Effects of Low-Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors during Weight Loss and Weight Maintenance in Obese Adults with Type 2 Diabetes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants, Randomization, and Study Design
2.2. Diet and Exercise Interventions
2.3. Statistical Analysis
3. Results
3.1. Participants
3.2. Dietary Analysis and Physical Activity Compliance
3.3. Body Weight
3.4. Glycaemic Control
3.5. Body Composition
3.6. Blood Pressure (BP), Insulin Resistance, and CRP
3.7. Blood Lipids
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
ADA | American Diabetes Association |
ARENA | Alliance for Research in Exercise, Nutrition and Activity |
BGL | blood glucose level |
BMI | body mass index |
BP | blood pressure |
CRP | C-reactive protein |
CSIRO | Commonwealth Scientific and Industrial Research Organization |
CVD | cardiovascular disease |
DBP | diastolic blood pressure |
DEXA | dual energy x-ray absorptiometry |
DPP-4 | Dipeptidyl Peptidase-4 |
GLP-1 | glucagon-like peptide 1 |
HbA1c | glycosylated haemoglobin |
HC | higher-carbohydrate, lower-protein |
HDL | high-density lipoproteins |
HOMA2-IR | homeostasis model of assessment index 2 of insulin resistance |
HP | higher-protein, lower-carbohydrate |
ITT | intention-to-treat |
kg | kilogram |
kJ | kilojoule |
LDL | low-density lipoprotein |
MES | medication effect score |
MUFA | monounsaturated fat |
PUFA | polyunsaturated fat |
RCT | randomised controlled trial |
RPE | rate of perceived exertion |
SBP | systolic blood pressure |
T2DM | type 2 diabetes mellitus |
% en | percent of energy |
% TF | percent of total fat |
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Higher-Protein Diet N = 32 | Higher-Carbohydrate Diet N = 29 | |
---|---|---|
Age (years) | 54 ± 8 | 55 ± 8 |
Sex—Male (%) | 17 (53) | 16 (55) |
Sex—Female (%) | 15 (47) | 13 (45) |
Years with T2DM | 7.9 ± 6.0 | 6.5 ± 4.2 |
Body Composition | ||
Body Weight (kg) | 97.3 ± 17.1 | 101.5 ± 16.6 |
BMI (kg/m2) | 34.3 ± 5.4 | 34.4 ± 4.7 |
Waist Circumference (cm) | 112.8 ± 12.6 | 112.5 ± 12.3 |
Total Fat Mass (kg) * | 38.5 ± 10.4 | 39.9 ± 11.0 |
Total Lean Mass (kg) * | 58.8 ± 12.4 | 60.2 ± 11.7 |
Glycaemic Control | ||
HbA1c (%) | 8.0 ± 1.3 | 8.1 ± 1.5 |
Fasting Glucose (mmol/L) | 9.1 ± 3.2 | 9.3 ± 3.5 |
Cardiometabolic Health Risk Factors | ||
Systolic Blood Pressure (mmHg) | 131.8 ± 13.2 | 135.1 ± 8.3 |
