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A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes

Abstract

Background/Objectives:

There is controversy over dietary protein's effects on cardiovascular disease risk factors in diabetic subjects. It is unclear whether observed effects are due to increased protein or reduced carbohydrate content of the consumed diets. The aim of this study was to compare the effects of two diets differing in protein to fat ratios on cardiovascular disease risk factors.

Subjects/Methods:

A total of 17 obese (body mass index (BMI) ranging from 31 to 45 kg/m2) volunteers with type 2 diabetes (DM2), aged 46±3 years, consumed two diets, each for 4 weeks, with 3 weeks of washout period in a random, blind, crossover design. The diets were: (1) a high-protein low-fat diet (HP–LF, with 30% protein, 50% carbohydrates and 20% fat) and (2) a low-protein high-fat diet (LP–HF, with 15% protein, 50% carbohydrates and 35% fat). Their effects on fasting glycemic control, lipid levels and blood pressure, and on postprandial glucose and insulin responses after a standard test meal at the beginning and end of each dietary intervention were analyzed.

Results:

Both diets were equally effective in promoting weight loss and fat loss and in improving fasting glycemic control, total cholesterol and low-density lipoprotein (LDL) cholesterol, but the HP–LF diet decreased to a greater extent triglyceride (TG) levels (P=0.04) when compared with the LP–HF diet. HP–LF diet improved significantly both systolic and diastolic blood pressure when compared with the LP–HF diet (P<0.001 and P<0.001, respectively). No differences were observed in postprandial glucose and insulin responses.

Conclusions:

A protein to fat ratio of 1.5 in diets significantly improves blood pressure and TG concentrations in obese individuals with DM2.

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References

  • American Diabetes Association (2008). Diagnosis and classification of diabetes mellitus. Diabetes Care 31, S55–S60.

    Article  Google Scholar 

  • Barre DE (2007). The role of consumption of alpha-linolenic, eicosapentaenoic and docosahexaenoic acids in human metabolic syndrome and type 2 diabetes—a mini review. J Oleo Sci 56, 319–325.

    CAS  Article  Google Scholar 

  • Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G et al. (1998). Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes 47, 1643–1649.

    CAS  Article  Google Scholar 

  • Claessens M, Saris WH, van Baak MA (2008). Glucagon and insulin responses after ingestion of different amounts of intact and hydrolysed proteins. Br J Nutr 100, 61–69.

    CAS  Article  Google Scholar 

  • Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB et al. (2006). Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 91, 4930–4937.

    CAS  Article  Google Scholar 

  • Farnsworth E, Luscombe ND, Noakes M, Wittert G, Argyiou E, Clifton PM (2003). Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Am J Clin Nutr 78, 31–39.

    CAS  Article  Google Scholar 

  • Friedewald WT, Levy RI, Fredrickson DS (1972). Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18, 499–502.

    CAS  PubMed  Google Scholar 

  • Garg A, Bonanome A, Grundy SM, Zhang ZJ, Unger RH (1988). Comparison of a high-carbohydrate diet with a high monounsaturated-fat diet in patients with non-insulin dependent diabetes mellitus. N Engl J Med 319, 829–834.

    CAS  Article  Google Scholar 

  • Ginsberg HN (2000). Insulin resistance and cardiovascular disease. J Clin Invest 106, 453–458.

    CAS  Article  Google Scholar 

  • Harris JA, Benedict FG (1919). A Biometric Study of Basal Metabolism in Man. Carnegie Institute of Washington: Washington DC. (Publication 279).

    Google Scholar 

  • Joannic JL, Auboiron S, Raison J, Basdevant A, Bornet F, Guy-Grand B (1997). How the degree of unsaturation of dietary fatty acids influences the glucose and insulin responses to different carbohydrates in mixed meals. Am J Clin Nutr 65, 1427–1433.

    CAS  Article  Google Scholar 

  • Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL (2008). Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc 108, 91–100.

    CAS  Article  Google Scholar 

  • Liu L, Ikeda K, Sullivan DH, Ling W, Yamori Y (2002). Epidemiological evidence of the association between dietary protein intake and blood pressure: a meta-analysis of published data. Hypertens Res 25, 689–695.

    CAS  Article  Google Scholar 

  • Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM (2005). Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids. Am J Clin Nutr 81, 762–772.

    CAS  Article  Google Scholar 

  • Matsuda M, DeFronzo RA (1999). Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 22, 1462–1470.

    CAS  Article  Google Scholar 

  • Papakonstantinou E, Panagiotakos DB, Pitsavos C, Chrysohoou C, Zampelas A, Skoumas Y et al. (2005). Food group consumption and glycemic control in people with and without type 2 diabetes: the ATTICA study. Diabetes Care 28, 2539–2540.

    Article  Google Scholar 

  • Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Iraklianou S, Berdanier CD, Zampelas A (2010). A high protein low fat meal does not influence glucose and insulin responses in obese individuals with or without type 2 diabetes. J Hum Nutr Diet (epub ahead of print 22 January 2010).

  • Parker B, Noakes M, Luscombe N, Clifton P (2002). Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 25, 425–430.

    Article  Google Scholar 

  • Petersen A, Marckmann P, Sanstrom B (1999). Postprandial lipoprotein, glucose and insulin responses after two consecutive meals containing rapeseed oil, sunflower or palm oil with or without glucose at the first meal. Br J Nutr 82, 97–104.

    Google Scholar 

  • Piatti PM, Monti F, Fermo I, Baruffaldi L, Nasser R, Santambrogio G et al. (1994). Hypocaloric high-protein diet improves glucose oxidation and spares lean body mass: comparison to hypocaloric high-carbohydrate diet. Metabolism 43, 1481–1487.

    CAS  Article  Google Scholar 

  • Rasmussen O, Lauszus FF, Christiansen C, Thomsen C, Hermansen K (1996). Differential effects of saturated and monounsaturated fat on blood glucose and insulin responses in subjects with non-insulin-dependent diabetes mellitus. Am J Clin Nutr 63, 249–253.

    CAS  Article  Google Scholar 

  • Robertson MD, Jackson KG, Fielding BA, Williams CM, Frayn KN (2002). Acute effects of meal fatty acid composition on insulin sensitivity in healthy post-menopausal women. Br J Nutr 88, 635–640.

    CAS  Article  Google Scholar 

  • Sharman MJ, Gomez AL, Kraemer WJ, Volek JS (2004). Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men. J Nutr 134, 880–885.

    CAS  Article  Google Scholar 

  • Skov AR, Toubro S, Ronn B, Holm L, Astrup A (1999). Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord 23, 528–536.

    CAS  Article  Google Scholar 

  • Storlien LH, Baur LA, Kriketos AD, Pan DA, Cooney GJ, Jenkins AB et al. (1996). Dietary fats and insulin action. Diabetologia 39, 621–631.

    CAS  Article  Google Scholar 

  • Thomsen C, Rasmussen O, Lousen T, Holst JJ, Fenselau S, Schrezenmeir J et al. (1999). Differential effects of saturated and monounsaturated fatty acids on postprandial lipaemia and incretin responses in healthy subjects. Am J Clin Nutr 69, 1135–1143.

    CAS  Article  Google Scholar 

  • Thomsen C, Storm H, Holst JJ, Hermansen K (2003). Differential effects of saturated and monounsaturated fats on postprandial lipemia and glucagon-like peptide 1 responses in subjects with type 2 diabetes. Am J Clin Nutr 77, 605–611.

    CAS  Article  Google Scholar 

  • van Loon LJ, Kruijshoop M, Menheere PP, Wagenmakers AJ, Saris WH, Kveizer HA (2003). Amino acid ingestion strongly enhances insulin secretion in patients with long-term type 2 diabetes. Diabetes Care 26, 625–630.

    CAS  Article  Google Scholar 

  • Vazquez JA, Kazi U, Madani N (1995). Protein metabolism during weight reduction with very-low-energy diets: evaluation of the independent effects of protein and carbohydrate on protein sparing. Am J Clin Nutr 62, 93–103.

    CAS  PubMed  Google Scholar 

  • Volek J, Sharman M, Gomez A, Judelson D, Rubin M, Watson G et al. (2004). Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nuvtr Metab (Lond) 1, 13.

    Article  Google Scholar 

  • Wolfe BM, Giovannetti PM (1991). Short-term effects of substituting protein for carbohydrate in the diets of moderately hypercholesterolemic human subjects. Metabolism 40, 338–343.

    CAS  Article  Google Scholar 

  • World Health Organization (1989). Measuring obesity-classification and description of anthropometric data. Report on a WHO consultation of the epidemiology of obesity. Warsaw. 21–23 October 1987 World Health Organization: Copenhagen, Denmark.

  • Zampelas A, Murphy M, Morgan LM, Williams CM (1994). Postprandial lipoprotein lipase, insulin and gastric inhibitory polypeptide responses to test meals of different fatty acid composition: comparison of saturated, n-6 and n-3 polyunsaturated fatty acids. Eur J Clin Nutr 48, 849–858.

    CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Mrs Lavidopoulou Fani, head nurse of 1st Pathology Unit of Tzanio General Hospital of Piraeus for her invaluable help with patient evaluation, screening and blood drawing and Dr Iraklianou Stella for her help with patient recruitment. This work was funded by Novartis Hellas, S.A.C.I., Metamorfossi, Greece.

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Correspondence to A Zampelas.

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The authors declare no conflict of interest.

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Contributors: EP and AZ were responsible for the conception of the study, the perspective under which it was conducted and conducted the analyses. All authors were responsible for literature search and writing and editing the sections of the manuscript related to each author's area of expertise.

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Papakonstantinou, E., Triantafillidou, D., Panagiotakos, D. et al. A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes. Eur J Clin Nutr 64, 595–602 (2010). https://doi.org/10.1038/ejcn.2010.29

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  • DOI: https://doi.org/10.1038/ejcn.2010.29

Keywords

  • diet
  • protein
  • coronary heart disease
  • diabetes
  • obesity

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