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Noronha JC, Nishi SK, Khan TA, Blanco Mejia S, Kendall CWC, Kahleová H, Rahelić D, Salas-Salvadó J, Leiter LA, Lean MEJ, Sievenpiper JL. Weight management using meal replacements and cardiometabolic risk reduction in individuals with pre-diabetes and features of metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2024; 25:e13751. [PMID: 38693302 DOI: 10.1111/obr.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
This review synthesized the evidence from randomized controlled trials comparing the effect of meal replacements (MRs) as part of a weight loss intervention with conventional food-based weight loss diets on cardiometabolic risk in individuals with pre-diabetes and features of metabolic syndrome. MEDLINE, EMBASE, and Cochrane Library were searched through January 16, 2024. Data were pooled using the generic inverse variance method and expressed as mean difference [95% confidence intervals]. The overall certainty of the evidence was assessed using GRADE. Ten trials (n = 1254) met the eligibility criteria. MRs led to greater reductions in body weight (-1.38 kg [-1.81, -0.95]), body mass index (BMI, -0.56 kg/m2 [-0.78, -0.34]), waist circumference (-1.17 cm [-1.93, -0.41]), HbA1c (-0.11% [-0.22, 0.00]), LDL-c (-0.18 mmol/L [-0.28, -0.08]), non-HDL-c (-0.17 mmol/L [-0.33, -0.01]), and systolic blood pressure (-2.22 mmHg [-4.20, -0.23]). The overall certainty of the evidence was low to moderate owing to imprecision and/or inconsistency. The available evidence suggests that incorporating MRs into a weight loss intervention leads to small important reductions in body weight, BMI, LDL-c, non-HDL-c, and systolic blood pressure, and trivial reductions in waist circumference and HbA1c, beyond that seen with conventional food-based weight loss diets.
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Affiliation(s)
- Jarvis C Noronha
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephanie K Nishi
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Alimentació, Nutrició, Desenvolupament i Salut Mental, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hana Kahleová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Alimentació, Nutrició, Desenvolupament i Salut Mental, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Lawrence A Leiter
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael E J Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Peres M, Costa HS, Silva MA, Albuquerque TG. The Health Effects of Low Glycemic Index and Low Glycemic Load Interventions on Prediabetes and Type 2 Diabetes Mellitus: A Literature Review of RCTs. Nutrients 2023; 15:5060. [PMID: 38140319 PMCID: PMC10746079 DOI: 10.3390/nu15245060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Diets with a low glycemic index (GI) and a low glycemic load (GL) can improve glycemic control, blood lipids, blood pressure and BMI in prediabetes and type 2 diabetes (T2DM), but evidence regarding other aspects of cardiometabolic health is limited. We searched the literature for RCTs published from 2013 to 2023 and reviewed the evidence on low-GI/GL diets and their effects on different aspects of health in prediabetes and T2DM, aiming to build a report on all relevant outcomes included in the studies. We included 14 RCTs with 1055 participants, who were mostly middle-aged individuals with T2DM. Interventions were mostly low GI and lasted 1-36 months. Low-GI/GL foods and diets showed benefits in terms of short-term glycemic control, weight and adiposity. Longer-term trials would be necessary to determine whether these benefits persist over time and/or lead to lower CVD risk and mortality. Effects on lipid profile were inconsistent. Some studies also reported positive effects of low-GI/GL interventions on blood pressure, inflammatory biomarkers, renal function and gut microbiota composition. Future trials should focus on some of these novel outcome measures, which may provide important insights into the metabolic effects of low-GI diets on individuals with diabetes.
