Manny Noakes Research Director CSIRO FOOD AND NUTRITION Omega-3 Nutrition- Fish versus Supplements.
Www.csiro.au High Protein Low Carbohydrate Diets: Targeting Who Benefits Dr Manny Noakes Senior...
-
Upload
tobias-fennel -
Category
Documents
-
view
212 -
download
0
Transcript of Www.csiro.au High Protein Low Carbohydrate Diets: Targeting Who Benefits Dr Manny Noakes Senior...
www.csiro.au
High Protein Low Carbohydrate Diets: Targeting Who Benefits
Dr Manny Noakes
Senior Research Dietitian
CSIRO Human Nutrition (Clinical Research Unit)
Diabetes risk increases with obesity and will more than double, from 140 million to 300 million in the next 25 years.
Diabetes leads to serious complications such as heart, eye and kidney disease and a shortened life span.
Costs of obesity to community > $6b/y
Obesity Epidemic
Other terms that are used that generally refer to the same syndrome include:
Syndrome X
Metabolic Syndrome
Insulin Resistance Syndrome
Deadly Quartet
Syndromic Obesity
Constellation of major risk factors, life-habit risk factors and emerging risk factors
Over-represented among populations with heart disease
Clue is distinctive body-type with increased abdominal circumference (although some leaner men and women can have metabolic syndrome)
Metabolic Syndrome
ATP III Guidelines
Glucose Abdominal Obesity HDL-C BP TG
Glucose 6.1mmol/LWaist Circumference
102cm 88cm
HDL-C≤ 1.0 mmol/L≤ 1.3 mmol/L
BP 130/85 mmHgTriglycerides 1.7mmol/L
Diagnosis is made when 3 or more of these risk criteria are met
Diagnostic Criteria for Metabolic Syndrome
InactivityAging
Atherosclerosis
Genetics
Obesity
PCOS
Dyslipidemia
Hypertension
Type 2 diabetes
NASH
Genetics
Insulin Resistance: Causes and Associated Conditions
INSULIN RESISTANCE
* Total area under 3-hour response curve (mean of 2 tests). Olefsky JM et al. Am J Med. 1974;57:551-560.
625
500
400
300
200
100
100 200 300 400 500 600
Insulin Response to Oral Glucose*
Pla
sma
TG
(m
g/d
L)
r = 0.73P < 0.0001
Insulin Resistance and Hypertriglyceridemia
Ford ES, et al JAMA 2002
45
35
0
8814 aged 20 years or older from NHANES III (1988-1994)
The age-adjusted prevalence : men (24.0%) women (23.4%)
Prevalence of Metabolic Syndrome
0
5
10
15
20
25
30
35
40
45
20-29 30-39 40-49 50-59 60-69 >70
Marketing Weight Loss
Skov et al 1999
High-carbohydrate
(HC, protein 12% energy) n=25
High-protein
(HP, protein 25% energy) n=25
Results After 6 Months
5.1 kg in the HC group
8.9 kg in the HP group (P < 0.001)
More subjects lost > 10 kg in the HP group (35% vs 9%).
HP diet decreased fasting plasma triglycerides significantly.
Protein Versus Carbohydrate in ad libitum Fat Reduced Diet
Greater weight and fat loss (Skov et al,1999)
Obese subjects
Increased satiety (Latner & Schwartz, 1999)
Glucose tolerant women
Thermic effects (Hwalla Baba et al,1999)
Obese, hyperinsulinaemic men
Lean body mass spared (Piatti et al,1994)
Glucose tolerant women
High protein/Low GI (Dumesnil et al)
25% decrease in ad libitum intake
Obese men
Increased Protein / Carbohydrate Ratio
Insulin sensitivity (Clifton et al,1998)
Subjects with IGT
Greater abdominal fat mass loss (Parker et al 2002)
Type 2 diabetes
Greater lowering of LDL-C (Parker et al 2002)
Type 2 diabetes
Thermic effect of HP meal 28% greater (Luscombe et al 2002)
No change in REE
Type 2 diabetes
Greater lowering of TG (Farnsworth et al (in press))
Subjects with elevated insulin
Lean body mass spared (Farnsworth et al (in press))
Subjects with elevated insulin
Increase Protein / Carbohydrate Ration: CSIRO Studies
Renal Function
Urinary albumin excretion was not affected by dietary protein during weight loss:
N=19 with microalbuminuria.
HP diet: 24.2 to 19.8 mg/l (n=12)
LP diet: 4.3 to 3.5 mg/l (n=7)
Aim
To compare a high protein weight loss diet with a high carbohydrate diet in women participating in a 12 week intervention (and subsequent follow up for 1 year) on the following outcomes:
Weight loss and body composition
Nutrient status
Bone turnover markers
Measures of heart disease risk
.
Diets:
High carbohydrate
High protein, high red meat
High Meat Protein (5600 KJ)
Cereal
Low fat milk (250ml)
Wholemeal bread (2 slices)
Fruit (2)
Beef / lamb 200g - dinner
Chicken/fish/meat 100g - lunch
Vegetables 2.5 cups
Diet Yoghurt 200g
Canola oil 3 tsp
Wine 2 glasses/week (optional)
34% protein 20% fat 46% carbohydrate
109g protein 31g fat 161g carbohydrate
Cereal
SKIM milk (250ml)
Wholemeal bread (3 slices)
Fruit (3)
Chicken / pork / fish 80g
Vegetables 2.5 cups
Canola oil 3 tsp
Pasta/rice 120g cooked
Low fat biscuits 3
Wine 2 glasses/week (optional)
High Carbohydrate (5600 KJ)
17% protein 20% fat 64% carbohydrate
57g protein 31g fat 229g carbohydrate
Overall Results
Diet Average Weight Loss
Min Weight Loss
Max Weight Loss
N Dropouts
High Protein 7.6kg 0.55kg 18.2kg 51 5
High Carbohydrate 6.9kg 0.15kg 14.5kg 49 16
Weight Loss by Triglyceride Status
8.2
9.29.3
6.9
3
4
5
6
7
8
9
10
Low TG High TG
wei
gh
t lo
ss (
kg)
* Sig Diet Effect
High Protein
High Carb
Arm Fat
Leg Fat
Abdominal Fat
DEXA
5.135.86
6.28
3.63
0
2
4
6
8
high protein -low TG
highcarbohydrate-
low TG
high protein -high TG
highcarbohydrate-
high TG
kgTotal And Midriff Fat Loss - DEXA Data
* Sig Diet Effect
High Protein
High Carb
LDL Cholesterol
2
2.5
3
3.5
4
4.5
5
week 0 week 4 week 8 week 12
LD
L-C
mm
ol/L
4.8% High Protein
High Carb
Triglycerides
0.5
1
1.5
2
2.5
3
week 0 week 4 week 8 week 12
TG
(m
mo
l/L)
4%
13%
High Protein
High Carb
Triglycerides by TG status
0
0.5
1
1.5
2
2.5
week 0 week 4 week 8 week 12
TG
mm
ol/L
HIGH TG
LOW TG
10%
28%
High Protein
High Carb
DIET
% c
han
ge
in T
G30
20
10
0
-10
insulin split
low insulin
high insulin
High Protein High Carb
P=0.036
26%
9%
Triglyceride Change By Insulin Status
Ch
ang
e in
TG
Insulin Split
Low Insulin
High Insulin
Cal
ciu
m e
xcre
tio
n m
mo
l/24
hr
High Protein High Carb
Week 0
Week 12
Reference Range: 2.5-7.5mmol/24hr
Calcium Excretion
Calcium excretion decreased on both diets
Protein versus Carbohydrate and Markers of Bone Turnover
Deoxypyridinoline/creatinine ratio Pyridinolone /creatinine ratio
High Protein High CarbHigh Protein High Carb
Both weight loss strategies associated with increased bone turnover.No effect of diet composition.
Week 0
Week 12
Haemoglobin
High Protein High Carb
Reference Range:115-165g/L
*
No change
Mea
n
Week 0
Week 12
Vitamin B12
High Protein High Carb
Reference Range: 140-700pmol/L12%
increase
13%decrease
Week 0
Week 12
Conclusion #1
Moderately High protein high red meat diets and conventional high carbohydrate weight loss diets provide health benefits.
Plasma triglycerides lowered on average 9%.
LDL cholesterol lowered on average 5%.
Insulin lowered on average 19%.
Glucose lowered on average 4%.
Conclusion #2
Moderately high protein high red meat diets provide advantages in women.
Greater weight, fat and midriff loss on high protein diet in those women with elevated TG.
Greater lowering of plasma triglycerides on high protein diet in those women with elevated insulin or TG.
Haemoglobin levels improved more on high protein high red meat diet.
B12 status improved on high protein high red meat diet.
Conclusion #3
Moderately high protein diets can be a safe and effective option to conventional high carbohydrate weight loss diets.
For some, HP diet may be easier to follow for longer periods as it may be more satisfying.
HP diet as used in this study is safe and nutritionally adequate.
It was easier to achieve RDI for all nutrients on HP diet.
Questions?
Book 1 published in May 2005.
Booklet released in August 2003 in the Australian Women’s weekly, then as a free booklet by Meat & Livestock Australia (MLA).
www.csiro.au
Thank You
CSIRO Human Nutrition
Name Associate Professor Dr Manny Noakes
Title Senior Dietitian / Research Scientist
Phone +61 8 8303 8827
Email [email protected]
Web www.csiro.au/twd
Contact CSIRO
Phone 1300 363 400
+61 3 9545 2176
Email [email protected]
Web www.csiro.au