Analysis of the cost-effectiveness of the paleolithic diet compared to the diet supported by guidelines for weight loss in obese people: a randomized clinical trial

Authors

DOI:

https://doi.org/10.33448/rsd-v9i10.8384

Keywords:

Paleolithic diet; Weight loss; Cost-effectiveness; Obesity.

Abstract

The aim of this study was to compare the cost of the paleolithic (PD) diet with that of the traditional diet supported by guidelines (DTG) in obese patients treated by the Brazilian public health system. It is a randomized clinical trial with obese patients who were divided into two groups according to the dietary prescription: DP and DTG, involving, respectively, 82 and 73 patients. They were followed up for 30 and 60 days, with two monthly 24h (R24h) reminders. A cost-effectiveness analysis of the DP and DTG diets was performed. The daily cost of each R24h was calculated with the aid of the PROCONOMIZE tool, a free application available on the IOS platform. As a measure of efficiency or outcome, the patient's weight loss variable was used, and the average cost ratio was calculated by varying the patients' weight. The cost-effectiveness calculation was carried out taking into account the cost ratio, considering the standard deviation, for efficiency. There was no difference between groups in terms of demographic, socioeconomic, nutritional status and usual expenditure on daily food before starting treatment. Regarding the average cost, the DP proved to be more economical when compared to the DTG. In addition, PD is more efficient, as it has a lower cost-effectiveness ratio, both at 30 days and 60 days, in addition to greater weight loss, when compared to DTG. PD is a viable option for treating obesity, with a similar cost to DTG.

References

Blomquist, C., Chorell, E., Ryberg, M., Mellberg, C., Worrsjo, E., Makoveichuk, E., et al. (2018). Decreased lipogenesis-promoting factors in adipose tissue in postmenopausal women with overweight on a Paleolithic-type diet. Eur J Nutr., 57(8):2877-2886. https://doi.org/10.1007/s00394-017-1558-0

Brasil. Ministério da Saúde. (2012). Resolução nº 466/12.

Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. (2014). Estratégias para o cuidado da pessoa com doença crônica: obesidade. Brasília: Ministério da Saúde.

Conklin, A. I., Monsivais, P., Khaw, K. T., Wareham, N. J., & Forouhi, N. G. (2016). Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study. PLoS Med., 13(7):e1002085. https://doi.org/10.1371/journal.pmed.1002085

Cordain, L. (2015). Real Paleo Fast & Easy: More Than 175 Recipes Ready in 30 Minutes or Less. New York: Houghton Mifflin Harcourt.

Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. (4a ed.), New York: Oxford Univeristy Press.

Fisberg, R. M., Marchioni, D. M. L., & Colucci, A. C. A. (2009). Avaliação do consumo alimentar e da ingestão de nutrientes na prática clínica. Arq Bras Endocrinol Metab. 53(5):617-624. https://doi.org/10.1590/S0004-27302009000500014

Gadde, K. M., Martin, C. K., Brthoud, H., & Heymsfield, S. B. (2018). Obesity: Pathophysiology and Management. J Am Coll Cardiol., 71(1):69-84. https://doi.org/10.1016/j.jacc.2017.11.011

Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., & Jastreboff, A. M. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endroc Pract., 22(3):1-203. https://doi.org/10.4158/EP161365.GL

Hammarstrom, A., Wiklund, A. F., Lindahl, B., Larsson, C., & Ahlgren, C. (2014). Experiences of barriers and facilitators to weight-loss in a diet intervention - a qualitative study of women in northern Sweden. BMC Womens Health, 14:59. https://doi.org/10.1186/1472-6874-14-59

Instituto Brasileiro de Geografia e Estatística. (2011). Pesquisa de orçamentos familiares 2008-2009: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: IBGE.

Jonsson, T., Granfeldt, Y., Ahren, B., Branell, U. C., Palsson, G., Hansson, A., et al. (2009). Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol., 8(35). https://doi.org/10.1186/1475-2840-8-35

Jonsson, T., Granfeldt, Y., Erlanson-Albertsson, C., Ahren, B., & Lindeberg, S. (2010). A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease. Nutr Metab (Lond)., 7(85). https://doi.org/10.1186/1743-7075-7-85

Manheimer, E. W., van Zuuren, E. J., Fedorowicz, Z., & Pijl, H. (2015). Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. Am J Clin Nutr., 102(4):922-932. https://doi.org/10.3945/ajcn.115.113613

Masharani, U., Sherchan, P., Schloetter, M., Stratford, S., Xiao, A., Sebastian, A., et al. (2015). Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr., 69(8):944-948. https://doi.org/10.1038/ejcn.2015.39

Mellberg, C., Sandberg, S., Ryberg, M., Eriksson, M., Brage, S. C., Larsson, C., et al. (2014). Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a two-year randomized trial. Eur J Clin Nutr., 68(3):350-357. https://doi.org/10.1038/ejcn.2013.290

