Transcript High protein diet and weight loss

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High protein diet and weight loss
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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.
Side effect?
Effect?
Safety?
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Background
• A high-protein diet with resistance exercise training
improves weight loss
and 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 Resistance
Exercise Training Improves Weight Loss
and Body Composition in Overweight and
Obese 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)
randomized
CON diet
n=19
HP diet
n=21
CON diet +RT
n=22
HP diet +RT
n=20
16 weeks
CON diet
n=16
HP diet
n=12
CON diet +RT
n=17
HP diet +RT
n=14
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Research design and methods
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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Research design and methods
Diet intervention
Con diet
Exercise intervention
High protein diet
♀:~1428kcal/day
♂:~1666kcal/day
CHO:53%
Protein:19%
(~0.7 kg/day)
Fat:26%
CHO:43%
Protein:33%
(~1.2 kg/day)
Fat:22%
every 2 weeks consult qualified dietitian
7 consecutive days diet record
3 nonconsecutive days /week
8 separate exercise /day
2 sets /per exercise
8-12 repetitions /set
rest between two set:1-2min
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Research design and methods
Measure project
In week 0 /16
24hr urine
Exercise performance
Body weight
Body composition
Blood pressure
WC
Serum lipids
Serum insulin
Plasma glucose
C-reactive protein
Creatinine
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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 weightloss diet.
Clifton PM, Keogh JB, Noakes M.
Am J Clin Nutr. 2008 Jan;87:23-29.
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Research design and methods
Eligible for participation (n=133)
Randomization (n=119)
LP diet
n=58
HP diet
n=61
64 weeks
LP diet
n=38
HP diet
n=41
women
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Research design and methods
Diet intervention
Low protein diet
High protein diet
~1333 kcal/day
CHO:64%
Protein:17%
Fat:20%
CHO:46%
Protein:34%
Fat:20%
initial 12 week
=> every 4 weeks consult qualified 2 dietitian
52 week follow up => 3 monthly intervals consult dietitian
3 days diet record
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Research design and methods
Measure project
In week 0 / 64
24hr urine
Body weight
Body composition
Serum lipids
Serum insulin
Plasma glucose
C-reactive protein
Creatinine
Serum homocysteine
Iron
ferritin
folate
vitamin B-12
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Result
CON diet
n=38
HP diet
n=41
Participant with diet record (n=73)
RLP
n=46
RHP
n=27
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 methods
Eligible for participation (n=122)
Randomization (n=118)
Very-low-carbohydrate, high-fat diet
n=57
High-carbohydrate, low-fat diet
n=61
1 year
Very-low-carbohydrate, high-fat diet
n=33
High-carbohydrate, low-fat diet
n=35
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Research design and methods
Diet intervention
High-carbohydrate, low-fat diet
Very-low-carbohydrate, high-fat diet
1433~1672 kcal/day
CHO:46%
Protein:24%
Fat:30%
CHO:4%
Protein:35%
Fat:61%
initial 2 month
=> every 2 weeks consult qualified dietitian
follow up
=> monthly intervals consult dietitian
3 days diet record (2 weekday and 1 weekend day)
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Research design and methods
Measure project
In week 0 /52
Body weight
Body composition
24hr urine
Serum Creatinine
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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-lowcarbohydrate 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-lowcarbohydrate 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
Long-term effect of a
Renal function following longResistance
high-protein weight-loss term weight loss in individuals
Exercise Training Improves Weight diet.
with abdominal obesity on a
Loss
very low carbohydrate diet vs
and Body Composition in
high carbohydrate diet.
Overweight and
Obese Patients With Type 2
Diabetes.
研究目的 比較對於過重或肥胖的第 長期追蹤高蛋白減 長期追蹤低碳水化合物
二型糖尿病病患，以高、 重飲食的成效與影 飲食對於腎功能的影響
低蛋白質比例之低脂減重 響
飲食，搭配阻力運動對於
減重、身體組成的改變的
成效
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總結
A High-Protein Diet With
Long-term effect of a highResistance
protein weight-loss diet.
Exercise Training Improves Weight
Loss
and Body Composition in
Overweight and
Obese Patients With Type 2
Diabetes.
設計對象
Type 2 DM
Obese
(BMI:35.3±4.5 kg/m2)
實驗時間
16 week
飲食設計
高蛋白組
對照組
CHO
43%
53%
Protein
33%
19%
Fat
22%
26%
飲食追蹤方 每2個星期找營養師諮詢
式
飲食紀錄
Obese
(BMI:35.6±3.3)
Renal function following long-term
weight loss in individuals with
abdominal obesity on a very low
carbohydrate diet vs high
carbohydrate diet.
Obese
(BMI:33.5±4.4)
64 week
1 year
高蛋白組 對照組 高蛋白組 對照組
46%
64%
4%
46%
34%
17%
35%
24%
20%
20%
61%
30%
起初12星期每4星期 起初2個月每2星期找營養
找營養師諮詢，之後 師諮詢，之後每個月定期
每三個月定期回診 回診
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在回診期間取連續7天做 每次回診期間取3天 每次回診期間取3天做飲食
飲食紀錄
做飲食紀錄
紀錄(2天平日1天假日)
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總結
結果
A High-Protein Diet With
Resistance
Exercise Training Improves
Weight Loss
and Body Composition in
Overweight and
Obese Patients With Type 2
Diabetes.
Long-term effect of a Renal function following
high-protein weight- long-term weight loss in
loss diet.
individuals with abdominal
obesity on a very low
carbohydrate diet vs high
carbohydrate diet.
Body weight and composition
Peripheral fat
Cardiometabolic
outcome
Cardiometabolic outcome and
glycemic control
Creatinine clearance and urinary
alboumin
Serum creatinine
eGFR
Urea
Vit B12
Ferritin
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Thank you for attention