Gilardini et al.

BMC Complementary and Alternative Medicine (2016) 16:233

DOI 10.1186/s12906-016-1214-x

RESEARCH ARTICLE Open Access

Effects of Greenselect Phytosome®

on weight maintenance after weight
loss in obese women: a randomized
placebo-controlled study
Luisa Gilardini1*, Lucia Pasqualinotto1, Francesco Di Pierro2, Paolo Risso3 and Cecilia Invitti1

Abstract
Background: Most subjects regain weight after weight loss due to compensatory adaptations finalized to maintain
stable body energy stores. Green tea (GT) preparations, which help maintain energy expenditure while dieting could
be a useful strategy to facilitate weight maintenance. The usefulness of GT preparations in weight maintenance has
been poorly studied so far with conflicting results. This study evaluated if a supplement of GSP and piperine helps
obese women to maintain the weight loss obtained with a 3-month lifestyle intervention.
Methods: In a randomized placebo-controlled study, we examined whether a highly bioavailable GT extract may
counteract weight regain after weight loss. Forty obese women (age 50.1 ± 10.1 years, Body Mass Index (BMI)
36.3 ± 2.7 kg/m2) underwent a 3-month lifestyle intervention. At the end of the intervention, the women were
randomized in two groups for the weight-maintenance phase: 20 of them were prescribed twice a day, for 3 months,
with a formula containing 150 mg/dose of Greenselect Phytosome® and 15 mg/dose of pure piperine (GSP group),
and 20 were given placebo (P group). Anthropometric measures and body composition were measured before (V-3)
and after lifestyle intervention (V0), 1 (V1), 2 (V2), and 3 (V3) months after prescribing supplements and 3 months
following the discontinuation of supplements (V6).
Results: Lifestyle intervention induced a significant weight reduction in both groups with similar weight change
(−6.2 ± 2.6 in GSP group vs. −4.8 ± 3.1 % in P group). In the GSP group, V1 in comparison to V0, had further reduction
in weight and fat mass, which remained stable at V2 and V3 and increased at V6. In the P group, weight and fat mass
increased from V2 onwards. Weight changes in GSP group and P group from V0 to V3 were −1.0 kg (95 % CI −2.5
to +0.5) and + 0.3 kg (95 % CI −0.9 to +1.6), respectively.
The proportion of women with weight loss ≥ 5 % was greater in the GSP group than in the P group (75 % vs. 45 % at
V1, and 60 % vs. 30 % at V6, p < 0.05 for both groups).
Conclusions: Greenselect Phytosome® devoid of caffeine may have a clinical potential for the maintenance of weight
after intentional weight loss.
Trial registration: Clinicaltrials.gov NCT02542449 (September 2015)
Keywords: Green tea, Weight maintenance, Obesity, Fat mass

* Correspondence: [email protected]
1
Department of Medical Sciences and Rehabilitation, IRCCS Istituto
Auxologico Italiano, Via Ariosto 13, 20145 Milan, Italy
Full list of author information is available at the end of the article

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Gilardini et al. BMC Complementary and Alternative Medicine (2016) 16:233 Page 2 of 7

