Chronologically scheduled snacking with high-protein products within the habitual diet in type-2 diabetes patients leads to a fat mass loss: a longitudinal study

Santiago Navas-Carretero, Itziar Abete, M Angeles Zulet, J Alfredo Martínez, Santiago Navas-Carretero, Itziar Abete, M Angeles Zulet, J Alfredo Martínez

Abstract

Background: Obesity is the most relevant overnutrition disease worldwide and is associated to different metabolic disorders such as insulin resistance and type-2 diabetes. Low glycemic load foods and diets and moderately high protein intake have been shown to reduce body weight and fat mass, exerting also beneficial effects on LDL-cholesterol, triglyceride concentrations, postprandial glucose curve and HDL-cholesterol levels. The present study aimed at studying the potential functionality of a series of low glycemic index products with moderately high protein content, as possible coadjuvants in the control of type-2 diabetes and weight management following a chronologically planned snacking offer (morning and afternoon).

Methods: The current trial followed a single group, sequential, longitudinal design, with two consecutive periods of 4 weeks each. A total of 17 volunteers participated in the study. The first period was a free living period, with volunteers' habitual ad libitum dietary pattern, while the second period was a free-living period with structured meal replacements at breakfast, morning snack and afternoon snack, which were exchanged by specific products with moderately high protein content and controlled low glycemic index, following a scheduled temporal consumption. Blood extractions were performed at the beginning and at the end of each period (free-living and intervention). Parameters analysed were: fasting glucose, insulin, glycosylated hemoglobin, total-, HDL- and LDL-cholesterol, triglyceride, C - reactive protein and Homocysteine concentrations. Postprandial glucose and insulin were also measured. Anthropometrical parameters were monitored each 2 weeks during the whole study.

Results: A modest but significant (p = 0.002) reduction on body weight (1 kg) was observed during the intervention period, mainly due to the fat mass loss (0.8 kg, p = 0.02). This weight reduction was observed without apparently associated changes in total energy intake. None of the biochemical biomarkers measured was altered throughout the whole study.

Conclusions: Small changes in the habitual dietary recommendations in type-2 diabetes patients by the inclusion of specific low-glycemic, moderately high-protein products in breakfast, morning and afternoon snacks may promote body weight and fat-mass loss, without apparently altering biochemical parameters and cardiovascular risk-related factors.

Trial registration: Trial registered at clinicaltrials.gov NCT01264523.

Figures

Figure 1
Figure 1
Anthropometrical changes during the study. The free living period corresponds to week 0 - week 4, while the nutritional intervention with 40-30-30 products corresponds to weeks 4-8. 1a: Body weight evolution. 1b: Fat mass Vs Fat-free mass.
Figure 2
Figure 2
VAS postprandial questionnaire results. 2(a). Hunger score; 2(b). Satiety score; 2(c). Satisfaction score; 2(d) Intake score.
Figure 3
Figure 3
Postprandial glucose and insulin curves either with the habitual breakfast and the 40-30-30 snacks, which were not significantly different. 3a: Postprandial glucose curve. 3b: Postprandial insulin curve.

