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Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E, Ludwig DS. 9) kg, corresponding to 13. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Phenotypic and genetic variation in leptin as determinants of weight regain. Participants had to be 30 to 70 years of age and have a body-mass index (the weight in kilograms divided by the square of the height in meters) of 25 to 40. 1%-33. Many people can lose weight for a few months, but most have difficulty maintaining clinically significant weight loss over the long term. The crucial question is whether overweight people have a better response in the long term to diets that emphasize a specific macronutrient composition. Effect of a Stepped-Care Intervention Approach on Weight Loss in Adults. Thus, we recognized the need for a large trial that would be designed to overcome the limitations of previous trials and that would compare the effects of three principal dietary macronutrients. We enrolled 32 participants, including 17 men and 15 women. 1% (95% CI, 25. 0%-37. Regarding components of the metabolic syndrome, indexes of peripheral ( P. Methodological detail can be found in the eMethods. 5% decrease in body weight, and established energy requirements for stabilizing weight at the reduced level. Weight regain after a diet-induced loss is predicted by higher baseline leptin and lower ghrelin plasma levels. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. Of these, 11 participants did not complete the study ( Figure 2 ). A low-glycemic index diet and exercise intervention reduces TNF(alpha) in isolated mononuclear cells of older, obese adults. Dietary macronutrient content alters cortisol metabolism independently of body weight changes in obese men. Cortisol clearance and associations with insulin sensitivity, body fat and fatty liver in middle-aged men. 22 We used SAS version 9. (ClinicalTrials. In an accompanying 7263, Dr Bray discusses diet and exercise for weight loss. Dr Jakicic and coauthors compared a stepped-care weight loss intervention with a standard behavioral weight loss intervention to determine which one would result in greater weight loss and cost savings. Our goal was to design test diets that (1) would encompass a broad range of macronutrient composition and glycemic load, (2) have been commonly recommended for obesity treatment, and (3) could be physiologically sustainable for long periods. The participants were offered group and individual instructional sessions for 2 years. To avoid bias, we formulated menus with healthful components inherent to typical prescriptions for respective diets. To examine the effects of 3 diets differing widely in macronutrient composition and glycemic load on energy expenditure following weight loss. Media in This Article Poll Results Contributors Figure 1 Mean Change in Body Weight and Waist Circumference from Baseline to 2 Years According to Dietary Macronutrient Content. 2 (SAS Institute Inc) for all computations. The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective. Noncompleters did not differ from completers with respect to any of these characteristics. 5 -. Obesity treatment should emphasize behavioral methods to foster and maintain decreased energy intake. Participants Our goal was to recruit 800 overweight and obese subjects (400 at each site), of whom about 40% would be men. 2%) at baseline to 29. The very low-carbohydrate diet was modeled on the Atkins Diet and had a low glycemic load due to more severe restriction of carbohydrate. Long-term persistence of hormonal adaptations to weight loss. However, the effect of dietary composition on energy expenditure during weight-loss maintenance has not been studied. The project staff of the National Heart, Lung, and Blood Institute also participated in the development of the protocol, monitoring of progress, interpretation of results, and critical review of the manuscript. Percentage body fat by dual-energy x-ray absorptiometry decreased from a mean of 33. 20. Energy expenditure during weight-loss maintenance differed significantly among the 3 diets ( Table 3 and Figure 3 ). We assessed body composition by dual-energy x-ray absorptiometry before and after weight loss. Abstract Background The possible advantage for weight loss of a diet that emphasizes protein, fat, or carbohydrates has not been established, and there are few studies that extend beyond 1 year. We applied an outlier-deletion algorithm with optimal properties, equivalent to robust regression.
21 As missing values were uncommon (typically 1 per outcome), we did not perform any imputation, relying on the unbiasedness of mixed-effects regression when data are missing at random. Baseline characteristics for the 21 participants who completed the study are shown in Table 2. gov number, NCT00072995. 3 (0. Cortisol is negatively associated with insulin sensitivity in overweight Latino youth. Participants included men and women aged 18 to 40 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or higher. 1%) after weight loss. Data are shown as mean (95% CI) unless otherwise noted. Variables with skewed distribution were log-transformed for analysis. Table 1 shows the composition of the run-in and test diets. An alternative explanation is that weight loss elicits biological adaptations—specifically a decline in energy expenditure (adaptive thermogenesis) and an increase in hunger—that promote weight regain. Baseline Characteristics of the Study Participants a View Large Download Table 3. Several recent clinical trials indicate a direct relationship between dietary adherence and weight loss, regardless of dietary treatment group assignment. Effects of experimental weight perturbation on skeletal muscle work efficiency in human subjects. Long-term weight loss maintenance in the United States. Reduced energy expenditure following weight loss is thought to contribute to weight gain. 6% (95% CI, 30. Effects of experimental weight perturbation on skeletal muscle work efficiency, fuel utilization, and biochemistry in human subjects. Composition of the Run-in and Test Diets During Weight-Loss Maintenance (per 2000 kcal) View Large Download Table 2. Study Design of the Run-in and Test Phases View Large Download Body composition was assessed during the weight monitoring period of the run-in phase and following weight loss. We followed the intention-to-treat principle, ascribing the assigned diet to each measure regardless of adherence. Effect of a Stepped-Care Intervention Approach on Weight Loss in Adults. We measured study outcomes during an inpatient hospital admission and under free-living conditions at baseline and the end of each test diet period. Assessments during inpatient hospital admissions and under free-living conditions occurred during the weight monitoring period and at the end of each test diet period. ) Full Text of Discussion. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. Effects of weight loss and leptin on skeletal muscle in human subjects. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. The primary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content. Immediately before the 3-day inpatient hospital admission, the assessments under free-living conditions were conducted over 14 (total energy expenditure) or 7 (physical activity) days. Supplemental Content Ebbeling CB, Swain JF, Feldman HA, et al. The study comprised run-in and test phases ( Figure 1 ). Glycemic index of foods: a physiological basis for carbohydrate exchange. One variable with extreme skew (CRP) was rank transformed for analysis. In view of the mechanistic nature of this study, relying on a feeding protocol, we did not design the diets for long-term practicality. Low-dose leptin reverses skeletal muscle, autonomic, and neuroendocrine adaptations to maintenance of reduced weight. The diets improved lipid-related risk factors and fasting insulin levels. 3, 4. Figure 2 Mean Changes in Body Weight and Waist Circumference at Various Time Points. The diets consisted of similar foods and met guidelines for cardiovascular health. Connected lines indicate individual outcomes for each participant. 6% of baseline body weight. The institutional review boards at all participating institutions approved the study protocol, and participants provided written informed consent. Meal-induced thermogenesis and macronutrient oxidation in lean and obese women after consumption of carbohydrate-rich and fat-rich meals. Stable isotope analysis for assessing total energy expenditure (TEE) was conducted at Baylor College of Medicine, Houston, Texas. Conclusions Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize. During the run-in phase, we obtained baseline data for study outcomes, restricted energy intake of participants to achieve a 12. Primary outcome was resting energy expenditure (REE), with secondary outcomes of total energy expenditure (TEE), hormone levels, and metabolic syndrome components. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. During the run-in phase, participants lost a mean (SD) of 14.
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