Dokumentation for vægttab og sundhed

Der er to vigtige elementer i, at Madital virker - både på kort og lang sigt. Det skyldes, at vi har implementeret to vigtige elementer i programmet: kalorietæthed samt de officielle kostråd. Dette gør samtidig Madital til en unik kalorieberegner på markedet.

Herunder kan du læse uddrag fra videnskabelige undersøgelser inden for hvert område samt finde links til undersøgelserne, hvis du ønsker at blive endnu klogere på materialet.

Kalorietæthed er vigtigt for vægttab

Kalorieunderskud er det vigtigste for dit vægttab. Det er også vigtigt, at du er mæt, når du er i kalorieunderskud. Hvis du ikke er mæt, øges sandsynligheden for, at du spiser mere og ender ud med et kalorieoverskud.

Vi præsenterer dig først for to systematiske gennemgange. Disse er vurderinger af mange undersøgelser samlet, og de må derfor betragtes at vægte højere end resultater fra enkeltundersøgelser.

I den systematiske gennemgang fra 2016 konkluderes det, at en høj kalorietæthed er direkte forbundet med en øget risiko for vægtøgning, og at lavere kalorietæthed bør betragtes som en forebyggelsesstrategi overfor fedme. Se det engelske uddrag nedenfor.

I den systematiske gennemgang fra 2012 konkluderes det, at den understøtter, at der er en relation mellem kalorietæthed og kropsvægt hos både voksne og børn og unge, som gør at indtagelse af en kost med lavere kalorietæthed kan være en effektiv strategi til at regulere kropsvægt. Se nedenfor.

OBJECTIVE: Although many studies have shown an association between dietary energy density (DED) and obesity, there has been no systematic review and meta-analysis on this topic. Therefore, the objective of this study was to qualitatively and quantitatively review and summarize the literature on association between DED and obesity.
CONCLUSION: The present review showed that DED was directly associated with risk of excess adiposity, higher weight change, and BMI. Lower DED should be considered a prevention strategy for obesity.
SOURCE: Associations between dietary energy density and obesity: A systematic review and meta-analysis of observational studies, 2016 .
ABSTRACT: Energy density is a relatively new concept that has been identified as an important factor in body weight control in adults and in children and adolescents. The Dietary Guidelines for Americans 2010 encourages consumption of an eating pattern low in energy density to manage body weight. This article describes the systematic evidence-based review conducted by the 2010 Dietary Guidelines Advisory Committee (DGAC), with support from the US Department of Agriculture's Nutrition Evidence Library, which resulted in this recommendation. [...]
Based on this evidence, the 2010 Dietary Guidelines Advisory Committee concluded that strong and consistent evidence in adults indicates that dietary patterns relatively low in energy density improve weight loss and weight maintenance. In addition, the committee concluded that there was moderately strong evidence from methodologically rigorous longitudinal cohort studies in children and adolescents to suggest that there is a positive association between dietary energy density and increased adiposity. This review supports a relationship between energy density and body weight in adults and in children and adolescents such that consuming diets lower in energy density may be an effective strategy for managing body weight.
SOURCE: Dietary Energy Density and Body Weight in Adults and Children: A Systematic Review, 2012 .

Vi har også fundet en del enkeltundersøgelser, som alle konkluderer det samme blot i forskellige vendinger. Nemlig det at kalorietæthed er dén faktor, som gennemgående viser en sammenhæng med vægtregulering og vægtvedligehold. En høj kalorietæthed fører til større kalorieindtag og dermed vægtøgning. En lav kalorietæthed fører til lavere kalorieindtag og dermed vægttab.

Vi har ikke udeladt nogen fundne undersøgelser, hverken i dette eller andre afsnit. Vi har altså ikke fundet et eneste studie, som konkluderer det modsatte - at en lav kalorietæthed fører til vægtøgning eller en høj kalorietæthed fører til vægttab.

Vi er dermed meget overbeviste om, at der ligger et betydeligt - og desværre meget lidt omtalt - potentiale i kalorietæthed set i forhold til vægttab. Det er selvfølgelig grunden til, at vi har implementeret det som en del af Madital, så du kan få det redskab, som hjælper dig bedst.

 
I den anden rapport fra World Cancer Research Fund og American Institute for Cancer Research var angivet anbefalingen om at sænke energitætheden ned imod 125 kcal pr. 100 gram. Derfor finder vi efterfølgeren af denne rapport særligt interessant.

I den tredje rapport fra World Cancer Research Fund og American Institute for Cancer Research, afsnit Energy balance and body fatness, 2018 er energitæthed (engelsk: energy density) nævnt intet mindre end 52 gange.

Kilderne angående energitæthed i rapporten er følgende:
KILDE: Energy density, diet composition and palatability: influences on overall food energy intake in humans, 2004 .
KILDE: The influence of food portion size and energy density on energy intake: implications for weight management., 2005 .
KILDE: Fast foods, energy density and obesity: a possible mechanistic link., 2003 .
KILDE: Covert manipulation of dietary fat and energy density: effect on substrate flux and food intake in men eating ad libitum., 1995 .
KILDE: Covert manipulation of the ratio of dietary fat to carbohydrate and energy density: effect on food intake and energy balance in free-living men eating ad libitum., 1995 .
SYNOPSIS: A number of dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.
CONCLUSIONS: Obesity is a multifactorial disease, with both individual and environmental factors influencing dietary adherence. Dietary approaches with a reduction in energy intake that have led to success at weight loss have focused on macronutrient composition and food patterns. A unifying principle for weight loss across eating patterns is dietary energy density. [...]
SOURCE: Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns, 2019 .
PURPOSE: Recent public health messages have advised consumers to lower dietary energy density (ED) for weight management, but it is not known whether the proportion of the diet from low-ED foods is related to weight status. In a nationally representative sample of US adults, we evaluated whether the proportions of dietary energy intake contributed by low- and high-ED foods are associated with body mass index (BMI) and waist circumference (WC).
CONCLUSION: Higher proportions of energy intake and food weight contributed by very low- and low-ED foods are associated with lower BMI (and WC).
SOURCE: Dietary energy density and obesity: how consumption patterns differ by body weight status, 2018 .
ABSTRACT: Studies conducted by behavioural scientists show that energy density (kcal/g) provides effective guidance for healthy food choices to control intake and promote satiety. Energy density depends upon a number of dietary components, especially water (0 kcal/g) and fat (9 kcal/g). Increasing the proportion of water or water-rich ingredients, such as vegetables or fruit, lowers a food's energy density. A number of studies show that when the energy density of the diet is reduced, both adults and children spontaneously decrease their ad libitum energy intake. Other studies show that consuming a large volume of a low-energy-dense food such as soup, salad, or fruit as a first course preload can enhance satiety and reduce overall energy intake at a meal. Current evidence suggests that energy density influences intake through a complex interplay of cognitive, sensory, gastrointestinal, hormonal and neural influences. Other studies that focus on practical applications show how the strategic incorporation of foods lower in energy density into the diet allows people to eat satisfying portions while improving dietary patterns. This review discusses studies that have led to greater understanding of the importance of energy density for food intake regulation and weight management.
SOURCE: Dietary energy density: Applying behavioural science to weight management, 2017 .
ABSTRACT: Regulating the energy density of food could be used as a novel approach for successful body weight reduction in clinical practice. The aim of this study was to conduct a systemic review of the literature on the relationship between food energy density and body weight changes in obese adults to obtain solid evidence supporting this approach. [...] In conclusions, this study adds evidence which supports the energy density of food as a simple but effective measure to manage weight in the obese with the aim of weight reduction.
SOURCE: Link between Food Energy Density and Body Weight Changes in Obese Adults, 2016 .
PURPOSE: Given the current prevalence of obesity, it is important to identify dietary factors that may aid in disease prevention. The objective of the present study was to evaluate the association between consumption of an energy-dense diet and established markers factors for chronic disease, including body weight and measures of body fatness.
CONCLUSION: These findings support recent obesity and disease prevention recommendations to consume a diet low in ED.
SOURCE: Dietary energy density is associated with obesity and other biomarkers of chronic disease in US adults, 2015 .
OBJECTIVE: The energy density (kilocalories per gram) of foods influences short-term energy intake. This 1-year clinical trial tested the effect on weight loss of a diet incorporating one or two servings per day of foods equal in energy but differing in energy density.
DISCUSSION: On an energy-restricted diet, consuming two servings of low energy-dense soup daily led to 50% greater weight loss than consuming the same amount of energy as high energy-dense snack food. Regularly consuming foods that are low in energy density can be an effective strategy for weight management.
SOURCE: Provision of Foods Differing in Energy Density Affects Long-Term Weight Loss, 2012 .
BACKGROUND: 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.
CONCLUSION: 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.
SOURCE: Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets, 2007 .
OBJECTIVE: This study investigated food choices made by individuals consuming diets differing in energy density and explores relationships between energy density and diet quality.
CONCLUSIONS: These analyses further demonstrate the beneficial effects of a low-energy-density diet, which was associated with lower energy intakes, higher food intakes, and higher diet quality than a high-energy-density diet. To achieve a low-energy-density diet, individuals should be encouraged to eat a variety of fruits and vegetables as well as low-fat/reduced-fat, nutrient-dense, and/or water-rich grains, dairy products, and meats/meat alternatives.
SOURCE: Low-energy-density diets are associated with high diet quality in adults in the United States, 2006 .
BACKGROUND: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons.
CONCLUSIONS: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management.
SOURCE: Dietary energy density is associated with energy intake and weight status in US adults, 2006 .
ABSTRACT: Weight maintenance 2 years after participation in a weightloss program promoting low-energy density foods.
DISCUSSION: Our results indicate that low-energy-density eating habits are associated with long-term weight maintenance. Those who maintain weight after the EatRight program consume a low-energy-density dietary pattern and smaller portions of food groups potentially high in energy density than those who regain weight.
SOURCE: Weight Maintenance 2 Years after Participationin a Weight Loss Program PromotingLow-Energy Density Foods, 2006 .
ABSTRACT: A growing body of laboratory-based, clinical, and epidemiological data suggests that low-energy-dense diets are associated with better diet quality, lower energy intakes, and body weight. [...] Low-energy-dense diets can be successfully incorporated into clinical dietetics since they help lower energy intake without reducing food volume and thus help individuals avoid feeling hungry and deprived. There are multiple steps that could be taken by nutrition professionals and food manufacturers to encourage the consumption of low-energy-dense diets. The goal is to develop reduced-calorie eating plans that meet personal food preferences and also provide satisfying food portions. [...]
SOURCE: Changing the Energy Density of the Diet as a Strategy for Weight Management, 2005 .