Diastolic Blood Pressure (mmHg) | 78.4 ± 8.2 | 79.0 ± 7.1 |
Fasting Insulin (mU/L) ^ | 21.7 ± 14.8 | 22.8 ± 12.6 |
HOMA2-IR § | 2.9 ± 1.6 | 2.8 ± 1.4 |
Total Cholesterol (mmol/L) | 4.7 ± 0.9 | 4.5 ± 0.8 |
LDL (mmol/L) ¥ | 2.7 ± 0.9 | 2.5 ± 0.6 |
HDL (mmol/L) | 1.2 ± 0.3 | 1.2 ± 0.3 |
Triglycerides (mmol/L) | 2.0 ± 1.2 | 2.0 ± 1.0 |
C-Reactive Protein (mg/L) † | 3.7 ± 3.9 | 4.6 ± 3.8 |
Medications | ||
Medication Effect Score | 1.11 ± 0.99 | 1.22 ± 0.99 |
Metformin n (%) | 18 (58) | 18 (64) |
Sulphonylureas n (%) | 5 (16) | 5 (18) |
GLP-1 Agonists n (%) | 2 (7) | 2 (7) |
DPP-4 Inhibitors n (%) | 2 (7) | 3 (11) |
Combination # n (%) | 3 (10) | 1 (4) |
Insulin n (%) | 6 (19) | 6 (21) |
Lipid Lowering Medication n (%) | 16 (52) | 18 (64) |
Antihypertensive Medication n (%) | 19 (61) | 12 (43) |
Physical Activity | ||
Treadmill Speed (km/h) | 4.6 ± 1.1 | 4.7 ± 0.7 |
Phase 1: Weight Loss | Phase 2: Weight Maintenance | |||||
---|---|---|---|---|---|---|
HP (n = 31) | HC (n = 28) | Diet * | HP (n = 23) | HC (n = 22) | Diet * | |
Energy (kJ) | 6236 ± 617 | 5945 ± 866 | 0.14 | 7267 ± 1022 | 6975 ± 1038 | 0.35 |
Carbohydrate (g) | 132.4 ± 18.6 | 179.6 ± 22.2 | <0.001 | 149.2 ± 18.8 | 199.3 ± 23.6 | <0.001 |
Carbohydrate (% en) | 34.5 ± 3.7 | 49.6 ± 3.9 | <0.001 | 33.6 ± 3.2 | 47.2 ± 4.5 | <0.001 |
Protein (g) | 107.1 ± 10.0 | 73.8 ± 10.0 | <0.001 | 121.3 ± 19.6 | 82.1 ± 12.5 | <0.001 |
Protein (% en) | 29.4 ± 2.3 | 21.3 ± 1.7 | <0.001 | 28.5 ± 2.8 | 20.1 ± 1.5 | <0.001 |
Total Fat (g) | 50.9 ± 6.9 | 36.1 ± 9.7 | <0.001 | 62.2 ± 10.4 | 47.8 ± 11.7 | <0.001 |
Total Fat (% en) | 30.1 ± 2.4 | 22.1 ± 3.8 | <0.001 | 31.6 ± 2.9 | 25.1 ± 3.6 | <0.001 |
Saturated Fat (% en) | 9.5 ± 1.1 | 6.4 ± 1.6 | <0.001 | 10.3 ± 1.3 | 7.5 ± 1.5 | <0.001 |
Saturated Fat (% TF) | 34.8 ± 3.4 | 32.7 ± 4.6 | 0.04 | 36.0 ± 4.4 | 33.3 ± 3.9 | 0.04 |
MUFA (% TF) | 46.7 ± 2.8 | 45.3 ± 4.3 | 0.14 | 46.3 ± 2.5 | 45.5 ± 3.8 | 0.37 |
PUFA (% TF) | 18.5 ± 2.0 | 22.0 ± 5.1 | 0.001 | 17.7 ± 3.1 | 21.2 ± 4.2 | 0.002 |
Dietary Fiber (g) | 25.1 ± 4.6 | 28.5 ± 4.3 | 0.005 | 25.7 ± 5.3 | 28.9 ± 5.0 | 0.04 |
Physical Activity | ||||||
Total Minutes/Week ^ | 211 ± 79 | 271 ± 133 | 0.08 | 194 ± 111 | 242 ± 158 | 0.24 |
p Value | ||||||||
---|---|---|---|---|---|---|---|---|
Week 12 | Change in Phase 1 * | Week 24 | Change in Phase 2 ^ | Overall Change § | Diet | Time | Group × Time | |
Weight (kg) | 0.20 | <0.001 | 0.47 | |||||
HP | 89.3 ± 2.7 | −8.0 ± 0.80 | 88.4 ± 2.8 | −1.0 ± 0.6 | −8.9 ± 1.3 | |||
HC | 94.0 ± 2.9 | −7.6 ± 0.8 | 93.8 ± 2.9 | −0.2 ± 0.6 | −7.7 ± 1.3 | |||
Body Mass Index (BMI, kg/m2) | 0.65 | <0.001 | 0.53 | |||||
HP | 31.5 ± 0.85 | −2.80 ± 0.25 | 31.2 ± 0.91 | −0.30 ± 0.19 | −3.10 ± 0.39 | |||
HC | 31.9 ± 0.89 | −2.56 ± 0.26 | 31.9 ± 0.99 | −0.01 ± 0.20 | −2.57 ± 0.40 | |||
HbA1c (%) | 0.78 | <0.001 | 0.19 | |||||
HP | 6.5 ± 0.2 | −1.53 ± 0.20 | 6.7 ± 0.2 | 0.19 ± 0.16 | −1.34 ± 0.21 | |||
HC | 6.8 ± 0.2 | −1.30 ± 0.20 | 6.6 ± 0.2 | −0.20 ± 0.16 | −1.50 ± 0.22 | |||
Fasting Glucose (mmol/L) | 0.66 | <0.001 | 0.74 | |||||
HP | 6.8 ± 0.3 | −2.3 ± 0.5 | 7.0 ± 0.4 | 0.24 ± 0.3 | −2.1 ± 0.6 | |||
HC | 6.5 ± 0.3 | −2.8 ± 0.6 | 6.8 ± 0.5 | 0.30 ± 0.3 | −2.5 ± 0.6 | |||
Fasting Insulin (mU/L) | 0.50 | <0.001 | 0.52 | |||||
HP | 13.5 ± 1.4 | −8.1 ± 1.8 | 12.1 ± 1.5 | −1.4 ± 1.2 | −9.6 ± 2.1 | |||
HC | 13.9 ± 1.4 | −8.9 ± 1.9 | 14.9 ± 1.6 | 0.9 ± 1.3 | −7.9 ± 2.2 | |||
Medication Effect Score | 0.43 | 0.02 | 0.08 | |||||
HP | 0.90 ± 0.16 | −0.21 ± 0.06 | 0.97 ± 0.15 | 0.07 ± 0.04 | −0.13 ± 0.06 | |||
HC | 1.18 ± 0.16 | −0.04 ± 0.06 | 1.13 ± 0.16 | −0.05 ± 0.04 | −0.09 ± 0.06 | |||
Waist circumference (cm) | 0.75 | <0.001 | 0.47 | |||||
HP | 104.2 ± 2.1 | −8.5 ± 0.9 | 103.2 ± 2.2 | −1.0 ± 0.6 | −9.6 ± 1.2 | |||
HC | 105.6 ± 2.2 | −7.0 ± 0.9 | 105.0 ± 2.3 | −0.6 ± 0.6 | −7.5 ± 1.2 | |||
Fat mass (kg) † | 0.25 | <0.001 | 0.44 | |||||
HP | 31.8 ± 1.9 | −6.7 ± 0.7 | 30.7 ± 2.0 | −1.1 ± 0.5 | −7.8 ± 1.0 | |||
HC | 35.1 ± 2.0 | −5.5 ± 0.7 | 34.7 ± 2.0 | −0.4 ± 0.5 | −5.9 ± 1.1 | |||
Fat-Free Mass (kg) † | 0.63 | <0.001 | 0.56 | |||||
HP | 57.6 ± 2.1 | −1.2 ± 0.4 | 57.8 ± 2.0 | 0.10 ± 0.3 | −1.1 ± 0.5 | |||
HC | 58.9 ± 2.2 | −1.8 ± 0.4 | 59.0 ± 2.1 | 0.13 ± 0.3 | −1.7 ± 0.5 | |||
SBP (mmHg) # | 0.25 | <0.001 | 0.07 | |||||
HP | 123.9 ± 2.4 | −7.9 ± 1.9 | 119.5 ± 2.3 | −4.4 ± 1.8 | −12.3 ± 1.8 | |||
HC | 123.8 ± 2.5 | −11.2 ± 2.0 | 125.2 ± 2.3 | 1.4 ± 1.8 | −9.8 ± 1.9 | |||
DBP (mmHg) # | 0.51 | <0.001 | 0.07 | |||||
HP | 72.3 ± 1.4 | −6.2 ± 1.2 | 70.7 ± 1.6 | −1.5 ± 1.1 | −7.7 ± 1.4 | |||
HC | 71.9 ± 1.4 | −7.2 ± 1.2 | 74.1 ± 1.6 | 2.3 ± 1.1 | −4.9 ± 1.4 | |||
HOMA2_IR ǂ | 0.94 | <0.001 | 0.45 | |||||
HP | 1.82 ± 0.20 | −1.21 ± 0.25 | 1.60 ± 0.21 | −0.22 ± 0.19 | −1.44 ± 0.32 | |||
HC | 1.64 ± 0.21 | −1.19 ± 0.25 | 1.79 ± 0.21 | 0.14 ± 0.19 | −1.04 ± 0.33 | |||
