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Kakoschke N, Zajac IT, Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert G, Brinkworth GD. Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial. Eur J Nutr 2021; 60:4251-4262. [PMID: 34018052 DOI: 10.1007/s00394-021-02587-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
AIMS Very low-carbohydrate (LC) diets are popular for type 2 diabetes (T2DM) management; however, long-term effects on psychological health remain largely unknown. This study reports the effects of a LC diet on mood and cognitive function after 2 years and explores the potential predictors of changes in psychological health. METHODS 115 adults (57% males; age: 58.5 ± 7.1 years) with obesity and T2DM were randomized to consume an energy reduced (~ 500 to 1000 kcal/day deficit), LC diet [14% energy as carbohydrate, 28% protein, 58% fat (< 10% saturated fat)] or an isocaloric high unrefined carbohydrate, low-fat diet [HC: 53% carbohydrate, 17% protein, 30% fat (< 10% saturated fat)] for 2 years. Both diets were combined with aerobic/resistance exercise (1 h, 3 days/week). Mood/well-being [Beck Depression Inventory (BDI), Spielberger State Anxiety Inventory (SAI), Profile of Mood States (POMS)], diabetes-related quality of life [Diabetes-39 (D-39)] and distress [Problem Areas in Diabetes (PAID) Questionnaire], and cognitive function were assessed during and post-intervention. RESULTS 61 (LC: 33, HC: 28) participants completed the study. Weight loss was 9.1% after 12 months and 6.7% after 2 years with no difference between diet groups. There were no differences between the groups for the changes in any psychological health outcome (smallest p ≥ 0.19 for all time x diet interactions). Overtime, improvements in BDI, POMS [Total Mood Disturbance (TMD); four subscales], PAID, and D-39 (three subscales) scores occurred (p ≤ 0.05, time). Stepwise regression analysis showed improvements in BDI, POMS (TMD; two subscales), D-39, SAI, and PAID scores were significantly (p < 0.05) correlated with reductions in body weight and glycated hemoglobin. CONCLUSION In adults with obesity and T2DM, energy-restricted LC and HC diets produced comparable long-term improvements on a comprehensive range of psychological health outcomes. The findings suggest both diets can be used as a diabetes management strategy as part of a holistic lifestyle modification program without concern of negative effects on mental well-being or cognition. TRIAL REGISTRATION ACTRN12612000369820, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362168&isReview=true . Data described in the manuscript, code book, and analytic code will not be made available because approval has not been granted by participants.
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Affiliation(s)
- Naomi Kakoschke
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Ian T Zajac
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Jeannie Tay
- A-Star Singapore-Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Campbell H Thompson
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Grant D Brinkworth
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia. .,Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Riverside Corporate Park, 11 Julius Avenue, North Ryde, NSW, 2113, Australia.
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Tay J, Thompson CH, Luscombe-Marsh ND, Noakes M, Buckley JD, Wittert GA, Brinkworth GD. Nutritional adequacy of very low- and high-carbohydrate, low saturated fat diets in adults with type 2 diabetes: A secondary analysis of a 2-year randomised controlled trial. Diabetes Res Clin Pract 2020; 170:108501. [PMID: 33058957 DOI: 10.1016/j.diabres.2020.108501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Growing evidence supports use of very low-carbohydrate (LC) diets for glycaemic control in type 2 diabetes. However, limited data on the micronutrient adequacy of LC diets exist. OBJECTIVE This study compared the long-term effects of a very low-carbohydrate, high unsaturated/low saturated fat (LC) diet to a high-carbohydrate, low-fat (HC) diet on micronutrient biomarkers in adults with obesity and type 2 diabetes. METHODS 115 adults with type 2 diabetes (mean[SD]; BMI:34.6[4.3]kg/m2, age:58[7]yrs, HbA1c:7.3[1.1]%, 56[12]mmol/mol) were randomized to one of two planned, nutritionally-replete, energy-matched, hypocaloric diets (500-1000 kcal/day deficit): (1) LC:14% energy carbohydrate, 28%protein, 58%fat[<10% saturated fat]) or (2) HC:53%carbohydrate, 17%protein, 30%fat [<10%saturated fat]) for 2 years. Nutritional biomarkers- folate, β-carotene, vitamin B12, D, E, copper, zinc, selenium, calcium, magnesium, sodium, potassium, iron, ferritin, transferrin and transferrin saturation were measured in fasting blood at baseline, 24, 52 and 104 weeks. RESULTS 61 participants completed the study with similar dropouts in each group (P = 0.40). For all biomarkers assessed, there were no differential response between groups overtime (P ≥ 0.17 time × diet interaction). Mean vitamin and mineral levels remained within normal (laboratory-specific) reference ranges without any reported cases of clinical deficiencies. CONCLUSION In free-living individuals with type 2 diabetes, nutrition biomarkers within normal ranges at baseline did not change significantly after 2 years on a prescribed LC or HC diet. These results demonstrate the feasibility of delivering a nutritionally replete LC diet and the importance of considering nutritional factors in planning LC diets that have strong public health relevance to the dietary management of type 2 diabetes. TRIAL REGISTRATION http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820.
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Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore.
| | | | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Sydney, Australia
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Wycherley TP, Buckley JD, Noakes M, Clifton PM, Brinkworth GD. Correction to: Comparison of the effects of weight loss from a high-protein versus standard-protein energy-restricted diet on strength and aerobic capacity in overweight and obese men. Eur J Nutr 2020; 59:3867. [PMID: 32910261 DOI: 10.1007/s00394-020-02376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article unfortunately contained a mistake.
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Affiliation(s)
- Thomas P Wycherley
- Division of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Jonathan D Buckley
- Division of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Manny Noakes
- Preventative Health Flagship, Commonwealth Scientific and Industrial Research Organisation, Food and Nutritional Sciences, PO Box 10041 BC, Adelaide, 5000, Australia
| | | | - Grant D Brinkworth
- Preventative Health Flagship, Commonwealth Scientific and Industrial Research Organisation, Food and Nutritional Sciences, PO Box 10041 BC, Adelaide, 5000, Australia.
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Gupta CC, Centofanti S, Dorrian J, Coates A, Stepien JM, Kennaway D, Wittert G, Heilbronn L, Catcheside P, Noakes M, Coro D, Chandrakumar D, Banks S. Altering meal timing to improve cognitive performance during simulated nightshifts. Chronobiol Int 2019; 36:1691-1713. [DOI: 10.1080/07420528.2019.1676256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Charlotte C Gupta
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Stephanie Centofanti
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
- University of South Australia Online, University of South Australia, Adelaide, Australia
| | - Jillian Dorrian
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Alison Coates
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jacqueline M Stepien
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - David Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, Australia
| | - Gary Wittert
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Leonie Heilbronn
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australia Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide Australia
| | - Manny Noakes
- Food and Nutrition Flagship, Commonwealth Scientific and Industrial Research Organization, Adelaide, Australia
| | - Daniel Coro
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Dilushi Chandrakumar
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Siobhan Banks
- Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
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Brindal E, Hendrie GA, Freyne J, Noakes M. A Mobile Phone App Designed to Support Weight Loss Maintenance and Well-Being (MotiMate): Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12882. [PMID: 31486407 PMCID: PMC6834303 DOI: 10.2196/12882] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background Few people successfully maintain lost weight over the longer term. Mobile phones have the potential to deliver weight loss management programs that can encourage self-monitoring while also providing some behavioral therapy to assist users in developing personal skills that may be necessary for improved longer term weight loss maintenance. Objective The aim of this study was to evaluate a program supporting weight maintenance, which uses a behaviorally based mobile phone app to manage weight, food, exercise, mood, and stress. Methods In a randomized controlled trial over 24 weeks, the full version of the app (MotiMate) was compared with a control app (monitoring only; excluding mood and stress) for its effect on weight, diet, and psychological well-being. Both apps had the same visual appearance and were designed to deliver all intervention content without face-to-face contact. The control version included features to track weight, food intake, and exercise with limited feedback and no encouraging/persuasive features. The intervention app included more persuasive and interactive features to help users track their weight, food intake, and physical activity and prompted users to enter data each day through notifications and included a mood and stress workshopping tool. Participants were recruited through advertising and existing databases. Clinic visits occurred at baseline, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. At all visits, the clinical trial manager recorded body weight, and participants then completed a computer-delivered survey, which measured psychological and lifestyle outcomes. Objective app usage data were recorded throughout the trial. Results A total of 88 adults who had lost and maintained at least 5% of their body weight within the last 2 years were randomized (45 MotiMate and 43 control). Overall, 75% (66/88) were female, and 69% (61/88) completed week 24 with no differences in dropout by condition (χ21,87=0.7, P=.49). Mixed models suggested no significant changes in weight or psychological outcomes over 24 weeks regardless of condition. Of 61 completers, 53% (32/61) remained within 2% of their starting weight. Significant increases occurred over 24 weeks for satisfaction with life and weight loss self-efficacy regardless of app condition. Diet and physical activity behaviors did not vary by app or week. Negative binomial models indicated that those receiving the full app remained active users of the app for 46 days longer than controls (P=.02). Users of the full version of the app also reported that they felt more supported than those with the control app (P=.01). Conclusions Although some aspects of the intervention app such as usage and user feedback showed promise, there were few observable effects on behavioral and psychological outcomes. Future evaluation of the app should implement alternative research methods or target more specific populations to better understand the utility of the coping interface. Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12614000474651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366120
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Affiliation(s)
- Emily Brindal
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Gilly A Hendrie
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Jill Freyne
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Epping, Australia
| | - Manny Noakes
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
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Gupta CC, Centofanti S, Dorrian J, Coates AM, Stepien JM, Kennaway D, Wittert G, Heilbronn L, Catcheside P, Noakes M, Coro D, Chandrakumar D, Banks S. Subjective Hunger, Gastric Upset, and Sleepiness in Response to Altered Meal Timing during Simulated Shiftwork. Nutrients 2019; 11:nu11061352. [PMID: 31208092 PMCID: PMC6628383 DOI: 10.3390/nu11061352] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 01/28/2023] Open
Abstract
Shiftworkers report eating during the night when the body is primed to sleep. This study investigated the impact of altering food timing on subjective responses. Healthy participants (n = 44, 26 male, age Mean ± SD = 25.0 ± 2.9 years, BMI = 23.82 ± 2.59kg/m2) participated in a 7-day simulated shiftwork protocol. Participants were randomly allocated to one of three eating conditions. At 00:30, participants consumed a meal comprising 30% of 24 h energy intake (Meal condition; n = 14, 8 males), a snack comprising 10% of 24 h energy intake (Snack condition; n = 14; 8 males) or did not eat during the night (No Eating condition; n = 16, 10 males). Total 24 h individual energy intake and macronutrient content was constant across conditions. During the night, participants reported hunger, gut reaction, and sleepiness levels at 21:00, 23:30, 2:30, and 5:00. Mixed model analyses revealed that the snack condition reported significantly more hunger than the meal group (p < 0.001) with the no eating at night group reporting the greatest hunger (p < 0.001). There was no difference in desire to eat between meal and snack groups. Participants reported less sleepiness after the snack compared to after the meal (p < 0.001) or when not eating during the night (p< 0.001). Gastric upset did not differ between conditions. A snack during the nightshift could alleviate hunger during the nightshift without causing fullness or increased sleepiness.
