GLP-1 Temelli Obezite Tedavilerinde Beslenme Riski: Yağsız Kütlenin Korunması, Mikro Besin Ögesi Alım Yetersizlikleri ve Diyetetik İzlem

Öz

Amaç: Glukagon benzeri peptid-1 (GLP-1) temelli tedaviler obezite yönetiminde belirgin ağırlık kaybı sağlamakla birlikte, iştah ve besin alımındaki azalma; yetersiz protein ve mikro besin ögesi alımı, gastrointestinal tolerans sorunları ve yağsız kütle kaybı açısından klinik kaygılar oluşturmaktadır. Bu derlemenin amacı, GLP-1 temelli obezite tedavilerinde beslenme risklerini değerlendirmek, yağsız kütle ve kas sağlığına ilişkin kanıtları incelemek ve diyetetik izleme yönelik bir çerçeve sunmaktır. Materyal ve Metot: PubMed/MEDLINE, Web of Science Core Collection ve Scopus veri tabanlarında GLP-1 reseptör agonistleri, semaglutid, liraglutid, tirzepatid, iştah, enerji ve besin ögesi alımı, vücut kompozisyonu, yağsız kütle, iskelet kası, sarkopeni, protein, direnç egzersizi ve diyetetik izlem ile ilişkili terimler kullanılarak anlatı derlemesi yapılmıştır. İnsanlarda yürütülen randomize kontrollü çalışmalar, gözlemsel araştırmalar, sistematik derlemeler ve meta-analizler öncelikli olarak değerlendirilmiştir. Bulgular: GLP-1 temelli tedaviler açlık, besin isteği ve enerji alımını azaltırken tokluk ve yeme kontrolünü artırmaktadır. Bununla birlikte azalan besin tüketimi ve gastrointestinal yan etkiler, protein, sıvı, lif ve bazı mikro besin ögelerinin yetersiz alınmasına yol açabilmektedir. Yağ kütlesiyle birlikte yağsız kütlede de azalma bildirilmesine karşın, bu değişim doğrudan iskelet kası kaybı veya sarkopeni anlamına gelmemektedir. Kas miktarı; kas kalitesi, kas gücü ve fiziksel işlevle birlikte değerlendirilmelidir. İleri yaş, kırılganlık, düşük kas rezervi, fiziksel inaktivite ve yetersiz protein alımı daha yüksek riskle ilişkilidir. Sonuç: Tedavi başarısı yalnızca ağırlık kaybıyla değerlendirilmemelidir. Beslenme yeterliliği, gastrointestinal tolerans, vücut kompozisyonu, kas gücü ve fiziksel işlev birlikte izlenmeli; bireyselleştirilmiş beslenme desteği, direnç egzersizi ve düzenli diyetetik izlem tedaviye entegre edilmelidir.

Anahtar Kelimeler

• Glukagon benzeri peptid-1 reseptör agonistleri
• obezite
• vücut bileşimi
• sarkopeni
• mikro besleyiciler
• beslenme değerlendirmesi

Destekleyen Kurum

Yazar, bu çalışma için herhangi bir maddi destek almadığını beyan eder.

Nutritional Risk During GLP-1-Based Obesity Treatment: Preservation of Lean Mass, Inadequate Micronutrient Intake and Dietetic Monitoring

Öz

Objective: Glucagon-like peptide-1 (GLP-1)-based therapies produce substantial weight loss in obesity management; however, reductions in appetite and food intake may increase the risks of inadequate protein and micronutrient intake, gastrointestinal intolerance, and loss of lean mass. This review aimed to evaluate nutritional risks during GLP-1-based obesity treatment, examine evidence on lean mass and muscle health, and provide a framework for dietetic monitoring. Materials and Methods: PubMed/MEDLINE, Web of Science Core Collection, and Scopus were searched using terms related to GLP-1 receptor agonists, semaglutide, liraglutide, tirzepatide, appetite, energy and nutrient intake, body composition, lean mass, skeletal muscle, sarcopenia, protein, resistance exercise, and dietetic monitoring. Randomized controlled trials in humans, observational studies, systematic reviews and meta-analyses were prioritized. Results: GLP-1-based therapies reduce hunger, food cravings, and energy intake while improving satiety and control of eating. Nevertheless, lower food intake and gastrointestinal adverse effects may compromise the intake of protein, fluids, fiber, and several micronutrients. Although reductions in lean mass occur alongside fat loss, they do not directly indicate skeletal muscle loss or sarcopenia. Changes in muscle quantity should be interpreted together with muscle quality, strength, and physical function. Older age, frailty, low baseline muscle reserve, physical inactivity, and inadequate protein intake appear to increase risk. Conclusion: Treatment success should not be evaluated solely by weight loss. Nutritional adequacy, gastrointestinal tolerance, body composition, muscle strength, and physical function should be monitored together. Individualized nutrition support, resistance exercise, and regular dietetic follow-up should be integrated into treatment.

Anahtar Kelimeler

• Glucagon-like peptide-1 receptor agonists
• obesity
• body composition
• sarcopenia
• micronutrients
• nutrition assessment

Destekleyen Kurum

The author declares that no financial support was received for this study.

Kaynakça

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