www.pronutritionist.net
Diets with High or Low Protein Content
and Glycemic Index for Weight-Loss
Maintenance
Larsen T et ...
Page 2
Pronutritionist’s background
• There is a constant dispute if macronutrient content of diet is
a major determinant ...
Methods (1/2)
• a randomized dietary-intervention study
• n = 773 (entered the weight-maintenance phase)
– BMI 27 – 47
• P...
Methods (2/2)
• Five maintenance diets were:
– a diet low in protein (13 E%) with a low glycemic index
– a diet low in pro...
Results (1/6)
• The mean initial weight loss with the low-calorie
diet was 11 kg
• Mean weight regain during the maintenan...
Results (2/6): changes in body weight
and waist circumference
www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363...
Results (3/6): drop-out rates at 26
weeks
www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 7
*)...
Results (4/6)
• Achieved difference in protein content was 5.4
percentage points between the high-protein and
the low-prot...
Results (5/6): Dietary intake at week 26
Low protein
Low GI
Low protein
High GI
High protein
Low GI
High protein
High GI
C...
Results (6/6): Changes in fat and fat
free mass from 0 to week 26
www.pronutritionist.netLarsen T et al. N Eng J Med 2010;...
Pronutritionist’s discussion 1/4
• In this trial, the achieved dietary changes were again far
from targeted
• In protein i...
Pronutritionist’s discussion 2/4
• Authors conclude “ … a diet that was moderately high in
protein content and slightly re...
Pronutritionist’s discussion 3/4
• Achieved results were reached by the exclusive
interplay of protein and carbohydrate ch...
Pronutritionist’s discussion 4/4
• There were no differences in body compositions
between the groups. Muscle mass seemed t...
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Protein and glycemic index in weight maintenance larsen 2010

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This large clinical trial showed that moderately high protein low GI diet may improve changes to keep weight off after initial weight loss.

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Protein and glycemic index in weight maintenance larsen 2010