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Affiliation(s)
- Charlotte C Gupta
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Stephanie Centofanti
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Jillian Dorrian
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Alison M Coates
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
- Division of Health Sciences, University of South Australia, 5000 Adelaide, Australia.
| | - Jacqueline M Stepien
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - David Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, 5000 Adelaide, Australia.
| | - Gary Wittert
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, 5000Adelaide, Australia.
| | - Leonie Heilbronn
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, 5000Adelaide, Australia.
- South Australia Medical Research Institute (SAHMRI), 5000 Adelaide, Australia.
| | - Peter Catcheside
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, 5042 Adelaide, Australia.
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation - Food and Nutrition Flagship, 5000 Adelaide, Australia.
| | - Daniel Coro
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Dilushi Chandrakumar
- Cognitive Ageing Impairment Neurosciences Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
| | - Siobhan Banks
- Sleep and Chronobiology Laboratory, Behaviour-Brain-Body Research Centre, School of Psychology, Social Work and Social Policy, University of South Australia, 5072 Adelaide, Australia.
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Moran LJ, Noakes M, Clifton P, Buckley J, Brinkworth G, Thomson R, Norman RJ. Predictors of Lifestyle Intervention Attrition or Weight Loss Success in Women with Polycystic Ovary Syndrome Who Are Overweight or Obese. Nutrients 2019; 11:nu11030492. [PMID: 30813612 PMCID: PMC6470873 DOI: 10.3390/nu11030492] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/06/2019] [Accepted: 02/19/2019] [Indexed: 01/12/2023] Open
Abstract
Background/objectives: Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women. Weight management is a first-line treatment for PCOS according to international evidence-based guidelines. However, the factors associated with attrition or success in weight loss interventions are not known for women with PCOS. The objective of this study was to identify characteristics associated with attrition and weight loss success in women with PCOS and overweight or obesity undergoing weight loss interventions. Methods: Four randomised controlled clinical weight loss trials comprising energy restricted diets and/or exercise interventions of 2⁻8 months duration. The interventions were conducted over 2001⁻2007 in outpatient clinical research centres with n = 221 premenopausal women with PCOS and overweight/obesity recruited through community advertisement. The main outcome measures were attrition and ≥5% weight loss at 2 months and study completion. Results: Weight loss was 5.7 ± 2.9 kg at 2 months and 7.4 ± 5.3 kg after study completion (p < 0.001). Attrition was 47.1% and ≥5% weight loss occurred in 62.5% and 62.7% of women at 2 months and study completion respectively. Baseline depressive symptoms (OR 1.07 95% CI 0.88, 0.96, p = 0.032) and lower appointment attendance by 2 months (OR 0.92 95% CI 0.88, 0.96, p < 0.001) were independently associated with attrition. Lower appointment attendance over the whole study was independently associated with not achieving ≥5% weight loss at study completion (OR 0.95 95% CI 0.92, 0.99, p = 0.020). Conclusions: Despite high attrition, successful weight loss was achieved by 63% of women with PCOS in a clinical research setting. Higher baseline depressive symptoms were associated with greater attrition and higher appointment attendance was associated with lower attrition and greater weight loss success. These finding have implications for development of successful weight management programs in PCOS.
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Affiliation(s)
- Lisa J Moran
- School of Medicine, Robinson Research Institute, University of Adelaide, Adelaide, SA 5000, Australia.
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic 3163, Australia.
| | - Manny Noakes
- CSIRO Division of Health Sciences and Nutrition, Australia.
| | - Peter Clifton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia.
| | - Jon Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia.
| | | | - Rebecca Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia.
| | - Robert J Norman
- School of Medicine, Robinson Research Institute, University of Adelaide, Adelaide, SA 5000, Australia.
- Fertility SA, Adelaide, SA 5000, Australia.
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Shi Z, Taylor AW, Riley M, Byles J, Liu J, Noakes M. Cadmium intake and chronic kidney disease: Response to Kawada T. Clin Nutr 2018; 37:1774. [DOI: 10.1016/j.clnu.2018.06.976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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Bowen J, Brindal E, James-Martin G, Noakes M. Randomized Trial of a High Protein, Partial Meal Replacement Program with or without Alternate Day Fasting: Similar Effects on Weight Loss, Retention Status, Nutritional, Metabolic, and Behavioral Outcomes. Nutrients 2018; 10:E1145. [PMID: 30142886 PMCID: PMC6165084 DOI: 10.3390/nu10091145] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Higher-protein diets, meal replacements, and greater early weight loss have separately been associated with greater weight loss. We compared a high-protein, meal replacement program with daily energy restriction (DER) to one which provided greater energy restriction adding alternate day fasting (ADF + DER; alternating days of modified-fasting and DER plus 1 ad libitum day/week) on retention, weight loss, physiological, nutritional, and behavioral markers. Participants were randomized to ADF + DER or DER for 16 weeks (n = 162, age 40 ± 8 years BMI 36 ± 6 kg/m² (Mean ± SD)) plus 8 weeks weight maintenance. At week 16 weight change was -10.7 ± 0.5 kg and -11.2 ± 0.6 kg in ADF + DER and DER groups (treatment NS). Fat mass, visceral adipose tissue, and lean mass (p < 0.05) were similarly reduced between treatments. Weight loss was sustained to 24 weeks (treatment NS). Fasting LDL-cholesterol, triglycerides, insulin, hsCRP, glucose, and blood pressure all improved (p < 0.05; treatment NS). Transferrin saturation, ferritin, serum zinc, folate, and B12 improved (p < 0.05; treatment NS). Plasma thiamine and vitamin D levels decreased, reflecting lower carbohydrate intakes and seasonal changes, respectively. Food cravings, quality of life, and mood improved (treatment NS). Energy, fatigue, and pain improved slightly more in DER (p < 0.05). This study supports the use of higher protein, meal replacement programs with or without ADF in weight management.
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Affiliation(s)
- Jane Bowen
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia.
| | - Emily Brindal
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia.
| | | | - Manny Noakes
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia.
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Trautwein E, Koppenol W, A deJong, Hiemstra H, Vermeer M, Noakes M, Luscombe-Marsh N. Plant sterols lowers both fasting LDL-cholesterol and triglycerides in dyslipidaemic individuals with or at risk of developing type 2 diabetes. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, Howe PRC, Noakes M, Murphy KJ. Comparison of two low-fat diets, differing in protein and carbohydrate, on psychological wellbeing in adults with obesity and type 2 diabetes: a randomised clinical trial. Nutr J 2018; 17:62. [PMID: 29907153 PMCID: PMC6004092 DOI: 10.1186/s12937-018-0367-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Although higher-protein diets (HP) can assist with weight loss and glycemic control, their effect on psychological wellbeing has not been established. The objective of this study was to compare the effects of a HP and a higher-carbohydrate diet (HC), combined with regular exercise, on psychological wellbeing both during weight loss (WL) and weight maintenance phases (WM). Methods In a parallel RCT, 61 adults with T2D (mean ± SD: BMI 34.3 ± 5.1 kg/m2, aged 55 ± 8 years) consumed a HP diet (29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%), with moderate intensity exercise, for 12 weeks of WL and 12 weeks of WM. Secondary data evaluating psychological wellbeing was assessed using: Problems Areas in Diabetes (PAID); Diabetes-39 Quality of Life (D-39); Short Form Health Survey (SF-36); Perceived Stress Scale-10 (PSS-10) and the Leeds Sleep Evaluation Questionnaire (LSEQ) at Weeks 0, 12 and 24 and evaluated with mixed models analysis. Results Independent of diet, improvements for PAID; D-39 diabetes control; D-39 severity of diabetes; SF-36 physical functioning and SF-36 general health were found following WL (d = 0.30 to 0.69, P ≤ 0.04 for all) which remained after 12 weeks of WM. SF-36 vitality improved more in the HP group (group x time interaction P = 0.03). Associations were seen between HbA1c and D-39 severity of diabetes rating (r = 0.30, P = 0.01) and SF-36 mental health (r = − 0.32, P = 0.003) and between weight loss and PAID (r = 0.30, P = 0.01). Conclusion Several improvements in diabetes-related and general psychological wellbeing were seen similarly for both diets following weight loss and a reduction in HbA1c with most of these improvements remaining when weight loss was sustained for 12 weeks. A HP diet may provide additional increases in vitality. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000008729) on 4 January 2013.
