One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: does diet composition matter? TCF7L2 genetic variants modulate the effect of dietary fat intake on changes in body composition during a weight-loss intervention. Attenuated Low-Grade Inflammation Following Long-Term Dietary Intervention in Postmenopausal Women with Obesity. Soy Protein Intake, Cardiorenal Indices, and C-Reactive Protein in Type 2 Diabetes With Nephropathy Differential effects of macronutrient content in 2 energy-restricted diets on cardiovascular risk factors and adipose tissue cell size in moderately obese individuals: a randomized controlled trial. Promotion of Faster Weight Gain in Infants Born Small for Gestational Age: Is There an Adverse Effect on Later Blood Pressure? Combination of recreational soccer and caloric restricted diet reduces markers of protein catabolism and cardiovascular risk in patients with type 2 diabetes Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial Early behavioral adherence predicts short and long-term weight loss in the POUNDS LOST study Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women Sitagliptin Reduces Inflammation and Chronic Immune Cell Activation in HIV+ Adults With Impaired Glucose Tolerance. Long-term intake of soy protein improves blood lipid profiles and increases mononuclear cell low-density-lipoprotein receptor messenger RNA in hypercholesterolemic, postmenopausal women. Effects of supplemented isoenergetic diets differing in cereal fiber and protein content on insulin sensitivity in overweight humans. Short-term effects of substituting protein for carbohydrate in the diets of moderately hypercholesterolemic human subjects. Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial Effects of lupin-enriched foods on body composition and cardiovascular disease risk factors: a 12-month randomized controlled weight loss trial Low‐calorie diet induced weight loss may alter regulatory hormones and contribute to rebound visceral adiposity in obese persons with a family history of type‐2 diabetes Isocaloric Diets High in Animal or Plant Protein Reduce Liver Fat and Inflammation in Individuals With Type 2 Diabetes. Effect of dietary protein restriction on the progression of kidney disease: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Inflammation and cardiovascular risk in dialysis patients. Lupin protein positively affects plasma LDL cholesterol and LDL:HDL cholesterol ratio in hypercholesterolemic adults after four weeks of supplementation: a randomized, controlled crossover study
BACKGROUND For many people , maintenance of weight loss is elusive . Whereas high-protein ( HP ) diets have been found to be superior to high-carbohydrate ( HC ) diets for weight loss in the short term , their benefits long term are unclear , particularly for weight maintenance . Furthermore , the literature lacks consensus on the long-term effects of an HP diet on cardiovascular disease risk factors . OBJECTIVE The objective was to investigate whether macronutrient dietary composition plays a role in weight maintenance and in improvement of cardiovascular disease risk factors . DESIGN The study comprised 2 phases . Phase 1 featured a very-low-energy diet for 3 mo . In phase 2 , the subjects were r and omly assigned to an HP or an HC diet for 12 mo . The diets were isocaloric , tightly controlled , and individually prescribed for weight maintenance . The subjects were overweight or obese but otherwise healthy men and women . RESULTS The subjects lost an average of 16.5 kg during phase 1 and maintained a mean ( + /-SEM ) weight loss of 14.5 + /- 1.2 kg ( P < 0.001 ) during phase 2 ; no significant differences between groups were observed . By the end of the study , reductions in systolic blood pressure were 14.3 + /- 2.4 mm Hg for the HP group and 7.7 + /- 2.2 mm Hg for the HC group ( P < 0.045 ) . Forty-seven percent of the 180 subjects who began the study completed both phases . CONCLUSIONS The results indicate that the protein or carbohydrate content of the diet has no effect on successful weight-loss maintenance . A general linear model analysis indicated that dietary treatment ( HP or HC ) was a significant factor in systolic blood pressure change and in favor of the HP diet . This trial was registered at www . clinical trials.gov as NCT 00625236 BACKGROUND TCF7L2 gene variants have been associated with increased risk of  type 2 diabetes and higher adiposity .  Observational studies and short-term trials have suggested that macronutrients may modify these effects . However , to our knowledge , this has yet to be verified in long-term interventions . OBJECTIVE In a long-term intervention setting , we investigated the effects of TCF7L2 polymorphisms rs7903146 and rs12255372 and dietary total fat on changes in body composition and subsequent glycemic control . DESIGN Data were analyzed for 591 participants in the Preventing Overweight Using Novel Dietary Strategies ( Pounds Lost ) trial , which is a 2-y weight-loss r and omized clinical trial of diets that differed in macronutrient proportions . Adjusted means for changes in body composition at 6 and 24 mo were obtained for gene main effects and interactions with a low-fat diet ( 20 % from energy ) compared with a high-fat diet ( 40 % from energy ) . Interactions with protein and carbohydrate intakes were also tested . Predicted changes in glycemic control from changes in adiposity were determined by genotype and diet type . RESULTS Significant interactions were observed for rs12255372 TT ( risk genotype ) and fat intake for changes in BMI , total fat mass , and trunk fat mass ( all P/q < 0.05 ) at 6 mo , with nonsignificant larger