CRP (mg/L) ¥ | 0.28 | <0.001 | 0.99 | |||||
HP | 2.52 ± 0.60 | −1.19 ± 0.36 | 2.37 ± 0.53 | −0.15 ± 0.37 | −1.33 ± 0.37 | |||
HC | 3.63 ± 0.62 | −0.94 ± 0.34 | 2.85 ± 0.55 | −0.78 ± 0.37 | −1.72 ± 0.37 | |||
Treadmill Speed (km/h) | ||||||||
HP | 5.3 ± 0.2 | 0.67 ± 0.12 | 5.6 ± 0.2 | 0.35 ± 0.12 | 1.02 ± 0.18 | 0.99 | <0.001 | 0.70 |
HC | 5.6 ± 0.2 | 0.53 ± 0.13 | 5.5 ± 0.2 | 0.28 ± 0.13 | 0.8 ± 0.19 |
p Value | ||||||||
---|---|---|---|---|---|---|---|---|
Week 12 | Change * | Week 24 | Change ^ | Overall Change | Diet | Time | Group × Time | |
Total cholesterol (mmol/L) | 0.93 | <0.001 | 0.049 | |||||
HP | 4.1 ± 0.2 | −0.6 ± 0.1 | 4.3 ± 0.2 | 0.3 ± 0.1 | −0.4 ± 0.1 | |||
HC | 4.2 ± 0.2 | −0.2 ± 0.1 | 4.4 ± 0.2 | 0.2 ± 0.1 | −0.03 ± 0.1 | |||
LDL-C (mmol/L) § | 0.94 | 0.02 | 0.18 | |||||
HP | 2.3 ± 0.2 | −0.3 ± 0.1 | 2.4 ± 0.2 | 0.02 ± 0.1 | −0.3 ± 0.1 | |||
HC | 2.4 ± 0.2 | −0.1 ± 0.1 | 2.5 ± 0.2 | 0.1 ± 0.1 | −0.004 ± 0.1 | |||
HDL-C (mmol/L) | 0.87 | 0.004 | 0.14 | |||||
HP | 1.1 ± 0.05 | −0.05 ± 0.03 | 1.2 ± 0.05 | 0.1 ± 0.04 | 0.03 ± 0.03 | |||
HC | 1.2 ± 0.05 | 0.02 ± 0.03 | 1.3 ± 0.06 | 0.1 0.04 | 0.1 ± 0.03 | |||
Triglycerides (mmol/L) | 0.43 | <0.001 | 0.15 | |||||
HP | 1.3 ± 0.1 | −0.8 ± 0.2 | 1.6 ± 0.2 | 0.3 ± 0.2 | −0.4 ± 0.2 | |||
HC | 1.5 ± 0.1 | −0.5 ± 0.2 | 1.5 ± 0.2 | −0.03 ± 0.2 | −0.6 ± 0.2 |
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Watson, N.; Dyer, K.; Buckley, J.; Brinkworth, G.; Coates, A.; Parfitt, G.; Howe, P.; Noakes, M.; Murphy, K. Effects of Low-Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors during Weight Loss and Weight Maintenance in Obese Adults with Type 2 Diabetes. Nutrients 2016, 8, 289. https://doi.org/10.3390/nu8050289
Watson N, Dyer K, Buckley J, Brinkworth G, Coates A, Parfitt G, Howe P, Noakes M, Murphy K. Effects of Low-Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors during Weight Loss and Weight Maintenance in Obese Adults with Type 2 Diabetes. Nutrients. 2016; 8(5):289. https://doi.org/10.3390/nu8050289
Chicago/Turabian StyleWatson, Nerylee, Kathryn Dyer, Jonathan Buckley, Grant Brinkworth, Alison Coates, Gaynor Parfitt, Peter Howe, Manny Noakes, and Karen Murphy. 2016. "Effects of Low-Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors during Weight Loss and Weight Maintenance in Obese Adults with Type 2 Diabetes" Nutrients 8, no. 5: 289. https://doi.org/10.3390/nu8050289