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Affiliation(s)
- Nerylee Ann Watson
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Kathryn Ann Dyer
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Jonathan David Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Grant David Brinkworth
- Commonwealth Scientific and Industrial Research Organization - Health and Biosecurity, PO Box 10041, Adelaide, SA, 5000, Australia
| | - Alison Mary Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organization - Health and Biosecurity, PO Box 10041, Adelaide, SA, 5000, Australia
| | - Karen Joy Murphy
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, Howe PRC, Noakes M, Murphy KJ. Reductions in food cravings are similar with low-fat weight loss diets differing in protein and carbohydrate in overweight and obese adults with type 2 diabetes: A randomized clinical trial. Nutr Res 2018; 57:56-66. [PMID: 30122196 DOI: 10.1016/j.nutres.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/22/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
Abstract
Food cravings are common in type 2 diabetes (T2D). Higher-protein diets are effective in improving satiety but their effect on cravings is unclear. It was hypothesized that a high protein (HP) diet would provide greater reductions in cravings than an isocaloric higher-carbohydrate diet (HC). In a randomized controlled trial, 61 adults (54% males) with T2D (means ± SD: BMI 34.3 ± 5.1 kg/m2; aged 55 ± 8 years) consumed either a HP diet (mean across study: 29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%) for 12-weeks each of weight loss (WL) and weight maintenance (WM). The Food Craving Inventory (FCI), measuring types of foods craved and the General Food Craving Questionnaires measuring traits (G-FCQ-T) and states (G-FCQ-S) were assessed at Weeks 0, 12 and 24. Weight changes were similar between groups (means ± SEM: WL: -7.8 ± 0.6 kg, WM: -0.6 ± 0.4 kg). No group effects or group x time interactions were found for any outcome (P ≥ .07). Independent of group, all food cravings (except carbohydrates) and G-FCQ-T subscales decreased over the 24-week study (P ≤ .04) with sweets and fast food cravings, loss of control and emotional cravings reducing following WL (P ≤ .03). Obsessive preoccupation with food decreased following both phases (WL: P = .03; WM: P = .001). Weight was associated with several FCI subscales (r ≥ 0.24, P ≤ .04). In conclusion, both the HP and HC diets provided significant reductions in food cravings after similar weight losses which were maintained when weight was stabilized.
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Affiliation(s)
- Nerylee A Watson
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Kathryn A Dyer
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Grant D Brinkworth
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, PO Box 10041, Adelaide, SA 5000, Australia.
| | - Alison M Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Peter R C Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD 4300, Australia.
| | - Manny Noakes
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organization, PO Box 10041, Adelaide, SA 5000, Australia.
| | - Karen J Murphy
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Parker SM, Stocks N, Nutbeam D, Thomas L, Denney-Wilson E, Zwar N, Karnon J, Lloyd J, Noakes M, Liaw ST, Lau A, Osborne R, Harris MF. Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial. BMJ Open 2018; 8:e023239. [PMID: 29866737 PMCID: PMC5988137 DOI: 10.1136/bmjopen-2018-023239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. METHODS AND ANALYSIS A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. ETHICS AND DISSEMINATION The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval. TRIAL REGISTRATIONREGISTRATION NUMBER ACTRN12617001508369; Pre-results.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Don Nutbeam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicholas Zwar
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jon Karnon
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Manny Noakes
- Nutrition and Health Program, CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Richard Osborne
- School of Health and Social Development, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Hendrie GA, Rebuli MA, Golley RK, Noakes M. Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument. J Acad Nutr Diet 2018; 118:1864-1873. [PMID: 29724505 DOI: 10.1016/j.jand.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 02/23/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Methods to address misreporting associated with short dietary assessment instruments are needed. OBJECTIVE Our objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake. DESIGN Validation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls. PARTICIPANTS/SETTING Three population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013-2014). The indirect validation compared data from the 2011-2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015-2016). MAIN OUTCOME MEASURES Food group intake (in servings) was measured. STATISTICAL ANALYSES PERFORMED Descriptive and inferential statistical analyses were conducted. RESULTS Direct validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from -0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat. CONCLUSIONS Adjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.
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Brindal E, Hendrie GA, Freyne J, Noakes M. Incorporating a Static Versus Supportive Mobile Phone App Into a Partial Meal Replacement Program With Face-to-Face Support: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e41. [PMID: 29669704 PMCID: PMC5932334 DOI: 10.2196/mhealth.7796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
Background Mobile phone apps may be acceptable to users and could improve retention and adherence over more traditional methods, but there is mixed literature supporting their efficacy. In the weight management space, very little is known about how a mobile phone app integrating features beyond text messaging (short message service) can affect behavior, particularly when combined with face-to-face support. Objective The objective of this study was to examine the effectiveness of a mobile phone app when combined with a partial meal replacement program including face-to-face support. This paper compares a static versus supportive app over a 6-month randomized trial for effects on weight loss, weight-related biomarkers, and psychological outcomes. Methods Overweight and obese adults (71.2% female, 104/146; mean 48.11, SD 11.75 years) were recruited to participate in the weight loss study, and they were randomized on a 1:1 basis using a computer algorithm. The supportive app (n=75) provided information, food intake recording, rewards, prompts for regular interaction through reminders, and the opportunity to review personal compliance with the dietary program. The static app (n=71) included only recipes and weight loss information. Both groups recieved equal amounts of face-to-face support in addition to app. Results The overall reduction in app usage over 24 weeks was lower for the supportive app in comparison with the static app; approximately 39.0% (57/146) of the users were still using the app at week 24. Despite the promising results for app usage, there were no differences in weight loss between groups (F1,128.12=0.83, P=.36). However, it should be noted that almost 60% (49/84) of all participants lost 5% or more of body weight during the trial. No weight-related biomarkers were significantly different between groups. Both groups experienced an increase in positive mood, but this was significantly higher for those who received the static app (F1,118.12=4.93, P=.03). Conclusions Although the supportive app was well received by users, we found little evidence of the added benefit of this versus the static app in combination with face-to-face support in a community-delivered weight loss program. Future versions of the app may incorporate more unique behavioral techniques beyond those provided by the consultant to improve the potency of the app. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12613000547741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364187 (Archived by WebCite http://www.webcitation.org/6yivwfMI9)
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Affiliation(s)
| | | | - Jill Freyne
- CSIRO Australian E-Health Research Centre, Marsfield, Australia
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Tay J, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD. Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes Obes Metab 2018; 20:858-871. [PMID: 29178536 DOI: 10.1111/dom.13164] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 12/20/2022]
Abstract
AIM To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight and obese patients with type 2 diabetes (T2D). METHODS A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m2 ; age, 58 [7] years; HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets combined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as carbohydrate, 28% as protein, 58% as fat (<10% saturated fat); or low-fat, high-carbohydrate, low-glycaemic index diet (HC): 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat). HbA1c, glycaemic variability (GV), anti-glycaemic medication effect score (MES, calculated based on the potency and dosage of diabetes medication), weight, body composition, CVD and renal risk markers were assessed before and after intervention. RESULTS A total of 61 (LC = 33, HC = 28) participants completed the study (trial registration: http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820). Reductions in weight (estimated marginal mean [95% CI]; LC, -6.8 [-8.8,-4.7], HC, -6.6 [-8.8, -4.5] kg), body fat (LC, -4.3 [-6.2, -2.4], HC, -4.6 [-6.6, -2.7] kg), blood pressure (LC, -2.0 [-5.9, 1.8]/ -1.2 [-3.6, 1.2], HC, -3.2 [-7.3, 0.9]/ -2.0 [-4.5, 0.5] mmHg), HbA1c (LC, -0.6 [-0.9, -0.3], HC, -0.9 [-1.2, -0.5] %) and fasting glucose (LC, 0.3 [-0.4, 1.0], HC, -0.4 [-1.1, 0.4] mmol/L) were similar between groups (P ≥ 0.09). Compared to HC, the LC achieved greater reductions in diabetes medication use (MES; LC, -0.5 [-0.6, -0.3], HC, -0.2 [-0.4, -0.02] units; P = 0.03), GV (Continuous Overall Net Glycemic Action calculated every 1 hour (LC, -0.4 [-0.6, -0.3], HC, -0.1 [-0.1, 0.2] mmol/L; P = 0.001), and 4 hours (LC, -0.9 [-1.3, -0.6], HC, -0.2 [-0.6, 0.1] mmol/L; P = 0.02)); triglycerides (LC, -0.1 [-0.3, 0.2], HC, 0.1 [-0.2, 0.3] mmol/L; P = 0.001), and maintained HDL-C levels (LC, 0.02 [-0.05, 0.1], HC, -0.1 [-0.1, 0.01] mmol/L; P = 0.004), but had similar changes in LDL-C (LC, 0.2 [-0.1, 0.5], HC, 0.1 [-0.2, 0.4] mmol/L; P = 0.85), brachial artery flow mediated dilatation (LC, -0.5 [-1.5, 0.5], HC, -0.4 [-1.4, 0.7] %; P = 0.73), eGFR and albuminuria. CONCLUSIONS Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management.
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Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Agency for Science, Technology and Research (A-STAR), Singapore
| | | | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
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Hendrie GA, Golley RK, Noakes M. Compliance with Dietary Guidelines Varies by Weight Status: A Cross-Sectional Study of Australian Adults. Nutrients 2018; 10:E197. [PMID: 29439463 PMCID: PMC5852773 DOI: 10.3390/nu10020197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 12/31/2022] Open
Abstract
Population surveys have rarely identified dietary patterns associated with excess energy intake in relation to risk of obesity. This study uses self-reported food intake data from the validated Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey to examine whether apparent compliance with dietary guidelines varies by weight status. The sample of 185,951 Australian adults were majority female (71.8%), with 30.2%, 35.3% and 31.0% aged between 18-30, 31-50 and 51-70 years respectively. Using multinomial regression, in the adjusted model controlling for gender and age, individuals in the lowest quintile of diet quality were almost three times more likely to be obese than those in the highest quintile (OR 2.99, CI: 2.88:3.11; p < 0.001). The differential components of diet quality between normal and obese adults were fruit (difference in compliance score 12.9 points out of a possible 100, CI: 12.3:13.5; p < 0.001), discretionary foods (8.7 points, CI: 8.1:9.2; p < 0.001), and healthy fats (7.7 points, CI: 7.2:8.1; p < 0.001). Discretionary foods was the lowest scoring component across all gender and weight status groups, and are an important intervention target to improve diet quality. This study contributes to the evidence that diet quality is associated with health outcomes, including weight status, and will be useful in framing recommendations for obesity prevention and management.
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Affiliation(s)
- Gilly A Hendrie
- CSIRO Health and Biosecurity, P.O. Box 10041, Adelaide, SA 5000, Australia.
| | - Rebecca K Golley
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Manny Noakes
- CSIRO Health and Biosecurity, P.O. Box 10041, Adelaide, SA 5000, Australia.