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Affiliation(s)
- Maria Peres
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
| | - Helena S. Costa
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Mafalda Alexandra Silva
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Tânia Gonçalves Albuquerque
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Zhong Y, Chen X, Huang C, Chen Y, Zhao F, Hao R, Wang N, Liao W, Xia H, Yang L, Wang S, Sun G. The effects of a low carbohydrate diet combined with partial meal replacement on obese individuals. Nutr Metab (Lond) 2023; 20:18. [PMID: 36997952 PMCID: PMC10064565 DOI: 10.1186/s12986-023-00740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE We explored the dietary effects of replacing normal dietary staple foods with supplementary nutritional protein powder, dietary fiber, and fish oil on several metabolic parameters. We examined weight loss, glucose and lipid metabolism, and intestinal flora in obese individuals when compared with individuals on a reduced staple food low carbohydrate diet. METHODS From inclusion and exclusion criteria, 99 participants (28 kg/m2 ≤ body mass index (BMI) ≤ 35 kg/m2) were recruited and randomly assigned to control and intervention 1 and 2 groups. Physical examinations and biochemical indices were performed/gathered before the intervention and at 4 and 13 weeks post intervention. After 13 weeks, feces was collected and 16s rDNA sequenced. RESULTS After 13 weeks, when compared with controls, body weight, BMI, waist circumference, hip circumference, systolic blood pressure, and diastolic blood pressure values in intervention group 1 were significantly reduced. In intervention group 2, body weight, BMI, waist circumference, and hip circumference were significantly reduced. Triglyceride (TG) levels in both intervention groups were significantly reduced. Fasting blood glucose, glycosylated hemoglobin, glycosylated albumin, total cholesterol, and apolipoprotein B levels in intervention group 1 were decreased, while high density lipoprotein cholesterol (HDL-c) decreased slightly. Glycosylated albumin, TG, and total cholesterol levels in intervention group 2 decreased, while HDL-c decreased slightly, High sensitive C-reactive protein, MPO, Ox-LDL, LEP, TGF-β1, IL-6, GPLD1, pro NT, GPC-4, and LPS levels in both intervention groups were lower when compared with controls. Adiponectin (ADPN) levels in intervention groups were higher when compared with controls. Tumor necrosis factor-α (TNF-α) levels in intervention group 1 were lower when compared with controls. There is no obvious difference in α diversity and β diversity between intestinal flora of 3 groups. Among the first 10 species of Phylum, only the control group and the intervention group 2 had significantly higher Patescibacteria than the intervention group 1. Among the first 10 species of Genus, only the number of Agathobacter in intervention group 2 was significantly higher than that in control group and intervention group 1. CONCLUSIONS We showed that an LCD, where nutritional protein powder replaced some staple foods and dietary fiber and fish oil were simultaneously supplemented, significantly reduced weight and improved carbohydrate and lipid metabolism in obese individuals when compared with an LCD which reduced staple food intake.
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Affiliation(s)
- Yulian Zhong
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Ximin Chen
- Beijing Institute of Nutritional Resources, Beijing, 100069, China
| | - Chao Huang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Yuexiao Chen
- Institute of Biotechnology and Health, Beijing Academy of Science and Technology, Beijing, 100089, China
| | - Fengyi Zhao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Runhua Hao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Niannian Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Wang Liao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Hui Xia
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Ligang Yang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China.