References

    1. Cugnet-Anceau C, Bauduceau B. Glycaemic control and cardiovascular morbi-mortality: The contribution of the 2008 studies. Ann Endocrinol (Paris) 2009;70:48–54.
    1. World Health Organisation, "Obesity Fact Sheets". Accessed April, 2011.
    1. Abete I, Astrup A, Martinez JA, Thorsdottir I, Zulet MA. Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. Nutr Rev. 2010;68:214–231. doi: 10.1111/j.1753-4887.2010.00280.x.
    1. Astrup A, Grunwald GK, Melanson EL, Saris WH, Hill JO. The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int J Obes Relat Metab Disord. 2000;24:1545–1552. doi: 10.1038/sj.ijo.0801453.
    1. Due A, Larsen TM, Hermansen K, Stender S, Holst JJ, Toubro S, Martinussen T, Astrup A. Comparison of the effects on insulin resistance and glucose tolerance of 6-mo high-monounsaturated-fat, low-fat, and control diets. Am J Clin Nutr. 2008;87:855–862.
    1. Brand-Miller JC, Holt SH, Pawlak DB, McMillan J. Glycemic index and obesity. Am J Clin Nutr. 2002;76:281S–285S.
    1. Abete I, Parra MD, Martinez de Morentin B, Martinez JA. Effects of two energy-restricted diets differing in the carbohydrate/protein ratio on weight loss and oxidative changes of obese men. Int J Food Sci Nutr. 2008;25:1–13.
    1. Abete I, Parra MD, Zulet MA, Martínez JA. Different dietary strategies for weight loss in obesity: Role of energy and macronutrient content. Nutr Res Rev. 2006;19:5–17. doi: 10.1079/NRR2006112.
    1. Liu S, Manson JE, Stampfer MJ, Holmes MD, Hu FB, Hankinson SE, Willet WC. Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. Am J Clin Nutr. 2001;73:560–566.
    1. Jarvi AE, Karlstrom BE, Granfeldt YE, Bjorck IE, Asp NG, Vessby BO. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients. Diabetes Care. 1999;22:10–18. doi: 10.2337/diacare.22.1.10.
    1. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AFH, Martinez JA, Handjieva-Darlenska T, Kunešová M, Pihlsgård M, Stender S, Holst C, Saris WHM, Astrup A. for the Diet and Genes (Diogenes) Project. Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance. N Engl J Med. 2010;363:2102–2113. doi: 10.1056/NEJMoa1007137.
    1. Pal S, Lim S, Eger G. The effect of a low glycemic index breakfast on blood glucose, insulin, lipid profiles, blood pressure, body weight, body composition and satiety in obese and overweight individuals: A pilot study. J Am Coll Nutr. 2008;3:387–393.
    1. Buyken AE, Toeller M, Heitkamp G, Karamanos B, Rottiers R, Muggeo M, Fuller JH. EURODIAB IDDM. Complications Study group: Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids. Am J Clin Nutr. 2001;73:574–581.
    1. Luscombe ND, Noakes M, Clifton PM. Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM. Eur J Clin Nutr. 1999;53:473–478. doi: 10.1038/sj.ejcn.1600779.
    1. Anderson GH, Woodend D. Effect of glycemic carbohydrates on short-term satiety and food intake. Nutr Rev. 2003;61:S17–S26. doi: 10.1301/nr.2003.may.S17-S26.
    1. Shai I, Schwarfuchs D, Henkin Y, Shahar DR, WItkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, BlÚher M, Stumvoll M, Stampfer MJ. Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New Engl J Med. 2008;359:229–41. doi: 10.1056/NEJMoa0708681.
    1. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranio N, Leboff MS, Rood JC, de Jongue L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein and carbohydrates. New Engl J Med. 2009;360:859–873. doi: 10.1056/NEJMoa0804748.
    1. Hamdy O, Carver C. The Why WAIT program: improving clinical outcomes through weight management in type 2 diabetes. Curr Diab Rep. 2008;8:413–20. doi: 10.1007/s11892-008-0071-5.
    1. Kabir M, Oppert JM, Vidal H, Bruzzo F, Fiquet C, Wursch P, Slama G, Rizkalla SW. Four-week low-glycemic index breakfast with a modest amount of soluble fibers in type 2 diabetes. Metabolism. 2002;51:819–26. doi: 10.1053/meta.2002.33345.
    1. Gannon MC, Nuttal FQI, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003;78:734–41.
    1. Schulz KF, Altman DG, Moher D. for the CONSORT group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. British Med J. 2010;340:698–702.
    1. Hernández Ruiz de Eguilaz M, Martínez de Morentin BE, Pérez-Diez S, Navas-Carretero S, Martinez JA. Comparative study of body composition measures by dual X-ray absorptiometry, bioimpedance and skinfolds in women. An R Acad Nac Farm. 2010;76:209–222.
    1. Kumar PR, Bhansali A, Ravikiran M, Bhansali S, Dutta P, Thakur JS, Sachdeva N, Bhadada SK, Walia R. Utility of glycated hemoglobin in diagnosing type 2 diabetes mellitus: a community-based study. J Clin Endocrinol Metab. 2010;95:2832–5. doi: 10.1210/jc.2009-2433.
    1. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. doi: 10.1007/BF00280883.
    1. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.
    1. Navas-Carretero S, Cuervo M, Abete I, Zulet MA, Martínez JA. Frequent Consumption of Selenium-Enriched Chicken Meat by Adults Causes Weight Loss and Maintains Their Antioxidant Status. Biol Trace Elem Res. in press .
    1. Flint A, Raben A, Blundell JE, Astrup A. Reproducibility, power and validity of visual analogue scales in assessment of appetite sensations in single test meal studies. Int J Obes. 2000;24:38–48. doi: 10.1038/sj.ijo.0801083.