Background women to maintain the weight loss obtained with a

Genetic, epidemiological, and physiological studies indi- 3-month lifestyle intervention.
cate that body weight is highly regulated, and the
increasing prevalence of obesity reflects the interactions
Methods
of genes favoring energy conservation and storage in an
Study participants
environment that enables access to food calories and a
The study sample consisted of 40 obese Caucasian
more sedentary lifestyle. Weight loss can be achieved by
women who were recruited from those patients referred
reducing energy intake and at the same time sustaining
to the IRCCS Istituto Auxologico Italiano for a weight-
energy expenditure. Although weight loss interventions
loss lifestyle intervention. Women with uncontrolled
usually lead to weight loss shortly after intervention,
hypertension and history of cardiovascular or cerebro-
majority of subjects once again regain weight after the
vascular events were excluded from the study. Sample
intervention due to compensatory adaptations finalized
size was calculated assuming a ≥5 % weight loss would
to maintain stable body energy stores. The physiological
be the outcome obtained with 3 months of lifestyle
adaptation to weight loss involves several biological
intervention. The effective size of the study group was
pathways mediating the utilization and storage of energy
calculated for a binomial test irrespective of weight
and the regulation of appetite [1]. In both, lean and
loss ≥5 %, looking for at least a difference of 25 % be-
obese individuals, maintenance of a 10 % or greater re-
tween the proportion of women reaching this goal in the
duction in body weight is associated with a decline in
placebo and treatment group. We designed our trial with
24-hour energy expenditure of approximately 20–25 %
an alpha error of 5 % and a power of 95 %. Calculation
[2]. The restraint of the decline in energy expenditure
was performed using G*Power 3.1, obtaining a sample size
while dieting along with GT preparations could be a use-
of 42 subjects, that was rounded to 20 women for
ful strategy to facilitate weight maintenance. GT contains
each group.
a complex mixture of polyphenolic compounds belong-
The Ethics Committee of the Istituto Auxologico
ing to the family of catechins, mainly epigallocatechin
Italiano approved the study, and all subjects gave their
gallate, which are responsible for most of the pharmaco-
informed consent after we provided a full explanation of
logical activity of GT. The principal mechanisms of GT
the study.
are stimulation of fat oxidation through up-regulation of
lipid-metabolizing enzymes and an increase in norepin-
ephrine levels and energy expenditure through inhibition Intervention
of catechol-O-methyltransferase [3]. All obese women completed a 3-month lifestyle interven-
The ability of GT preparations assisting weight loss tion. At the end of the intervention, women were randomly
was evaluated in a Cochrane Systematic Review that assigned to two groups for the weight-maintenance phase:
included 14 randomized controlled trials [4]. This review 20 of them were prescribed supplements twice a day for
concluded that the weight loss produced by GT prepara- 3 months and were named GSP group. This included
tions is unlikely to be clinically relevant since it was not Globes® (Pharmextracta, Pontenure, Piacenza, Italy), an
statistically significant in majority of the studies. How- enteric coated formulation containing 150 mg/dose of
ever, the usefulness of GT preparations in weight main- Greenselect Phytosome®. Greenselect Phytosome® is a
tenance has been poorly studied so far with conflicting highly standardized extract of Camellia sinensis, titrated
results [4]. as > 60 % polyphenols and > 40 % in epigallocatechin-O-
Despite the wide “nutraceutical” use of GT, pharmaco- gallate, complexed with soy distearoylphosphatidylcholine,
logical and clinical data show that these molecules are and pure piperine (15 mg/dose) from Piper nigrum L. The
poorly absorbed orally. Formulation with phospholipids remaining 20 were designated as the P group and received
(Phytosome strategy) however, has shown increased ab- placebo twice a day for 3 months, which was undistin-
sorption with some classes of natural products, includ- guishable from the active in terms of size, shape, taste,
ing polyphenolics. Thus, the absorption of Greenselect odor, primary and secondary packaging. Tested dietary
Phytosome® (GSP) is about 3-fold higher compared to supplements and placebo were both manufactured in
the unformulated extract [5], and GSP was also shown S.I.I.T. srl (Trezzano S/N, Milan, Italy). Randomization was
to reduce body weight in subjects with obesity and meta- done using the sealed envelope system and compliance
bolic syndrome [6, 7]. Currently, a new formulation of was checked by counting the left-over and returned cap-
GSP combined with piperine, a thermogenic agent, has sules. The whole trial was conducted in blind, including
been developed. This new formulation increases the the subjects and the dietician who collected anthropo-
absorption of various phenolics [8] and enhances the metric measures and assessed the adherence to diet during
pharmacodynamics of GSP. This study evaluated whether dietary supplements and follow-up visits. All women
dietary supplements of GSP and piperine help obese attended a monthly clinical visit while they were taking
Gilardini et al. BMC Complementary and Alternative Medicine (2016) 16:233 Page 3 of 7