decreases for TT carriers on a low-fat diet . No significant associations were observed at 24 mo or for other macronutrients . Changes in body composition for TT carriers predicted reductions in plasma glucose and insulin only on the low-fat diet . CONCLUSIONS Individuals with the TCF7L2 rs12255372 risk genotype may reduce body adiposity by consuming a diet lower in total fat . These reductions may induce better glycemic control for such individuals predisposed to type 2 diabetes . The Pounds Lost trial was registered at clinical trials.gov as NCT00072995 OBJECTIVE Abdominal fat accumulation after menopause is associated with low- grade inflammation and increased risk of metabolic disorders . Effective long-term lifestyle treatment is therefore needed . METHODS Seventy healthy postmenopausal women ( age 60 ± 5.6 years ) with BMI 32.5 ± 5.5 were r and omized  to a Paleolithic-type diet ( PD ) or a prudent control diet ( CD ) for 24 months . Blood sample s and fat biopsies  were collected at baseline , 6 months , and 24 months to analyze inflammation-related parameters . RESULTS And roid fat decreased significantly more in the PD group ( P = 0.009 ) during the first 6 months with weight maintenance at 24 months in both groups . Long-term significant effects ( P < 0.001 ) on adipose gene expression were found for toll-like receptor 4 ( decreased at 24 months ) and macrophage migration inhibitory factor ( increased at 24 months ) in both groups . Serum interleukin 6 ( IL-6 ) and tumor necrosis factor α levels were decreased at 24 months in both groups ( P < 0.001 ) with a significant diet-by-time interaction for serum IL-6 ( P = 0.022 ) . High-sensitivity C-reactive protein was decreased in the PD group at 24 months ( P = 0.001 ) . CONCLUSIONS A reduction of abdominal obesity in postmenopausal women is linked to specific changes in inflammation-related adipose gene expression OBJECTIVE —Several short-term trials on the effect of soy consumption on cardiovascular risks are available , but little evidence exists regarding the impact of long-term soy protein consumption among type 2 diabetic patients with nephropathy . To determine the effects of long-term soy consumption on cardiovascular risks , we measured C-reactive protein ( CRP ) and kidney function indexes among type 2 diabetic patients with nephropathy . RESEARCH DESIGN AND METHODS —This longitudinal r and omized clinical trial was conducted among 41 type 2 diabetic patients with nephropathy ( 18 men and 23 women ) . Twenty patients in the soy protein group consumed a diet containing 0.8 g protein/kg body weight ( 35 % animal proteins , 35 % textured soy protein , and 30 % vegetable proteins ) and 21 patients in the control group consumed a similar diet containing 70 % animal proteins and 30 % vegetable proteins for 4 years . RESULTS —Soy protein consumption significantly affected cardiovascular risks such as fasting plasma glucose ( mean change in the soy protein versus control groups : −18 ± 3 vs. 11 ± 2 mg/dl ; P = 0.03 ) , total cholesterol ( −23 ± 5 vs. 10 ± 3 mg/dl ; P = 0.01 ) , LDL cholesterol ( −20 ± 5 vs. 6 ± 2 mg/dl ; P = 0.01 ) , and serum triglyceride ( −24 ± 6 vs. −5 ± 2 mg/dl ; P = 0.01 ) concentrations . Serum CRP levels were significantly decreased by soy protein intake compared with those in the control group ( 1.31 ± 0.6 vs. 0.33 ± 0.1 mg/l ; P = 0.02 ) . Significant improvements were also seen in proteinuria ( −0.15 ± 0.03 vs. 0.02 ± 0.01 g/day ; P = 0.001 ) and urinary creatinine ( −1.5 ± 0.9 vs. 0.6 ± 0.3 mg/dl , P = 0.01 ) by consumption of soy protein . CONCLUSIONS —Longitudinal soy protein consumption significantly affected cardiovascular risk factors and kidney-related biomarkers among type 2 diabetic patients with nephropathy BACKGROUND The most effective and safe dietary approach for weight loss and its impact on the metabolic functions and morphology of adipose tissue remain unclear . OBJECTIVES We evaluated whether an energy-restricted high-protein diet with a low glycemic index and soluble fiber ( LC-P-LGI ) would be more effective than a low-calorie conventional diet ( LC-CONV ) on weight loss and related metabolic risk factors . We further determined factors that may influence adipocyte size during energy restriction . DESIGN Thirteen obese participants were r and omly assigned in a crossover design to 2 periods of a 4-wk hypocaloric diet as either LC-P-LGI or LC-CONV , separated by 8-wk washout intervals . RESULTS In comparison with the LC-CONV diet , the main effect of the LC-P-LGI diet was a greater decrease in adipocyte diameter ( P = 0.048 ) , plasma plasminogen activator inhibitor protein-1 ( P = 0.019 ) , vascular endothelial growth factor ( P = 0.032 ) , and interferon-γ inducible protein 10 ( P = 0.010 ) . Whereas fasting plasma glucose and high-sensitivity C-reactive protein decreased only after the LC-P-LGI diet , with no differences between diets , fasting plasma insulin and insulin resistance were lower after the LC-CONV diet . The diet results did not differ for body composition and lipid variables . Kinetic modifications in adipocyte diameter were associated with metabolic variables and genes implicated in adipocyte proliferation , apoptosis , and angiogenesis . CONCLUSIONS In comparison with the LC-CONV diet , the LC-P-LGI diet was associated with improvement in some cardiometabolic risk factors and greater reduction in adipocyte size . Profiles of genes involved in inhibiting adipogenesis and angiogenesis , but increasing apoptosis , were correlated with decreased adipocyte size . This study provides insight into the adipose tissue-remodeling changes that induce regulation of adipocyte size