    1. Kushner RF, Doerfler B. Low-carbohydrate, high-protein diets revisited. Curr Opin Gastroenterol. 2008;24:198–203. doi: 10.1097/MOG.0b013e3282f43a87.
    1. Larsen TM, Dalskov S, van Baak M, Jebb S, Kafatos A, Pfeiffer A, Martinez JA, Handjieva-Darlenska T, Kunesová M, Holst C, Saris WH, Astrup A. The Diet, Obesity and Genes (Diogenes) Dietary Study in eight European countries - a comprehensive design for long-term intervention. Obes Rev. 2010;11:76–91. doi: 10.1111/j.1467-789X.2009.00603.x.
    1. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082–2090. doi: 10.1056/NEJMoa022207.
    1. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778–785.
    1. Thorsdottir I, Tomasson H, Gunnarsdottir I, Gisladottir E, Kiely M, Parra MD, Bandarra NM, Schaafsma G, Martinéz JA. Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content. Int J Obes (Lond) 2007;31:1560–6. doi: 10.1038/sj.ijo.0803643.
    1. Handjieva-Darlenska T, Handjiev S, Larsen TM, van Baak MA, Jebb S, Papadaki A, Pfeiffer AF, Martinez JA, Kunesova M, Holst C, Saris WH, Astrup A. Initial weight loss on an 800-kcal diet as a predictor of weight loss success after 8 weeks: the Diogenes study. Eur J Clin Nutr. 2010;64:994–9. doi: 10.1038/ejcn.2010.110.
    1. Gatenby SJ. Eating frequency: methodological and dietary aspects. Br J Nutr. 1997;77(Suppl 1):7–20.
    1. Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunesová M, Holst C, Astrup A, Saris WH, Kafatos A. DioGenes Study group. The effect of protein and glycemic index on children's body composition: the DiOGenes randomized study. Pediatrics. 2010;126:1143–52. doi: 10.1542/peds.2009-3633.
    1. Morenga LT, Williams S, Brown R, Mann J. Effect of a relatively high-protein, high-fiber diet on body composition and metabolic risk factors in overweight women. Eur J Clin Nutr. 2010;64:1323–1331. doi: 10.1038/ejcn.2010.163.
    1. Farnsworth E, Luscombe ND, Noakes M, Wittert G, Argyiou E, Clifton PM. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Am J Clin Nutr. 2003;78:31–39.
    1. Sebely P, Siew L, Egger G. The effect of a low glycaemic index breakfast on blood glucose, insulin, lipid profiles, blood pressure, body weight, body composition and satiety in obese and overweight individuals: A pilot study. J Am Coll Nutr. 2008;27:387–393.
    1. Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB. High glycemic index foods, overeating and obesity. Pediatrics. 1999;103:26–31. doi: 10.1542/peds.103.3.e26.
    1. Clifton PM, Bastiaans K, Keogh JB. High protein diets decrease total and abdominal fat and improve CVD risk profile in overweight and obese men and women with elevated triacylglycerol. Nutr Metab Cardiovasc Dis. 2009;19:548–54. doi: 10.1016/j.numecd.2008.10.006.
    1. Noakes M, Keogh JB, Foster PR, Clifton PM. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr. 2005;81:1298–306.
    1. Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM. Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids. Am J Clin Nutr. 2005;81:762–72.
    1. Kerksick CM, Wismann-Bunn J, Fogt D, Thomas AR, Taylor IV L, Campbell BI, Wilborn CD, Harvey T, Roberts MD, La Bounty P, Galbreath M, Marcello B, Rasmussen CJ, Kreider RB. Changes in weight loss, body composition and cardiovascular disease risk after altering macronutrient distributions during a regular exercise program in obese women. Nutrition Journal. 2010;9:59. doi: 10.1186/1475-2891-9-59.
    1. Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev. 2009;10:36–50. doi: 10.1111/j.1467-789X.2008.00518.x.
    1. Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, Stein RI, Mohammed BS, Miller B, Rader DJ, Zemel B, Wadden TA, Tanhave T, Newcomb CW, Klein S. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010;153:147–57.
    1. Abete I, Parra D, Martinez JA. Legume-, fish-, or high-protein-based hypocaloric diets: effects on weight loss and mitochondrial oxidation in obese men. J Med Food. 2009;12:100–108. doi: 10.1089/jmf.2007.0700.
    1. Martínez González MA, Sánchez Villegas A, Faulin Fajardo J. In: Bioestadística amigable. 3 Díaz de Santos, Madrid, editor. 2010.
    1. Specter SE, Bellisle F, Hémery-Véron S, Fiquet P, Bornet FR, Slama G. Reducing ice cream energy density does not condition decreased acceptance or engender compensation following repeated exposure. Eur J Clin Nutr. 1998;52:703–710. doi: 10.1038/sj.ejcn.1600627.
    1. Labayen I, Diez N, Parra MD, Gónzalez A, Martínez JA. Time-course changes in macronutrient metabolism induced by a nutritionally balanced low-calorie diet in obese women. Int J Food Sci Nutr. 2004;55:27–35. doi: 10.1080/09637480310001642457.
    1. Young KW, Greenwood CE, van Reekum R, Binns MA. Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status. J Am Geriatr Soc. 2004;52:1305–12. doi: 10.1111/j.1532-5415.2004.52360.x.
    1. Rolls BJ, Roe LS, Meengs JS. Larger portion sizes lead to a sustained increase in energy intake over 2 days. J Am Diet Assoc. 2006;106:543–9. doi: 10.1016/j.jada.2006.01.014.
    1. Abete I, Parra D, Martinez JA. Energy-restricted diets based on a distinct food selection affecting the glycemic index induce different weight loss and oxidative response. Clin Nutr. 2008;27:545–51. doi: 10.1016/j.clnu.2008.01.005.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit