High protein diet and weight loss

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High protein diet and weight loss

12/21實習學生：周少鼎指導老師：彭惠鈺

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Background

• In response to the obesity epidemic, there has been increased public interest and use of alternative weight-loss diet that contravene conventional dietary guidelines. (ex: atkines diet, zone diet ..etc)

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Background

• Popular alternatives include high-protein diets, which have a common theme of restricting carbohydrate intake while increasing protein.

Effect?

Safety?

Side effect?

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Background

• A high-protein diet with resistance exercise training improves weight lossand body composition in overweight and obese patients with type 2 diabetes.

• Long-term effect of a high-protein weight-loss diet.

• Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.

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A High-Protein Diet With ResistanceExercise Training Improves Weight Loss

and Body Composition in Overweight andObese Patients With Type 2 Diabetes.

Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD.

Diabetes Care 33:969-976, 2010

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Research design and methods

Questionnaires received (n=126)

Eligible for participation (n=82)

CON diet n=19

HP diet n=21

CON diet +RT n=22

HP diet +RT n=20

randomized

16 weeks

CON diet n=16

HP diet n=12

CON diet +RT n=17

HP diet +RT n=14

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Participants information

• BMI:35.3±4.5 kg/m2

• Age:55.0±8.4

• Type 2 DM (without using insulin)

• No specific diseases

• Lack of regular exercise habit

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CHO:53%Protein:19%(~0.7 kg/day)Fat:26%

Diet intervention

CHO:43%Protein:33%(~1.2 kg/day)Fat:22%

Con diet High protein diet

♀:~1428kcal/day♂:~1666kcal/day

Exercise intervention

3 nonconsecutive days /week8 separate exercise /day2 sets /per exercise8-12 repetitions /setrest between two set:1-2minevery 2 weeks consult qualified dietitian

7 consecutive days diet record

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Body weightBody compositionBlood pressureWC

Serum lipidsSerum insulin Plasma glucoseC-reactive proteinCreatinine

24hr urineMeasure projectIn week 0 /16

Exercise performance

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Result

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Result

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Result

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Result

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Result

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Discussion

• Although previous studies have observed protective effects of RT and HP diets on FFM during caloric restriction, these effects have not been consistently shown.

(protein 1.12g kg/day)

Diabetes care 2002;25:431-438, 2002;25:425-430

Metabolism 1994;43:1481-1487

• The previous studies showed that the degree of FFM retention during weight loss increases with increasing quartiles of protein intake. (protein ≥ 1.4g kg/day)

Am J Clin Nutr 2006;83:260-274

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Conclusion

• the Participants in RT produced greater weight and fat loss and increase in muscular strength compared with energy restriction alone.

• Additionally, replacement of some carbohydrate for protein further magnified these effects, resulting in greatest reductions in weight, fat mass, WC, and insulin.

• All treatment had similar improvements in glycemic control and CVD risk.

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Long-term effect of a high-protein weight-loss diet.

Clifton PM, Keogh JB, Noakes M.

Am J Clin Nutr. 2008 Jan;87:23-29.

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Research design and methodsEligible for participation (n=133)

LP diet n=58

HP diet n=61

64 weeks

LP diet n=38

HP diet n=41

Randomization (n=119)

women

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CHO:64%Protein:17%Fat:20%

Diet intervention


Low protein diet High protein diet

~1333 kcal/day

initial 12 week => every 4 weeks consult qualified 2 dietitian52 week follow up => 3 monthly intervals consult dietitian 3 days diet record

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Body weightBody composition

Serum lipidsSerum insulin Plasma glucoseC-reactive proteinCreatinine

24hr urineMeasure projectIn week 0 / 64

Serum homocysteineIronferritinfolatevitamin B-12

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Result

CON diet n=38

HP diet n=41

Participant with diet record (n=73)

RHP n=27

RLP n=46

The prescription for protein in the original study was 110 g/d. We defined compliance at 80% of this original prescription and found that this was the top tertile of reported protein intake

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Result

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Result

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Result

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Result

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Result

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Conclusion

• A higher protein intake appears to confer some weight-loss benefit after 64 week.

• Overall, cardiovascular disease risk markers improved, but protein intake per se did not appear to confer any extra benefit.

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Renal function following long-term weight loss in individuals with abdominal obesity on a very low

carbohydrate diet vs high carbohydrate diet.

Brinkworth GD, Buckley JD, Noakes M, Clifton PM.

Journal of the American Dietetic Association

Volume 110, Issue 4, April 2010, Pages 633–638

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Research design and methodsEligible for participation (n=122)

Very-low-carbohydrate, high-fat diet n=57

High-carbohydrate, low-fat diet n=61

1 year

Randomization (n=118)

Very-low-carbohydrate, high-fat diet n=33

High-carbohydrate, low-fat diet n=35

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Diet intervention


High-carbohydrate, low-fat diet Very-low-carbohydrate, high-fat diet

1433~1672 kcal/day

initial 2 month => every 2 weeks consult qualified dietitianfollow up => monthly intervals consult dietitian3 days diet record (2 weekday and 1 weekend day)

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Body weightBody composition

Serum Creatinine

24hr urineMeasure projectIn week 0 /52

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Result

MDRD equation ：(eGFR) (mL/min/1.73 m2)=186.3(serum creatinine [mg/dL])1.154*(age)0.203 *0.742 (if female).Salazar and Corcoran equation :For men: eGFR(mL/min)=(137-age)*[(0.285*weight)+(12.1*height2)]/(51*creatinine concentration) for women: eGFR (mL/min)(146-age)*[(0.287*weight)+(9.74*height2)]/(60*creatinine concentration)

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Discussion

• Chronic consumption of a very-low-carbohydrate diet (high protein) may affect kidney function by increasing glomerular pressure and hyperfiltration that may lead to progressive loss of renal function

Nutr Rev. 2002;60:189-200.

Obes Rev. 2005;6:235-245.

• In this study, the original hypothesis that a very-low-carbohydrate diet would adversely affect renal function was not supported.

obesity time

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Conclusion

• In people with abdominal obesity and normal renal function, consumption of a very-low-carbohydrate high-fat weight loss diet for 52 week does not adversely affect renal function compared with a conventional high carbohydrate, low-fat diet.

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總結

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總結• 綜觀短期與長期的影響，對於肥胖與腎功能正常

的病人來說，高蛋白飲食相較於一般飲食減重可以減少肌肉的流失與增加體脂肪的消耗。

• 根據研究指出，在 64 個星期內，高蛋白飲食(35% protein) 不會增加腎的負擔。

• 高蛋白飲食搭配阻力訓練可以達到更顯著的減重效果。

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總結 A High-Protein Diet With

ResistanceExercise Training Improves Weight Lossand Body Composition in Overweight andObese Patients With Type 2 Diabetes.


Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.

研究目的比較對於過重或肥胖的第二型糖尿病病患，以高、低蛋白質比例之低脂減重飲食，搭配阻力運動對於減重、身體組成的改變的成效

長期追蹤高蛋白減重飲食的成效與影響

長期追蹤低碳水化合物飲食對於腎功能的影響

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總結 A High-Protein Diet With

ResistanceExercise Training Improves Weight Lossand Body Composition in Overweight andObese Patients With Type 2 Diabetes.



設計對象 Type 2 DMObese (BMI:35.3±4.5 kg/m2)

Obese(BMI:35.6±3.3)

Obese(BMI:33.5±4.4)

實驗時間 16 week 64 week 1 year飲食設計CHO Protein Fat

高蛋白組43%33%22%

對照組53% 19% 26%

高蛋白組 46%34%20%

對照組64% 17%20%

高蛋白組4% 35% 61%

對照組46%24%30%

飲食追蹤方式

每 2 個星期找營養師諮詢起初 12 星期每 4 星期找營養師諮詢，之後每三個月定期回診

起初 2 個月每 2 星期找營養師諮詢，之後每個月定期回診

飲食紀錄在回診期間取連續 7 天做飲食紀錄

每次回診期間取 3 天做飲食紀錄

每次回診期間取 3 天做飲食紀錄 (2 天平日 1 天假日 )

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總結

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A High-Protein Diet With ResistanceExercise Training Improves Weight Lossand Body Composition in Overweight andObese Patients With Type 2 Diabetes.



結果 Body weight and composition

Cardiometabolic outcome and glycemic control

Creatinine clearance and urinary alboumin

Peripheral fatCardiometabolic outcome

UreaVit B12Ferritin

Serum creatinine

eGFR

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Thank you for attention

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High protein diet and weight loss