Menezes, E. V. A., Sampaio, H. A. C., Carioca, A. A. F., Parente, N. A., Brito, F. O., Moreira, T. M. M., et al. (2019). Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis. Nutr J., 18(1):41. https://doi.org/10.1186/s12937-019-0457-z

Metzgara, M. F., Rideout, T. C., Fontes-Villalba, M., & Kuipers, R. S. (2011). The feasibility of a Paleolithic diet for low-income consumers. Nutr Res., 31(6):444-451. https://doi.org/10.1016/j.nutres.2011.05.008

Obert, J., Pearlman, M., Obert, L., & Chapin, S. (2017). Popular Weight Loss Strategies: a Review of Four Weight Loss Techniques. Curr Gastroenterol Rep., 19(12):61. https://doi.org/10.1007/s11894-017-0603-8

Otten, J., Mellberg, C., Ryberg, M., Sandberg, S., Kullberg, J., Lindahl, B., et al. (2016). Strong and persistent effect on liver fat with a Paleolithic diet during a two-year intervention. Int J Obes (Lond), 40(5), 747-753. https://doi.org/10.1038/ijo.2016.4

Park, M. L. (2016). A Cost Analysis of Three Popular Diets: the Mediterranean Diet, a Modified Paleo Diet and Intermittent Fasting (Thesis, Master of Dietetics). University of Otago. Retirado de http://hdl.handle.net/10523/6239

Pastore, R. L., Brooks, J. T., & Carbone, J. W. (2015). Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Nutr Res., 35(6), 474-479. https://doi.org/10.1016/j. nutres.2015.05.002

Pocock, S. J. (1983). Clinical Trials: a practical approach. John Wiley & Sons, Chichester—New York—Brisbane—Toronto—Singapore.

PROCON. Fundação de Ciência, Tecnologia e Inovação. (2018). PROCONOMIZAR. Recuperado de https://play.google.com/store/apps/details?id=br.com.app.gpu1917978.gp udfd905ac7029bc68e3eb55cb2850bb59&hl=pt_BR

Rehm, C. D., Monsivais, P., & Drewnowski, A. (2016). Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010. Prev Med., 73, 70-75. https://doi.org/10.1016/j.ypmed.2015.01.019

Sarti, F. M., & Cyrillo, D. C. (2010). A farmacoeconomia no ponto de vista do profissional da economia. In: Nita, M. E., Campino, A. C. C., Secoli, S. R., Sarti, F. M., Nobre, M. R. C., Costa, A. M. N., Ono-Nita, S. K., Carrilho, F. J. (Org.). Avaliação de tecnologias em saúde: Evidência clínica, análise econômica e análise de decisão. Porto Alegre: ARTMED, 237-247.

Saulle, R., Semyonov, L., & La Torre, G. (2013). Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients., 5(11), 4566-4586. https://doi.org/10.3390/nu5114566

Secoli, S. R., Nita, M. E., Ono-Nita, S. K., & Nobre, M. (2010). Avaliação de tecnologia em saúde. II. A análise de custo-efetividade. Arq. Gastroenterol. 47(4), 329-333. https://doi.org/10.1590/S0004-28032010000400002

Stewart, A., Marfell-Jones, M., Olds, T., & Ridder, H. D. (2011). International standards for anthropometric assessment. New Zealand: Lower Hutt.

Stomby, A., Simonyte, K., Mellberg, C., Ryberg, M., Stimson, R. H., Larsson, C., et al. (2015). Diet-induced weight loss has chronic tissue-specific effects on glucocorticoid metabolism in overweight postmenopausal women. Int J Obes (Lond)., 39(5), 814-819. https://doi.org/10.1038/ijo.2014.188

Verly-Jr, E., Sichieri, R., Darmon, N., Maillot, M., & Sarti, F. M. (2019). Planning dietary improvements without additional costs for low-income individuals in Brazil: linear programming optimization as a tool for public policy in nutrition and health. Nutr J., 18(1), 40. https://doi.org/10.1186/s12937-019-0466-y

Zinn, C., North, S., Donovan, K., Muir, C., & Henderson, G. (2019). Low‐carbohydrate, healthy‐fat eating: A cost comparison with national dietary guidelines. Nutr Diet., 77(2), 283-291. https://doi.org/10.1111/1747-0080.12534

Published

18/09/2020

How to Cite

PARENTE, N. de A.; SAMPAIO, H. A. de C.; CARIOCA, A. A. F.; BRITO, F. de O.; CACAU, L. T.; SOUSA, M. H. L.; PORTO, M. I. S. de O.; LUPPI, L. C. Analysis of the cost-effectiveness of the paleolithic diet compared to the diet supported by guidelines for weight loss in obese people: a randomized clinical trial. Research, Society and Development, [S. l.], v. 9, n. 10, p. e639108384, 2020. DOI: 10.33448/rsd-v9i10.8384. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/8384. Acesso em: 22 nov. 2024.

Issue

Section

Health Sciences