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High-Protein, Low-Glycaemic Meal Replacement Decreases Fasting Insulin and Inflammation Markers-A 12-Month Subanalysis of the ACOORH Trial.
Kempf, K, Röhling, M, Banzer, W, Braumann, KM, Halle, M, McCarthy, D, Predel, HG, Schenkenberger, I, Tan, S, Toplak, H, et al
Nutrients. 2021;(5)
Abstract
Lifestyle interventions, including meal replacement, are effective in the prevention and treatment of type-2-diabetes and obesity. Since insulin is the key weight regulator, we hypothesised that the addition of meal replacement to a lifestyle intervention reduces insulin levels more effectively than lifestyle intervention alone. In the international multicentre randomised controlled ACOORH (Almased Concept against Overweight and Obesity and Related Health Risk) trial, overweight or obese persons who meet the criteria for metabolic syndrome (n = 463) were randomised into two groups. Both groups received nutritional advice focusing on carbohydrate restriction and the use of telemonitoring devices. The intervention group substituted all three main meals per day in week 1, two meals per day in weeks 2-4, and one meal per day in weeks 5-26 with a protein-rich, low-glycaemic meal replacement. Data were collected at baseline and after 1, 3, 6 and 12 months. All datasets providing insulin data (n = 446) were included in this predefined subanalysis. Significantly higher reductions in insulin (-3.3 ± 8.7 µU/mL vs. -1.6 ± 9.8 µU/mL), weight (-6.1 ± 5.2 kg vs. -3.2 ± 4.6 kg), and inflammation markers were observed in the intervention group. Insulin reduction correlated with weight reduction and the highest amount of weight loss (-7.6 ± 4.9 kg) was observed in those participants with an insulin decrease > 2 µU/mL. These results underline the potential for meal replacement-based lifestyle interventions in diabetes prevention, and measurement of insulin levels may serve as an indicator for adherence to carbohydrate restriction.
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A pilot randomised controlled trial of a periodised resistance training and protein supplementation intervention in prostate cancer survivors on androgen deprivation therapy.
Kiwata, JL, Dorff, TB, Todd Schroeder, E, Salem, GJ, Lane, CJ, Rice, JC, Gross, ME, Dieli-Conwright, CM
BMJ open. 2017;(7):e016910
Abstract
INTRODUCTION Prostate cancer survivors (PCS) receiving androgen deprivation therapy (ADT) experience deleterious side effects such as unfavourable changes in cardiometabolic factors that lead to sarcopenic obesity and metabolic syndrome (MetS). While loss of lean body mass (LBM) compromises muscular strength and quality of life, MetS increases the risk of cardiovascular disease and may influence cancer recurrence. Exercise can improve LBM and strength, and may serve as an alternative to the pharmacological management of MetS in PCS on ADT. Prior exercise interventions in PCS on ADT have been effective at enhancing strength, but only marginally effective at enhancing body composition and ameliorating cardiometabolic risk factors. This pilot trial aims to improve on existing interventions by employing periodised resistance training (RT) to counter sarcopenic obesity in PCS on ADT. Secondary aims compare intervention effects on cardiometabolic, physical function, quality of life and molecular skeletal muscle changes. An exploratory aim examines if protein supplementation (PS) in combination with RT elicits greater changes in these outcomes. METHODS AND ANALYSIS A 2×2 experimental design is used in 32 PCS on ADT across a 12-week intervention period. Participants are randomised to resistance training and protein supplementation (RTPS), RT, PS or control. RT and RTPS groups perform supervised RT three times per week for 12 weeks, while PS and RTPS groups receive 50 g whey protein per day. This pilot intervention applies a multilayered approach to ameliorate detrimental cardiometabolic effects of ADT while investigating molecular mechanisms underlying skeletal muscle changes in PCS. ETHICS AND DISSEMINATION This trial was approved by the University of Southern California Institutional Review Board (HS-13-00315). Results from this trial will be communicated in peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER NCT01909440; Pre-results.