during dietary weight loss . This trial was registered at clinical trials.gov as NCT01312740 Background — Being born small for gestational age is associated with later risk factors for cardiovascular disease , such as high blood pressure . Promotion of postnatal growth has been proposed to ameliorate these effects . There is evidence in animals and infants born prematurely , however , that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk . We report the long-term impact of growth promotion in term infants born small for gestational age ( birth weight < 10th percentile ) . Methods and Results — Blood pressure was measured at 6 to 8 years in 153 of 299 ( 51 % ) of a cohort of children born small for gestational age and r and omly assigned at birth to receive either a  st and ard or a nutrient-enriched formula . The enriched formula contained 28 % more protein than st and ard formula and promoted weight gain . Diastolic and mean ( but not systolic ) blood pressure was significantly lower in children assigned to st and ard compared with nutrient-enriched formula ( unadjusted mean difference for diastolic blood pressure , −3.2 mm Hg ; 95 % CI , −5.8 to −0.5 ; P=0.02 ) independent of potential confounding factors ( adjusted difference , −3.5 mm Hg ; P=0.01 ) . In observational analyses , faster weight gain in infancy was associated with higher later blood pressure . Conclusions — In the present r and omized study targeted to investigate the effect of early nutrition on long-term cardiovascular health , we found that a nutrient-enriched diet increased later blood pressure . These findings support an adverse effect of relative “ overnutrition ” in infancy on long-term cardiovascular disease risk , have implication s for the early origins of cardiovascular disease hypothesis , and do not support the promotion of faster weight gain in infants born small for gestational age Background Moderate calorie-restricted diets and exercise training prevent loss of lean mass and cardiovascular risk . Because adherence to routine exercise recommendation is generally poor , we utilized recreational soccer training as a novel therapeutic exercise intervention in type 2 diabetes ( T2D ) patients . Objective We compared the effects of acute and chronic soccer training plus calorie-restricted diet on protein catabolism and cardiovascular risk markers in T2D . Design , setting and subjectsFifty-one T2D patients ( 61.1±6.4 years , 29 females : 22 males ) were r and omly allocated to the soccer+diet-group ( SDG ) or to the dietgroup ( DG ) . The 40-min soccer sessions were held 3 times per week for 12 weeks . Results Nineteen participants attended 100 % of scheduled soccer sessions , and none suffered any injuries . The SDG group showed higher levels of growth hormone ( GH ) , free fatty acids and ammonia compared with DG . After 12 weeks , insulin-like growth factor binding protein (IGFPB)-3 and glucose levels were lower in SDG , whereas insulin-like growth factor (IGF)-1/ IGFBP-3 ratio increased in both groups . After the last training session , an increase in IGF-1/IGFBP-3 and attenuation in ammonia levels were suggestive of lower muscle protein catabolism . Conclusions Recreational soccer training was popular and safe , and was associated with decreased plasma glucose and IGFBP-3 levels , decreased ammoniagenesis , and increased lipolytic activity and IGF-1/IGFBP-3 ratio , all indicative of attenuated catabolism Aims /hypothesisThis study compared the long-term weight loss and health outcomes at 1-year follow-up , after a 12-week intensive intervention consisting of two low-fat , weight-loss diets , which differed in protein content . Methods We r and omly assigned 66 obese patients ( BMI : 27–40 kg/m2 ) with Type 2 diabetes to either a low-protein ( 15 % protein , 55 % carbohydrate ) or high-protein diet ( 30 % protein , 40 % carbohydrate ) for 8 weeks of energy restriction ( ~6.7 MJ/day ) and 4 weeks of energy balance . Subjects were asked to maintain the same dietary pattern for a further 12 months of follow-up . Results The study was completed by 38 of the subjects , with equal dropouts in each group . At Week 64 , weight reductions against baseline were −2.2±1.1 kg ( low protein ) and −3.7±1.0 kg ( high protein ) , p<0.01 , with no diet effect . Fat mass was not different from baseline in either group . At Week 12 , both diets reduced systolic and diastolic blood pressure by 6 and 3 mm Hg respectively , but blood pressure increased more with weight regain during follow-up in the low-protein group ( p≤0.04 ) . At Week 64 , both diets significantly increased HDL cholesterol and lowered C-reactive protein concentrations . There was no difference in the urinary urea : creatinine ratio at baseline between the two groups , but this ratio increased at Week 12 ( in the high-protein group only , p<0.001 , diet effect ) , remaining stable during follow-up in both diets . Conclusions /interpretationA high-protein weight-reduction diet may in the long term have a more favourable cardiovascular risk profile than a low-protein diet with similar weight reduction in people with Type 2 diabetes The primary aim of this study was to test the association of early ( first 6 months ) adherence related to diet , self-monitoring , and attendance with  changes in adiposity and cardiovascular risk factors .  This study used data from the 24-month POUNDS LOST trial that tested the efficacy of four dietary macronutrient compositions for short- and long-term weight loss . A computer tracking system was used to record data on eight indicator variables related to adherence . Using canonical correlations at the 6 and 24 month measurement periods , early behavioral adherence was associated with changes in percent weight loss and waist circumference at 6 months ( R = 0.52 ) and 24 months ( R = 0.37 ) , but was not associated with cardiovascular disease risk factor levels . Early dietary adherence was associated with changes in insulin at 6 months ( R = 0.19 ) , but not at 24 months ( R = 0.08 , ns ) . Early dietary adherence was not associated with changes in adiposity OBJECTIVE The long-term health consequences of diets used for weight control are not established . We have evaluated the association of the frequently recommended low carbohydrate diets - usually characterized by concomitant increase in protein intake - with long-term mortality . DESIGN The Women 's Lifestyle and Health cohort study initiated in Sweden during 1991 - 1992 , with a 12-year almost complete follow up . SETTING The Uppsala Health Care Region . SUBJECTS 42,237 women , 30 - 49 years old at baseline , volunteers from a r and om sample , who completed an extensive question naire  and were traced through linkages to national registries until 2003 . MAIN OUTCOME MEASURES We evaluated the association of mortality with : decreasing carbohydrate intake ( in deciles ) ; increasing protein intake ( in deciles ) and an additive combination of these variables ( low carbohydrate-high protein score from 2 to 20 ) , in Cox models controlling for energy intake , saturated fat intake and several nondietary covariates . RESULTS Decreasing carbohydrate or increasing protein intake by one decile were associated with increase in total mortality by 6 % ( 95 % CI : 0 - 12 % ) and 2 % ( 95 % CI : -1 to 5 % ) , respectively . For cardiovascular mortality , amongst women 40 - 49 years old at enrolment , the corresponding increases were , respectively , 13 % ( 95 % CI : -4 to 32 % ) and 16 % ( 95 % CI : 5 - 29 % ) , with the additive score being even more predictive . CONCLUSIONS A diet characterized by low carbohydrate and high protein intake was associated with increased total and particularly cardiovascular mortality  amongst women . Vigilance with respect to long-term adherence to such weight control regimes is advisable Aims /hypothesisA diet low in saturated fatty acids and rich in wholegrains , vegetables and fruit is recommended in order to reduce the risk of obesity , cardiovascular disease and type 2 diabetes mellitus . However there is widespread interest in high-fat ( “ Atkins Diet ” ) and high-protein ( “ Zone Diet ” ) alternatives to the conventional high-carbohydrate , high-fibre approach . We report on a r and omised trial that compared these two alternative approaches with a conventional diet in overweight insulin-resistant women . Methods Ninety-six normoglycaemic , insulin-resistant women ( BMI > 27 kg/m2 ) were r and omised to one of three dietary interventions : a high-carbohydrate , high-fibre ( HC ) diet , the high-fat ( HF ) Atkins Diet , or the high-protein ( HP ) Zone Diet . The experimental approach was design ed to mimic what might be achieved in clinical practice : the recommendations involved advice concerning food choices and were not prescriptive in terms of total energy . There were supervised weight loss and weight maintenance phases ( 8 weeks each ) , but there was no contact between the research team and the participants during the final 8 weeks of the study . Outcome was assessed in terms of body composition and indicators of cardiovascular and diabetes risk . Results Body weight , waist circumference , triglycerides and insulin levels decreased with all three diets but , apart from insulin , the reductions were significantly greater in the HF and HP groups than in the HC group . These observations suggest that the popular diets reduced insulin resistance to a greater extent than the st and ard dietary advice did . When compared with the HC diet , the HF and HP diets were shown to produce significantly ( p<0.01 ) greater reductions in several parameters , including weight loss ( HF −2.8 kg , HF −2.7 kg ) , waist circumference ( HF −3.5 cm , HF −2.7 cm ) and triglycerides ( HF −0.30 mmol/l , HF −0.22 mmol/l ) . LDL cholesterol decreased in individuals on the HC and HP diets , but tended to fluctuate in those on the HF diet to the extent that overall levels were significantly lower in the HP group than in the HF group ( −0.28 mmol/l , 95 % CI 0.04–0.52 , p=0.02 ) . Of those on the HF diet , 25 % showed a > 10 % increase in LDL cholesterol , whereas this occurred in only 13 % of subjects on the HC diet and 3 % of those on the HP diet . Conclusions /interpretationIn routine practice a reduced-carbohydrate , higher protein diet may be the most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes . To achieve similar benefits on a HC diet , it may be necessary to increase fibre-rich wholegrains , legumes , vegetables and fruits , and to reduce saturated fatty acids to a greater extent than appears to be achieved by implementing current guidelines . The HF approach appears successful for weight loss in the short term , but lipid levels should be monitored . The potential deleterious effects of the diet in the long term remain a concern CONTEXT HIV infection is associated with a greater risk for fasting hyperinsulinemia , impaired glucose tolerance , and higher incidence rates for vascular disease , myocardial infa rct ion , or stroke despite effective combination antiretroviral therapy ( cART ) . The underlying mechanism(s ) may involve chronic low- grade systemic inflammation and immune cell activation . Dipeptidyl peptidase-4 inhibitors ( sitagliptin ) improve glucose tolerance and may possess immunomodulatory effects because leukocyte CD26 cell