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Interventions and public health nutrition

Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: results from the Diogenes trial

European Journal of Clinical Nutrition volume 67, pages 990–995 (2013)Cite this article

Subjects

Abstract

Background/Objectives:

To investigate acceptability and tolerability of diets of different protein and glycemic index (GI) content aimed at weight maintenance following a phase of rapid weight loss, as part of a large pan-European dietary intervention trial.

Subjects/Methods:

The Diogenes study (www.diogenes-eu.org) consisted of an initial 8-week rapid weight-loss phase (800–1000 kcal/day), followed by a 6-month weight maintenance intervention with five different diets varying in protein and GI content. Measurement of a range of outcomes relating to experience of the Diogenes diets in terms of acceptability, experience and mood were recorded via end of day questionnaires throughout the study.

Results:

Weight change during the initial weight loss phase weakly, but positively correlated with acceptability of the programme (r range=−0.08 to 0.2, P⩽0.05, n=685 on four of five dimensions). Success at weight maintenance positively correlated with acceptance of the programme (r range=−0.21 to −0.34, P<0.001, n=540 for all five dimensions). The diets with higher protein content were more acceptable than the low protein (LP) diets, however, no differences between the high vs low GI diets were found concerning acceptability and tolerability.

Conclusions:

Results suggest that moderately high protein diets, compared with LP diets, are more acceptable diets for weight control in overweight individuals.

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References

  1. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM . Meta-analysis: the effect of dietary counseling for weight loss. Ann Int Med 2007; 147: 41.

    Article  Google Scholar 

  2. Astrup A, Larsen TM, Harper A . Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet 2004; 364: 897–899.

    Article  Google Scholar 

  3. Sloth B, Krog-Mikkelsen I, Flint A, Tetens I, Björck I, Vinoy S et al. No difference in body weight decrease between a low-glycemic-index and a high-glycemic-index diet but reduced LDL cholesterol after 10-wk ad libitum intake of the low-glycemic-index diet. Am J Clin Nutr 2004; 80: 337.

    Article  CAS  Google Scholar 

  4. Eisenstein J, Roberts SB, Dallal G, Saltzman E . High-protein weight-loss diets: are they safe and do they work? A review of the experimental and epidemiologic data. Nutr Rev 2002; 60: 189–200.

    Article  Google Scholar 

  5. Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS . A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatrics Adolescent Med 2003; 157: 773.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Aller EEJG, Abete I, Astrup A, Martinez JA, Baak MAv . Starches, sugars and obesity. Nutrients 2011; 3: 341–369.

    Article  CAS  Google Scholar 

  8. Soenen S, Westerterp-Plantenga MS . Proteins and satiety: implications for weight management. Curr Opin Clin Nutr Metab Care 2008; 11: 747–751.

    Article  CAS  Google Scholar 

  9. Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M . Protein, weight management, and satiety. Am J Clin Nutr 2008; 87: 1558S–1561S.

    Article  CAS  Google Scholar 

  10. Layman DK, Evans E, Baum JI, Seyler J, Erickson DJ, Boileau RA . Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J Nutr 2005; 135: 1903–1910.

    Article  CAS  Google Scholar 

  11. Skov A, Toubro S, Rønn B, Holm L, Astrup A . Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 1999; 23: 528.

    Article  CAS  Google Scholar 

  12. Weigle DS, Breen PA, Matthys CC, Callahan HS, Meeuws KE, Burden VR et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr 2005; 82: 41–48.

    Article  CAS  Google Scholar 

  13. Brand-Miller JC, Holt SHA, Pawlak DB, McMillan J . Glycemic index and obesity. Am J Clin Nutr 2002; 76: 281S.

    Article  CAS  Google Scholar 

  14. Thomas D, Elliott E, Baur L . Low glycaemic index or low glycaemic load diets for overweight and obesity (Review). Cochrane Database Syst Rev 2007;; 3.

  15. Bornet FRJ, Jardy-Gennetier AE, Jacquet N, Stowell J . Glycaemic response to foods: impact on satiety and long-term weight regulation. Appetite 2007; 49: 535–553.

    Article  CAS  Google Scholar 

  16. Nuttall F, Gannon M . Metabolic response of people with type 2 diabetes to a high protein diet. Nutr Metab 2004; 1: 6.

    Article  Google Scholar 

  17. Brand-Miller J, Colagiuri S, Gan S . Insulin sensitivity predicts glycemia after a protein load. Metabolism 2000; 49: 1–5.

    Article  CAS  Google Scholar 

  18. Ludwig DS, Ebbeling CB . Weight-loss maintenance—Mind over Matter? N Engl J Med 2010; 363: 2159–2161.

    Article  CAS  Google Scholar 

  19. VanWormer JJ, Martinez AM, Cosentino D, Pronk NP . Satisfaction With a Weight Loss Program: What Matters? Am J Health Promotion 2010; 24: 238–245.

    Article  Google Scholar 

  20. Larsen TM, Dalskov S, van Baak M, Jebb S, Kafatos A, Pfeiffer A et al. 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.

    Article  CAS  Google Scholar 

  21. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AFH et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med 2010; 363: 2102–2113.

    Article  CAS  Google Scholar 

  22. Gögebakan Ö, Kohl A, Osterhoff MA, van Baak MA, Jebb SA, Papadaki A et al. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors/clinical perspective. Circulation 2011; 124: 2829–2838.

    Article  Google Scholar 

  23. Moore C, Lindroos A, Kreutzer M, Larsen T, Astrup A, van Baak M et al. Dietary strategy to manipulate ad libitum macronutrient intake, and glycaemic index, across eight European countries in the Diogenes Study. Obes Rev 2010; 11: 67–75.

    Article  CAS  Google Scholar 

  24. Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AFH et al. The effect of protein and glycemic index on children’s body composition: The DiOGenes Randomized Study. Pediatrics 2010; 126: e1143–e1152.

    Article  Google Scholar 

  25. McConnon A, Raats M, Astrup A, Bajzová M, Handjieva-Darlenska T, Lindroos AK et al. Application of the Theory of planned behaviour to weight control in an overweight cohort. results from a pan-European dietary intervention trial (DiOGenes). Appetite 2012; 58: 313–318.

    Article  Google Scholar 

  26. Handjieva-Darlenska T, Handjiev S, Larsen TM, van Baak MA, Jebb S, Papadaki A et al. 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: 994–999.

    Article  CAS  Google Scholar 

  27. WMA. The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects 2004;, Ferney-Voltaire, France: World Medical Association.

  28. Jones N, Furlanetto D, Jackson J, Kinn S . An investigation of obese adults’ views of the outcomes of dietary treatment. J Human Nutr Diet 2007; 20: 486–494.

    Article  CAS  Google Scholar 

  29. Polivy J, Herman CP . The effects of resolving to diet on restrained and unrestrained eaters: the ‘false hope syndrome’. Int J Eat Disord 1999; 26: 434–447.

    Article  CAS  Google Scholar 

  30. Polivy J, Herman CP . The False-Hope Syndrome. Curr Directions Psychol Sci 2000; 9: 128.

    Article  Google Scholar 

  31. Finch EA, Linde JA, Jeffery RW, Rothman AJ, King CM, Levy RL . The effects of outcome expectations and satisfaction on weight loss and maintenance: correlational and experimental analyses—a randomized trial. Health Psychol 2005; 24: 608–616.

    Article  Google Scholar 

  32. Dalle Grave R, Calugi S, Molinari E, Petroni ML, Bondi M, Compare A et al. Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Obesity Research 2005; 13: 1961–1969.

    Article  Google Scholar 

  33. Rothman AJ . Toward a theory-based analysis of behavioral maintenance. Health Psychol 2001; 19: 64–69.

    Article  Google Scholar 

  34. Pratt C . Factors related to the completion of a weight reduction program. J Am Diet Assoc 1990; 90: 1268.

    CAS  PubMed  Google Scholar 

  35. Pratt CA, McLaughlin GW, Gaylord C . A multivariate analysis of weight-loss behavior. Psychol Rep 1992; 71: 1075–1084.

    Article  CAS  Google Scholar 

  36. Stubbs R, Van Wyk M, Johnstone A, Harbron C . Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. Eur J Clin Nutr 1996; 50: 409.

    CAS  PubMed  Google Scholar 

  37. Rolls BJ, Hetherington M, Burley VJ . The specificity of satiety: the influence of foods of different macronutrient content on the development of satiety. Physiol Behav 1988; 43: 145–153.

    Article  CAS  Google Scholar 

  38. Barkeling B, Rössner S, Björvell H . Effects of a high-protein meal (meat) and a high-carbohydrate meal (vegetarian) on satiety measured by automated computerized monitoring of subsequent food intake, motivation to eat and food preferences. Int J Obesity 1990; 14: 743–751.

    CAS  Google Scholar 

  39. Clifton PM, Keogh JB, Noakes M . Long-term effects of a high-protein weight-loss diet. Am J Clin Nutr 2008; 87: 23–29.

    Article  CAS  Google Scholar 

  40. 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: 1298–1306.

    Article  CAS  Google Scholar 

  41. Baba NH, Sawaya S, Torbay N, Habbal Z, Azar S, Hashim S . High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects. Int J Obes Relat Metab Disord J Int Assoc Study Obes 1999; 23: 1202.

    Article  CAS  Google Scholar 

  42. Boan J, Kolotkin R, Westman E, McMahon R, Grant J . Binge eating, quality of life and physical activity improve after roux-en-y gastric bypass for morbid obesity. Obes Surg 2004; 14: 341–348.

    Article  Google Scholar 

  43. Holm L, Hoff A, Erichsen L, Møhl M, Toubro S, Astrup A . Social and cultural acceptability of fat reduced diets among Danish overweight subjects: high-protein versus high-carbohydrate diets. Food Quality Preference 2008; 19: 43–50.

    Article  Google Scholar 

  44. Lloyd HM, Green MW, Rogers PJ . Mood and cognitive performance effects of isocaloric lunches differing in fat and carbohydrate content. Physiol Behav 1994; 56: 51–57.

    Article  CAS  Google Scholar 

  45. Rosen JC, Hunt DA, Sims E, Bogardus C . Comparison of carbohydrate-containing and carbohydrate-restricted hypocaloric diets in the treatment of obesity: effects of appetite and mood. Am J Clin Nutr 1982; 36: 463–469.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the staff of the dietary intervention centres for their work in recruitment and data collection. This work was funded by a grant from the EU Food Quality and Safety Priority of the Sixth Framework Programme, contract no. FP6-2005-513946.

Author information

Authors and Affiliations

  1. The Food, Consumer Behaviour and Health Research Centre, School Psychology, University of Surrey, Guildford, UK

    A McConnon, R Shepherd & M M Raats

  2. Biomathematics and Statistics Scotland, Scotland, UK

    G W Horgan

  3. Human Appetite Research Unit, Institute of Psychological Sciences, University of Leeds, Leeds, UK

    C Lawton

  4. Nutrition Department, Slimming World, Derbyshire, UK

    J Stubbs

  5. Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Copenhagen, Denmark

    A Astrup & T M Larsen

  6. National Multiprofile Transport Hospital, Sofia, Bulgaria

    T Handjieva-Darlenska

  7. Department of Sport Medicine, Charles University in Prague, Prague, Czech Republic

    M Kunešová

  8. MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK

    A K Lindroos

  9. National Food Agency, Uppsala, Sweden

    A K Lindroos

  10. Department of Physiology and Nutrition, University of Navarra, Navarra, Spain

    J A Martinez

  11. Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Heraklion, Greece

    A Papadaki

  12. Department of Clinical Nutrition, German Institute of Human Nutrition, Potsdam, Arthur-Scheunert Allee 114-116, Nuthetal, Germany

    A F H Pfeiffer

  13. Department of Endocrinology, Diabetes and Nutrition, Charité University Medicine Berlin, Berlin, Germany

    A F H Pfeiffer

  14. Department of Human Biology, NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands

    M A van Baak

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Correspondence to A McConnon.

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Competing interests

TML and AA report that their department, the Department of Nutrition, Exercise and Sport at the University of Copenhagen, has received research support from 100 food companies for this and other studies. AA reports serving as Advisor or member of advisory boards for a number of food and pharmaceutical producers and so on: Communications and Scientific Advisory Board of The Global Dairy Platform, Kraft Health and Wellness Advisory Council, Glenview, Il, USA; Scientifc Board member, Beer Knowledge Institute (Amsterdam); Arena Pharmaceuticals, San Diego, USA; Basic Research, Salt Lake City, USA; Novo Nordisk, Denmark, Pathway Genomics Corporation, La Jolla, USA; Jennie Craig, Carlsbad, USA; Vivus, Mountain View, USA; Recipient of honoraria as speaker for a wide range of Danish and international concerns. AFHP reports serving as a board member or receiving consulting fees from Danone Medical Nutrition and also reports that his institution, the German Institute of Human Nutrition, receives grants from Bundesministerium für Bildung und Forschung, the German Diabetes Foundation, the German Research Foundation DFG, Bayer, and Rettenmayer and Soehne. MAB reports receiving lecture fees from Nutrition et Santé (Belgium), and Asociación General Fabricantes de Azúcar (Spain); she also reports that her institution, Maastricht University Medical Center, received research support from Top Institute Food and Nutrition (Wageningen, the Netherlands) and a commercial obesity treatment center, Center for Obesity Europe (Heerlen, the Netherlands). GWH reports having done consultancy for a weight loss company, a food retailer and a functional foods producer in recent years. JS reports working for the commercial slimming organisation, Slimming World. MMR’s research centre has provided consultancy to and received travel funds to present research results from organisations supported by food and drinks companies. The remaining authors declare no conflict of interest.

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McConnon, A., Horgan, G., Lawton, C. et al. Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: results from the Diogenes trial. Eur J Clin Nutr 67, 990–995 (2013). https://doi.org/10.1038/ejcn.2013.99

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