BACKGROUND: Dietary energy density (ED) reductions are associated with energy intake (EI) reductions. [...]
CONCLUSION: Both large and modest ED reductions were associated with weight loss and improved diet quality.
SOURCE: Reductions in dietary energy density are associated with weight loss in overweight and obese participants in the PREMIER trial, 2005 .
ACSTRACT: [...] Several studies have demonstrated that eating low-energy-dense foods (such as fruits, vegetables, and soups) maintains satiety while reducing energy intake. In a clinical trial, advising individuals to eat portions of low-energy-dense foods was a more successful weight loss strategy than fat reduction coupled with restriction of portion sizes. Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while restricting energy intake for weight management.
SOURCE: The influence of food portion size and energy density on energy intake: implications for weight management, 2005 .
OBJECTIVE: We tested the effect on meal intake of varying the energy density and portion size of a compulsory first-course salad.
CONCLUSIONS: Eating a low-energy-dense first course enhances satiety and reduces meal energy intake. Consuming a large portion of a low-energy-dense food at the start of a meal may be an effective strategy for weight management.
SOURCE: Salad and satiety: energy density and portion size of a first-course salad affect energy intake at lunch, 2004 .
ABSTRACT: This study examined the effect of energy density, independent of fat content and palatability, on food and energy intakes. [...] Results showed that subjects consumed a similar amount of food (by weight) across the three conditions of energy density. [...] There were no differences in hunger or fullness before meals, after meals, or over the 2 d across conditions. The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability, suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content.
SOURCE: Energy density of foods affects energy intake in normal-weight women, 1998 .

De officielle kostråd opfylder dine behov

Fødevarestyrelsens officielle kostråd er baseret på videnskabelig evidens.

De officielle kostråd omfatter 10 simple råd om kost og motion, som størstedelen af den danske befolkning med fordel kan leve efter. Lever du efter de 10 kostråd vil din krop med stor sandsynlighed få tilført, hvad den har behov for af næringsstoffer samt få tilstrækkelig med fysisk bevægelse. Dette er baseret på de kendte sammenhænge der er undersøgt imellem livsstil samt livsstilsrelaterede sygdomme.

Hvert af de 10 råd er baseret på videnskabeligt grundlag. Ønsker du at blive klogere på evidensen for de officielle kostråd, kan du læse rapporten Evidensgrundlaget for danske råd om kost og fysisk aktivitet, DTU Fødevareinstituttet, 2013

Det er vigtigt at fremhæve, at evidensgrundlaget ikke bygger på én enkelt undersøgelse. De officielle kostråd er dannet på baggrund af en gennemgang af mange undersøgelser. Se Fødevarestyrelsens foreklarende video om, hvordan de officielle kostråd er blevet udvalgt .

Hvad så når nogle undersøgelser viser noget - og andre det modsatte? Det er ikke unormalt, at undersøgelser viser forskellige resultater. Det afhænger af, hvordan de er udført. Modstridende undersøgelser kan skabe megen forvirring. Det vigtige er at se på alle eksisterende undersøgelser indenfor de enkelte områder og vurdere validiten af hver eneste undersøgelse - gode som dårlige - for at komme frem til en samlet konklusion.

Ovenstående omhandler dog kun evidensgrundlaget. Den endelige tilblivelse af kostrådene sker ved, at evidensgrundlaget bliver formuleret, så den danske befolkning kan forstå og omsætte evidensen til en sund hverdag ud fra de kost- og motionsvaner, der nu engang eksisterer i den danske befolkning. Her har konklusionerne gennemgået en formuleringsproces, som har resulteret i de officielle kostråd.

I forhold til implementeringen af de officielle kostråd i Madital, må følgende sætning fremhæves:

Hvor der er angivet mængder, skal disse opfattes som vejledende og skal tilpasses den enkelte i forhold til både energibehov og andre behov. Samtidig er mængderne angivet som gennemsnit over en periode.

Citat fra rapporten: Evidensgrundlaget for danske råd om kost og fysisk aktivitet, DTU Fødevareinstituttet, 2013

Citatet betyder med andre ord, at mængdeangivelserne i Madital skal opfattes som vejledende og ikke præcis. Herudover er det ikke vigtigt, at du lever op til de enkelte råd hver eneste dag, når blot du nogenlunde opfylder rådene set over en periode.

Der findes andre måder at sammensætte en sund kost. Du behøver ikke at leve efter de officielle kostråd for at leve sundt - og du afgør alene, hvad du ønsker at spise og i hvilke mængder. Uanset hvilken retning du vælger, så vær som minimum sikker på, at retningen ikke bare bygger på en enkelt undersøgelse men derimod et solidt vidensgrundlag, som er til at stole på.

Madital har valgt at implementere kostrådene, da vi finder grundlaget for de officielle kostråd som det mest valide inden for kost og motion.

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