surface receptors express dipeptidyl peptidase-4 activity . OBJECTIVE Sitagliptin will reduce inflammatory and immune cell activation markers known to be elevated in cART-treated HIV-infected ( HIV+ ) adults with impaired glucose tolerance . DESIGN This was design ed as a prospect i ve , r and omized , placebo-controlled , double-blind trial of sitagliptin in HIV+ adults . SETTING The setting was an academic medical center . PATIENTS Patients were cART-treated HIV+ men and women ( n = 36 ) with stable HIV disease and impaired glucose tolerance . INTERVENTIONS Interventions included sitagliptin 100 mg/d or placebo for 8 weeks . MAIN OUTCOME MEASURES At baseline and week 8 , plasma high-sensitivity C-reactive protein and C-X-C motif chemokine 10 concentrations ( ELISA ) , oral glucose tolerance , and abdominal sc adipose mRNA expression for M1 macrophage markers ( monocyte chemotactic protein-1 , EGF-like module-containing , mucin-like hormone receptor 1 ) . RESULTS Sitagliptin reduced glucose area under the curve ( P = .002 ) and improved oral glucose insulin sensitivity index ( P = .04 ) more than placebo . Sitagliptin reduced plasma high-sensitivity C-reactive protein and C-X-C motif chemokine 10 levels more than placebo ( P < .009 ) . Adipose tissue monocyte chemotactic protein-1 mRNA abundance declined significantly more ( P = .01 ) , and adipose EGF-like module-containing , mucin-like hormone receptor 1 mRNA expression tended to decline more ( P = .19 ) in sitagliptin than placebo . CONCLUSION Sitagliptin had beneficial systemic and adipose anti-inflammatory effects in cART-treated HIV+ adults with impaired glucose tolerance . Large-scale , long-term studies should determine whether sitagliptin reduces cardiovascular risk and events in HIV+ adults The long-term clinical effects of soy protein containing various amounts of isoflavones on lipoproteins , mononuclear cell LDL receptor messenger RNA concentrations , and other selected cardiovascular risk factors are not well known . Sixty-six hypercholesterolemic , free-living , postmenopausal women were investigated during a 6-mo parallel-group , double-blind trial with 3 interventions . After a control period of 14 d , all subjects were r and omly assigned to 1 of 3 dietary groups ( all with 40 g protein ) : a National Cholesterol Education Program ( NCEP ) Step 1 diet with protein from casein and nonfat dry milk ( control ) , an NCEP Step 1 diet with protein from isolated soy protein containing moderate amounts of isoflavones ( ISP56 ) , or an NCEP Step 1 diet with protein from isolated soy protein containing high amounts of isoflavones ( ISP90 ) . Non-HDL cholesterol in both the ISP56 and ISP90 groups was reduced compared with the control group ( P < 0.05 ) , whereas total cholesterol was not changed . HDL cholesterol increased in both the ISP56 and ISP90 groups ( P < 0.05 ) , whereas the ratio of total to HDL cholesterol decreased significantly in both groups compared with the control ( P < 0.05 ) . Mononuclear cell LDL receptor messenger RNA concentrations increased in subjects consuming ISP56 or ISP90 compared with the control ( P < 0.05 ) . These results indicate that soy protein , with different amounts of isoflavones , may decrease the risk of cardiovascular disease via improved blood lipid profiles , and that the mechanism by which apolipoprotein B-containing lipoproteins were depressed may be via alterations in LDL receptor quantity or activity BACKGROUND Despite their beneficial effects on weight loss and blood lipids , high-protein ( HP ) diets have been shown to increase insulin resistance and diabetes risk , whereas high-cereal-fiber ( HCF ) diets have shown the opposite effects on these outcomes . OBJECTIVE We compared the effects of isoenergetic HP and HCF diets and a diet with moderate increases in both cereal fibers and dietary protein ( Mix diet ) on insulin sensitivity , as measured by using euglycemic-hyperinsulinemic clamps with infusion of [6,6-(2)H(2)]glucose . DESIGN We r and omly assigned 111 overweight adults with features of the metabolic syndrome to 1 of 4 two-phased , 18-wk isoenergetic diets by group-matching . Per 3-d food protocol s , the percentages of energy derived from protein and carbohydrates and the intake of cereal fiber per day , respectively , were as follows-after 6 wk : 17 % , 52 % , and 14 g ( control ) ; 17 % , 52 % , and 43 g ( HCF ) ; 28 % , 43 % , and 13 g ( HP ) ; 23 % , 44 % , and 26 g ( Mix ) ; after 18 wk : 17 % , 51 % , and 15 g ( control ) ; 17 % , 51 % , and 41 g ( HCF ) ; 26 % , 45 % , and 14 g ( HP ) ; and 22 % , 46 % , and 26 g ( Mix ) . Eighty-four participants completed the study successfully and were included in the final analyses . Adherence was supported by the provision of tailored dietary supplements twice daily in all groups . RESULTS Insulin sensitivity expressed as an M value was 25 % higher after 6 wk of the HCF diet than after 6 wk of the HP diet ( subgroup analysis : 4.61 ± 0.38 compared with 3.71 ± 0.36 mg · kg(-1 ) · min(-1 ) , P = 0.008 ; treatment × time interaction : P = 0.005 ) . Effects were attenuated after 18 wk ( treatment × time interaction : P = 0.054 ) , which was likely explained by lower adherence to the HP diet . HP intake was associated with a tendency to increased protein expression in adipose tissue of the translation initiation factor serine-kinase-6 - 1 , which is known to mediate amino acid-induced insulin resistance . Biomarkers of protein intake indicated interference of cereal fibers with dietary protein absorption . CONCLUSION Greater changes in insulin sensitivity after intake of an isoenergetic HCF than after intake of an HP diet might help to explain the diverse effects of these diets on diabetes risk . This trial is registered at clinical trials.gov as NCT00579657 The short-term effects on plasma lipoprotein lipids of substituting meat and dairy protein for carbohydrate in the diets of 10 free-living moderately hypercholesterolemic human subjects ( four men , six women ) were studied under closely supervised dietary control during the consumption of constant , low intakes of fat and cholesterol and the maintenance of stable body weight as well as constant fiber consumption . Subjects were r and omly allocated to either the high or low protein diets ( mean , 23 % v 11 % of energy as protein , 24 % as fat , and 53 % v 65 % as carbohydrate ) and then switched to the other diet for another 4 to 5 weeks . Mean fasting plasma high-density lipoprotein cholesterol ( HDL-C ) was significantly higher by 12 % + /- 4 % ( 0.97 + /- 0.08 v 0.89 + /- 0.08 mmol/L , P less than .01 ) , whereas mean total cholesterol ( TC ) was lower by 6.5 % + /- 1.3 % ( 5.7 + /- 0.3 v 6.1 + /- 0.3 mmol/L , P less than .001 ) , mean low-density lipoprotein-cholesterol ( LDL-C ) lower by 6.4 % + /- 2.0 % ( 4.5 + /- 0.2 v 4.8 + /- 0.2 mmol/L , P less than .02 ) , mean total triglycerides ( TG ) lower by 23 % + /- 5 % ( 1.7 + /- 0.1 v 2.4 + /- 0.3 mmol/L , P less than .02 ) , and mean high versus low protein diet . Mean values for LDL-C were significantly lower during weeks 3 to 5 of the high protein diet than during either weeks 1 to 5 or weeks 1 to 2 of the high protein diet ( 4.3 + /- 0.3 , 4.5 + /- 0.2 , and 4.7 + /- 0.3 mmol/L , respectively , P less than .05 ) and 11 % + /- 3 % lower than on low protein diet , P less than .005 . The ratio of plasma LDL-C to HDL-C was consistently lower by 17 % + /- 3 % during the high versus low protein diet ( 4.9 + /- 0.5 v 5.8 + /- 0.5 , P less than .001 ) . Lowering plasma TC and LDL-C and total TG and VLDL-TG and increasing HDL-C by chronic isocaloric substitution of dietary for carbohydrate may enhance the cardiovascular risk reduction obtained by restriction of dietary fat and cholesterol OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown . We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus , a trial design ed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention . RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years ( n = 626 ) were r and omized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet , physical activity promotion , and behavioral support ( IG ) or a control group ( CG ) . The primary and secondary outcomes were changes in weight and cardiovascular risk markers , respectively . RESULTS Diet and physical activity changes were in the expected direction , with significant improvements in IG versus CG . After 12 months , IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG ( P < 0.001 ) , a mean difference of −2.5 kg ( 95 % CI −3.1 to −1.9 ) . Weight loss ≥5 % occurred in 33.7 % of IG participants compared with 11.9 % in the CG ( P < 0.001 ) . Compared with the CG , cardiovascular risk factors , including waist circumference , fasting glucose , triglycerides , and HDL cholesterol , significantly improved in IG participants ( P < 0.002 ) . Reductions in insulin resistance , HbA1c , and circulating levels of leptin , interleukin-18 , and MCP-1 were greater in IG than CG participants ( P < 0.05 ) . IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity , along with triglycerides and HDL cholesterol levels compared with their CG counterparts . CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome , as well as in individuals with or at risk for diabetes Background : Regular consumption of diets with increased protein or fibre intakes may benefit body weight and composition and cardiovascular disease risk factors .  Lupin flour is a novel food ingredient high in protein and fibre . Objective : To investigate the effects of a lupin-enriched diet , during and following energy restriction , on body weight and composition and cardiovascular disease risk factors  in overweight individuals . Design : Participants ( n=131 ) were recruited to a 12-month parallel- design trial . They were r and omly assigned to consume lupin-enriched foods or matching high-carbohydrate control foods . All participants underwent 3 months of weight loss , 1 month of weight stabilization and 8 months of weight maintenance . Body weight and composition and cardiovascular disease risk factors were assessed at baseline , 4 and 12 months . Results : Lupin , relative to control , did not significantly influence ( mean difference ( 95 % CI ) ) weight loss at 4 months ( 0.1 kg ( −1.2 , 1.4 ) ) and 12 months ( −0.6 kg ( −2.0 , 0.8 ) ) , maintenance of weight loss from 4 to 12 months ( −0.7 kg ( −1.83 , 0.48 ) ) or measures of body fat and fat-free mass . Relative to control , 24-h ambulatory systolic ( −1.3 mm Hg ( −2.4 , −0.3 ) , P=0.016 ) and diastolic ( −1.0 mm Hg ( −1.9 , −0.2 ) , P=0.021 ) blood pressures were lower at 12 months but not at 4 months ; fasting insulin concentrations and homeostasis model assessment ( HOMA ) scores were significantly lower at 4 months ( −1.2 mU l–1 ( −1.3 , −1.1 ) , P=0.004 and −0.6 units ( −1.0 , −0.19 ) , P=0.004 ) and 12 months ( −1.3 mU l–1 ( −1.4 , −1.1 ) , P<0.001 and −0.7 units ( −1.1 , −0.24 ) , P=0.002 ) . Conclusions : A diet higher in protein and fibre derived from lupin-enriched foods does not enhance weight loss or improve the maintenance of weight loss . However , such a diet may provide cardiovascular health benefits in terms of insulin sensitivity and blood pressure Purpose : To examine potential detrimental long‐term effects of acute diet‐induced weight loss on visceral adiposity , insulin resistance , cortisol , and adipokines in obese individuals at risk for type‐2 diabetes . Data sources : Anthropometric measures ( height , weight , waist circumference ) , self‐report instruments , abdominal computed tomography ( CT ) scan , and blood sample s ( glucose , insulin , interleukin‐6 , leptin , adiponectin ) were obtained from a convenience sample of 20 participants at baseline , after a 28‐day low‐calorie diet ( 800 kcal/day ) intervention , and again 6 months later . Conclusions : Fifteen of 20 participants completed the 28‐day diet intervention and had a mean weight loss of 15 pounds . Comparison between baseline , postdiet , and 6‐month data , demonstrated that although participants had significant improvements after the diet , they regained fat mass , particularly in the visceral area . Implication s for practice : Clinicians may need to revise recommendations for using low‐calorie diets to achieve weight loss . Diet‐induced weight cycling may contribute to dysregulation of metabolism and have long‐term detrimental consequences for accumulation of visceral adipose tissue . The likelihood of success is low , with high dropout rates , and those patients who achieve weight loss are very likely to regain it . Thus , the perceived short‐term benefits of calorie‐restricted diets in this population likely do not outweigh the potential long‐term detrimental effects BACKGROUND & AIMS Nonalcoholic fatty liver disease ( NAFLD ) is associated with increased risk of hepatic , cardiovascular , and metabolic diseases . High-protein diets , rich in methionine and branched chain amino acids ( BCAAs ) , apparently reduce liver fat , but can induce insulin resistance . We investigated the effects of diets high in animal protein ( AP ) vs plant protein ( PP ) , which differ in levels of methionine and BCAAs , in patients with type 2 diabetes and NAFLD . We examined levels of liver fat , lipogenic indices , markers of inflammation , serum levels of fibroblast growth factor 21 ( FGF21 ) , and activation of signaling pathways in adipose tissue . METHODS We performed a prospect i ve study of individuals with type 2 diabetes and NAFLD at a tertiary medical center in Germany from June 2013 through March 2015 . We analyzed data from 37 subjects placed on a diet high in AP ( rich in meat and dairy foods ; n = 18 ) or PP ( mainly legume protein ; n = 19 ) without calorie restriction for 6 weeks . The diets were isocaloric with the same macronutrient composition ( 30 % protein , 40 % carbohydrates , and 30 % fat ) . Participants were examined at the start of the study and after the 6-week diet period for body mass index , body composition , hip circumference , resting energy expenditure , and respiratory quotient . Body fat and intrahepatic fat were detected by magnetic resonance imaging and spectroscopy , respectively . Levels of glucose , insulin , liver enzymes , and inflammation markers , as well as individual free fatty acids and free amino acids , were measured in collected blood sample s. Hyperinsulinemic euglycemic clamps were performed to determine whole-body insulin sensitivity . Subcutaneous adipose tissue sample s were collected and analyzed for gene expression patterns and phosphorylation of signaling proteins . RESULTS Postpr and ial levels of BCAAs and methionine were significantly higher in subjects on the AP vs the PP diet . The AP and PP diets each reduced liver fat by 36%-48 % within 6 weeks ( for AP diet P = .0002 ; for PP diet P = .001 ) . These reductions were unrelated to change in body weight , but correlated with down-regulation of lipolysis and lipogenic indices . Serum level of FGF21 decreased by 50 % in each group ( for AP diet P < .0002 ; for PP diet P < .0002 ) ; decrease in FGF21 correlated with loss of hepatic fat . In gene expression analyses of adipose tissue , expression of the FGF21 receptor cofactor β-klotho was associated with reduced expression of genes encoding lipolytic and lipogenic proteins . In patients on each diet , levels of hepatic enzymes and markers of inflammation decreased , insulin sensitivity increased , and serum level of keratin 18 decreased . CONCLUSIONS In a prospect i ve study of patients with type 2 diabetes , we found diets high in protein ( either animal or plant ) significantly reduced liver fat independently of body weight , and reduced markers of insulin resistance and hepatic necroinflammation . The diets appear to mediate these changes via lipolytic and lipogenic pathways in adipose tissue . Negative effects of BCAA or methionine were not detectable . FGF21 level appears to be a marker of metabolic improvement . Clinical Trials.gov ID NCT02402985 BACKGROUND The long-term effect of a low-protein diet on the progression of chronic kidney disease is unknown . We evaluated effects of protein restriction on kidney failure and all-cause mortality during extended follow-up of the Modification of Diet in Renal Disease Study . METHODS Study A was a r and omized controlled trial from 1989 to 1993 of 585 patients with predominantly nondiabetic kidney disease and a moderate decrease in glomerular filtration rate ( 25 to 55 mL/min/1.73 m(2 ) [ 0.42 to 0.92 mL/s/1.73 m(2 ) ] ) assigned to a low- versus usual-protein diet ( 0.58 versus 1.3 g/kg/d ) . We used registries to ascertain the development of kidney failure ( initiation of dialysis therapy or transplantation ) or a composite of kidney failure and all-cause mortality through December 31 , 2000 . We used Cox regression models and intention-to-treat principles to compute hazard ratios for the low- versus usual-protein diet , adjusted for baseline glomerular filtration rate