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Abstract
The food system is a major source of environmental impact, and dietary change has been recommended as an important and necessary strategy to reduce this impact. However, assessing the environmental performance of diets is complex due to the many types of foods eaten and the diversity of agricultural production systems and local environmental settings. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of environment and diet was undertaken, with particular focus on the completeness of coverage of environmental concerns and the metrics used. Compared with the 14 discrete environmental areas of concern identified in the United Nations Sustainable Development Goals, the located journal literature mainly addressed greenhouse gas (GHG) emissions and, to a lesser extent, land and water use. Some relevant concerns were rarely addressed or not addressed at all. In the case of GHG emissions, changes in land use and soil carbon stocks were seldom considered. This represents a disconnect between the science informing strategic climate action in the agricultural sector and the science informing public health nutrition. In the case of land and water use, few studies used metrics that are appropriate in a life-cycle context. Some metrics produce inherently biased results, which misinform about environmental impact. The limited evidence generally points to recommended diets having lower environmental impacts than typical diets, although not in every case. This is largely explained by the overconsumption of food energy associated with average diets, which is also a major driver of obesity. A shared-knowledge framework is identified as being needed to guide future research on this topic. Until the evidence base becomes more complete, commentators on sustainable diets should not be quick to assume that a dietary strategy to reduce overall environmental impact can be readily defined or recommended.
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Affiliation(s)
- Bradley G Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Victoria, Australia;,University of the Free State, Department of Agricultural Economics, Bloemfontein, South Africa; and
| | - Gilly A Hendrie
- CSIRO Biosecurity and Health, Adelaide, South Australia, Australia
| | - Manny Noakes
- CSIRO Biosecurity and Health, Adelaide, South Australia, Australia
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Dibb-Smith AE, Brindal E, Chapman J, Noakes M. A mixed-methods investigation of psychological factors relevant to weight maintenance. J Health Psychol 2016; 24:440-452. [DOI: 10.1177/1359105316678053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated perceptions of and engagement with the concepts of planning and problem-solving, within a weight management sample. A total of 53 participants (62% female, 20–74 years old) completed a semi-structured interview and quantitative measures after a 16-week weight maintenance period. Preliminary weight maintainers (who had maintained losses of, at least 10% of their original weight) were compared with heavier-than-baseline participants (who had re-gained more weight than was originally lost). The maintainers exhibited stronger problem-solving skills ( p < .05). The heavier-than-baseline participants tended towards non-rational problem-solving styles. Qualitatively, the maintainers described more planning events and were more accepting of mistakes than the heavier-than-baseline participants. Implications are discussed.
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Tay J, Zajac IT, Thompson CH, Luscombe-Marsh ND, Danthiir V, Noakes M, Buckley JD, Wittert GA, Brinkworth GD. A randomised-controlled trial of the effects of very low-carbohydrate and high-carbohydrate diets on cognitive performance in patients with type 2 diabetes. Br J Nutr 2016; 116:1-9. [PMID: 27876096 DOI: 10.1017/s0007114516004001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study compared the longer-term effects of a very low-carbohydrate, high-fat diet with a high-carbohydrate, low-fat diet on cognitive performance in individuals with type 2 diabetes (T2D). In total, 115 obese adults with T2D (sixty-six males, BMI: 34·6 (sd 4·3) kg/m2, age: 58 (sd 7) years, HbA1c: 7·3 (sd 1·1) %, diabetes duration: 8 (sd 6) years) were randomised to consume either an energy-restricted, very low-carbohydrate, low-saturated-fat (LC) diet or an energy-matched high unrefined carbohydrate, low-fat (HC) diet with supervised aerobic/resistance exercise (60 min, 3 d/week) for 52 weeks. Body weight, HbA1c and cognitive performance assessing perceptual speed, reasoning speed, reasoning ability, working memory, verbal fluency, processing speed, short-term memory, inhibition and memory scanning speed were assessed before and after intervention. No differences in the changes in cognitive test performance scores between the diet groups were observed for any of the cognitive function outcomes assessed (P≥0·24 time×diet). Percentage reduction in body weight correlated with improvements with perceptual speed performance. In obese adults with T2D, both LC and HC weight-loss diets combined with exercise training had similar effects on cognitive performance. This suggests that an LC diet integrated within a lifestyle modification programme can be used as a strategy for weight and diabetes management without the concern of negatively affecting cognitive function.
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Affiliation(s)
- Jeannie Tay
- 1Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity,Adelaide,SA 5000,Australia
| | - Ian T Zajac
- 1Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity,Adelaide,SA 5000,Australia
| | | | - Natalie D Luscombe-Marsh
- 1Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity,Adelaide,SA 5000,Australia
| | - Vanessa Danthiir
- 1Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity,Adelaide,SA 5000,Australia
| | - Manny Noakes
- 1Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity,Adelaide,SA 5000,Australia
| | - Jonathan D Buckley
- 4Alliance for Research in Exercise, Nutrition and Activity (ARENA),Sansom Institute for Health Research,University of South Australia,Adelaide,SA 5001,Australia
| | - Gary A Wittert
- 2Discipline of Medicine,University of Adelaide,Adelaide, SA 5000,Australia
| | - Grant D Brinkworth
- 1Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity,Adelaide,SA 5000,Australia
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Brinkworth GD, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert G, Wilson CJ. Long-term effects of very low-carbohydrate and high-carbohydrate weight-loss diets on psychological health in obese adults with type 2 diabetes: randomized controlled trial. J Intern Med 2016; 280:388-97. [PMID: 27010424 DOI: 10.1111/joim.12501] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVE Very low-carbohydrate, high-fat (LC) diets are used for type 2 diabetes (T2DM) management, but their effects on psychological health remain largely unknown. This study examined the long-term effects of an LC diet on psychological health. METHODS One hundred and fifteen obese adults [age: 58.5 ± 7.1 years; body mass index: 34.6 ± 4.3 kg m(-2) ; HbA1c : 7.3 ± 1.1%] with T2DM were randomized to consume either an energy-restricted (~6 to 7 MJ), planned isocaloric LC or high-carbohydrate, low-fat (HC) diet, combined with a supervised exercise programme (3 days week(-1) ) for 1 year. Body weight, psychological mood state and well-being [Profile of Mood States (POMS), Beck Depression Inventory (BDI) and Spielberger State Anxiety Inventory (SAI)] and diabetes-specific emotional distress [Problem Areas in Diabetes (PAID) Questionnaire] and quality of life [QoL Diabetes-39 (D-39)] were assessed. RESULTS Overall weight loss was 9.5 ± 0.5 kg (mean ± SE), with no difference between groups (P = 0.91 time × diet). Significant improvements occurred in BDI, POMS (total mood disturbance and the six subscales of anger-hostility, confusion-bewilderment, depression-dejection, fatigue-inertia, vigour-activity and tension-anxiety), PAID (total score) and the D-39 dimensions of diabetes control, anxiety and worry, sexual functioning and energy and mobility, P < 0.05 time. SAI and the D-39 dimension of social burden remained unchanged (P ≥ 0.08 time). Diet composition had no effect on the responses for the outcomes assessed (P ≥ 0.22 time × diet). CONCLUSION In obese adults with T2DM, both diets achieved substantial weight loss and comparable improvements in QoL, mood state and affect. These results suggest that either an LC or HC diet within a lifestyle modification programme that includes exercise training improves psychological well-being.
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Affiliation(s)
- G D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation - Food and Nutrition, Adelaide, SA, Australia.
| | - N D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation - Food and Nutrition, Adelaide, SA, Australia.,Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - C H Thompson
- Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - M Noakes
- Commonwealth Scientific and Industrial Research Organisation - Food and Nutrition, Adelaide, SA, Australia
| | - J D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Samson Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - G Wittert
- Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - C J Wilson
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, SA, Australia
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22
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Moran LJ, Brinkworth GD, Martin S, Wycherley TP, Stuckey B, Lutze J, Clifton PM, Wittert GA, Noakes M. Long-Term Effects of a Randomised Controlled Trial Comparing High Protein or High Carbohydrate Weight Loss Diets on Testosterone, SHBG, Erectile and Urinary Function in Overweight and Obese Men. PLoS One 2016; 11:e0161297. [PMID: 27584019 PMCID: PMC5008754 DOI: 10.1371/journal.pone.0161297] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022] Open
Abstract
Introduction Obesity is associated with reduced testosterone and worsened erectile and sexual function in men. Weight loss improves these outcomes. High protein diets potentially offer anthropometric and metabolic benefits, but their effects on reproductive and sexual outcomes is not known. Aim To examine the long-term effects of weight loss with a higher protein or carbohydrate diet on testosterone, sex hormone binding globulin, erectile dysfunction, lower urinary tract symptoms and sexual desire in overweight and obese men. Methods One-hundred and eighteen overweight or obese men (body mass index 27–40 kg/m2, age 20–65 years) were randomly assigned to an energy restricted higher protein low fat (35% protein, 40% carbohydrate, 25% fat; n = 57) or higher carbohydrate low fat diet (17% protein, 58% carbohydrate, 25% fat, n = 61) diet for 52 weeks (12 weeks weight loss, 40 weeks weight maintenance). Primary outcomes were serum total testosterone, sex hormone binding globulin and calculated free testosterone. Secondary outcomes were erectile function as assessed by the International Index of Erectile Function (IIEF) (total score and erectile function domain), lower urinary tract symptoms and sexual desire. Results Total testosterone, sex hormone binding globulin and free testosterone increased (P<0.001) and the total IIEF increased (P = 0.017) with no differences between diets (P≥0.244). Increases in testosterone (P = 0.037) and sex hormone binding globulin (P<0.001) and improvements in the total IIEF (P = 0.041) occurred from weeks 0–12 with a further increase in testosterone from week 12–52 (P = 0.002). Increases in free testosterone occurred from week 12–52 (p = 0.002). The IIEF erectile functon domain, lower urinary tract symptoms and sexual desire did not change in either group (P≥0.126). Conclusions In overweight and obese men, weight loss with both high protein and carbohydrate diets improve testosterone, sex hormone binding globulin and overall sexual function. Trial Registration Anzctr.org.au ACTRN12606000002583
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Affiliation(s)
- Lisa J. Moran
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
- * E-mail:
| | | | - Sean Martin
- Freemasons Foundation Centre for Mens Health, University of Adelaide, and South Australian Institute for Health and Medical Research, Adelaide, South Australia, Australia
| | - Thomas P. Wycherley
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Janna Lutze
- CSIRO Food and Nutrition, Adelaide, South Australia, Australia
| | - Peter M. Clifton
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gary A. Wittert
- Freemasons Foundation Centre for Mens Health, University of Adelaide, and South Australian Institute for Health and Medical Research, Adelaide, South Australia, Australia
| | - Manny Noakes
- CSIRO Food and Nutrition, Adelaide, South Australia, Australia
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23
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Thomson RL, Brinkworth GD, Noakes M, Buckley JD. Response to comment on: Thomson et al. Muscle strength gains during resistance exercise training are attenuated with soy compared with dairy or usual protein intake in older adults: A randomized controlled trial. Clinical Nutrition 35:27-33, 2016. Clin Nutr 2016; 35:1573-1574. [PMID: 27472928 DOI: 10.1016/j.clnu.2016.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Rebecca L Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
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24
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Wycherley TP, Thompson CH, Buckley JD, Luscombe-Marsh ND, Noakes M, Wittert GA, Brinkworth GD. Long-term effects of weight loss with a very-low carbohydrate, low saturated fat diet on flow mediated dilatation in patients with type 2 diabetes: A randomised controlled trial. Atherosclerosis 2016; 252:28-31. [PMID: 27494448 DOI: 10.1016/j.atherosclerosis.2016.07.908] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Very-low carbohydrate diets can improve glycaemic control in patients with type 2 diabetes (T2DM). However, compared to traditional higher carbohydrate, low fat (HighCHO) diets, they have been associated with impaired endothelial function (measured by flow mediated dilatation [FMD]) that is possibly related to saturated fat. This study aimed to examine the effects of a 12-month hypocaloric very-low carbohydrate, low saturated fat (LowCHO) diet compared to an isocaloric HighCHO diet. METHODS One hundred and fifteen obese patients with T2DM (age:58.4 ± 0.7 [SEM] yr, BMI:34.6 ± 0.4 kg/m(2), HbA1c:7.33 [56.3 mmol/mol] ± 0.10%) were randomised to consume an energy restricted LowCHO diet (Carb:Pro:Fat:Sat-Fat 14:28:58: < 10% energy; n = 58) or isocaloric HighCHO diet (53:17:30: < 10%; n = 57) whilst undertaking exercise (60 min, 3/wk). Bodyweight, HbA1c and FMD were assessed. RESULTS Seventy eight participants completed the intervention (LowCHO = 41, HighCHO = 37). Both groups experienced similar reductions in weight and HbA1c (-10.6 ± 0.7 kg, -1.05 ± 0.10%; p < 0.001 time, p ≥ 0.48 time × diet). FMD did not change (p = 0.11 time, p = 0.20 time × diet). CONCLUSIONS In patients with obesity and T2DM, HighCHO diet and LowCHO diet have similar effects on endothelial function.