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, Jiangsu, 210009, China
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Berg A, McCarthy HD. A soy-yoghurt-honey product as a therapeutic functional food: mode of action and narrative review. Heliyon 2022; 8:e11011. [DOI: 10.1016/j.heliyon.2022.e11011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/18/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
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Dharmalingam M, Das R, Jain S, Gupta S, Gupta M, Kudrigikar V, Bachani D, Mehta S, Joglekar S. Impact of Partial Meal Replacement on Glycemic Levels and Body Weight in Indian Patients with Type 2 Diabetes (PRIDE): A Randomized Controlled Study. Diabetes Ther 2022; 13:1599-1619. [PMID: 35834107 PMCID: PMC9281377 DOI: 10.1007/s13300-022-01294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Partial meal replacement (PMR) offers potential glycemic and weight control benefits in type 2 diabetes mellitus (T2DM) patients. We evaluated the clinical impact of PMR (diabetes-specific nutritional supplement [DSNS]) in overweight/obese Indian patients with T2DM. METHODS PRIDE, a 12-week, phase IV, open-label, multicenter study randomized (1:1) newly diagnosed T2DM patients (≤ 1 year) to either DSNS plus standard of care (SOC; diabetes treatment with dietary counseling) group (PMR) or SOC alone group (SOC). The primary endpoint was mean change in glycated hemoglobin (HbA1c) from baseline to week 12. Secondary endpoints were changes in glucose profiles, body weight, waist circumference, lipid profile, and factors impacting quality-of-life (QoL) at week 6 and 12 from baseline. Safety was assessed throughout the study. RESULTS Of the 176 patients enrolled, 171 (n = 85 in PMR group; n = 86 in SOC group) were included in the modified intent-to-treat population. The mean reduction in HbA1c at week 12 from baseline in PMR group was significant compared to the SOC group (- 0.59 vs. - 0.21%, p = 0.002). At week 12, the PMR group showed significant reduction in mean body weight (- 2.19 vs. - 0.22 kg; p = 0.001) and waist circumference (- 2.34 vs. - 0.48 cm; p = 0.001) compared to SOC group. Mean fasting plasma glucose and post-prandial glucose significantly reduced from baseline at week 6 and 12 in each group (p < 0.05). No significant change was observed in lipid profile. QoL parameters (treatment adherence, general well-being, and energy fulfilment) in the PMR were significantly better than SOC group (p < 0.05). Patients were satisfied with the taste of DSNS. No serious adverse events were reported. CONCLUSIONS DSNS is an encouraging option for PMR strategy, as it significantly improved HbA1c, body weight, waist circumference, and overall well-being among overweight/obese Indian T2DM patients. TRIAL IDENTIFICATION NO CTRI/2019/10/021595.
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Affiliation(s)
- Mala Dharmalingam
- Endocrinology and Diabetes Research Center and Laboratory, Bangalore, 560003, India
| | - Rupam Das
- Downtown Hospital, Guwahati, 781006, India
| | - Sandeep Jain
- Marudhar Hospital, Jaipur, Rajasthan, 302012, India
| | - Sachin Gupta
- Shubham Multispeciality Hospital, Amraiwadi, Ahmedabad, 380026, India
| | - Manoj Gupta
- Health Point Hospital, Kolkata, 700025, India
| | - Vinay Kudrigikar
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India.
| | - Deepak Bachani
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India
| | - Suyog Mehta
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India
| | - Sadhna Joglekar
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India
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Kim SY, Shin IS, Park YJ. Comparative effectiveness of a low-calorie diet combined with acupuncture, cognitive behavioral therapy, meal replacements, or exercise for obesity over different intervention periods: A systematic review and network meta-analysis. Front Endocrinol (Lausanne) 2022; 13:772478. [PMID: 36093081 PMCID: PMC9458910 DOI: 10.3389/fendo.2022.772478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the comparative effectiveness of a low-calorie diet (LCD) combined with acupuncture, cognitive behavioral therapy (CBT), meal replacements (MR), and exercise on weight loss. METHODS The electronic databases MEDLINE, EMBASE, CENTRAL, CNKI, RISS, and KISS were searched systematically. Randomized controlled trials (RCTs) that directly compared the effect of a low-calorie diet (LCD)-combined acupuncture, CBT, and exercise and an MR-based diet on weight loss with LCD-alone for adults with simple obesity (body mass index [BMI] > 25) published before August 2021 were included in the study. Two investigators extracted and coded the data using a template. Any disagreements between investigators were resolved through discussion. Changes in BMI or weight were transformed to Hedges' g values with a 95% CI, and network meta-analyses using a Bayesian random-effects model were conducted. RESULTS A total of thirty-two trials involving 3,364 patients were finally included in the study. The effect sizes of four interventions were medium, in the order of acupuncture (Hedges' g = 0.48, 95% CI = 0.25 - 0.71), CBT (Hedges' g = 0.42, 95% CI = 0.20 - 0.63), MR (Hedges' g = 0.32, 95% CI = 0.19 - 0.45), and exercise (Hedges' g = 0.27, 95% CI = 0.06 - 0.46).In terms of intervention period, acupuncture was effective in the short period (≤ 12 weeks, Hedges' g = 0.39, 95% CI = 0.12 - 0.67) and the long period (>12 weeks, Hedges' g = 0.89, 95% CI = 0.37 - 1.40), whereas CBT (Hedges' g = 0.51, 95% CI = 0.26 - 0.76) and exercise (Hedges' g = 0.37, 95% CI = 0.12 - 0.59) were effective only in the long period. MR was effective only in the short period (Hedges' g = 0.35, 95% CI = 0.18 - 0.53). CONCLUSIONS This study suggests that acupuncture, CBT, MR, and exercise for simple obesity show a medium effect size, and their effectiveness differs according to the intervention period.
