Mediterranean Diet, Exercise Reduce Weight, Cholesterol Levels in PWS Patients, Study Shows

A three-week program based on Mediterranean diet and exercise, and performed three times in six years, led to significant weight loss and reduced cholesterol levels in adults with Prader-Willi syndrome (PWS), an Italian study reports.

The study, “Changes of Body Weight and Body Composition in Obese Patients with Prader–Willi Syndrome at 3 and 6 Years of Follow-Up: A Retrospective Cohort Study,” was published in the Journal of Clinical Medicine.

People with PWS typically develop an insatiable appetite and chronic overeating (hyperphagia) starting in childhood.

When compared to healthy individuals of the same age and sex, PWS patients have significantly higher body fat mass, and lower fat-free mass and resting energy expenditure (the amount of energy a person uses while resting).

Multidisciplinary programs in PWS are based not only on diets, but also on physical activity and psychological support. Although lifestyle changes are key to losing weight for obese people with or without PWS, they are harder to achieve in those with PWS due to their severe hyperphagia and behavioral symptoms.

Researchers at the Istituto Auxologico Italiano studied 45 adults with PWS and obesity (median age 26, 69% with class 3 obesity). Twenty-five patients had metabolic syndrome and none used anti-obesity medicines or underwent bariatric surgery during the study.

The participants underwent a long-term metabolic rehabilitation program that lasted three weeks, and was performed at the start (baseline) and then after three and six years. It focused on diet and exercise. Mediterranean diet was prescribed in all cases, with a decreased energy content — removing a maximum 500 kilocalories from the patient’s total energy expenditure.

Physical activity involved five days of training per week and included one hour of moderate aerobic exercise of both arms and legs, under the supervision of an instructor. It also included 20 to 30 minutes on an exercise bicycle or three to four kilometers (1.8 to 2.4 miles) of walking outdoors on flat terrain.

The patients were monitored from June 2001 to January 2013, and were followed every six months.

After three years, the mean weight loss was 3.6 kg (7.9 lbs), reaching 4.6 kg (10.1 lbs) after six years.

This corresponded to a mean decrease in body mass index of 1.7 kilograms per square meter (kg/m²) after three years and 2.1 kg/m² after six years.

The levels of total cholesterol and the low-density cholesterol (LDL), the so-called “bad cholesterol,” also were significantly less after six years — 11.7 milligrams per deciliter (mg/dL, total cholesterol) and 8.1 mg/dL (LDL).

A favorable trend was observed for increases in the high-density cholesterol (HDL) levels — the so-called “good cholesterol” — lower triglycerides (a type of fat) and lower blood pressure.

Fat mass was measured using dual-energy X-ray absorptiometry and was available for 36 patients. In this group, the team found a mean reduction of 2.3% in fat mass at year three, and 1.8% at year six.

Overall, the study shows that “patients with PWS undergoing a long-term multidisciplinary metabolic rehabilitation program show clinically relevant weight loss at 6 years of follow-up, which is accompanied by a loss of percent [fat mass] and by a decrease in total and LDL cholesterol,” the researchers wrote.

“This long-term result is especially important for patients with PWS, which is characterized by severe hyperphagia, behavioral disturbances, and cognitive impairment and is generally considered “resistant” to classical weight loss interventions,” they concluded.