Original Article | Published:

Interventions and public health nutrition

Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial

European Journal of Clinical Nutrition volume 68, pages 350357 (2014) | Download Citation

Contributors: Study concept and design; acquisition of data; and drafting the manuscript: CM, SS, MR, CL, TO, and BL. Analysis and interpretation of data and critical revision of the manuscript for important intellectual content: all the authors. Statistical analysis: CM, SS. ME, and BL. Obtained funding: TO, BL, and MR. Administrative, technical or material support: SB, CL, TO, and BL. Study supervision: MR, CL, TO, and BL.

Subjects

Abstract

Background/Objectives:

Short-term studies have suggested beneficial effects of a Palaeolithic-type diet (PD) on body weight and metabolic balance. We now report the long-term effects of a PD on anthropometric measurements and metabolic balance in obese postmenopausal women, in comparison with a diet according to the Nordic Nutrition Recommendations (NNR).

Subjects/Methods:

Seventy obese postmenopausal women (mean age 60 years, body mass index 33 kg/m2) were assigned to an ad libitum PD or NNR diet in a 2-year randomized controlled trial. The primary outcome was change in fat mass as measured by dual-energy X-ray absorptiometry.

Results:

Both groups significantly decreased total fat mass at 6 months (−6.5 and−2.6 kg) and 24 months (−4.6 and−2.9 kg), with a more pronounced fat loss in the PD group at 6 months (P<0.001) but not at 24 months (P=0.095). Waist circumference and sagittal diameter also decreased in both the groups, with a more pronounced decrease in the PD group at 6 months (−11.1 vs−5.8 cm, P=0.001 and−3.7 vs−2.0 cm, P<0.001, respectively). Triglyceride levels decreased significantly more at 6 and 24 months in the PD group than in the NNR group (P<0.001 and P=0.004). Nitrogen excretion did not differ between the groups.

Conclusions:

A PD has greater beneficial effects vs an NNR diet regarding fat mass, abdominal obesity and triglyceride levels in obese postmenopausal women; effects not sustained for anthropometric measurements at 24 months. Adherence to protein intake was poor in the PD group. The long-term consequences of these changes remain to be studied.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , , , , et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377: 557–567.

  2. 2.

    , , , , , et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–2260.

  3. 3.

    , , , , , et al. Abdominal adiposity and coronary heart disease in women. JAMA 1998; 280: 1843–1848.

  4. 4.

    , , , , , et al. Understanding weight gain at menopause. Climacteric 2012; 15: 419–429.

  5. 5.

    , . The role of high-protein diets in body weight management and health. Br J Nutr 2012; 108 (Suppl 2), S130–S138.

  6. 6.

    , , , , . 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.

  7. 7.

    , , , , , et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.

  8. 8.

    , , , , . Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 2009; 63: 947–955.

  9. 9.

    , , , , , et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol 2009; 8: 35.

  10. 10.

    , , , , , et al. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007; 50: 1795–1807.

  11. 11.

    , , , . Effects of a short-term intervention with a paleolithic diet in healthy volunteers. Eur J Clin Nutr 2008; 62: 682–685.

  12. 12.

    , , , , , et al. Nordic Nutrition Recommendations 2004 – integrating nutrition and physical activity. Scand J Nutr 2004; 48: 178–187.

  13. 13.

    , , , , , et al. A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. J Intern Med 2013; 274: 67–76.

  14. 14.

    , . The use of 4-aminobenzoic acid as a marker to validate the completeness of 24 h urine collections in man. Clin Sci (Lond) 1983; 64: 629–635.

  15. 15.

    , , , , . Reliability and validity of the combined heart rate and movement sensor Actiheart. Eur J Clin Nutr 2005; 59: 561–570.

  16. 16.

    , , , , , et al. Hierarchy of individual calibration levels for heart rate and accelerometry to measure physical activity. J Appl Physiol 2007; 103: 682–692.

  17. 17.

    , , , . Gaussian process robust regression for noisy heart rate data. IEEE Trans Biomed Eng 2008; 55: 2143–2151.

  18. 18.

    , , , , , et al. Menopausal status and hepatic steatosis in a general female population. Gut 2007; 56: 594–595.

  19. 19.

    , , , , . Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord 1999; 23: 528–536.

  20. 20.

    , , , , . A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease. Nutr Metab (Lond) 2010; 7: 85.

  21. 21.

    , . The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr 2004; 23: 373–385.

  22. 22.

    , , , . Subjective satiety and other experiences of a Paleolithic diet compared to a diabetes diet in patients with type 2 diabetes. Nutr J 2013; 12: 105.

  23. 23.

    , , , , . Ghrelin and glucagon-like peptide 1 concentrations, 24-h satiety, and energy and substrate metabolism during a high-protein diet and measured in a respiration chamber. Am J Clin Nutr 2006; 83: 89–94.

  24. 24.

    , , , , , . Protein, weight management, and satiety. Am J Clin Nutr 2008; 87: 1558S–1561S.

  25. 25.

    , , , , , . A diet rich in long chain omega-3 fatty acids modulates satiety in overweight and obese volunteers during weight loss. Appetite 2008; 51: 676–680.

  26. 26.

    , , , . The health benefits of omega-3 polyunsaturated fatty acids: a review of the evidence. J Hum Nutr Diet 2004; 17: 449–459.

  27. 27.

    , , , , , . The effect of a high-MUFA, low-glycaemic index diet and a low-fat diet on appetite and glucose metabolism during a 6-month weight maintenance period. Br J Nutr 2009; 101: 1846–1858.

  28. 28.

    , . Proteins and satiety: implications for weight management. Curr Opin Clin Nutr Metab Care 2008; 11: 747–751.

  29. 29.

    , , , , , et al. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial. Am J Clin Nutr 2012; 95: 614–625.

  30. 30.

    , . A call for an end to the diet debates. JAMA 2013; 310: 687–688.

  31. 31.

    , . Family influences on food choice: context of surviving breast cancer. J Nutr Educ Behav 2004; 36: 320–326.

  32. 32.

    , . Age and gender differences in children's food preferences. Br J Nutr 2005; 93: 741–746.

  33. 33.

    , . Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 2004; 79: 6–16.

Download references

Acknowledgements

We thank all of the women who participated in this study for their invaluable patience and cooperation. Erik Hägg, Jonas Andersson, Lars-Göran Sjöström, Göran Ericsson, Inger Arnesjö, Katarina Iselid and Monica Holmgren made important contributions to screening the health of study subjects and technical assistance. Johanna Larsson helped process food records. Kate Westgate and Stefanie Mayle (MRC Epidemiology Unit, University of Cambridge, Cambridge, UK) assisted with processing physical activity data. Paul Franks contributed important views on planning the study. This study was supported by grants from The Swedish Council for Working Life and Social Research (2006-0699 and 2010-0398), the Swedish Research Council (K2011-12237-15-6), the Swedish Heart and Lung Foundation, the County Council of Västerbotten and Umeå University, Sweden.

Author information

Author notes

    • C Mellberg
    • , S Sandberg
    •  & M Ryberg

    These authors share first authorship.

    • T Olsson
    •  & B Lindahl

    These authors share senior authorship.

Affiliations

  1. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

    • C Mellberg
    • , M Ryberg
    •  & T Olsson
  2. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden

    • S Sandberg
    •  & B Lindahl
  3. Department of Statistics, USBE, Umeå University, Umeå, Sweden

    • M Eriksson
  4. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

    • S Brage
  5. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden

    • C Larsson
  6. Department of Food and Nutrition, Umeå University, Umeå, Sweden

    • C Larsson

Authors

  1. Search for C Mellberg in:

  2. Search for S Sandberg in:

  3. Search for M Ryberg in:

  4. Search for M Eriksson in:

  5. Search for S Brage in:

  6. Search for C Larsson in:

  7. Search for T Olsson in:

  8. Search for B Lindahl in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to C Mellberg.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/ejcn.2013.290