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Affiliation(s)
- Seo-Young Kim
- Department of Biofunctional Medicine & Diagnostics of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - In-Soo Shin
- Department of Transdisciplinary Security, Dongguk University, Seoul, South Korea
| | - Young-Jae Park
- Department of Biofunctional Medicine & Diagnostics of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Department of Biofunctional Medicine & Diagnostics, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Department of Diagnosis and Biofunctional Medicine, College of Korean Medicine Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- *Correspondence: Young-Jae Park,
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Coutts A. The nurse's role in providing strategies and advice on weight management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S20-S27. [PMID: 34839689 DOI: 10.12968/bjon.2021.30.21.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Maintaining a healthy weight is a concern for a large proportion of adults in the UK, with obesity rates having almost doubled between 1993 and 2011. With overweight and obesity linked to several diseases and health conditions, nurses are often tasked with raising the subject with their clients/patients and advising on lifestyle modifications. This article examines ways to identify whether a person needs to lose weight and establishing targets. It then reviews the evidence base for different approaches to weight management currently available and the advice nurses can provide.
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Affiliation(s)
- Alison Coutts
- Senior Lecturer, School of Health Sciences, City, University of London
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Meal replacement by formula diet reduces weight more than a lifestyle intervention alone in patients with overweight or obesity and accompanied cardiovascular risk factors-the ACOORH trial. Eur J Clin Nutr 2020; 75:661-669. [PMID: 33128036 DOI: 10.1038/s41430-020-00783-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/03/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND As formula diets have demonstrated to be effective in reducing weight, we hypothesised that in patients with overweight or obesity and accompanied cardiovascular risk factors, combining a liquid formula diet with a lifestyle intervention is superior in reducing weight and improving cardiovascular risk factors than lifestyle intervention alone. METHODS In this multicenter RCT 463 participants with overweight or obesity (BMI: 27-35 kg/m²; at least one additional co-morbidity of the metabolic syndrome) were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 155) or a lifestyle intervention group including a liquid meal replacement (INT, n = 308). Both groups used telemonitoring devices (scales and pedometers), received information on healthy diet and were instructed to increase physical activity. Telemonitoring devices automatically transferred data into a personalised online portal and acquired data were discussed. INT obtained a liquid meal replacement substituting three meals/day (~1200 kcal) within the first week. During weeks 2-4, participants replaced two meals/day and during weeks 5-26 only one meal/day was substituted (1300-1500 kcal/day). Follow-up was conducted after 52 weeks. Intention-to-treat analyses were performed. Primary outcome was weight change. Secondary outcomes comprised changes in cardiometabolic risk factors including body composition and laboratory parameters. RESULTS From the starting cohort 360 (78%, INT: n = 244; CON: n = 116) and 317 (68%, INT: n = 216; CON: n = 101) participants completed the 26-weeks intervention phase and the 52-weeks follow-up. The estimated treatment difference (ETD) between both groups was -3.2 kg [-4.0; -2.5] (P < 0.001) after 12 weeks and -1.8 kg [-2.8; -0.8] (P < 0.001) after 52 weeks. CONCLUSIONS A low-intensity lifestyle intervention combined with a liquid meal replacement is superior regarding weight reduction and improvement of cardiovascular risk factors than lifestyle intervention alone.
