Comparison of the effects of cows• milk, fortified soy milk, and calcium supplement on weight and fat loss in premenopausal overweight and obese women

Nutrition, Metabolism & Cardiovascular Diseases (2009) xx, 1e5 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m Comparison of the effects of cows’ milk, fortifiedsoy milk, and calcium supplement on weightand fat loss in premenopausal overweight andobese women Sh Faghih , A.R. Abadi , M. Hedayati S.M. Kimiagar a Department of Nutrition, Faculty of Nutrition Sciences and Food Technology, Arghavan Ave, Farahzadi Bulv, Tehran, Iranb Department of Statistics, Faculty of Medicine, Evin, Tehran, Iranc Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences,Parvaneh Ave, Chamran Expressway, Tehran, Iran Received 17 July 2009; received in revised form 17 November 2009; accepted 28 November 2009 Background and aims: Recent studies suggest that calcium metabolism and perhaps other components of dairy products may contribute to shifting the energy balance and thus play a role in weight regulation. We compared the effects of cows’ milk, calcium fortified soy milk and calcium supplement on weight and body fat reduction in premenopausal over- weight and obese women.
Methods and Results: In this clinical trial, 100 healthy overweight or obese premenopausalwomen were randomized to one of the following dietary regimens for 8 weeks: (1) a control dietproviding a 500 kcal/day deficit, with 500e600 mg/day dietary calcium; (2) a calcium-supplemen-ted diet identical to the control diet with 800 mg/day of calcium as calcium carbonate; (3) a milkdiet providing a 500 kcal/day deficit and containing three servings of low-fat milk; (4) a soymilk diet providing a 500 kcal/day deficit and containing three servings of calcium fortified soymilk. At baseline and after 8 weeks, weight, waist circumference, and hip circumference weremeasured. Three 24-h dietary records and physical activity records were also taken. Comparingthe mean differences in weight, waist circumference, body mass index (BMI) and waist-to-hip ratio(WHR) using repeated measure of variance analysis showed that changes in waist circumferenceand WHR were significant among the four groups (p Z 0.029 and p Z 0.015, respectively). Afteradjustment for baseline values, changes in weight and BMI were also significant (p Z 0.017 andp Z 0.019, respectively). Weight reductions in high milk, soy milk, calcium supplement andcontrol groups were 4.43 Æ 1.93 (kg), 3.46 Æ 1.28 (kg), 3.89 Æ 2.40 (kg) and 2.87 Æ 1.55 (kg),respectively. The greatest changes were seen in the high dairy group in all variables.
* Corresponding author. Tel.: þ98 2122357484.
E-mail addresses: (S. Faghih), (A.R. Abadi), (M. Hedayati), 0939-4753/$ - see front matter ª 2009 Published by Elsevier B.V.
doi:10.1016/j.numecd.2009.11.013 Please cite this article in press as: Faghih S, et al., Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement onweight and fat loss in premenopausal overweight and obese women, Nutr Metab Cardiovasc Dis (2009), doi:10.1016/j.numecd.2009.11.013 Conclusion: Increasing low fat milk consumption significantly reduces the general and centralobesity beyond a low calorie diet.
ª 2009 Published by Elsevier B.V.
Obesity is recognized as one of the most significant public Subjects were studied for a 2-week run-in period for baseline dietary and physical activity assessment and then random- chronic diseases such as heart disease, cancer, stroke and ized to one of the following dietary regimens for 8 weeks: (1) a control diet providing a 500 kcal/day deficit with Weight loss is associated with improvement in risk factors for cardiovascular disease (CVD) and diabetes 500e600 mg/day dietary calcium; (2) a calcium-supple- mellitus Although much effort has been devoted to mented diet identical to the control diet with 800 mg/day of study the effects of macronutrients on weight control, the calcium (as calcium carbonate); (3) a milk diet providing role of micronutrients has not been well studied . Recent a 500 kcal/day deficit and containing three servings (220 ml) findings indicate that calcium metabolism and perhaps of low fat milk (1.5%); (4) a soy milk diet providing a 500 kcal/ other components of dairy products may contribute to day deficit and containing three servings of calcium fortified shifting the energy balance and thus play a role in weight soy milk. Total calcium content of the milk diet and the soy milk diet was between 1200 and 1300 mg/day.
in 1,25-dihydroxy vitamin D which in turn stimulates Daily caloric requirements were calculated by using the calcium influx into adipocytes, resulting in stimulation of HarriseBenedict equation An activity factor and meal lipogenesis, inhibition of lipolysis and expansion of adipo- plan based on a 500 kcal/day deficit from estimated caloric cyte triglyceride stores. Suppressing 1,25-(OH) requirements were given to each individual . The diets increasing dietary calcium would be predicted to inhibit for all groups were designed to provide comparable levels of macronutrients as follows: 55% carbohydrate, 18% Calcium in the form of dairy products may be more protein and 27% fat. At baseline and at 2-week intervals, weight, waist circumference, and hip circumference were bioactive compounds and high concentrations of measured and 24 h-dietary records as well as physical branched chain amino acids in dairy products are activity records (2 weekdays and 1 weekend day) were taken. Body fat mass was measured at the beginning of the To study this, we decided to compare the effects of study and at week 8 using Bodystat bioelectric impedance cows’ milk, calcium fortified soy milk and calcium supple- ment on weight and body fat reduction in premenopausal Weight was recorded in light clothing to the nearest 0.1 kg, using a digital scale. Height was measured bare footto the nearest 0.1 cm using a stadiometer. Then BMI wascalculated as weight (kg)/height2 (m). Waist and hip circumferences were measured to the nearest 0.1 cm usinga plastic measuring tape at the smallest circumference below the rib cage and above the umbilicus and thelargest circumference between the waist and the knees,respectively .
One hundred healthy premenopausal overweight or obesewomen ranging in age from 20 to 50 years volunteered to participate in this randomized clinical trial while 85completed the study. There were no significant differencesbetween those who completed the study and those who did Dietary records were analyzed using Nutritionist 4 software not for any parameters. Inclusion criteria were as follows: (N _V). Statistical analyses were performed using SPSS body mass index (BMI) more than 25 kg/m2 (range 25 software version 15. One-way ANOVA was used to compare taking no medications or supplements which might affect the characteristics of subjects in the four groups at base- metabolism of calcium, vitamin D or weight loss; absence of line, and to compare the changes in weight, BMI, waist and menopause; stable body weight (body weight change less hip circumference, and body fat mass among the four than 3 kg for the last 2 months); absence of coronary-artery, groups. The paired t-test was used to estimate the effect of diabetes, hypertension, thyroid, and kidney diseases. The intervention in each group. A p-value <0.05 was considered subjects were not pregnant and non-lactating with no allergy to milk or soy milk and were not lactose intolerant. We alsomade sure that the subjects had not participated in any other studies within the last 6 months of screening. The study wasapproved by the ethics committee of the National Nutrition Of the 100 women meeting the general eligibility criteria, and Food Technology Research Institute. Each potential 15 dropped out before completing the weight loss period participant was informed of the risks and benefits associated (5, 3, 3, and 4 persons in the control, calcium supplement, with this study and provided written signed consent.
high milk, and soy milk groups, respectively).
Please cite this article in press as: Faghih S, et al., Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement onweight and fat loss in premenopausal overweight and obese women, Nutr Metab Cardiovasc Dis (2009), doi:10.1016/j.numecd.2009.11.013 Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement - Baseline characteristics of subjects under study.
BMI, body mass index; MET, metabolic equivalent task units; WHR, waist-to-hip ratio.
a Mean Æ standard deviation (all such values).
b One-way ANOVA.
Baseline characteristics of the subjects are shown in in the high milk group compared to the controls (p < 0.01).
It is apparent that there were no significant There were no significant differences between body weight differences between the age, weight, BMI, or energy and and BMI changes in the soy milk and calcium supplement calcium intake of the subjects in the four groups.
groups and the controls. Weight change (% of initial) in the Comparison of the mean of physical activity levels among high milk group was significantly greater than in the soy milk the four groups at baseline using one-way ANOVA showed no group (p < 0.05) and the controls (p < 0.01).
significant difference (p Z 0.28). Also there was no signifi-cant difference between the physical activity levels ofsubjects at baseline and during the study period.
Estimates of the energy, macronutrients, calcium and fiber intakes during the study period, from food records are The results of this study demonstrated that a low energy shown in which indicates there were no differences diet (500 kcal/day deficit) for 8 weeks can lead to a signif- in the energy, macronutrients and fiber intakes among the icant reduction in weight, BMI, waist circumference, WHR, four groups. Also, it is shown that the percentages of body fat mass and percent body fat. A modest weight loss in carbohydrate, protein and fat intake were very close to the obese individuals (5%e10% of initial body weight) is likely to recommended amounts of 55%, 18%, and 27%, respectively.
improve their health in the short term by reducing the As shown in body weight, BMI, waist circum- severity of comorbidities associated with obesity .
ference, waist-to-hip ratio (WHR), body fat mass and Our findings also indicate that a high milk diet can lead to percent body fat of all groups decreased significantly after a higher reduction in weight, BMI, waist circumference, and 8 weeks of weight loss intervention (p < 0.001 for all), while WHR. Zemel et al. showed that 18 subjects receiving 3 cups the amount of these reductions was significantly different of yogurt per day (1100 mg/day calcium) lost more weight among the four groups just for waist circumference (6.63 kg vs. 4.99 kg), body fat (4.43 kg vs. 2.75 kg), and (p Z 0.028), WHR (p Z 0.015) and weight change (% of abdominal circumference (3.99 cm vs. 0.58 cm) while initial) (p Z 0.026). After adjustment for baseline values by attenuating loss of fat-free mass (1353 g vs. 1968 g) in using analysis of covariance, however, changes in weight comparison with 16 subjects in a low calcium control group and BMI were significantly different among the four groups (400e500 mg/day) . Zemel et al. also studied the effect (p Z 0.017 and p Z 0.019, respectively).
of an energy-restricted diet (providing either 400e500 mg/ Post Hoc tests showed that the changes in waist circum- day from dairy products or 1200e1300 mg/day from an ference and WHR were significantly higher in the high milk additional 800 mg of calcium carbonate or from an addi- (p < 0.01) and soy milk (p < 0.05) groups versus the controls.
tional three servings of dairy products) on weight and fat loss Also reductions in weight and BMI were significantly greater in 32 obese or overweight women. Their results indicated - Estimates of the daily intake of energy, macronutrients, calcium and fiber of subjects during the study period.
a Mean Æ standard deviation (all such values).
b One-way ANOVA.
Please cite this article in press as: Faghih S, et al., Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement onweight and fat loss in premenopausal overweight and obese women, Nutr Metab Cardiovasc Dis (2009), doi:10.1016/j.numecd.2009.11.013 that increasing dietary calcium significantly augmented weight and fat loss secondary to caloric restriction . Afterconducting a clinical trial on 256 obese diabetic patients, Shahar et al. reported that dairy calcium intake was asso-ciated with weight loss percentage. Among the high tertileof dairy calcium intake, the odds ratio for weight loss of >8%was 2.4, p Z 0.04, compared with the first tertile, after controlling for non-dairy calcium intake, diet type, and the change in energy intake from baseline. They concluded thata diet rich in dairy calcium intake enhances weight reduction In contrast, in a 6-month trial by Harvey et al., 54 obese adults were randomly assigned to either a high- or low-dairy treatment along with energy restriction (500 kcal/day).
There was no significant difference in weight loss between the groups. The authors speculated that differences inbaseline calcium intake and degree of adiposity at onsetmay have affected the response to dietary regimens Also when Bowen et al. randomly assigned 50 overweight Australian adults to an energy-restricted diet, who derived 34% of calories from protein either largely from dairy products (2400 mg Ca/day) or mixed sources (500 mg Ca/ day), there was no significant difference in weight loss between the groups over 12 weeks. Considering the fact that calcium supplementation is more effective when its usual intake is low, the participants’ baseline calcium intake of about 800 mg/day is a possible reason for the Our findings showed that reductions in waist circumfer- ence and WHR were more pronounced in the soy milk group than the controls. Results of two randomized clinical trials on obese or overweight women showed that soy protein-rich food and soy isoflavones did not have any beneficial effects on weight loss. Also data from a review article by Cope et al. suggest that soy foods are as good as other protein sources for promoting weight loss . So it is assumed that higher reductions of WHR and waist circumference in the soy milk group compared to the controls are related to the difference in calcium intake between the two groups.
To date, numerous observational studies have identified a strong inverse relationship between body weight and dietary calcium and dairy product intake High dietary calcium intake is associated with reduced 1,25-vitamin D levels which in turn act in decreasing calcium influx into the cell and, thus, the intracellular levels of the ion. These modifications eventually stimulate lipolysis and inhibit lipogenesis in the adipocytes Some recent findings in animals and in humans suggest that there may be greater effects on body weight from dairy-containing foods than might be predicted from their calcium level alone It has been suggested that milk is rich in bioactive compounds that may also act independently from calcium in modulating body fat accumulation and in this regard, milk bioactive substances have been shown to act as angiotensin converting enzyme inhibitors . Also the branched chain amino acid content of dairy protein and specific bioactive whey-derived peptides are candidates for We also found that weight change (% of initial) in the high milk group was significantly greater than that of the soy milk group. On the other hand, Lukaszuk et al. reported that consumption of either 720 ml of soy milk or 720 ml of skim Please cite this article in press as: Faghih S, et al., Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement onweight and fat loss in premenopausal overweight and obese women, Nutr Metab Cardiovasc Dis (2009), doi:10.1016/j.numecd.2009.11.013 Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement milk for 8 weeks had similar effects on body weight, and [10] Parikh SJ, Yanovski JA. Calcium intake and adiposity. Am abdominal circumference reductions . Considering that Lukaszuk et al. added 6.5 g/day protein (containing leucine [11] Shahar DR, Abel R, Elhayany A, Vardi H, Fraser D. Does dairy but no whey) to their soy milk diet, and considering the effect calcium intake enhance weight loss among overweightdpatients? Diabetes Care 2007;30:485 of branched chain amino acids specifically leucine [12] Zemel MB. Role of calcium and dairy products in energy par- on weight loss, it is assumed that weight reduction in the soy titioning and weight management. Am J Clin Nutr 2004;79(5): milk group was augmented by the added protein.
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Please cite this article in press as: Faghih S, et al., Comparison of the effects of cows’ milk, fortified soy milk, and calcium supplement onweight and fat loss in premenopausal overweight and obese women, Nutr Metab Cardiovasc Dis (2009), doi:10.1016/j.numecd.2009.11.013

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