Abstract
BackgroundThe practical relevance of metabolic adaptation remains a controversial issue. To the best of our knowledge, no study has properly evaluated the role of metabolic adaptation in modulating weight loss outcomes. Therefore, the aim of this study was to determine the association between metabolic adaptation, at the level of resting metabolic rate (RMR), and weight and fat mass (FM) loss after low-energy diets (LED), after adjusting for dietary adherence and other confounders.Methods71 individuals with obesity (BMI: 34.6 ± 3.4 kg/m2; age: 45.4 ± 8.2 years; 33 males) were randomized to one of three 1000 kcal/day diets for 8 weeks. Body weight, FM and fat-free mass (FFM) (air displacement plethysmography), RMR (indirect calorimetry) and physical activity level (PAL) (armbands) were measured at baseline and at week 9. Metabolic adaptation at week 9 was defined as measured RMR minus predicted RMR at week 9. An equation to predict RMR was derived from baseline data of all participants that were part of this analysis and included age, sex, FM and FFM as predictors. Dietary adherence was calculated from RMR, PAL and body composition changes. Linear regression was used to assess the potential role of metabolic adaptation in predicting weight and FM loss after adjusting for dietary adherence, average PAL, sex, baseline FM and FFM and randomization group.ResultsParticipants lost on average 14 ± 4 kg of body weight (13 ± 3%) and presented with metabolic adaptation (−92 ± 110 kcal/day, P < 0.001). Metabolic adaptation was a significant predictor of both weight (β = −0.009, P < 0.001) and FM loss (β = −0.008, P < 0.001), even after adjusting for confounders (R2 = 0.88, 0.93, respectively, P < 0.001 for both). On average, an increase in metabolic adaptation of 50 kcal/day was associated with a 0.5 kg lower weight and FM loss in response to the LED.ConclusionIn individuals with obesity, metabolic adaptation at the level of RMR is associated with less weight and FM loss in response to LED.Trial registration ID: NCT02944253.
Highlights
The practical relevance of metabolic adaptation remains a controversial issue
This is in line with previous findings showing that the existence or not of metabolic adaptation depends on study design, with cross-sectional studies, comparing obesereduced individuals to body mass index (BMI)-matched controls, not reporting metabolic adaptation [10,11,12,13,14], while longitudinal studies report metabolic adaptation [15,16,17,18,19,20], likely because measurements are taken during negative Energy balance (EB)
We found that the larger the metabolic adaptation (RMRm-RMR predicted (RMRp)) in absolute terms, the smaller the weight and fat mass (FM) loss seen, independently of age, sex and BMI, and after adjusting for variables known to modulate weight loss responses, namely adherence to the diet, average physical activity level (PAL), sex and baseline body composition
Summary
The practical relevance of metabolic adaptation remains a controversial issue. To the best of our knowledge, no study has properly evaluated the role of metabolic adaptation in modulating weight loss outcomes. Linear regression was used to assess the potential role of metabolic adaptation in predicting weight and FM loss after adjusting for dietary adherence, average PAL, sex, baseline FM and FFM and randomization group. Despite being significant during negative EB (on average 100 kcal/d), metabolic adaptation is of minor magnitude (on average 50 kcal/day) when measurements are done under conditions of weight stability following weight loss [8, 9] This is in line with previous findings showing that the existence or not of metabolic adaptation depends on study design, with cross-sectional studies, comparing obesereduced individuals to body mass index (BMI)-matched controls, not reporting metabolic adaptation [10,11,12,13,14], while longitudinal studies report metabolic adaptation [15,16,17,18,19,20], likely because measurements are taken during negative EB. These results suggest that metabolic adaptation during negative EB may be relevant to weight loss success
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