dietary supplements and 3 months after the end of the sup- three months after their discontinuation in GSP and pla-
plement intake (Fig. 1). cebo group.
Lifestyle intervention consisted of weekly individual The secondary outcomes were the changes in weight
sessions for nutritional education, advice reinforcement and fat mass during the intake of dietary supplements
on exercise activity and peer group psychological and three months after their discontinuation in GSP and
support. A self-monitor diary, which included details of placebo group.
food consumption, daily physical activity and emotional Further outcomes were changes in blood pressure and
reactions, was used as a tool for education and rein- heart rate during the intake of dietary supplements and
forcement. Daily caloric requirement was calculated three months after their discontinuation in GSP and pla-
using the Harris-Benedict equation and an individual ac- cebo group.
tivity factor. A diet based on a 500-kcal/d deficit from
the individual estimated caloric requirement was pre- Measurements
scribed. The diet, which was high in vegetables, low in Anthropometric measures, body composition, blood
salt and simple sugars consisted of 25 % of total energy pressure (BP) and heart rate were measured at V-3, V0,
intake as protein, 20 % as fat and 55 % as carbohydrate. V1, V2, V3, and V6. Anthropometry was measured using
Fresh foods, at least three fish meals per week and a body composition analyzer, which measures weight,
avoiding alcohol, were recommended. The prescribed height and Body Mass Index (BMI) with joined function
physical activity program was 210 min per week consist- of body fat analysis (Biki 300, Jawon Medical, Korea).
ing of 70 % moderate-intensity aerobic physical activity Waist circumference was measured at the level of the
and 30 % muscle-strengthening activities. The patient’s umbilicus. At V0, V3 and V6, the women’s adherence to
dietary compliance and the average weekly level of phys- the diet was recorded by the dietician using a short
ical activity were recorded at each session. Diet history questionnaire (9 items) that provided a score ranging
and levels of physical activity were collected before and from 0 to 18, where lower values indicate better adher-
after the 3-month lifestyle intervention. Food energy and ence (Additional file 1). Three BP measurements sepa-
nutrient intake was calculated using a computerized rated by 5 min were obtained in sitting position at each
database and analysis program (Dietosystem version 3.0; visit and mean values were used for the analysis.
DS Medica S.r.l., Milan, Italy). Physical activity was
assessed using the short version of the International Statistical analysis
physical activity questionnaire (IPAQ) that computes the Analysis of variance was used to compare differences
Metabolic Equivalent (MET: time spent in physical activ- among groups. Frequencies were compared using a χ2 test.
ity, expressed in minutes per week) [9]. Paired t-test was used to compare a) differences between
At the end of the 3-month lifestyle intervention, variables at V0 vs. V-3 in each group (Table 1), b) differ-
women were encouraged to continue with the same diet ences between weight and fat mass at V0 vs. V-3, at V1 vs.
and physical activity program recommended during life- V0, at V2 vs. V1, at V3 vs. V2 and at V6 vs. V3 (Fig. 3).
style intervention. Logistic regression analysis was used to evaluate the prob-
ability to have a weight reduction ≥5 % with Globes® with
Outcome measures respect to placebo. A probability value < 0.05 was consid-
The primary outcome was the proportion of women ered significant. Data are given as the means ± SD. All
with ≥ 5 % weight loss during dietary supplements and analyses were performed using SPSS version 22.0 (SPSS,
Chicago, IL, US).

Results
The adherence to dietary supplements was complete in
both groups and all subjects completed the study. The
flow of patients in the study is shown in Fig. 2. Table 1
shows the characteristics of obese women belonging to
GSP and P groups before (V-3) and after the 3-month
lifestyle intervention (V0). No differences were observed
between the two groups at V-3 except for the energy
intake that was greater in the GSP group than in the
P group. At V0, the energy intake decreased and physical
activity increased in both groups (Additional file 2). The
intervention induced a significant weight reduction in
Fig. 1 Study design
both groups with similar weight changes (−6.2 ± 2.6 in
Gilardini et al. BMC Complementary and Alternative Medicine (2016) 16:233 Page 4 of 7

