cause
weight loss. However, in combination with decreased caloric intake, exercise
can achieve significant weight loss. This matches our results as with both
caloric restriction and regular physical activity over a period of 6 months
our patients achieved weight reduction. Wittmeier et al., 2008 [21], also,
reported that lower durations of both moderate physical activity (MPA) and
vigorous physical activity (VPA) are associated with increased odds of
overweight and adiposity. They concluded that forty-five minutes of MPA and
fifteen minutes of VPA were associated with reduced body fat and BMI. A
total of one hour per day of moderate-intensity activity, such as walking on
most days of the week, is probably needed to maintain a healthy body weight
[22].
In general, to lose weight, you either have to decrease the amount of
calories you are eating and drinking, exercise to burn more calories, or
even better, do a combination of both. To lose 1 pound in 1 week, you can
decrease your calories by 500 a day or burn 500 extra calories a day. The
American Diabetic Association [23] stated that: Use of a reduced-energy diet
(not less than 1200 kcl/ day) in the acute treatment phase for adolescent
overweight is generally effective for short-term improvement in weight
status; and this is agreed with our data which showed significant reduction
in weight of the studied group.
The BMI can be easily assessed at low cost, and has a strong association
with body fatness and health risks [24]. The subcutaneous skin fold
thicknesses have been widely used to estimate body fat. The main advantages
are simplicity of use and suitability for epidemiological studies [25]. It
is used as a measure of nutritional status in children on assumption that
increased subcutaneous fat reflects a greater caloric reserve (26). It has
been shown to correlate with estimates of total body fat and with lean body
mass [27].
In this study, BMI and sum of skin fold thickness were used as indicators of
overall adiposity. The sum of skin fold is reported as a reliable estimate
of obesity and regional fat distribution [28]. WC was considered as an
appropriate predictor of abdominal fat in children [29] and adolescents
[30]. Another indicator of abdominal adiposity is WHR, which was reported as
a better indicator of adiposity independent of age and sex [31]. But in this
study the changes of WHR were discrete and not significant, so the future
investigations are needed about the sensitivity of WHR in detection of
obesity, in the population of Egyptian girls.
Highly significant reduction in waist circumference was also, noticed after
following the dietary program and physical activity. However, the change in
BMI was not significant. Skin fold thickness at 5 sites (triceps, biceps,
sub scapular, suprailiac and abdominal) were significantly deceased. Highly
significant reduction in fat mass, peripheral and central adiposity;
significant reduction in fat %; and highly significant increase in total
body water were found. There was a highly significant increase of the basal
metabolic rate, but the increase of fat free mass was not significant. The
BMI didn’t show a reduction, and probably one of the possible reasons for
this is a highly significant increase of total body water in our
investigated girls.
Decrease in the fat percent with preservation of the FFM and increase of the
resting metabolic rate (RMR) of the girls was also observed. The weight
reduction and maintenance appears to be antagonized by a reduction in the
resting metabolic rate (RMR) which comes in agree with our results. As the
largest component of daily energy expenditure, RMR comprises approximately
60–70%, Fat-free mass (FFM) is the main factor that accounts for the
magnitude of resting metabolism [32]. As a heterogeneous compartment, FFM
consists of highly metabolically active muscle and organs and low-metabolic
rate tissues such as bone and connective tissue [33]. Therefore, any diet or
exercise interventions, which are capable of maintaining FFM or at least
attenuating its decline following weight loss, could have significant
effects on total energy balance. The foremost objective of a weight-loss
trial has to be the reduction in fat mass leading to a decrease in risk
factors for a metabolic syndrome. Both with regard to a reduction in risk
factors and long-term weight maintenance the content of adipose tissue in
the weight lost has to be maximized, thus preserving FFM [34]. A decline in
body weight can be achieved while favorably modifying body composition with
the maintenance of FFM is through physical activity [35].
Wells and Victoria [36], 2005, also, stated that changes in body composition
indicators may have important health implications, as it has been
demonstrated that the health risks associated with obesity derive primarily
from fat rather than body weight. Moreover, it is not only the total amount
of fat that is important, but also the distribution of fat in the body [37],
with central fatness being most related to health risks [38]. Teixeira et
al. (2001) [39] showed that measures of central adiposity such as WC and WHR
significantly correlated with serum lipid levels in obese children and
adolescents but not in leaner individuals. Kelishadi et al. (2007) [40]
concluded that BMI, WC and WSR were the most appropriate indices in
predicting CVD risk factors. Many studies confirming the predictive value of
BMI for CVD risk factors [41, 42].
Finally the current research also, revealed that after the 6 months
nutritional intervention, reduction in body weight, hip, and waist
circumference were significant after following the dietary program. However,
the change in BMI was minimal. The reduction in all the measured skin fold
thickness at the 5 sites (triceps, biceps, sub scapular, suprailiac and
abdominal), reflects a reduction in peripheral and central adiposity.
However, the change in waist-hip ratio was minimal.
In summary, it can be concluded from this research that dietary composition
can modify the physiological adaptations to energy restriction. A balanced
diet with moderate energy restriction together with moderate physical
activity and behavioral modification result in body weight loss with
preservation of the FFM and a decrease in the fat percentage. This study may
contribute in establishing evidence based Egyptian program for obesity and
overweight management.
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