ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

The Effects of Low-Carbohydrate Diet and Protein-rich Mixed Dieton Insulin Sensitivity, Basal Metabolic Rate and Metabolic Parameters in Obese Patients
Obez Hastalarda Düşük Karbonhidrat Diyeti ve Proteinden Zengin Karma Diyetin İnsülin Sensitivitesi, Bazal Metabolik Hız ve Metabolik Parametreler Üzerine Etkisi
Received Date : 05 Nov 2019
Accepted Date : 09 Jun 2020
Available Online : 22 Jun 2020
Doi: 10.25179/tjem.2019-72200 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:206-213
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Various diet plans with varying ratios of carbohydrates, proteins, and fat ensure weight loss in obesity. The primary aim of our study was to evaluate the effects of weight loss on metabolic parameters, and the secondary aim was to compare the successes of various weight loss regimens in maintaining weight loss. Material and Methods: A team of doctors comprising a dietary consultant and a psychologist developed a program that was followed throughout our study. Twenty-two patients were included in our study. Based on their preference, they were classified into two groups: low carbohydrate diet (Atkins) group and protein-rich mixed diet group. Results: The mean age of the patients was 52.4±3 years, and the mean body mass index (BMI) was 36.1±1.2 kg/m2. Five patients followed the Atkins diet, whereas 17 followed the protein-rich mixed diet. Compared with the baseline values, in the 3rd, 6th, and 12th months, body weight (BW), BMI, and waist circumference decreased significantly (p<0.001) in all the patients. Basal metabolic rate decreased in the third and sixth months but increased in the 12th. Fasting blood glucose, fasting insulin, HbA1c, 120- minute blood glucose level in oral glucose tolerance test, total cholesterol, low-density lipoprotein, free fatty acids, and uric acid did not change significantly (p>0.05). In the Atkins group, BMI decreased significantly in the 6th month (p=0.03) but increased in the 12th month (p=0.29). In the protein-rich mixed diet group, BMI (basal 35.1±1.5 kg/m2) decreased significantly (32.8±1.5, p<0.001) in the 6th month, and continued to decrease in the twelfth (31.5±1.2, p=0.007). Conclusion: In obesity, approximately 10% weight loss can change metabolic parameters moderately. The Atkins and protein-rich mixed diets caused similar weight loss ratios in the first six months, but a protein-rich mixed diet was more successful in terms of longterm sustainability and maintenance of weight loss.
ÖZET
Amaç: Değişen karbonhidrat, protein ve yağ oranlarına sahip diyet rejimleri obezitede kilo kaybını sağlar. Çalışmamızın birinci amacı, kilo kaybının metabolik parametreler üzerindeki etkilerini değerlendirmek, ikinci amacı ise çeşitli kilo kaybı rejimlerinin kilo kaybını sürdürmedeki başarılarını karşılaştırmaktır. Gereç ve Yöntemler: Çalışma boyunca doktor, diyet danışmanı ve psikoloğu içeren bir ekip tarafından program takip edildi. Yirmi iki hasta çalışmaya dâhil edildi. Tercihlerine göre hastalar, düşük karbonhidrat diyeti (Atkins) grubu ve proteinden zengin karma diyet grubu olmak üzere ikiye ayrıldı. Bulgular: Hastaların ortalama yaşı 52,4±3 yıl, ortalama beden kitle indeksi (BKİ) 36,1±1,2 idi. Hastaların 5’i Atkins diyetini, 17’si proteinden zengin karma diyeti takip etti. Başlangıç değerleri ile karşılaştırıldığında 3, 6 ve 12. aylarda, tüm hastaların vücut ağırlığı (VA), BKİ ve bel çevresi önemli ölçüde azaldı (p<0,001). Bazal metabolizma hızı 3 ve 6. aylarda azaldı, ancak12. ayda arttı. Açlık kan şekeri, açlık insülini, HbA1c, oral glukoz tolerans testinde 120. dk'da glukoz, total kolesterol, düşük yoğunluklu lipoprotein, serbest yağ asitleri ve ürik asit düzeylerinde anlamlı bir değişiklik olmadı (p>0,05). Atkins grubunda BKİ, 6. ayda anlamlı olarak azaldı (p=0,03), ancak 12. ayda arttı (p=0,29). Proteinden zengin karma diyet grubunda, 6. ayda BKİ (bazal 35,1±1,5 kg/m2) anlamlı olarak azaldı (32,8±1,5; p<0,001) ve 12. ayda azalmaya devam etti (31,5±1,2; p=0,007). Sonuç: Obezitede yaklaşık %10 kilo kaybı metabolik parametrelerde orta düzeyde değişime neden olabilir. Atkins ve proteinden zengin karma diyetler, ilk 6 ayda benzer oranda kilo kaybına yol açar, ancak proteinden zengin karma diyet, kilo kaybının sürdürülmesi ve uzun dönem devam edilmesinde daha başarılı olmuştur.
KAYNAKLAR
  1. Afshin A, Forouzanfar MH, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 countries over 25 years. GBD 2015 Obesity Collaborators. N Engl J Med. 2017;377:13‐27. [Crossref]  [PubMed]  [PMC] 
  2. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, Ludwing DS. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;17;352:1138-1145. [Crossref]  [PubMed] 
  3. Vallis M. Quality of life and psychological well-being in obesity management: improving the odds of success by managing distress. Int J Clin Pract. 2016;70:196-205. [Crossref]  [PubMed]  [PMC] 
  4. Bray GA, Frühbeck G, Ryan DH, Wilding JPH. Management of obesity. Lancet. 2016;7;387:1947-1956. [Crossref] 
  5. Tsai AG, Wadden TA. In the clinic: obesity. Ann İntern Med. 2013;3;159:ITC3-1-ITC3-15; quiz ITC3-16. [Crossref]  [PubMed] 
  6. Prospective Studies Collaboration; Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;28;373:1083-1096. [Crossref] 
  7. Ryan D, Heaner M. Guidelines (2013) for managing overweight and obesity in adults. Preface to the full report. Obesity (Silver Spring). 2014;22 Suppl 2:S1-3. [Crossref] 
  8. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GDC, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;3;312:923-933. [Crossref]  [PubMed] 
  9. Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS Jr, Kelly TN, He J, Bazzano LA. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. 2012;1;176 Suppl 7:S44-54. [Crossref]  [PubMed]  [PMC] 
  10. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;26;360:859-873. [Crossref]  [PubMed]  [PMC] 
  11. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z weight loss study: a randomized trial. JAMA. 2007;7;297:969‐977. [Crossref]  [PubMed] 
  12. 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. [Crossref]  [PubMed] 
  13. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377-1396. [Crossref] 
  14. McTigue K, Larson JC, Valoski A, Burke G, Kotchen J, Lewis CE, Stefanick ML, Horn LV, Kuller L. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA. 2006;5;296:79-86. [Crossref]  [PubMed] 
  15. Yan LL, Daviglus ML, Liu K, Stamler J, Wang R, Pirzada A, Garside DB, Dyer AR, Horn LV, Liao Y, Fries JF, Greenland P. Midlife body mass index and hospitalization and mortality in older age. JAMA. 2006;11;295:190-198. [Crossref]  [PubMed] 
  16. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, Hollenbeck A, Leitzmann MF. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;24;355:763-778. [Crossref]  [PubMed] 
  17. Rueda-Clausen CF, Ogunleye AA, Sharma AM. Health benefits of long-term weight-loss maintenance. Annu Rev Nutr. 2015;35:475-516. [Crossref]  [PubMed] 
  18. Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, Leibel RL. Obesity Pathogenesis: an endocrine society scientific statement. Endocr Rev. 2017;1;38:267-296. [Crossref]  [PubMed]  [PMC] 
  19. Yang WS, Lee WJ, Funahashi T, Tanaka S, Matsuzawa Y, Chao CL, Chen CL, Tai TY, Chuang LM. Weight reduction increases plasma levels of an adipose-derived anti-inflammatory protein, adiponectin. J Clin Endocrinol Metab. 2001;86:3815-3819. [Crossref]  [PubMed] 
  20. Ryan AS, Berman DM, Nicklas BJ, Elahi D. Adiponectin levels do not change with moderate dietary induced weight loss and exercise in obese postmenopausal women. Int J Obesity. 2003;27:1066-1071. [Crossref]  [PubMed] 
  21. Monzillo LU, Hamdy O, Horton ES, Ledbury S, Mullooly C, Jarema C, Porter S, Ovalle K, Moussa A, Mantzoros CS. Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res. 2003;11:1048-1054. [Crossref]  [PubMed] 
  22. Baratta R, Amato S, Degano C, Farina MG, Patane G, Vigneri R, Frittitta L. Adiponectin relationship with lipid metabolism is independent of body fat mass: evidence from both cross-sectional and intervention studies. J Clin Endocrinol Metab. 2004;89:2665-2671. [Crossref]  [PubMed] 
  23. Esposito K, Giugliano D. Mediterranean diet and the metabolic syndrome: the end of the beginning. Metab Syndr Relat Disord. 2010;8:197-200. [Crossref]  [PubMed] 
  24. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Jr., Brehm BJ, Bucher HC. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;13;166:285-293. [Crossref]  [PubMed]