Table 1 Characteristics of obese women of GSP and P group before and after the 3-month lifestyle intervention
GSP group (n = 20) P group (n = 20)
V-3 V0 V-3 V0
Age, years 47.6 ± 10.3 - 52.6 ± 9.6 -
Hypertension, % 10 - 35 -
Diabetes, % 5 - 15 -
Weight, kg 94.3 ± 9.8 88.4 ± 9.1** 90.6 ± 6.6 86.3 ± 5.6**
Waist circumference, cm 112.5 ± 10.0 107.1 ± 10.1** 113.9 ± 5.4 110.3 ± 5.7**
Fat mass, kg 43.0 ± 5.8 40.9 ± 5.7** 41.9 ± 3.5 40.7 ± 3.5*
Fat mass/soft lean mass, ratio 0.98 ± 0.10 0.96 ± 0.11 1.0 ± 0.09 0.99 ± 0.08
Systolic BP, mmHg 126.0 ± 13.9 120.5 ± 10.7* 123.7 ± 10.9 119.2 ± 8.6
Diastolic BP, mmHg 79.0 ± 6.4 77.2 ± 4.7 79.5 ± 6.8 77.5 ± 5.3
Heart rate, beats/min 73.8 ± 8.6 73.1 ± 6.9 73.4 ± 9.1 70.7 ± 6.7*
V-3: before lifestyle intervention. V0: after the 3-month lifestyle intervention-start of dietary supplements. *p < 0.05, **p < 0.0001 compared to V-3. Comparisons
between GSP and P group were NS at –V3 and at V0

GSP group vs. −4.8 ± 3.1 % in P group, NS). At V0 dietary supplements (V1), the GSP group showed a fur-
anthropometric measures, BP and heart rate were similar ther reduction in weight and fat mass that remained stable
in both groups. at V2 and V3 and increased three months after discon-
Changes in weight and fat mass during the study tinuation of the supplements (V6). In the P group, weight
period are depicted in Fig. 3. At the first month of and fat mass started to increase at V2. Weight change

Fig. 2 Flow of patients in the study

Gilardini et al. BMC Complementary and Alternative Medicine (2016) 16:233 Page 5 of 7

Fig. 3 Weight (left panel) and fat mass (right panel) in GSP group (solid line) and P group (dashed line) at V-3, 0, 1, 2, 3 and 6; p values indicate
differences between values at a defined visit and the preceding visit within each group. If the difference is not significant, the p value is not indicated

from V0 toV3 was −1.0 kg (95 % CI −2.5 to +0.5) in the more likely to maintain the reduction in body weight
GSP group and + 0.3 kg (95 % CI −0.9 to +1.6) in the achieved with the diet than those receiving placebo. In-
P group. deed, we observed that weight and fat mass decreased
The adherence to the diet progressively decreased in during the first month of dietary supplements with GSP
both groups from V0 to V6. Scores in GSP group were and then remained stable during the period of supple-
5.4 ± 3.9 at V3, 2.2 ± 1.3 at V0 (p < 0.05 for V3 vs. V0), ment intake despite the decrease in the adherence to the
and 6.4 ± 4.9 at V6 (p = NS for V3 vs. V6). The scores in diet. Conversely, the weight and fat mass of women be-
P group were 5.2 ± 4.0 at V3, 2.8 ± 1.6 at V0 (p < 0.05 for longing to the P group started to rise one month after
V3 vs. V0), and 7.8 ± 3.3 at V6 (p < 0.05 for V3 vs. V6). the end of the lifestyle intervention. The trend to return
Advices on physical activity were apparently followed in to the pre-body fatness is an expected event after suc-
both groups because fat-free mass remained stable from cessful weight loss because of the occurrence of coordin-
V0 to V6: scores in GSP group were 54.1 ± 3.3 % at V3, ate actions of behavioral, metabolic, neuroendocrine,
53.8 ± 2.7 % at V0 (p = NS for V3 vs. V0), and 54.6 ± 3.8 % and autonomic responses that are designed to maintain
at V6 (p = NS for V0 and V3). In the P group, the scores body energy stores [2]. GT has been shown to stimulate
were 52.6 ± 2.9 at V3, 53.0 ± 2.1 at V0 (p < 0.05 for V3 daily energy expenditure by 4–4.8 % [10, 11], particularly
vs. V0) and 53.2 ± 5.1 at V6 (p < 0.05 when compared under conditions of elevated sympathetic tone [12] such
to V0 and V3). as obesity. GSP may be therefore more useful to offset
Blood pressure and heart rate remained stable from the reduction in energy expenditure caused by the adap-
V0 to V6 in both groups (data not shown). tive thermogenesis when given in association with a
The proportion of obese women who maintained a weight loss program. In fact, during a low calorie diet
weight loss ≥ 5 % was greater in the GSP than in the and adequate physical activity, the increase in the daily
P group (75 % vs. 45 % at V1 and 60 % vs. 30 % at energy expenditure induced by GSP might not be effect-
V6, p < 0.05 for both). The logistic regression analysis ive enough due to the overriding effects of the initial
demonstrated a significantly higher probability to main- changes in diet and physical activity. This finding is
tain a ≥5 % weight loss at V1 and V6 in the GSP group likely to explain the modest effects of GT on weight loss
than in the P group (Fig. 4). reported in the majority of randomized intervention
studies [4, 13].
Discussion Few studies reported the effects of GT extracts on
Results of this study indicate that after a weight loss weight maintenance after a period of weight loss in over-
intervention, obese women supplemented with GSP are weight and moderately obese subjects. In a study by
Kovasc et al., a 4-week weight loss period with a very
low caloric diet was followed by a 13-week weight main-
tenance period in which, the subjects consumed their
habitual diet and received GT-caffeine mixture or pla-
cebo. No significant differences in body weight regain
were observed between the GT and placebo group how-
ever, a higher weight regain was observed in high caf-
feine consumers [14]. In another study, the same group
Fig. 4 Effect of Greenselect Phytosome® compared to placebo on
confirmed that GT–caffeine mixtures may induce fur-
the probability to maintain a ≥5 % weight loss at V1, 2, 3 and 6
ther weight reductions during the weight maintenance
Gilardini et al. BMC Complementary and Alternative Medicine (2016) 16:233 Page 6 of 7