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Effect of a High-Protein Energy-Restricted Diet Combined with Resistance Training on Metabolic Profile in Older Individuals with Metabolic Impairments.
Amamou, T, Normandin, E, Pouliot, J, Dionne, IJ, Brochu, M, Riesco, E
The journal of nutrition, health & aging. 2017;(1):67-74
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Adequate protein intake and resistance training are effective strategies to maintain muscle mass, but the effect of their combination on metabolic profile during weight loss remains to be determined in older adults. The main objective of this study was to determine the effect of a 16-week high-protein caloric restriction combined with resistance training on chronic disease risk factors in obese older individuals with metabolic impairments. A total of 26 overweight adults aged between 60 and 75 years (BMI 32.4 ± 3.9 kg/m2) with at least 2 factors of the metabolic syndrome participated in this study and were randomized into two groups: 1) high-protein caloric restriction (HP; n= 12) and 2) high-protein caloric restriction combined with dynamic-resistance training (HP+RT; n=14). Caloric intake was reduced by 500 kcal/d in all participants and protein intake equated 25-30% of total calories (~1.4 g/kg/d). Exercise training consisted of 3 session/week of resistance training on pulley machines. Outcome measures included total and trunk fat mass (FM), total and appendicular lean body mass (LBM), fasting glucose level, lipid profile and blood pressure. Our results showed that total and trunk FM (all p<0.0001) as well as fasting glucose (p<0.0001), triglycerides (p=0.002) and total cholesterol (p=0.03) levels decreased similarly in both groups. However, total (p=0.04) and appendicular (p=0.02) LBM decreased in the HP group only. Our data show that high-protein energy restriction improves health profile of obese elderly at high risk of chronic disease but needs to be combined with resistance training to maintain LBM.
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Effect of a High-Protein Diet versus Standard-Protein Diet on Weight Loss and Biomarkers of Metabolic Syndrome: A Randomized Clinical Trial.
Campos-Nonato, I, Hernandez, L, Barquera, S
Obesity facts. 2017;(3):238-251
Abstract
BACKGROUND Some studies have shown that protein-enriched diets can lead to greater weight loss and improvements in biomarkers of metabolic syndrome (MeS) than standard protein diets. Therefore, the aim of this study was to determine the effect of increased protein intake on weight loss in Mexican adults with MeS. METHODS Randomized controlled trial in 118 adults aged 47.4 ± 11.5 years and meeting the established criteria for MeS were randomized to prescribed hypocaloric diets (500 kcal less than resting metabolic rate) providing either 0.8 g/kg body weight (standard protein diet (SPD)) or 1.34 g/kg body weight (higher protein diet (HPD)) for 6 months. Body weight, waist circumference, percent body fat by bioimpedance analysis, fasting blood glucose, fasting insulin, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, triglycerides, C-reactive protein, creatinine, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase were measured at baseline, 3 months and at 6 months. RESULTS There were 105 subjects (51 for SPD and 54 for HPD) who completed the trial. Overall weight loss was 5.1 ± 3.6 kg in the SPD group compared to 7.0 ± 3.7 kg in the in HPD group. Both groups lost a significant percent of centimeters of waist circumference (SPD -6.5 ± 2.6 cm and HPD -8.8 ± 2.6 cm). There was no statistical difference Except for the varying weight losses the two groups did not show any further differences overall. However in the subgroup judged to be adherent more than 75% of the time with the prescribed diets, there was a significant difference in mean weight loss (SPD -5.8% vs. HPD -9.5%) after adjusting for baseline BMI. Both groups demonstrated significant decreases in waist circumference, glucose, insulin, triglycerides, and VLDL cholesterol, but there were no differences between the groups. There were no changes in blood tests for liver or renal function. CONCLUSIONS There were no significant differences in weight loss and biomarkers of MeS when the overall group was examined, but the participants with more adherence rate in the HPD group lost significantly more weight than adherent participants in the SPD group.