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Yau JW, Thor SM, Ramadas A. Nutritional Strategies in Prediabetes: A Scoping Review of Recent Evidence. Nutrients 2020; 12:E2990. [PMID: 33003593 PMCID: PMC7650618 DOI: 10.3390/nu12102990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes. However, recommended nutritional strategies evolve over time. Hence, we performed a scoping review on recently reported nutritional interventions for individuals with prediabetes. Ovid MEDLINE, PubMed, Embase, Scopus, CINAHL and PsycINFO databases were searched to identify relevant research articles published within the past 10 years. Ninety-five articles involving a total of 11,211 participants were included in this review. Nutritional strategies were broadly classified into four groups: low calorie diet, low glycemic index diet, specific foods, and a combination of diet and exercise. The most frequently assessed outcomes were plasma glucose, serum insulin, serum lipid profile, body mass index and body weight. More than 50% of reported interventions resulted in significant improvements in these parameters. Nutritional interventions have demonstrated feasibility and practicality as an effective option for prediabetes management. However, the intervention variability demonstrates the challenges of a 'one-size-fits-all' approach. Investigations in genetically diverse populations and objective assessment of progression rate to diabetes are necessary to better comprehend the impact of these nutritional strategies in prediabetes.
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Affiliation(s)
| | | | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (J.W.Y.); (S.M.T.)
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Prediabetes Conversion to Normoglycemia Is Superior Adding a Low-Carbohydrate and Energy Deficit Formula Diet to Lifestyle Intervention-A 12-Month Subanalysis of the ACOORH Trial. Nutrients 2020; 12:nu12072022. [PMID: 32646010 PMCID: PMC7400892 DOI: 10.3390/nu12072022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 01/02/2023] Open
Abstract
Lifestyle interventions have been shown to reverse hyperglycemia to normoglycemia. However, these effects are not long-lasting and are accompanied with high dropout rates. As formula diets have been shown to be simple in usage and effective in improving glycemic control, we hypothesised that adding a low-carbohydrate and energy deficit formula diet to a low-intensity lifestyle intervention is superior in reversing prediabetes compared with lifestyle intervention alone. In this predefined subanalysis of an international, multicenter randomised controlled trial (Almased Concept against Overweight and Obesity and Related Health Risk (ACOORH) study (ID DRKS00006811)), 141 persons with prediabetes were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 45) or a lifestyle intervention group accompanied with a formula diet (INT, n = 96). Both groups were equipped with telemonitoring devices. INT received a low-carbohydrate formula diet substituting three meals/day (~1200 kcal/day) within the first week, two meals/day during week 2–4, and one meal/day during week 5–26 (1300–1500 kcal/day). Follow-up was performed after 52 weeks and 105 participants (75%, INT: n = 74; CON: n = 31) finished the 26-week intervention phase. Follow-up data after 52 weeks were available from 93 participants (66%, INT: n = 65; CON: n = 28). Compared with CON, significantly more INT participants converted to normoglycemia after 52 weeks (50% vs. 31%; p < 0.05). The risk reduction led to a number-needed-to-treat of 5.3 for INT. Lifestyle intervention with a low-carbohydrate formula diet reduces prediabetes prevalence stronger than lifestyle intervention alone and is effective for type 2 diabetes prevention.
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Dagogo-Jack S, Brewer AA, Owei I, French L, Umekwe N, Rosenthal R, Wan J. Pathobiology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC) Study: design of lifestyle intervention. BMJ Open Diabetes Res Care 2020; 8:8/1/e000899. [PMID: 32527719 PMCID: PMC7292036 DOI: 10.1136/bmjdrc-2019-000899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Intensive lifestyle intervention (ILI) prevents progression from prediabetes to type 2 diabetes (T2D) but reversal of prediabetes is less well studied. RESEARCH DESIGN AND METHODS The overall objectives of the Pathobiology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC) Study (ClinicalTrials.gov ID: NCT02027571) are to determine the natural history and reversibility of prediabetes. The study tests specific hypotheses on the patterns of progression to prediabetes among normoglycemic African-American (AA) and European-American (EA) offspring of parents with T2D; emergence of microvascular and macrovascular complications during transition from normal to impaired glucose regulation; significance of the 'metabolically healthy' obese phenotype; and effect of duration of the prediabetic state on its reversibility with lifestyle intervention. Participants who developed incident prediabetes were offered ILI and evaluated quarterly for 5 years. The primary outcome was restoration of normal glucose regulation (fasting plasma glucose <100 mg/dL and two-hour plasma glucose (2hrPG)<140 mg/dL). RESULTS Of the 223 subjects enrolled in the PROP-ABC Study, 158 participants with incident prediabetes started ILI. The mean age was 53.3±9.28 years; body mass index 30.6±6.70 kg/m2; 70% were female, 52.4% AA and 47.6% EA. The ILI program used goal setting, weight-based calorie restriction, physical activity (180 min/week), self-monitoring, and meal replacement. Monthly face-to-face (F2F) counseling sessions during the initial 6 months, and quarterly visits thereafter, were supplemented with electronic and postal contacts. Attendance at F2F sessions was highly correlated with weight loss (r=0.98, p<0.0001). Meal replacement induced ~5 kg weight loss within 3 months in participants with recrudescent weight pattern. Self-reported exercise minutes correlated with pedometer step counts (r=0.47, p<0.0001). CONCLUSION The PROP-ABC Study has demonstrated the feasibility of executing an ILI program designed to test reversibility of incident prediabetes in a biracial cohort.
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Affiliation(s)
- Samuel Dagogo-Jack
- General Clinical Research Center, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Division of Endocrinology, Diabetes and Metabolism, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amy A Brewer
- General Clinical Research Center, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ibiye Owei
- General Clinical Research Center, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Division of Endocrinology, Diabetes and Metabolism, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lindsey French
- General Clinical Research Center, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nkiru Umekwe
- Division of Endocrinology, Diabetes and Metabolism, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Renate Rosenthal
- Department of Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jim Wan
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Al-Hamdan R, Avery A, Salter A, Al-Disi D, Al-Daghri NM, McCullough F. Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes. Nutrients 2019; 11:nu11051113. [PMID: 31109110 PMCID: PMC6566809 DOI: 10.3390/nu11051113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022] Open
Abstract
Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18–55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m2) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m2)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.
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Affiliation(s)
- Rasha Al-Hamdan
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Amanda Avery
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Andrew Salter
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Dara Al-Disi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Fiona McCullough
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
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Evaluation of a 12-week lifestyle education intervention with or without partial meal replacement in Thai adults with obesity and metabolic syndrome: a randomised trial. Nutr Diabetes 2018; 8:23. [PMID: 29695706 PMCID: PMC5916885 DOI: 10.1038/s41387-018-0034-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 01/22/2023] Open
Abstract
Background/Objectives There have been no studies examining the efficacy of meal replacement (MR) on weight loss and metabolic syndrome (MS) improvement in Southeast Asians. Thus, we undertook a 12-week randomised trial to evaluate the effect of a lifestyle education intervention alone (LEI) or with partial MR (LEI + MR) in obese Thai adults with MS. Subjects/Methods A total of 110 patients were randomised to receive either LEI or LEI + MR. Both groups received LEI to achieve weight loss. LEI + MR group additionally received two MR daily to replace either breakfast, lunch or dinner. Mean ± SE body mass index of all participants was 34.6 ± 0.6 kg/m2, mean ± SE age was 42.5 ± 1.1 years and 83% of patients were female. Both groups were compared for anthropometric and cardiometabolic indices at 12-week. Body weight was also compared at weeks 38 and 64. Results At 12 weeks, both groups exhibited statistically significant percentage weight loss (%WL) compared to initial weight but greater %WL was observed in LEI + MR compared to LEI, 2.9% vs. 1.5%, respectively (p < 0.05). MS criteria such as waist circumference and blood pressure improved significantly in both groups compared to baseline. However, improvement in fasting plasma glucose (FPG) was only significant in LEI + MR, and more participants with impaired FPG at baseline in LEI + MR (42.9%) than LEI (19%) returned to normal FPG at 12 weeks (p < 0.05). HbA1c, fasting insulin and HOMA-IR in LEI + MR were significantly lower than with LEI. At the end of the 12-week intervention period, 16% of participants no longer fulfilled MS criteria. A statistically significant weight loss from baseline persisted until 38 weeks but no longer reached statistically significant difference between groups Conclusions LEI and LEI + MR were acceptable and led to improvement in weight and MS. LEI + MR group exhibited additional weight reduction and glycemic benefits at 12 weeks.
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Johnston CS, Sears B, Perry M, Knurick JR. Use of Novel High-Protein Functional Food Products as Part of a Calorie-Restricted Diet to Reduce Insulin Resistance and Increase Lean Body Mass in Adults: A Randomized Controlled Trial. Nutrients 2017; 9:nu9111182. [PMID: 29143803 PMCID: PMC5707654 DOI: 10.3390/nu9111182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022] Open
Abstract
Significant reductions in insulin resistance (IR) can be achieved by either calorie restriction or by the increase of lean mass. However, calorie restriction usually results in significant loss of lean mass. A 6-week randomized controlled feeding trial was conducted to determine if a calorie-restricted, high-protein diet (~125 g protein/day consumed evenly throughout the day) using novel functional foods would be more successful for reducing IR in comparison to a conventional diet (~80 g protein/day) with a similar level of calorie restriction. Healthy adults (age 20-75 years; body mass index, 20-42 kg/m²) with raised triglyceride/high-density lipoprotein ratios were randomly assigned to the control group (CON: test foods prepared using gluten-free commercial pasta and cereal) or to the high-protein group (HPR: test foods prepared using novel high-protein pasta and cereal both rich in wheat gluten). Mean weight loss did not differ between groups (-2.7 ± 2.6 and -3.2 ± 3.0 kg for CON (n = 11) and HPR (n = 10) respectively, p = 0.801); however, the 6-week change in fat-free mass (FFM) differed significantly between groups (-0.5 ± 1.5 and +1.5 ± 3.8 kg for CON and HPR respectively, p = 0.008). IR improved in HPR vs. CON participants (homeostasis model assessment-estimated insulin resistance [HOMAIR] change: -1.7 ± 1.4 and -0.7 ± 0.7 respectively; p = 0.020). The change in HOMA-IR was related to the change in FFM among participants (r = -0.511, p = 0.021). Thus, a high-protein diet using novel functional foods combined with modest calorie restriction was 140% more effective for reducing HOMA-IR in healthy adults compared to a lower protein, standard diet with an equal level of calorie restriction.
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Affiliation(s)
- Carol S Johnston
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ 85004, USA.
| | - Barry Sears
- Inflammation Research Foundation, Peabody, MA 01960, USA.
| | - Mary Perry
- Inflammation Research Foundation, Peabody, MA 01960, USA.
| | - Jessica R Knurick
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ 85004, USA.
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Marques ADCR, Schiavon FPM, Travassos PB, Eik VF, Godoy G, Schamber CR, Bazotte RB. Evaluation of the impact of orally administered carbohydrates on postprandial blood glucose levels in different pre-clinical models. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000400021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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