and other factors previously associated with the rate of decrease in glomerular filtration rate . We estimated hazard ratios for the entire follow-up period and then , in time-dependent analyses , separately for 2 consecutive 6-year periods of follow-up . RESULTS Kidney failure and the composite outcome occurred in 327 ( 56 % ) and 380 patients ( 65 % ) , respectively . After adjustment for baseline factors , hazard ratios were 0.89 ( 95 % confidence interval [ CI ] , 0.71 to 1.12 ) and 0.88 ( 95 % CI , 0.71 to 1.08 ) , respectively . Adjusted hazard ratios for both outcomes were lower during the first 6 years ( 0.68 ; 95 % CI , 0.51 to 0.93 and 0.66 ; 95 % CI , 0.50 to 0.87 , respectively ) than afterward ( 1.27 ; 95 % CI , 0.90 to 1.80 and 1.29 ; 95 % CI , 0.94 to 1.78 ; interaction P = 0.008 and 0.002 , respectively ) . Limitations include lack of data for dietary intake and clinical conditions after conclusion of the trial . CONCLUSION The efficacy of a 2- to 3-year intervention of dietary protein restriction on progression of nondiabetic kidney disease remains inconclusive . Future studies should include a longer duration of intervention and follow-up BACKGROUND Chronic inflammation , as evidence d by increased levels of C-reactive protein ( CRP ) , predicts all-cause and cardiovascular mortality in hemodialysis patients in short-term studies . Whether CRP is also predictive in the long-term follow-up is unknown . METHODS We conducted a 4-year follow-up of a cross-sectional study in a cohort of 280 stable hemodialysis patients .  CRP was determined once at the beginning of the study , and all-cause as well as cardiovascular mortality was monitored prospect ively . RESULTS During follow-up , 123 patients ( 43.9 % ) had died , mostly from cardiovascular events ( 58.5 % ) corresponding to an annual mortality rate of 11 % . Overall mortality and cardiovascular mortality were significantly higher in patients with a CRP more than 8 mg/L ( 73 % vs. 39 % and 87 % vs. 55 % , respectively ) . Multivariate Cox regression analysis demonstrated that age , CRP , and preexisting cardiovascular disease were the most powerful predictors , but the presence of diabetes , albumin , and BMI also remained in the model . CONCLUSION A single determination of CRP is a powerful indicator of all cause and cardiovascular death even after a follow-up period of 4 years in patients on hemodialysis treatment Background A couple of studies indicate a favorable impact of lupin protein on  cardiovascular risk factors in humans . These studies , however , used relatively high doses of > 33 g/d , which can hardly be consumed under physiological conditions . Therefore , we investigated the effect of 25 g/d lupin protein isolate ( LPI ) on selected cardiovascular markers and on serum amino acids . Methods A total of 33 hypercholesterolemic subjects participated in a r and omized , controlled , double-blind crossover study . LPI and the active comparator milk protein isolate ( MPI ) were incorporated in protein drinks and consumed over 8 wk separated by a 4 wk washout period . Anthropometric data , blood pressure , and nutrient intake were assessed at baseline and after 8 wk of both protein interventions . Blood was sample d at baseline , wk 4 and wk 8 . All 33 subjects were included in final statistical analyses using repeated measures ANOVA with the general linear model or using linear mixed model . Results Except for higher HDL cholesterol at wk 4 of LPI ( P ≤ 0.036 ) , anthropometric parameters , blood pressure , and plasma lipids did not differ among LPI and MPI intervention . Compared to baseline , the primary outcome LDL cholesterol was significantly reduced after 4 wk of both interventions ( P ≤ 0.008 ) , while LDL : HDL cholesterol ratio was decreased only by LPI ( P = 0.003 ) . These time effects were restricted to subjects with higher hypercholesterolemia and disappeared after 8 wk . Blood pressure was reduced after 8 wk of LPI ( P ≤ 0.044 ) . Almost all serum amino acids were higher at wk 4 but not at wk 8 of MPI compared to LPI . Following 4 wk and 8 wk of LPI intervention , most amino acids remained unchanged . Both interventions caused a slight , but significant rise in body weight and body fat after 8 wk ( P ≤ 0.045 ) . Conclusion In conclusion , 25 g LPI can beneficially modulate plasma LDL cholesterol at least over short-term . Using appropriate dietetic conditions that improve consumer compliance and avoid changes in energy intake as well as in body composition , lupin protein could positively impact cardiovascular risk factors particularly in individuals with higher hypercholesterolemia . Trial registration Clinical Trials.gov :
No significant differences were observed for weight , waist circumference , fat mass , blood lipids ( i.e. total cholesterol , LDL-cholesterol , HDL-cholesterol , triacylglycerols ) , C-reactive protein , diastolic and systolic blood pressure , fasting glucose and glycosylated hemoglobin .
Sensitivity analysis of high quality RCTs confirmed the data of the primary analyses , while exclusion of studies with diabetic subjects result ed in an additional benefit of high-protein diets with respect to a more marked increase in HDL-cholesterol .
Conclusion According to the present meta- analysis of long-term RCTs , high-protein diets exerted neither specific beneficial nor detrimental effects on outcome markers of obesity , cardiovascular disease or glycemic control .
Background Meta-analyses of short-term studies indicate favorable effects of higher protein vs. lower protein diets on health outcomes like adiposity or cardiovascular risk factors , but their long-term effects are unknown .