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Higher Total Protein Intake and Change in Total Protein Intake Affect Body Composition but Not Metabolic Syndrome Indexes in Middle-Aged Overweight and Obese Adults Who Perform Resistance and Aerobic Exercise for 36 Weeks.
Campbell, WW, Kim, JE, Amankwaah, AF, Gordon, SL, Weinheimer-Haus, EM
The Journal of nutrition. 2015;(9):2076-83
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Abstract
BACKGROUND Studies assessing the effects of protein supplementation on changes in body composition (BC) and health rarely consider the impact of total protein intake (TPro) or the change in TPro (CTPro) from participants' usual diets. OBJECTIVE This secondary data analysis assessed the impact of TPro and CTPro on changes in BC and metabolic syndrome (MetS) indexes in overweight and obese middle-aged adults who participated in an exercise training program. METHODS Men and women [n = 117; age: 50 ± 0.7 y, body mass index (BMI; in kg/m(2)): 30.1 ± 0.3; means ± SEs] performed resistance exercise 2 d/wk and aerobic exercise 1 d/wk and consumed an unrestricted diet along with 200-kcal supplements (0, 10, 20, or 30 g whey protein) twice daily for 36 wk. Protein intake was assessed via 4-d food records. Multiple linear regression model and stratified analysis were applied for data analyses. RESULTS Among all subjects, TPro and CTPro were inversely associated (P < 0.05) with changes in body mass, fat mass (FM), and BMI. Changes in BC were different (P < 0.05) among groups that consumed <1.0 (n = 43) vs. ≥1.0 to <1.2 (n = 29) vs. ≥1.2 g · kg(-1) · d(-1) (n = 45). The TPro group with ≥1.0 to <1.2 g ·: kg(-1) ·: d(-1) reduced FM and %FM and increased percentage of LM (%LM) compared with the lowest TPro group, whereas the TPro group with ≥1.2 g ·: kg(-1) ·: d(-1) presented intermediate responses on changes in FM, %FM, and %LM. The gain in LM was not different among groups. In addition, MetS indexes were not influenced by TPro and CTPro. CONCLUSIONS In conjunction with exercise training, higher TPro promoted positive changes in BC but not in MetS indexes in overweight and obese middle-aged adults. Changes in TPro from before to during the intervention also influenced BC responses and should be considered in future research when different TPro is achieved via diet or supplements. This trial was registered at clinicaltrials.gov as NCT00812409.
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Normal vs. high-protein weight loss diets in men: effects on body composition and indices of metabolic syndrome.
Tang, M, Armstrong, CL, Leidy, HJ, Campbell, WW
Obesity (Silver Spring, Md.). 2013;(3):E204-10
Abstract
OBJECTIVE This study assessed the effectiveness of a prescribed weight-loss diet with 0.8 versus 1.4 g protein·kg(-1) day(-1) on changes in weight, body composition, indices of metabolic syndrome, and resting energy expenditure (REE) in overweight and obese men. DESIGN AND METHODS Men were randomized to groups that consumed diets containing 750 kcal day(-1) less than daily energy needs for weight maintenance with either normal protein (NP, n = 21) or higher protein (HP, n = 22) content for 12 weeks. The macronutrient distributions of the NP and HP diets were 25:60:15, and 25:50:25 percent energy from fat, carbohydrate, and protein, respectively. Assessments were made pre and post intervention. The subjects were retrospectively subgrouped into overweight and obese groups. RESULTS AND CONCLUSION Both diet groups lost comparable body weight and fat. The HP group lost less lean body mass than the NP group (-1.9 ± 0.3 vs. -3.0 ± 0.4 kg). The effects of protein and BMI status on lean body mass loss were additive. The reductions in total cholesterol, HDL-C, triacylglycerol, glucose, and insulin, along with LDL-C, total cholesterol-to-HDL-C ratio, and HOMA-IR, were not statistically different between NP and HP. Likewise, macronutrient distributions of the diet did not affect the reductions in REE, and blood pressure. In conclusion, energy restriction effectively improves multiple clinical indicators of cardiovascular health and glucose control, and consumption of a higher-protein diet and accomplishing weight loss when overweight versus obese help men preserve lean body mass over a short period of time.
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Higher protein diets consumed ad libitum improve cardiovascular risk markers in children of overweight parents from eight European countries.
Damsgaard, CT, Papadaki, A, Jensen, SM, Ritz, C, Dalskov, SM, Hlavaty, P, Saris, WH, Martinez, JA, Handjieva-Darlenska, T, Andersen, MR, et al
The Journal of nutrition. 2013;(6):810-7
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Dietary strategies to improve early cardiovascular markers in overweight children are needed. We investigated the effect of dietary protein and glycemic index (GI) on cardiovascular markers and metabolic syndrome (MetS) scores in 5- to 18-y-old children of overweight/obese parents from 8 European centers. Families were randomized to 1 of 5 diets consumed ad libitum: high protein (HP) or low protein (LP) combined with high GI (HGI) or low GI (LGI), or a control diet. At 6 centers, families received dietary instruction (instruction centers); at 2 centers, free foods were also provided (supermarket centers). Diet, anthropometry, blood pressure, and serum cardiovascular markers (lipid profile, glucose regulation, and inflammation) were measured in 253 children at baseline, 1 mo, and/or 6 mo. Protein intake was higher in the HP groups (19.9 ± 1.3% energy) than in the LP groups at 6 mo (16.8 ± 1.2% energy) (P = 0.001). The GI was 4.0 points lower (95% CI: 2.1, 6.1) in the LGI compared with the HGI groups (P < 0.001). In the supermarket centers, the HP and LP groups differed more in protein intake than did the groups in the instruction centers (P = 0.009), indicating better compliance. The HP diets evoked a 2.7-cm (95% CI: 0.9, 5.1) smaller waist circumference and a 0.25-mmol/L (95% CI: 0.09, 0.41) lower serum LDL cholesterol compared with the LP diets at 6 mo (P < 0.007). In a separate supermarket center analysis, the HP compared with LP diets reduced waist circumference (P = 0.004), blood pressure (P < 0.01), serum insulin (P = 0.013), and homeostasis model of assessment-insulin resistance (P = 0.016). In the instruction centers, the HP compared with the LP diets reduced LDL cholesterol (P = 0.004). No consistent effect of GI was seen and the MetS scores were not affected. In conclusion, increased protein intake improved cardiovascular markers in high-risk children, particularly in those undergoing most intensive intervention.
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Effects of supplemented isoenergetic diets differing in cereal fiber and protein content on insulin sensitivity in overweight humans.
