scholarly journals Energy Requirement Is Higher During Weight-Loss Maintenance in Adults Consuming a Low- Compared with High-Carbohydrate Diet

2020 ◽  
Vol 150 (8) ◽  
pp. 2009-2015 ◽  
Author(s):  
Cara B Ebbeling ◽  
Lisa Bielak ◽  
Paul R Lakin ◽  
Gloria L Klein ◽  
Julia M W Wong ◽  
...  
Keyword(s):  
Weight Loss ◽  
Energy Expenditure ◽  
Total Energy ◽  
Energy Requirement ◽  
Weight Loss Maintenance ◽  
High Carbohydrate Diet ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
High Carbohydrate ◽  
Low Carbohydrate

ABSTRACT Background Longer-term feeding studies suggest that a low-carbohydrate diet increases energy expenditure, consistent with the carbohydrate-insulin model of obesity. However, the validity of methodology utilized in these studies, involving doubly labeled water (DLW), has been questioned. Objective The aim of this study was to determine whether dietary energy requirement for weight-loss maintenance is higher on a low- compared with high-carbohydrate diet. Methods The study reports secondary outcomes from a feeding study in which the primary outcome was total energy expenditure (TEE). After attaining a mean Run-in weight loss of 10.5%, 164 adults (BMI ≥25 kg/m2; 70.1% women) were randomly assigned to Low-Carbohydrate (percentage of total energy from carbohydrate, fat, protein: 20/60/20), Moderate-Carbohydrate (40/40/20), or High-Carbohydrate (60/20/20) Test diets for 20 wk. Calorie content was adjusted to maintain individual body weight within ± 2 kg of the postweight-loss value. In analyses by intention-to-treat (ITT, completers, n = 148) and per protocol (PP, completers also achieving weight-loss maintenance, n = 110), we compared the estimated energy requirement (EER) from 10 to 20 wk of the Test diets using ANCOVA. Results Mean EER was higher in the Low- versus High-Carbohydrate group in models of varying covariate structure involving ITT [ranging from 181 (95% CI: 8–353) to 246 (64–427) kcal/d; P ≤0.04] and PP [ranging from 245 (43–446) to 323 (122–525) kcal/d; P ≤0.02]. This difference remained significant in sensitivity analyses accounting for change in adiposity and possible nonadherence. Conclusions Energy requirement was higher on a low- versus high-carbohydrate diet during weight-loss maintenance in adults, commensurate with TEE. These data are consistent with the carbohydrate-insulin model and lend qualified support for the validity of the DLW method with diets varying in macronutrient composition. This trial was registered at clinicaltrials.gov as NCT02068885.

scholarly journals Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial

BMJ ◽  
2018 ◽  
pp. k4583 ◽  
Author(s):  
Cara B Ebbeling ◽  
Henry A Feldman ◽  
Gloria L Klein ◽  
Julia M W Wong ◽  
Lisa Bielak ◽  
...  
Keyword(s):  
Weight Loss ◽  
Energy Expenditure ◽  
Total Energy ◽  
Total Energy Expenditure ◽  
Carbohydrate Diet ◽  
Intention To Treat ◽  
Low Carbohydrate Diet ◽  
High Carbohydrate ◽  
Low Carbohydrate ◽  
Treat Analysis