period only in low-level caffeine consumers [15]. These Authors’ contributions

studies are not comparable to our study that utilized a LG performed the statistical analysis, interpretation of data and drafted the
manuscript. CI participated in the design and coordination of the study and
GSP preparation devoid of caffeine, but with active poly- in the interpretation of data, and drafting the manuscript. LP recruited
phenols complexed with soy phospholipids and piperine participants and collected data. FDP conceived the study and helped in
to enhance bioavailability and stimulate thermogenesis. interpreting data and revising the manuscript. All authors read and approved
the final manuscript.
We observed that the effect of Globes® on body fatness
disappears after its discontinuation. This pattern does Authors’ information
not seem be due to a lower adherence to lifestyle recom- Not applicable.
mendations, because in GSP group the adherence to the
Competing interests
diet and fat-free mass (proxy of physical activity) were Francesco Di Pierro is the main formulator of Globes®. The other Authors do
similar between the end of the intake of dietary supple- not report any conflict of interest.
ments and follow-up. If we consider that the decline of
Consent for publication
energy expenditure occurring after weight loss persists Not applicable.
for at least one year [2], it can be assumed that GSP
preparations should be taken for several months after Ethic approval and consent to participate
The Ethics Committee of the Istituto Auxologico Italiano approved the study,
the intensive phase of a diet to favor weight mainten- and all subjects gave their informed consent after we provided a full
ance. This remains a hypothesis because energy expend- explanation of the study.
iture was not assessed in this study. Future research
Author details
having energy expenditure and respiratory quotient as 1
Department of Medical Sciences and Rehabilitation, IRCCS Istituto
primary endpoints would perhaps shed light on the Auxologico Italiano, Via Ariosto 13, 20145 Milan, Italy. 2Scientific Department,
mechanisms by which Globes® affect body fatness. Velleja Research, Milan, Italy. 3Department of Health Sciences (DISSAL),
University of Genoa, Genoa, Italy.
Finally, we emphasize that dietary supplements with
Globes® did not affect blood pressure and heart rate Received: 9 September 2015 Accepted: 14 July 2016
levels, suggesting that the increase in sympathetic
activity induced by GSP was not associated to significant
References
cardiovascular changes. 1. Sumithran P, Luke BS, Prendergast A, Delbridge E, Purcell K, Shulkes A, et al.
Long-Term Persistence of Hormonal Adaptations to Weight Loss. N Engl J
Med. 2011;365:1597–604.
Conclusion 2. Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. Int J Obes.
We believe that GSP extracts devoid of caffeine may 2010;34 Suppl 1:47–55.
3. Hursel R, Westerterp-Plantenga MS. Catechin- and caffeine-rich teas for control
have a clinical potential for the maintenance of weight of body weight in humans. Am J Clin Nutr. 2013;98 Suppl 6:1682–93.
after the intentional weight loss. More prolonged ran- 4. Jurgens TM, Whelan AM, Killian L, Doucette S, Kirk S, Foy E. Green tea for