  1. 1. www.pronutritionist.net Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance Larsen T et al. N Engl J Med 2010; 363: 2102-2113 Page 1 Larsen T et al. N Eng J Med 2010; 363: 2102-2113
  2. 2. Page 2 Pronutritionist’s background • There is a constant dispute if macronutrient content of diet is a major determinant of success in weight loss, or not • Diet low in carbohydrates and high in fat and protein have proved to be effective in weight loss. • It is speculated that protein rich diet enhances satiety and thermogenesis and may prevent wasting of muscles during weight loss (Halton & Hu 2004) • However, a long term trial could not confirm the assumed benefits of high protein diet in weight loss (Sacks et al 2009) • Low glycemic index diet may produce gastrointestinal anorectic hormones via receptors that bind short chain fatty acids, the end products of fermentable carbohydrates, and possibly improve satiety (Hord & Frost 2010) Larsen T et al. N Eng J Med 2010; 363: 2102-2113 www.pronutritionist.net
  3. 3. Methods (1/2) • a randomized dietary-intervention study • n = 773 (entered the weight-maintenance phase) – BMI 27 – 47 • Phase 1: 8-week low-calorie-diet period – 800 kcal per day (Modifast products) – 400 g vegetables/d was allowed – total energy intake with vegetables and Modifast 800-1000 kcal • Phase 2: weight-maintenance – randomization to one of five maintenance diets – duration 26 weeks Page 3 Larsen T et al. N Eng J Med 2010; 363: 2102-2113 www.pronutritionist.net
  4. 4. Methods (2/2) • Five maintenance diets were: – a diet low in protein (13 E%) with a low glycemic index – a diet low in protein (13 E%) with a high glycemic index – a diet high in protein (25 E%) with a low glycemic index – a diet high in protein (25 E%) with a high glycemic index – a control diet (followed dietary guidelines in each participating country) • All diets were designed to have a fat content of 25-30 E % • There was no restrictions on energy intake – in order to test the ability of the diets to regulate appetite and body weight • Dietary intake was followed by 3 day food diaries www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 4
  5. 5. Results (1/6) • The mean initial weight loss with the low-calorie diet was 11 kg • Mean weight regain during the maintenance period was 560 g. Only the participants assigned to the diet that was low in protein with a high glycemic index had significant weight regain (1.67 kg) • In high protein low GI diet participants lost -0,4 kg during the follow up • The weight increase during the maintenance period was – 930 g higher in the low-protein groups than in the high- protein groups (p = 0.003) – 950 g higher in the high-glycemic-index groups than in the low-glycemic-index groups (p = 0.003) • No differences in satiety were observed www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 5
  6. 6. Results (2/6): changes in body weight and waist circumference www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 6 Kg/ cm
  7. 7. Results (3/6): drop-out rates at 26 weeks www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 7 *) More drop outs in low protein high GI diet than in either all low GI or all high protein diets (P = 0.02 and P = 0.01)
  8. 8. Results (4/6) • Achieved difference in protein content was 5.4 percentage points between the high-protein and the low-protein groups – targeted difference was 12 E% (13 E% vs. 25 E%) • Achieved difference in glycemic index was 4.7 glycemic-index units between the low-glycemic- index and the high-glycemic-index groups – targeted difference was 15 glycemic-index units www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 8
  9. 9. Results (5/6): Dietary intake at week 26 Low protein Low GI Low protein High GI High protein Low GI High protein High GI Control diet Energy (kcal/d) 1673 1826 1753 1673 1716 Carbohydrates (E %) 50.8 50.9 44.6 44.7 46.4 Total fat (E%) 29.8 30.9 32 31.2 33.7 Protein (E%) 18.2 16.7 21.7 22.6 18.7 Fiber (g/d) 21 20.3 21.4 19 19.6 Glycemic index 56.2 61.6 56.5 61.4 59.4 Glycemic load (g/d) 121 137.9 108.9 113.1 117.6 www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 9 Low protein Low GI Low protein High GI High protein Low GI High protein High GI Control diet Protein (in grams) 76 76 95 95 80
  10. 10. Results (6/6): Changes in fat and fat free mass from 0 to week 26 www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 10 Low protein Low GI Low protein High GI High protein Low GI High protein High GI Control diet Protein (in grams) 76 76 95 95 80 Changes in body composition are not statistically significant kg
  11. 11. Pronutritionist’s discussion 1/4 • In this trial, the achieved dietary changes were again far from targeted • In protein intake, the targeted difference at 1800 kcal level was 54 grams but the achieved difference was circa 20 grams ( 76 vs. 95 grams) • However, the achieved level of protein intake may be more feasible in real life and therefore the results may have clinical high relevance • Protein-low GI diet did not improve self-reported satiety which is a bit against expectations. This may be a function of less than expected differences in diets • High protein diet in the trial contained same amount of protein as typical Western diet at level of circa 2 200 kcal/day www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 11
  12. 12. Pronutritionist’s discussion 2/4 • Authors conclude “ … a diet that was moderately high in protein content and slightly reduced in glycemic index… appears to be ideal for preventing weight gain” . Why do the authors not refer to a longer term trial which did not show significantly improved weight loss results on a diet rich protein (Sacks et al 2009) ? • As a diet for weight maintenance is expected to be life long, the effects of high protein diet on vascular health require attention. Interestingly, the authors do not point out this either. This argument has been one key argument against low carbohydrate diets • Given the above, the effects of protein rich diet need to confirmed in long term trials (several years) to clarify the effects of high (animal) protein intake on vascular health www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 12
  13. 13. Pronutritionist’s discussion 3/4 • Achieved results were reached by the exclusive interplay of protein and carbohydrate changes while fat intake was kept constant. According to the authors, this further underlines the importance of lowering glycemic load • Authors do not ponder the mechanisms how low-GI- diets may induce weigh loss or maintenance. Hord & Frost 2010 have suggested that indigestible carbohydrates may trigger release of anorectic gastrointestinal compounds via specific short chain fatty acid receptors • In a sub study of shop centers (Danish and Dutch centers) where foods were provided for free, high protein diet resulted in 3,7 kg greater weight loss compared to low protein diet. This further strengthens the observed effects www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 13
  14. 14. Pronutritionist’s discussion 4/4 • There were no differences in body compositions between the groups. Muscle mass seemed to be preserved similarly. This is a bit contrary to what is commonly believed. In the initial weight loss period, all groups lost comparable shares of fat and fat free mass • In this rather short term trial (26 weeks), moderately high protein and low GI diet improved maintenance of the diet. High protein diets (both of them) resulted in 1 kilo smaller weight gain, and so did both low GI diets. Low protein high GI diet was the only diet that induced significant weight gain (1,7 kg) • This study further underlines the importance of protein in maintaining healthy weight but leaves many questions open www.pronutritionist.netLarsen T et al. N Eng J Med 2010; 363: 2102-2113Page 14
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