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Affiliation(s)
- Thomas P Wycherley
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia; Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | | | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Food and Nutrition, Adelaide, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Food and Nutrition, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Food and Nutrition, Adelaide, Australia.
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25
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Shi Z, Riley M, Taylor A, Noakes M. Meal specific food patterns and the incidence of hyperglycemia in a Chinese adult population. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Watson N, Dyer K, Buckley J, Brinkworth G, Coates A, Parfitt G, Howe P, Noakes M, Murphy K. Effects of Low-Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors during Weight Loss and Weight Maintenance in Obese Adults with Type 2 Diabetes. Nutrients 2016; 8:nu8050289. [PMID: 27187457 PMCID: PMC4882702 DOI: 10.3390/nu8050289] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/26/2016] [Accepted: 05/05/2016] [Indexed: 12/25/2022] Open
Abstract
Despite evidence for the benefits of higher-protein (HP) diets in weight loss, their role in type 2 diabetes mellitus (T2DM) management and weight maintenance is not clear. This randomised study compared the effects of a HP diet (38% carbohydrate, 30% protein, 29% fat) to a isocaloric higher-carbohydrate diet (HC: 53%:21%:23%) on cardiometabolic risk factors for 12 weeks in energy restriction (~30% reduction) followed by 12 weeks of energy balance whilst performing regular exercise. Outcomes were measured at baseline and the end of each phase. Sixty-one overweight/obese adults (BMI (body mass index) 34.3 ± 5.1 kg/m2, aged 55 ± 8 years) with T2DM who commenced the study were included in the intention-to-treat analysis including the 17 participants (HP n = 9, HC n = 8) who withdrew. Following weight loss (M ± SEM: −7.8 ± 0.6 kg), there were significant reductions in HbA1c (−1.4% ± 0.1%, p < 0.001) and several cardiometabolic health risk factors. Improvements were sustained for 12 weeks when weight was stabilised and weight loss maintained. Both the HP and HC dietary patterns with concurrent exercise may be effective strategies for weight loss and weight maintenance in T2DM although further studies are needed to determine the longer term effects of weight maintenance.
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Affiliation(s)
- Nerylee Watson
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Kathryn Dyer
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Jonathan Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Grant Brinkworth
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization, PO Box 10041, Adelaide 5000, SA, Australia.
| | - Alison Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, SA, Australia.
| | - Peter Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan 2308, NSW, Australia.
| | - Manny Noakes
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization, PO Box 10041, Adelaide 5000, SA, Australia.
| | - Karen Murphy
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, SA, Australia.
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27
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Brindal E, Hendrie GA, Taylor P, Freyne J, Noakes M. Cohort Analysis of a 24-Week Randomized Controlled Trial to Assess the Efficacy of a Novel, Partial Meal Replacement Program Targeting Weight Loss and Risk Factor Reduction in Overweight/Obese Adults. Nutrients 2016; 8:nu8050265. [PMID: 27153085 PMCID: PMC4882678 DOI: 10.3390/nu8050265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/08/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022] Open
Abstract
Our aim was to design and evaluate a weight-loss program, including a partial meal replacement program, point-of-care testing and face-to-face and smartphone app support, appropriate for delivery in a community pharmacy setting. Overweight or obese adults (n = 146, 71.2% female, 48.18 ± 11.75 years old) were recruited to participate in a 24-week weight loss study and randomised to two app conditions. The dietary intervention was consistent regardless of app. Twelve weeks of clinic appointments with a trained consultant were followed by only app support for an additional 12 weeks. By week 24, retention was 57.5%. There were no differences between app conditions. Based on a cohort analysis of the trial, the mean decrease in weight from baseline to week 24 was 6.43 ± 1.06 kg for males (p < 0.001) and 5.66 ± 0.70 kg for females (p < 0.001). Mixed models also revealed decreases for LDL Cholesterol (−0.13 ± 0.08 mmol/L, nonsignificant), triglycerides (−0.08 ± 0.05 mmol/L, nonsignificant) and an increase in HDL cholesterol (+0.08 ± 0.04 mmol/L, ns) were not significant by week 24. Blood glucose (−0.23 ± 0.08 mmol/L, p = 0.040) and blood pressure (Systolic blood pressure −5.77 ± 1.21 Hg/mm, p < 0.001) were significantly lower at week 24 compared to baseline. Weight loss self-efficacy increased and remained significantly higher than baseline at week 24 (16.85 ± 2.93, p < 0.001). Overall, the program supported participants and was successful in achieving significant weight loss and improvements in health outcomes over 24 weeks.
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Affiliation(s)
- Emily Brindal
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| | - Gilly A Hendrie
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| | - Pennie Taylor
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| | - Jill Freyne
- Health and Biosecurity, CSIRO, GPO Box 76, Epping, New South Wales 1710, Australia.
| | - Manny Noakes
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
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28
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Moran LJ, Thomson RL, Buckley JD, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. Erratum to: Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome. Endocrine 2016; 52:404. [PMID: 26924153 DOI: 10.1007/s12020-016-0907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lisa J Moran
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - R L Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - J D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - M Noakes
- Fertility SA, Adelaide, SA, Australia
| | - P M Clifton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - R J Norman
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia
- Fertility SA, Adelaide, SA, Australia
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29
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Gow ML, Baur LA, Ho M, Chisholm K, Noakes M, Cowell CT, Garnett SP. Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial? Int J Behav Nutr Phys Act 2016; 13:43. [PMID: 27036113 PMCID: PMC4818484 DOI: 10.1186/s12966-016-0367-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle interventions in adolescents with obesity can result in weight loss following active intervention but individual responses vary widely. This study aimed to identify predictors of weight loss at 12- and 24-months in adolescents with obesity and clinical features of insulin resistance. METHODS Adolescents (n = 111, 66 girls, aged 10-17 years) were participants in a randomised controlled trial, the RESIST study, examining the effects of two diets differing in macronutrient content on insulin sensitivity. Eighty-five completed the 12-month program and 24-month follow-up data were available for 42 adolescents. Change in weight was determined by BMI expressed as a percentage of the 95th percentile (BMI95). The study physician collected socioeconomic data at baseline. Physical activity and screen time, and psychological dimensions of eating behavior were self-reported using the validated CLASS and EPI-C questionnaires, respectively. Stepwise multiple regressions were conducted to identify models that best predicted change in BMI95 at 12- and 24-months. RESULTS Mean BMI95 was reduced at 12-months compared with baseline (mean difference [MD] ± SE: -6.9 ± 1.0, P < 0.001) but adolescents had significant re-gain from 12- to 24-months (MD ± SE: 3.7 ± 1.5, P = 0.017). Participants who achieved greater 12-month weight loss had: greater 3-month weight loss, a father with a higher education, lower baseline external eating and parental pressure to eat scores and two parents living at home. Participants who achieved greater 24-month weight loss had: greater 12-month weight loss and a lower baseline emotional eating score. CONCLUSIONS Early weight loss is consistently identified as a strong predictor of long-term weight loss. This could be because early weight loss identifies those more motivated and engaged individuals. Patients who have baseline factors predictive of long-term weight loss failure may benefit from additional support during the intervention. Additionally, if a patient does not achieve early weight loss, further support or transition to an alternate intervention where they may have increased success may be considered. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071.