domized studies are needed to confirm these effects and weight loss and weight maintenance in overweight or obese adults.
Cochrane Database Syst Rev. 2012;12:CD008650.
evaluate the dose of GSP required to achieve expected 5. Pietta P, Simonetti P, Gardana C, Brusamolino A, Morazzoni P, Bombardelli E.
results. Relationship between rate and extent of catechin absorption and plasma
antioxidant status. Biochem Mol Biol Int. 1998;46:895–903.
6. Di Pierro F, Menghi AB, Barreca A, Lucarelli M, Calandrelli A. Greenselect
Additional files Phytosome as an adjunct to a low-calorie diet for treatment of obesity: a
clinical trial. Altern Med Rev. 2009;14:154–60.
7. Belcaro G, Ledda A, Hu S, Cesarone MR, Feragalli B, Dugall M. Greenselect
Additional file 1: Questionnaire for the evaluation of adherence to the phytosome for borderline metabolic syndrome. Evid Based Complement
diet. (DOCX 16 kb) Alternat Med. 2013;2013:869061.
Additional file 2: Table S1. Dietary composition and physical activity 8. Lambert JD, Hong J, Kim DH, Mishin VM, Yang CS. Piperine enhances the
of obese women of GSP and P group before and after the 3-month bioavailability of the tea polyphenol (−)-epigallocatechin-3-gallate in mice.
lifestyle intervention. (DOCX 16 kb) J Nutr. 2004;134:1948–52.
9. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et
al. International physical activity questionnaire: 12-country reliability and
Abbreviations validity. Med Sci Sports Exerc. 2003;35:1381–95.
BP, blood pressure; GSP, greenselect phytosome®; GT, green tea; MET, metabolic 10. Dulloo AG, Duret C, Rohrer D, Girardier L, Mensi N, Fathi M, et al. Efficacy of
equivalent; P, placebo; V, visit a green tea extract rich in catechin polyphenols and caffeine in increasing
24-h energy expenditure and fat oxidation in humans. Am J Clin Nutr.
1999;70:1040–45.
Acknowledgements 11. Dulloo AG, Seydoux J, Girardier L, Chantre P, Vandermander J. Green tea
Not applicable. and thermogenesis: interactions between catechin-polyphenols, caffeine
and sympathetic activity. Int J Obes Relat Metab Disord. 2000;24:252–58.
Funding 12. Hursel R, Viechtbauer W, Dulloo AG, Tremblay A, Tappy L, Rumpler W, et al.
None. The effects of catechin rich teas and caffeine on energy expenditure and fat
oxidation: a meta-analysis. Obes Rev. 2011;12:e573–81.
13. Mielgo-Ayuso J, Barrenechea L, Alcorta P, Larrarte E, Margareto J, Labayen I.
Availability of supporting data Effects of dietary supplementation with epigallocatechin-3-gallate on
Reference: Dataset GSP trial in LabArchives. weight loss, energy homeostasis, cardiometabolic risk factors and liver
Gilardini et al. BMC Complementary and Alternative Medicine (2016) 16:233 Page 7 of 7

function in obese women: randomized, double-blind, placebo-controlled

trial. Br J Nutr. 2014;111:1263–71.
14. Kovacs EM, Lejeune MP, Nijs I, Westerterp-Plantenga MS. Effects of green tea
on weight maintenance after body-weight loss. Br J Nutr. 2004;91:431–37.
15. Westerterp-Plantenga MS, Lejeune MP, Kovacs EM. Body weight loss and
weight maintenance in relation to habitual caffeine intake and green tea
supplementation. Obes Res. 2005;13:1195–204.

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