Weickert, MO, Roden, M, Isken, F, Hoffmann, D, Nowotny, P, Osterhoff, M, Blaut, M, Alpert, C, Gögebakan, O, Bumke-Vogt, C, et al
The American journal of clinical nutrition. 2011;(2):459-71
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BACKGROUND Despite their beneficial effects on weight loss and blood lipids, high-protein (HP) diets have been shown to increase insulin resistance and diabetes risk, whereas high-cereal-fiber (HCF) diets have shown the opposite effects on these outcomes. OBJECTIVE We compared the effects of isoenergetic HP and HCF diets and a diet with moderate increases in both cereal fibers and dietary protein (Mix diet) on insulin sensitivity, as measured by using euglycemic-hyperinsulinemic clamps with infusion of [6,6-(2)H(2)]glucose. DESIGN We randomly assigned 111 overweight adults with features of the metabolic syndrome to 1 of 4 two-phased, 18-wk isoenergetic diets by group-matching. Per 3-d food protocols, the percentages of energy derived from protein and carbohydrates and the intake of cereal fiber per day, respectively, were as follows-after 6 wk: 17%, 52%, and 14 g (control); 17%, 52%, and 43 g (HCF); 28%, 43%, and 13 g (HP); 23%, 44%, and 26 g (Mix); after 18 wk: 17%, 51%, and 15 g (control); 17%, 51%, and 41 g (HCF); 26%, 45%, and 14 g (HP); and 22%, 46%, and 26 g (Mix). Eighty-four participants completed the study successfully and were included in the final analyses. Adherence was supported by the provision of tailored dietary supplements twice daily in all groups. RESULTS Insulin sensitivity expressed as an M value was 25% higher after 6 wk of the HCF diet than after 6 wk of the HP diet (subgroup analysis: 4.61 ± 0.38 compared with 3.71 ± 0.36 mg · kg(-1) · min(-1), P = 0.008; treatment × time interaction: P = 0.005). Effects were attenuated after 18 wk (treatment × time interaction: P = 0.054), which was likely explained by lower adherence to the HP diet. HP intake was associated with a tendency to increased protein expression in adipose tissue of the translation initiation factor serine-kinase-6-1, which is known to mediate amino acid-induced insulin resistance. Biomarkers of protein intake indicated interference of cereal fibers with dietary protein absorption. CONCLUSION Greater changes in insulin sensitivity after intake of an isoenergetic HCF than after intake of an HP diet might help to explain the diverse effects of these diets on diabetes risk. This trial is registered at clinicaltrials.gov as NCT00579657.
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Comparison of high protein and high fiber weight-loss diets in women with risk factors for the metabolic syndrome: a randomized trial.
Te Morenga, LA, Levers, MT, Williams, SM, Brown, RC, Mann, J
Nutrition journal. 2011;:40
Abstract
BACKGROUND Studies have suggested that moderately high protein diets may be more appropriate than conventional low-fat high carbohydrate diets for individuals at risk of developing the metabolic syndrome and type 2 diabetes. However in most such studies sources of dietary carbohydrate may not have been appropriate and protein intakes may have been excessively high. Thus, in a proof-of-concept study we compared two relatively low-fat weight loss diets - one high in protein and the other high in fiber-rich, minimally processed cereals and legumes - to determine whether a relatively high protein diet has the potential to confer greater benefits. METHODS Eighty-three overweight or obese women, 18-65 years, were randomized to either a moderately high protein (30% protein, 40% carbohydrate) diet (HP) or to a high fiber, relatively high carbohydrate (50% carbohydrate, > 35 g total dietary fiber, 20% protein) diet (HFib) for 8 weeks. Energy intakes were reduced by 2000 - 4000 kJ per day in order to achieve weight loss of between 0.5 and 1 kg per week. RESULTS Participants on both diets lost weight (HP: -4.5 kg [95% confidence interval (CI):-3.7, -5.4 kg] and HFib: -3.3 kg [95% CI: -4.2, -2.4 kg]), and reduced total body fat (HP: -4.0 kg [5% CI:-4.6, -3.4 kg] and HFib: -2.5 kg [95% CI: -3.5, -1.6 kg]), and waist circumference (HP: -5.4 cm [95% CI: -6.3, -4.5 cm] and HFib: -4.7 cm [95% CI: -5.8, -3.6 cm]), as well as total and LDL cholesterol, triglycerides, fasting plasma glucose and blood pressure. However participants on HP lost more body weight (-1.3 kg [95% CI: -2.5, -0.1 kg; p = 0.039]) and total body fat (-1.3 kg [95% CI: -2.4, -0.1; p = 0.029]). Diastolic blood pressure decreased more on HP (-3.7 mm Hg [95% CI: -6.2, -1.1; p = 0.005]). CONCLUSIONS A realistic high protein weight-reducing diet was associated with greater fat loss and lower blood pressure when compared with a high carbohydrate, high fiber diet in high risk overweight and obese women.