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Affiliation(s)
- Megan L. Gow
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Louise A. Baur
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Mandy Ho
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Kerryn Chisholm
- />Nutrition and Dietetics and Weight Management Services, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Manny Noakes
- />CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide BC, SA 5000 Australia
| | - Chris T. Cowell
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Sarah P. Garnett
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
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30
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Brinkworth GD, Wycherley TP, Noakes M, Buckley JD, Clifton PM. Long-term effects of a very-low-carbohydrate weight-loss diet and an isocaloric low-fat diet on bone health in obese adults. Nutrition 2016; 32:1033-6. [PMID: 27157472 DOI: 10.1016/j.nut.2016.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Compromised bone health is a frequently cited concern of very-low-carbohydrate (LC) diets, although limited data are available from long-term, well-controlled, randomized studies. This study compared the effects of an energy-restricted LC diet and traditional, higher-carbohydrate, low-fat (LF) diet on bone health after 12 mo. METHODS One hundred eighteen abdominally obese adults were randomized to consume either an energy-restricted (∼6-7 MJ/d [∼1450-1650 kcal/d]), planned isocaloric LC, or LF diet for 12 mo. Body weight, total body bone mineral content and bone mineral density (BMD), and serum bone crosslaps were assessed pre- and postintervention. RESULTS Sixty-five participants completed the study (LC = 32, LF = 33; age: 51.3 ± 7.1 y; BMI: 33.4 ± 4.0 kg/m(2)). Weight loss was similar in both groups (LC: -14.5 ± 9.8 kg, LF: -11.7 ± 7.3 kg; P = 0.26). By 1 y, total body bone mineral content had not changed in either group (LC: 2.84 ± 0.47 to 2.88 ± 0.49 kg, LF: 3.00 ± 0.52 to 3.00 ± 0.51 kg; P = 0.07 time × diet effect). In both groups, total body BMD decreased (LC: 1.26 ± 0.10 to 1.22 ± 0.09 g/cm(2), LF: 1.26 ± 0.09 to 1.23 ± 0.08 g/m(2); P < 0.001 time) and bone serum crosslaps increased (LC: 319.3 ± 142.6 to 396.5 ± 172.0 ng/L, LF: 276.3 ± 100.6 to 365.9 ± 154.2 ng/L; P < 0.001 time) independent of diet composition (P ≥ 0.25 time × diet effect). Future studies would be strengthened by the assessment of regional BMD at clinically relevant sites (i.e., hip and spine) and multiple markers of bone turnover. CONCLUSIONS Weight loss following a hypocaloric LC diet compared with an LF diet does not differentially affect markers of bone health over 12 mo in overweight and obese adults.
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Affiliation(s)
- Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia.
| | - Thomas P Wycherley
- University of South Australia, School of Health Sciences, Adelaide, South Australia, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Peter M Clifton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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31
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Thomson RL, Brinkworth GD, Noakes M, Buckley JD. Muscle strength gains during resistance exercise training are attenuated with soy compared with dairy or usual protein intake in older adults: A randomized controlled trial. Clin Nutr 2016; 35:27-33. [DOI: 10.1016/j.clnu.2015.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 11/24/2022]
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32
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Moran LJ, Thomson RL, Buckley JD, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome. Endocrine 2015; 50:811-5. [PMID: 25957668 DOI: 10.1007/s12020-015-0625-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with features including hyperandrogenism and menstrual irregularity frequently treated with hormonal steroidal contraceptives. Women with PCOS appear to have lower bone mineral density (BMD). While steroidal contraceptives may positively affect bone health, their effect on BMD in PCOS is not known. The aim of this study was to assess BMD in women with PCOS according to recent contraceptive use. A cross-sectional analysis of 95 pre-menopausal overweight or obese sedentary women with PCOS [age 29.4 ± 6.4 years, body mass index (BMI) 36.1 ± 5.3 kg/m(2)] who either recently took steroidal contraceptives (ceased 3 months prior) or were not taking steroidal contraceptives was conducted. Clinical outcomes included BMD, anthropometry, insulin, glucose, reproductive hormones, dietary intake and vitamin use. BMD was significantly lower for women who used contraceptives compared to those who did not (mean difference 0.06 g/cm(2) 95 % confidence interval -0.11, -0.02, p = 0.005). In regression models, lower BMD was independently associated with contraceptive use (β = -0.05, 95 % CI -0.094, -0.002, p = 0.042), higher testosterone (β = -0.03, 95 % CI -0.05, -0.0008, p = 0.043) and lower BMI (β = 0.006, 95 % CI 0.002, 0.01, p = 0.007) (r (2) = 0.22, p = 0.001 for entire model). We report for the first time that overweight and obese women with PCOS with recent steroidal contraceptive use had lower BMD in comparison to non-users independent of factors known to contribute to BMD. Whether this observation is directly related to steroidal contraceptive use or other factors requires further investigation.
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Affiliation(s)
- Lisa J Moran
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - R L Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - J D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - M Noakes
- Fertility SA, Adelaide, SA, Australia
| | - P M Clifton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - R J Norman
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia
- Fertility SA, Adelaide, SA, Australia
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Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, Howe PRC, Noakes M, Dye L, Chadwick H, Murphy KJ. A randomised trial comparing low-fat diets differing in carbohydrate and protein ratio, combined with regular moderate intensity exercise, on glycaemic control, cardiometabolic risk factors, food cravings, cognitive function and psychological wellbeing in adults with type 2 diabetes: Study protocol. Contemp Clin Trials 2015; 45:217-225. [PMID: 26546883 DOI: 10.1016/j.cct.2015.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypocaloric low-fat diets, high in protein with moderate carbohydrate (HP) can enhance weight loss, improve glycaemic control and improve cardiometabolic health risk factors in type 2 diabetes mellitus (T2DM). However, it is unclear whether the metabolic benefits observed during weight loss are sustained during energy-balance and weight maintenance. Furthermore, there is a lack of evidence regarding the effect of HP diets on food cravings, cognitive function and psychological wellbeing in T2DM, despite carbohydrate food cravings, cognitive impairment and depression being associated with hyperglycaemia. METHODS/DESIGN Overweight/obese adults with T2DM were randomised to consume either a HP diet (n=32, ~32% protein, 33% carbohydrate, 30% fat) or a higher-carbohydrate diet (HC, n=29, ~22% protein, 51% carbohydrate, 22% fat) for 24 weeks with 30 min of moderate intensity exercise five days/week for the study duration. There were 2 phases: a 12 week weight loss phase followed by a 12 week weight maintenance phase. Primary outcome was glycaemic control (glycosylated haemoglobin; HbA1c). Secondary outcomes were cardiometabolic risk factors (body composition, fasting blood pressure, blood lipids, glucose, insulin and C-reactive protein), food cravings, cognitive function (memory; psychomotor and executive function and psychological well-being. Outcomes were measured at baseline and the end of each 12-week intervention phase. Data will be analysed as intention-to-treat using linear mixed effects models. CONCLUSION This study will examine the effects of two dietary interventions on health outcomes in T2DM during weight loss and notably following weight maintenance where there is a paucity of evidence.
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Affiliation(s)
- Nerylee Ann Watson
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Kathryn Ann Dyer
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Jonathan David Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Grant David Brinkworth
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, SA 5000, Australia.
| | - Alison Mary Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Manny Noakes
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, SA 5000, Australia.
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Helen Chadwick
- School of Psychology, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Karen Joy Murphy
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Tay J, Thompson CH, Luscombe-Marsh ND, Noakes M, Buckley JD, Wittert GA, Brinkworth GD. Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial. Medicine (Baltimore) 2015; 94:e2181. [PMID: 26632754 PMCID: PMC5059023 DOI: 10.1097/md.0000000000002181] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare the long-term effects of a very low carbohydrate, high-protein, low saturated fat (LC) diet with a traditional high unrefined carbohydrate, low-fat (HC) diet on markers of renal function in obese adults with type 2 diabetes (T2DM), but without overt kidney disease.One hundred fifteen adults (BMI 34.6 ± 4.3 kg/m, age 58 ± 7 years, HbA1c 7.3 ± 1.1%, 56 ± 12 mmol/mol, serum creatinine (SCr) 69 ± 15 μmol/L, glomerular filtration rate estimated by the Chronic Kidney Disease Epidemiology Collaboration formula (eGFR 94 ± 12 mL/min/1.73 m)) were randomized to consume either an LC (14% energy as carbohydrate [CHO < 50 g/day], 28% protein [PRO], 58% fat [<10% saturated fat]) or an HC (53% CHO, 17% PRO, 30% fat [<10% saturated fat]) energy-matched, weight-loss diet combined with supervised exercise training (60 min, 3 day/wk) for 12 months. Body weight, blood pressure, and renal function assessed by eGFR, estimated creatinine clearance (Cockcroft-Gault, Salazar-Corcoran) and albumin excretion rate (AER), were measured pre- and post-intervention.Both groups achieved similar completion rates (LC 71%, HC 65%) and reductions in weight (mean [95% CI]; -9.3 [-10.6, -8.0] kg) and blood pressure (-6 [-9, -4]/-6[-8, -5] mmHg), P ≥ 0.18. Protein intake calculated from 24 hours urinary urea was higher in the LC than HC group (LC 120.1 ± 38.2 g/day, 1.3 g/kg/day; HC 95.8 ± 27.8 g/day, 1 g/kg/day), P < 0.001 diet effect. Changes in SCr (LC 3 [1, 5], HC 1 [-1, 3] μmol/L) and eGFR (LC -4 [-6, -2], HC -2 [-3, 0] mL/min/1.73 m) did not differ between diets (P = 0.25). AER decreased independent of diet composition (LC --2.4 [-6, 1.2], HC -1.8 [-5.4, 1.8] mg/24 h, P = 0.24); 6 participants (LC 3, HC 3) had moderately elevated AER at baseline (30-300 mg/24 h), which normalized in 4 participants (LC 2, HC 2) after 52 weeks.Compared with a traditional HC weight loss diet, consumption of an LC high protein diet does not adversely affect clinical markers of renal function in obese adults with T2DM and no preexisting kidney disease.
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Affiliation(s)
- Jeannie Tay
- From the Commonwealth Scientific and Industrial Research Organisation (CSIRO)-Food and Nutrition (JT, NDL-M, MN, GDB); Discipline of Medicine, University of Adelaide (JT, CHT, NDL-M, GAW); Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia (JDB); and Agency for Science, Technology and Research (A-STAR), Singapore, Singapore (JT)
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Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr 2015; 102:780-90. [PMID: 26224300 DOI: 10.3945/ajcn.115.112581] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/02/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Few well-controlled studies have comprehensively examined the effects of very-low-carbohydrate diets on type 2 diabetes (T2D). OBJECTIVE We compared the effects of a very-low-carbohydrate, high-unsaturated fat, low-saturated fat (LC) diet with a high-carbohydrate, low-fat (HC) diet on glycemic control and cardiovascular disease risk factors in T2D after 52 wk. DESIGN In this randomized controlled trial that was conducted in an outpatient research clinic, 115 obese adults with T2D [mean ± SD age: 58 ± 7 y; body mass index (in kg/m(2)): 34.6 ± 4.3; glycated hemoglobin (HbA1c): 7.3 ± 1.1%; duration of diabetes: 8 ± 6 y] were randomly assigned to consume either a hypocaloric LC diet [14% of energy as carbohydrate (carbohydrate <50 g/d), 28% of energy as protein, and 58% of energy as fat (<10% saturated fat)] or an energy-matched HC diet [53% of energy as carbohydrate, 17% of energy as protein, and 30% of energy as fat (<10% saturated fat)] combined with supervised aerobic and resistance exercise (60 min; 3 d/wk). Outcomes were glycemic control assessed with use of measurements of HbA1c, fasting blood glucose, glycemic variability assessed with use of 48-h continuous glucose monitoring, diabetes medication, weight, blood pressure, and lipids assessed at baseline, 24, and 52 wk. RESULTS Both groups achieved similar completion rates (LC diet: 71%; HC diet: 65%) and mean (95% CI) reductions in weight [LC diet: -9.8 kg (-11.7, -7.9 kg); HC diet: -10.1 kg (-12.0, -8.2 kg)], blood pressure [LC diet: -7.1 (-10.6, -3.7)/-6.2 (-8.2, -4.1) mm Hg; HC diet: -5.8 (-9.4, -2.2)/-6.4 (-8.4, -4.3) mm Hg], HbA1c [LC diet: -1.0% (-1.2%, -0.7%); HC diet: -1.0% (-1.3%, -0.8%)], fasting glucose [LC diet: -0.7 mmol/L (-1.3, -0.1 mmol/L); HC diet: -1.5 mmol/L (-2.1, -0.8 mmol/L)], and LDL cholesterol [LC diet: -0.1 mmol/L (-0.3, 0.1 mmol/L); HC diet: -0.2 mmol/L (-0.4, 0.03 mmol/L)] (P-diet effect ≥ 0.10). Compared with the HC-diet group, the LC-diet group achieved greater mean (95% CI) reductions in the diabetes medication score [LC diet: -0.5 arbitrary units (-0.7, -0.4 arbitrary units); HC diet: -0.2 arbitrary units (-0.4, -0.06 arbitrary units); P = 0.02], glycemic variability assessed by measuring the continuous overall net glycemic action-1 [LC diet: -0.5 mmol/L (-0.6, -0.3 mmol/L); HC diet: -0.05 mmol/L (-0.2, -0.1 mmol/L); P = 0.003], and triglycerides [LC diet: -0.4 mmol/L (-0.5, -0.2 mmol/L); HC diet: -0.01 mmol/L (-0.2, 0.2 mmol/L); P = 0.001] and greater mean (95% CI) increases in HDL cholesterol [LC diet: 0.1 mmol/L (0.1, 0.2 mmol/L); HC diet: 0.06 mmol/L (-0.01, 0.1 mmol/L); P = 0.002]. CONCLUSIONS Both diets achieved substantial weight loss and reduced HbA1c and fasting glucose. The LC diet, which was high in unsaturated fat and low in saturated fat, achieved greater improvements in the lipid profile, blood glucose stability, and reductions in diabetes medication requirements, suggesting an effective strategy for the optimization of T2D management. This trial was registered at www.anzctr.org.au as ACTRN12612000369820.
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Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation-Food and Nutrition Flagship, Adelaide, Australia; Centre for Nutritional and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, Adelaide, Australia; Agency for Science, Technology and Research, Singapore
| | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation-Food and Nutrition Flagship, Adelaide, Australia; Centre for Nutritional and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Campbell H Thompson
- Centre for Nutritional and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation-Food and Nutrition Flagship, Adelaide, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Centre for Nutritional and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC; and
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation-Food and Nutrition Flagship, Adelaide, Australia;
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Nestel P, Clifton P, Colquhoun D, Noakes M, Mori TA, Sullivan D, Thomas B. Indications for Omega-3 Long Chain Polyunsaturated Fatty Acid in the Prevention and Treatment of Cardiovascular Disease. Heart Lung Circ 2015; 24:769-79. [DOI: 10.1016/j.hlc.2015.03.020] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/22/2015] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
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Watson N, Dyer K, Buckley J, Brinkworth G, Coates A, Parfitt G, Howe P, Noakes M, Murphy K. Low‐Fat Diets Differing in Protein and Carbohydrate Content on Cardiometabolic Risk Factors in Adults with Type 2 Diabetes. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.117.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nerylee Watson
- Sansom Institute for Health Research University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Kathryn Dyer
- Sansom Institute for Health Research University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Jonathon Buckley
- Sansom Institute for Health Research University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Grant Brinkworth
- Food and NutritionCommonwealth Scientific and Industrial Research OrganisationAdelaideSouth AustraliaAustralia
| | - Alison Coates
- Sansom Institute for Health Research University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Gaynor Parfitt
- Sansom Institute for Health Research University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Peter Howe
- Clinical Nutrition Research Centre University of NewcastleCallaghanNew South WalesAustralia
| | - Manny Noakes
- Food and NutritionCommonwealth Scientific and Industrial Research OrganisationAdelaideSouth AustraliaAustralia
| | - Karen Murphy
- Sansom Institute for Health Research University of South AustraliaAdelaideSouth AustraliaAustralia
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Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD. Response to comment on Tay et al. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care 2014;37:2909-2918. Diabetes Care 2015; 38:e65-6. [PMID: 25805878 DOI: 10.2337/dc14-3057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jeannie Tay
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia Agency for Science, Technology and Research (A*STAR), Singapore
| | - Natalie D Luscombe-Marsh
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia
| | | | - Manny Noakes
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia
| | - Jonathan D Buckley
- Nutritional Physiology Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - Grant D Brinkworth
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia
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Caperchione CM, Duncan M, Kolt GS, Vandelanotte C, Rosenkranz RR, Maeder A, Noakes M, Karunanithi M, Mummery WK. Examining an Australian physical activity and nutrition intervention using RE-AIM. Health Promot Int 2015; 31:450-8. [PMID: 25715801 DOI: 10.1093/heapro/dav005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Translating evidence-based interventions into community practice is vital to health promotion. This study used the RE-AIM framework to evaluate the larger dissemination of the ManUp intervention, an intervention which utilized interactive web-based technologies to improve the physical activity and nutrition behaviors of residents in Central Queensland, Australia. Data were collected for each RE-AIM measure (Reach, Effectiveness, Adoption, Implementation, Maintenance) using (i) computer-assisted telephone interview survey (N = 312) with adults (18 years and over) from Central Queensland, (ii) interviews with key stakeholders from local organizations (n = 12) and (iii) examination of project-related statistics and findings. In terms of Reach, 47% of participants were aware of the intervention; Effectiveness, there were no significant differences between physical activity and healthy nutrition levels in those aware and unaware; Adoption, 73 participants registered for the intervention and 25% of organizations adopted some part of the intervention; Implementation, 26% of participants initially logged onto the website, 29 and 17% started the web-based physical activity and nutrition challenges, 33% of organizations implemented the intervention, 42% considered implementation and 25% reported difficulties; Maintenance, an average of 0.57 logins and 1.35 entries per week during the 12 week dissemination and 0.27 logins and 0.63 entries per week during the 9-month follow-up were achieved, 22 and 0% of participants completed the web-based physical activity and nutrition challenges and 33.3% of organizations intended to continue utilizing components of the intervention. While this intervention demonstrated good reach, effectiveness, adoption and implementation warrant further investigation.
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Affiliation(s)
- Cristina M Caperchione
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, 3333 University Way, HSC117, Kelowna, BC V1V1V7, Canada
| | - Mitch Duncan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Gregory S Kolt
- School of Science and Health, University of Western Sydney, Sydney, NSW, Australia
| | - Corneel Vandelanotte
- Centre for Physical Activity Studies, Institute for Health and Social Science Research, CQUniversity Australia, Rockhampton, QLD, Australia
| | | | - Anthony Maeder
- School of Computing, Engineering & Math University of Western Sydney, Sydney, NSW, Australia
| | - Manny Noakes
- Food and Nutritional Sciences, CSIRO, Adelaide, SA, Australia
| | | | - W Kerry Mummery
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
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Stonehouse W, Brinkworth GD, Noakes M. Palmolein and olive oil consumed within a high protein test meal have similar effects on postprandial endothelial function in overweight and obese men: A randomized controlled trial. Atherosclerosis 2015; 239:178-85. [PMID: 25617858 DOI: 10.1016/j.atherosclerosis.2015.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/24/2014] [Accepted: 01/10/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study assessed the postprandial effects of high fat, high protein meals containing either palmolein or olive oil on endothelial function in overweight/obese men. DESIGN 28 men (32-65 yr; 25-35 kg/m(2)) consumed, in random order 1 wk apart, isocaloric high protein, high fat meals (2791 kJ, 40 g protein (∼3 g l-arginine), 44 g fat, 21 g carbohydrate) prepared with either 40 g palmolein or 40 g olive oil after an overnight fast. The SFA:MUFA:PUFA ratio of the oils were: palmolein, 42:47:12; olive oil, 17:76:7. Brachial artery flow-mediated dilatation (FMD), circulating endothelial function markers, nitrotyrosine (oxidative stress marker), triglycerides, glucose and insulin were assessed pre-meal and hourly for 5 h. Mixed model procedures were used to analyze the data. RESULTS Meal consumption increased serum triglycerides (time effect, P < 0.001); with no meal differences (meal × time interaction, P = 0.93). Serum insulin peaked 1 h post-consumption and returned to pre-meal concentrations by 5 h with both meals (time effect, P < 0.001; meal × time effect, P = 0.68). FMD, serum intercellular adhesion molecule-1 (ICAM-1) and E-selectin did not change (meal × time effect, P > 0.4). Olive oil transiently increased plasma nitrotyrosine after 1 h compared to palmolein (meal × time interaction, P = 0.002) whereas both meals increased serum vascular cell adhesion molecule-1 (VCAM-1) after 1 h (time effect, P < 0.001; meal × time interaction, P = 0.98). Both nitrotyrosine and VCAM-1 returned to pre-meal concentrations after 2 h. CONCLUSION In the context of a high protein meal, palmolein similarly to olive oil did not affect postprandial endothelial function in overweight/obese men. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/default.aspx). Trial ID: ACTRN12613000136707.
