Weight loss, glycemic control, and cardiovascular disease risk factors in response to differential diet composition in a weight loss program in type 2 diabetes: a randomized controlled trial

Cheryl L Rock, Shirley W Flatt, Bilge Pakiz, Kenneth S Taylor, Angela F Leone, Kerrin Brelje, Dennis D Heath, Elizabeth L Quintana, Nancy E Sherwood, Cheryl L Rock, Shirley W Flatt, Bilge Pakiz, Kenneth S Taylor, Angela F Leone, Kerrin Brelje, Dennis D Heath, Elizabeth L Quintana, Nancy E Sherwood

Abstract

Objective: To test whether a weight loss program promotes greater weight loss, glycemic control, and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake.

Research design and methods: This randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling, with prepackaged foods in a planned menu during the initial phase, or to usual care (UC; two weight loss counseling sessions and monthly contacts).

Results: Relative weight loss was 7.4% (95% CI 5.7-9.2%), 9.0% (7.1-10.9%), and 2.5% (1.3-3.8%) for the lower fat, lower carbohydrate, and UC groups (P < 0.001 intervention effect). Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year (fasting glucose 141 [95% CI 133-149] vs. 159 [144-174] mg/dL, P = 0.023; hemoglobin A1c 6.9% [6.6-7.1%] vs. 7.5% [7.1-7.9%] or 52 [49-54] vs. 58 [54-63] mmol/mol, P = 0.001; triglycerides 148 [134-163] vs. 204 [173-234] mg/dL, P < 0.001). The lower versus higher carbohydrate groups maintained lower hemoglobin A1c (6.6% [95% CI 6.3-6.8%] vs. 7.2% [6.8-7.5%] or 49 [45-51] vs. 55 [51-58] mmol/mol) at 1 year (P = 0.008).

Conclusions: The weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT01345500.

© 2014 by the American Diabetes Association.

References

    1. Ogden C, Carroll M, Kit B, Flegal K. Prevalence of obesity in the United States, 2009–2010 [article online]. Available from . Accessed 5 March 2014
    1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States [article online]. Available from . Accessed 5 March 2014
    1. Bantle JP, Wylie-Rosett J, Albright AL, et al. American Diabetes Association . Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31(Suppl. 1):S61–S78
    1. Pi-Sunyer X, Blackburn G, Brancati FL, et al. Look AHEAD Research Group . Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 2007;30:1374–1383
    1. Wing RR, Look AHEAD Research Group . Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010;170:1566–1575
    1. Alexander SC, Ostbye T, Pollak KI, Gradison M, Bastian LA, Brouwer RJ. Physicians’ beliefs about discussing obesity: results from focus groups. Am J Health Promot 2007;21:498–500
    1. Ruelaz AR, Diefenbach P, Simon B, Lanto A, Arterburn D, Shekelle PG. Perceived barriers to weight management in primary care—perspectives of patients and providers. J Gen Intern Med 2007;22:518–522
    1. Rock CL, Flatt SW, Sherwood NE, Karanja N, Pakiz B, Thomson CA. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: a randomized controlled trial. JAMA 2010;304:1803–1810
    1. Abete I, Astrup A, Martínez 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
    1. Stern L, Iqbal N, Seshadri P, et al. . 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. Guldbrand H, Dizdar B, Bunjaku B, et al. . In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia 2012;55:2118–2127
    1. Samaha FF, Iqbal N, Seshadri P, et al. . A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003;348:2074–2081
    1. U.S. Department of Agriculture and U.S. Department of Health and Human Services Dietary Guidelines for Americans. 7th ed. Washington, DC, U.S. Government Printing Office, 2010
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571
    1. Brazier JE, Harper R, Jones NM, et al. . Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305:160–164
    1. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985;10:141–146
    1. McArdle W, Katch F, Katch V. Exercise Physiology: Energy, Nutrition, and Human Performance. 6th ed. Baltimore, MD, Lippincott Williams & Wilkins, 2006
    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. Roberts WL, Moulton L, Law TC, et al. . Evaluation of nine automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications. Part 2. Clin Chem 2001;47:418–425
    1. Mills PJ, Natarajan L, von Känel R, Ancoli-Israel S, Dimsdale JE. Diurnal variability of C-reactive protein in obstructive sleep apnea. Sleep Breath 2009;13:415–420
    1. Gamboa-Pinto AJ, Rock CL, Ferruzzi MG, Schowinsky AB, Schwartz SJ. Cervical tissue and plasma concentrations of alpha-carotene and beta-carotene in women are correlated. J Nutr 1998;128:1933–1936
    1. Ware JH. Interpreting incomplete data in studies of diet and weight loss. N Engl J Med 2003;348:2136–2137
    1. American Diabetes Association . Standards of medical care in diabetes—2012. Diabetes Care 2012;35(Suppl. 1):S11–S63
    1. Food and Nutrition Board, Institute of Medicine of the National Academies Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids Washington, DC, National Academies Press, 2005
    1. Lichtenstein AH, Appel LJ, Brands M, et al. American Heart Association Nutrition Committee . Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006;114:82–96
    1. Rivellese AA, Giacco R, Costabile G. Dietary carbohydrates for diabetics. Curr Atheroscler Rep 2012;14:563–569
    1. Acheson KJ. Carbohydrate for weight and metabolic control: where do we stand? Nutrition 2010;26:141–145
    1. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005;293:43–53
    1. Foster GD, Wyatt HR, Hill JO, et al. . Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 2010;153:147–157
    1. Davis NJ, Tomuta N, Schechter C, et al. . Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care 2009;32:1147–1152
    1. Foster GD, Wadden TA, Lagrotte CA, et al. . A randomized comparison of a commercially available portion-controlled weight-loss intervention with a diabetes self-management education program. Nutr Diabetes 2013;3:e63.
    1. Hamdy O, Zwiefelhofer D. Weight management using a meal replacement strategy in type 2 diabetes. Curr Diab Rep 2010;10:159–164
    1. Jeffery RW, Drewnowski A, Epstein LH, et al. . Long-term maintenance of weight loss: current status. Health Psychol 2000;19(Suppl.):5–16
    1. Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res 2004;12(Suppl.):151S–162S
    1. Pittas AG, Das SK, Hajduk CL, et al. . A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial. Diabetes Care 2005;28:2939–2941
    1. Cornier MA, Donahoo WT, Pereira R, et al. . Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res 2005;13:703–709
    1. Herman WH, Edelstein SL, Ratner RE, et al. Diabetes Prevention Program Research Group . Effectiveness and cost-effectiveness of diabetes prevention among adherent participants. Am J Manag Care 2013;19:194–202

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever