http://www.medscape.com/viewarticle/558708

Fruit and Vegetable Intake Promotes Weight Loss by Reducing Dietary
Energy Density

June 22, 2007 — Patients who reduce their dietary energy density by
adding water-rich foods, such as fruits and vegetables, and limiting
fat intake lose a third more weight at 6 months compared with those
who only decrease their fat intake, according to the results of a
randomized controlled trial published in the June issue of the
American Journal of Clinical Nutrition.

"Consuming foods low in energy density (kcal/g) decreases energy
intake over several days, but the effectiveness of this strategy for
weight loss has not been tested," write Julia A. Ello-Martin, PhD,
from the Department of Nutritional Sciences at Pennsylvania State
University in University Park, and colleagues. "The effects on weight
loss of 2 strategies for reducing the energy density of the diet were
compared over 1 year."

In this study, 97 obese women were randomized to groups counseled
either to reduce fat intake (RF group) or to reduce fat intake and
increase intake of water-rich foods, particularly fruit and vegetables
(RF+FV group). The participants were not given goals for energy or fat
intake but rather were allowed to eat ad libitum amounts of food while
following the principles of their diet.

Patients in the RF+FV group lost a third more weight at 6 months
compared with those who only decreased their fat intake. At 1 year,
mean weight loss was 7.9 ± 0.9 vs 6.4 ± 0.9 kg, respectively.

Patients who completed the study (n = 71) in both groups had decreased
body weight after 1 year (P < .0001). However, subjects in the RF+FV
group had a significantly different pattern of weight loss (P = .002)
than did subjects in the RF group.

When all randomized subjects were included, there was still a
different pattern of weight loss between groups (P = .021). Although
both groups had similar reductions in fat intake, the RF+FV group had
a lower dietary energy density than did the RF group (P = .019)
because they consumed a greater weight of food (P = .025), especially
fruit and vegetables (P = .037). The RF+FV group also reported feeling
less hungry (P = .003).

Participants in both groups gave similar ratings of satisfaction for
the 2 dietary approaches, particularly for cost, convenience, and food
preparation, which indicates that specific instruction in techniques
for increasing fruit and vegetable intake was both effective and well
accepted by the participants.

"The 2 strategies for reducing energy density that were tested in this
trial were both effective in reducing body weight and maintaining
weight loss without prescribing limits for energy or fat intake," the
authors write. "Reducing dietary energy density, particularly by
combining increased fruit and vegetable intakes with decreased fat
intake, is an effective strategy for managing body weight while
controlling hunger."

Study limitations include large variability in daily energy intake and
use of self-reported diet records.

"Because a wide variety of foods can be included in a diet that is
reduced in energy density, this type of eating plan can be adapted to
individual food preferences," the authors conclude. "Individuals
should be encouraged to find a low-energy-density eating pattern that
is nutritionally balanced and that can be sustained for lifelong
weight management."

The National Institutes of Health supported this study. The authors
have disclosed no relevant financial relationships.

Am J Clin Nutr. 2007;85:1465-1477.

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