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Affiliation(s)
- Welma Stonehouse
- Commonwealth Scientific Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia.
| | - Grant D Brinkworth
- Commonwealth Scientific Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Manny Noakes
- Commonwealth Scientific Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
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Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, Howe PRC, Noakes M, Murphy KJ. Prescription of energy-restricted diets with higher and lower pork protein content achieves weight loss and improved glycaemic control in adults with type 2 diabetes. Anim Prod Sci 2015. [DOI: 10.1071/anv55n12ab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wycherley T, Luscombe-Marsh N, Thompson C, Buckley J, Noakes M, Wittert G, Brinkworth G. Effects of weight loss with a very low carbohydrate, low saturated fat diet on endothelial function in patients with T2DM. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tay J, Luscombe-Marsh N, Thompson C, Noakes M, Buckley J, Wittert G, Yancy W, Brinkworth G. Long-term consumption of a low carbohydrate, low saturated fat diet improves type 2 diabetes management. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stonehouse W, Brinkworth G, Noakes M. Palmolein and olive oil consumed as part of high protein test meals do not impair postprandial endothelial function. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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45
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Brinkworth G, Luscombe-Marsh N, Thompson C, Noakes M, Buckley J, Wittert G, Wilson C. Long-term effects of very low- and high-carbohydrate weight loss diets on mood response in obese adults with type 2 diabetes. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hendrie G, Noakes M. How does monthly food expenditure differ across self-reported dietary question reponses and weight status groups? Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Garnett SP, Gow M, Ho M, Baur LA, Noakes M, Woodhead HJ, Broderick CR, Chisholm K, Briody J, De S, Steinbeck K, Srinivasan S, Ambler GR, Cowell CT. Improved insulin sensitivity and body composition, irrespective of macronutrient intake, after a 12 month intervention in adolescents with pre-diabetes; RESIST a randomised control trial. BMC Pediatr 2014; 14:289. [PMID: 25422027 PMCID: PMC4252020 DOI: 10.1186/s12887-014-0289-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/06/2014] [Indexed: 01/01/2023] Open
Abstract
Background A higher protein to carbohydrate ratio in the diet may potentiate weight loss, improve body composition and cardiometabolic risk, including glucose homeostasis in adults. The aim of this randomised control trial was to determine the efficacy of two structured lifestyle interventions, differing in dietary macronutrient content, on insulin sensitivity and body composition in adolescents. We hypothesised that a moderate-carbohydrate (40-45% of energy), increased-protein (25-30%) diet would be more effective than a high-carbohydrate diet (55-60%), moderate-protein (15%) diet in improving outcomes in obese, insulin resistant adolescents. Methods Obese 10–17 year olds with either pre-diabetes and/or clinical features of insulin resistance were recruited at two hospitals in Sydney, Australia. At baseline adolescents were prescribed metformin and randomised to one of two energy restricted diets. The intervention included regular contact with the dietician and a supervised physical activity program. Outcomes included insulin sensitivity index measured by an oral glucose tolerance test and body composition measured by dual-energy x-ray absorptiometry at 12 months. Results Of the 111 adolescents recruited, 85 (77%) completed the intervention. BMI expressed as a percentage of the 95th percentile decreased by 6.8% [95% CI: −8.8 to −4.9], ISI increased by 0.2 [95% CI: 0.06 to 0.39] and percent body fat decreased by 2.4% [95% CI: −3.4 to −1.3]. There were no significant differences in outcomes between diet groups at any time. Conclusion When treated with metformin and an exercise program, a structured, reduced energy diet, which is either high-carbohydrate or moderate-carbohydrate with increased-protein, can achieve clinically significant improvements in obese adolescents at risk of type 2 diabetes. Trial registration Australian New Zealand Clinical Trail Registry ACTRN12608000416392. Registered 25 August 2008.
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Affiliation(s)
- Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Megan Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Mandy Ho
- The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Louise A Baur
- Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Manny Noakes
- CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide, BC South Australia, 5000, Australia.
| | - Helen J Woodhead
- Department of Paediatrics, Campbelltown Hospital, PO Box 149, Campbelltown, NSW, 2560, Australia. .,Department of Diabetes and Endocrinology, Sydney Children's Hospital Network, Randwick, Sydney, NSW, 2031, Australia.
| | - Carolyn R Broderick
- The Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Kerryn Chisholm
- Nutrition and Dietetics and Weight Management Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Sukanya De
- Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Katherine Steinbeck
- Academic Department of Adolescent Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, 2066, Australia.
| | - Shubha Srinivasan
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Chris T Cowell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
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Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care 2014; 37:2909-18. [PMID: 25071075 DOI: 10.2337/dc14-0845] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To comprehensively compare the effects of a very low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) with those of a high-unrefined carbohydrate, low-fat diet (HC) on glycemic control and cardiovascular disease (CVD) risk factors in type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS Obese adults (n = 115, BMI 34.4 ± 4.2 kg/m(2), age 58 ± 7 years) with T2DM were randomized to a hypocaloric LC diet (14% carbohydrate [<50 g/day], 28% protein, and 58% fat [<10% saturated fat]) or an energy-matched HC diet (53% carbohydrate, 17% protein, and 30% fat [<10% saturated fat]) combined with structured exercise for 24 weeks. The outcomes measured were as follows: glycosylated hemoglobin (HbA1c), glycemic variability (GV; assessed by 48-h continuous glucose monitoring), antiglycemic medication changes (antiglycemic medication effects score [MES]), and blood lipids and pressure. RESULTS A total of 93 participants completed 24 weeks. Both groups achieved similar completion rates (LC 79%, HC 82%) and weight loss (LC -12.0 ± 6.3 kg, HC -11.5 ± 5.5 kg); P ≥ 0.50. Blood pressure (-9.8/-7.3 ± 11.6/6.8 mmHg), fasting blood glucose (-1.4 ± 2.3 mmol/L), and LDL cholesterol (-0.3 ± 0.6 mmol/L) decreased, with no diet effect (P ≥ 0.10). LC achieved greater reductions in triglycerides (-0.5 ± 0.5 vs. -0.1 ± 0.5 mmol/L), MES (-0.5 ± 0.5 vs. -0.2 ± 0.5), and GV indices; P ≤ 0.03. LC induced greater HbA1c reductions (-2.6 ± 1.0% [-28.4 ± 10.9 mmol/mol] vs. -1.9 ± 1.2% [-20.8 ± 13.1 mmol/mol]; P = 0.002) and HDL cholesterol (HDL-C) increases (0.2 ± 0.3 vs. 0.05 ± 0.2 mmol/L; P = 0.007) in participants with the respective baseline values HbA1c >7.8% (62 mmol/mol) and HDL-C <1.29 mmol/L. CONCLUSIONS Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers. These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC. This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks.
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Affiliation(s)
- Jeannie Tay
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia Agency for Science, Technology and Research (A*STAR), Singapore
| | - Natalie D Luscombe-Marsh
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia
| | | | - Manny Noakes
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia
| | - Jon D Buckley
- Nutritional Physiology Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - Grant D Brinkworth
- Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia
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Ridoutt BG, Baird DL, Bastiaans K, Darnell R, Hendrie GA, Riley M, Sanguansri P, Syrette J, Noakes M, Keating BA. Short communication: a food-systems approach to assessing dairy product waste. J Dairy Sci 2014; 97:6107-10. [PMID: 25064645 DOI: 10.3168/jds.2014-8017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/16/2014] [Indexed: 11/19/2022]
Abstract
Concern about world population increase, food security, and the environmental burdens of food production have made food-waste reduction a social and environmental priority. In this context, the quantification of dairy product waste is especially difficult due to the varied means of disposal, by solid and liquid waste streams, and due to inclusion as an ingredient in many processed foods. In this study, food intake data from the Australian National Nutrition Survey (>13,000 participants; >4,500 food items) were disaggregated into basic foods and total national dairy product intake was expressed in whole-milk equivalents. This result was compared with total domestic milk supply, indicating a level of waste of 29% for dairy products in the Australian food system. With national food-waste reduction targets becoming increasingly common, reliable estimates of food waste at the national scale are important for goal setting, baseline reporting, and performance monitoring. For this purpose, the systems approach to assessing food waste demonstrated in this project is deemed to have advantages over other common methods of food-waste assessment, such as bin audits, waste diaries, and surveys.
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Affiliation(s)
- B G Ridoutt
- CSIRO Animal, Food and Health Sciences, Clayton, Victoria 3169, Australia.
| | - D L Baird
- CSIRO Animal, Food and Health Sciences, Adelaide, South Australia 5000, Australia
| | - K Bastiaans
- CSIRO Animal, Food and Health Sciences, Adelaide, South Australia 5000, Australia
| | - R Darnell
- CSIRO Computational Informatics, Dutton Park, Queensland 4102, Australia
| | - G A Hendrie
- CSIRO Animal, Food and Health Sciences, Adelaide, South Australia 5000, Australia
| | - M Riley
- CSIRO Animal, Food and Health Sciences, Adelaide, South Australia 5000, Australia
| | - P Sanguansri
- CSIRO Animal, Food and Health Sciences, Werribee, Victoria 3030, Australia
| | - J Syrette
- CSIRO Animal, Food and Health Sciences, Adelaide, South Australia 5000, Australia
| | - M Noakes
- CSIRO Animal, Food and Health Sciences, Adelaide, South Australia 5000, Australia
| | - B A Keating
- CSIRO Sustainable Agriculture National Research Flagship, Dutton Park, Queensland 4102, Australia
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Wycherley TP, Buckley JD, Noakes M, Clifton PM, Brinkworth GD. Long-Term Effects of a Very Low-Carbohydrate Weight Loss Diet on Exercise Capacity and Tolerance in Overweight and Obese Adults. J Am Coll Nutr 2014; 33:267-73. [DOI: 10.1080/07315724.2014.911668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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