Diet for the Maintenance of Weight Loss and Metabolic Health in Obese Postmenopausal Women
Diet for the Maintenance of Weight Loss and Metabolic Health in Obese Postmenopausal Women
The aim of the study will be comparing the effectiveness of two diets: moderate in fat with a
 high proportion of monounsaturated fatty acids (MUFAs) - the Mediterranean diet (MED) and 2)
 the low in fat and high in dietary fiber contents the dietary approaches to stop hypertension
 diet (DASH) on weight maintenance and cardiovascular risks following a recent body weight
 reduction in centrally obese postmenopausal women. The tested diets will be given ad libitum
 manner. Moreover, adherence to both prescribed weight-loss maintenance diets will be also
 evaluated by the plasma concentration of alkylresorcinols (AR) as a possible whole grain
 wheat/rye dietary biomarker and by the analysis of fatty acids profile in erythrocyte
 membranes as a dietary biomarker of a fatty acids consumption. The participants of this study
 will be 150 non-smoking, postmenopausal women with central obesity, who wished to lose weight
 and have at least one other criterion of metabolic syndrome. The intervention will include 3
 phases: Phase I (weeks 1-8), weight loss dietary intervention with 700 kcal/d energy deficit,
 Phase II (week 9-32), weight loss maintenance intervention for those participants losing ≥10%
 initial body weight the MED or the DASH diet will be offered in a random manner. The control
 group will receive oral dietary recommendations based on the Harvard model "Healthy Eating
 Plate". After this 32 weeks period will be finished, the participants will be discharged to
 the community with no contact by study personnel, until the 52-weeks follow-up period (Phase
 III).
The treatment of obesity can present a challenge because of the difficulty in maintaining
 body weight loss beyond one year. The aim of the study will be comparing the effectiveness of
 two energy-unrestricted diets containing different amount of macronutrients: 1) moderate in
 fat with high amounts of MUFAs - the MED diet and 2) low in fat with high dietary fiber
 contents - the DASH diet, on maintenance of weight loss and metabolic outcomes following a
 recent weight loss in centrally obese postmenopausal women. Since the outcomes of dietary
 interventions may depend greatly on adherence to the diet, we will measure the plasma AR
 concentrations and fatty acids profile in red blood cells (RBC). Plasma AR concentrations is
 a valid marker of intake of whole-grain wheat/rye in the DASH diet and fatty acids
 concentration in RBC is a valid marker of fatty acids intake (especially MUFAs) in the MED
 diet. A total of 150 non-smoking, centrally obese, with at least one other criterion of
 metabolic syndrome postmenopausal women up to 65 old years will be qualified. This study will
 be divided into 3 phases:

 -  Phase I lasting eight weeks (weeks 1-8). All participants will be introduced to a weight
 loss intervention with a daily energy deficit of 700 kcal per day. During this phase,
 changes in body weight and body composition (DEXA) and waist circumference will be
 measured every four weeks. Moreover, at each control visit, compliance with the
 prescribed diets will be measured by three-day food records. Moreover, the physical
 activity level will be done. Before and after weight loss phase changes in lipid and
 non-lipid parameters as well as eating behavior will be measured.

 -  Participants who will loss ≥10% initial body weight will be randomly assigned to phase
 II of the study (weight loss maintenance intervention). This phase will be lasting 24
 weeks (weeks 9-32). Participants will receive the MED (n = 50) or DASH diet (n = 50).
 The control group (n = 50) will receive oral dietary recommendations based on the
 Harvard model "Healthy Eating Plate". During this phase, changes in body weight, body
 composition, and waist circumference will be measured every four weeks. Moreover, at
 each control visit, compliance with the prescribed diets will be measured by three-day
 food records. Moreover, the physical activity level will be done. Before and after
 weight loss phase changes in lipid and non-lipid parameters as well as valid markers of
 whole-grain wheat/rye and faty acids intake and eating behavior will be measured.

 -  After this 32 weeks period will be finished, the participants will be discharged to the
 community with no contact from study personnel for 20 weeks, until follow-up at 52 weeks
 study (Phase III - weeks 33 - 52). After this time changes in body weight, body
 composition and waist circumference will be measured. Moreover, the physical activity
 level will be done again and changes in lipid and non-lipid parameters, as well as valid
 markers of intake and eating behavior, will be measured.
Inclusion Criteria:

 -  postmenopausal women, with the absence of menses of over 12 months or serum follicle
 stimulating hormone > 30 IU/mL;

 -  with central obesity waist circumference (WC) ≥ 80 cm

 -  with low physical activity (PAL = 1,40);

 -  who wished to lose weight and weight loss maintenance;

 -  and have at least one other criterion of metabolic syndrome increased systolic blood
 pressure ≥ 130 mm Hg or high blood pressure diastolic ≥ 85 mm Hg or ongoing treatment
 of previously diagnosed hypertension, increased serum triglyceride levels above >150
 mg/dl (1.7 mmol/l) or ongoing therapy hypertriglyceridemia, decreased HDL cholesterol
 below than <50 mg/dl (1.3 mmol/l), and fasting blood glucose > 100 mg/dl (5.6 mmol /
 l) or ongoing treatment of previously diagnosed type 2 diabetes.

 Exclusion Criteria:

 -  thyroid disease (hypothyroidism, hyperthyroidism, thyroiditis);

 -  hypercortisolism, Cushing's syndrome;

 -  kidney diseases;

 -  type 1 diabetes;

 -  asthma treated with oral and injectable steroids;

 -  cancers; mental disorders;

 -  New York Heart Association (NYHA) Class III heart failure;

 -  as well as any drug is known to influence liver function;

 -  endocrine disorders;

 -  hormonal replacement therapy;

 -  significant weight change in the six months prior to the current study;

 -  impaired absorption of nutrients (celiac disease, inflammatory bowel disease);

 -  intolerance or food allergy to key components of the intervention diets;

 -  smoking

 -  excessive alcohol consumption (consumption of more than 2 alcohol units per day - one
 alcohol unit equals one bottle of beer (340 g) or one glass of wine (140 g) or one
 glass of spirits (42.5 g of 40% spirit).