AbstractObjectiveTo determine the effects of diets varying in carbohydrate to fat ratio on total energy expenditure.DesignRandomized trial.SettingMulticenter collaboration at US two sites, August 2014 to May 2017.Participants164 adults aged 18-65 years with a body mass index of 25 or more.InterventionsAfter 12% (within 2%) weight loss on a run-in diet, participants were randomly assigned to one of three test diets according to carbohydrate content (high, 60%, n=54; moderate, 40%, n=53; or low, 20%, n=57) for 20 weeks. Test diets were controlled for protein and were energy adjusted to maintain weight loss within 2 kg. To test for effect modification predicted by the carbohydrate-insulin model, the sample was divided into thirds of pre-weight loss insulin secretion (insulin concentration 30 minutes after oral glucose).Main outcome measuresThe primary outcome was total energy expenditure, measured with doubly labeled water, by intention-to-treat analysis. Per protocol analysis included participants who maintained target weight loss, potentially providing a more precise effect estimate. Secondary outcomes were resting energy expenditure, measures of physical activity, and levels of the metabolic hormones leptin and ghrelin.ResultsTotal energy expenditure differed by diet in the intention-to-treat analysis (n=162, P=0.002), with a linear trend of 52 kcal/d (95% confidence interval 23 to 82) for every 10% decrease in the contribution of carbohydrate to total energy intake (1 kcal=4.18 kJ=0.00418 MJ). Change in total energy expenditure was 91 kcal/d (95% confidence interval −29 to 210) greater in participants assigned to the moderate carbohydrate diet and 209 kcal/d (91 to 326) greater in those assigned to the low carbohydrate diet compared with the high carbohydrate diet. In the per protocol analysis (n=120, P<0.001), the respective differences were 131 kcal/d (−6 to 267) and 278 kcal/d (144 to 411). Among participants in the highest third of pre-weight loss insulin secretion, the difference between the low and high carbohydrate diet was 308 kcal/d in the intention-to-treat analysis and 478 kcal/d in the per protocol analysis (P<0.004). Ghrelin was significantly lower in participants assigned to the low carbohydrate diet compared with those assigned to the high carbohydrate diet (both analyses). Leptin was also significantly lower in participants assigned to the low carbohydrate diet (per protocol).ConclusionsConsistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance. This metabolic effect may improve the success of obesity treatment, especially among those with high insulin secretion.Trial registrationClinicalTrials.govNCT02068885.

scholarly journals Higher energy requirement during weight-loss maintenance on a low- versus high-carbohydrate diet: secondary analyses from a randomized controlled feeding study

2019 ◽  
Author(s):  
Cara B Ebbeling ◽  
Lisa Bielak ◽  
Paul R Lakin ◽  
Gloria L Klein ◽  
Julia MW Wong ◽  
...  
Keyword(s):  
Weight Loss ◽  
Energy Expenditure ◽  
Energy Requirement ◽  
Weight Loss Maintenance ◽  
Total Energy Expenditure ◽  
High Carbohydrate Diet ◽  
Doubly Labeled Water ◽  
Carbohydrate Diet ◽  
High Carbohydrate ◽  
Feeding Study

ABSTRACTBackgroundLonger-term feeding studies suggest that a low-carbohydrate diet increases energy expenditure, consistent with the carbohydrate-insulin model of obesity. However, the validity of methodology utilized in these studies, involving doubly-labeled water, has been questioned.ObjectiveThe aim of this study was to determine whether dietary energy requirement for weight-loss maintenance is higher on a low-versus high-carbohydrate diet.MethodsThe study reports secondary outcomes and exploratory analyses from a feeding study in which the primary outcome was total energy expenditure. After attaining a mean Run-in weight loss of 10.5%, 164 adults with pre-weight-loss BMI of ≥25 were randomly assigned to Test diets containing Low (20%), Moderate (40%) or High (60%) carbohydrate for 20 weeks. Calorie content of Test diets was adjusted to maintain individual body weight within 2 kg of the post-weight-loss value. In analyses by Intention-to-Treat (ITT, study completers, n=148) and Per Protocol (PP, those achieving the weight-loss maintenance target, n=110), we compared estimated energy requirement from 10 to 20 weeks on the Test diets using ANCOVA. Insulin secretion was assessed pre-weight-loss as insulin concentration 30 minutes following 75 grams oral glucose (Insulin-30).ResultsEstimated energy requirement was higher in the Low vs High group by models involving ITT (ranging from 181 [CI 8–353] to 223 [40–406] kcal/d; P≤0.04) and PP (ranging from 245 [43–446] to 295 [91–499] kcal/d; P≤0.02). This difference remained significant in sensitivity analyses accounting for change in adiposity and possible non-adherence. In observational analyses, pre-weight loss Insulin-30 predicted adverse change in body composition following weight loss.ConclusionsEnergy requirement was higher on a low-versus high-carbohydrate diet during weight-loss maintenance, commensurate with total energy expenditure. These data are consistent with the carbohydrate-insulin model and lend qualified support for the validity of the doubly-labeled water method with diets varying in macronutrient composition.

Diets Varying in Carbohydrate Content Differentially Alter Brain Activity in Homeostatic and Reward Regions in Adults

2021 ◽  
Author(s):  
Laura M Holsen ◽  
W Scott Hoge ◽  
Belinda S Lennerz ◽  
Hilâl Cerit ◽  
Taryn Hye ◽  
...  
Keyword(s):  
Weight Loss ◽  
Insulin Secretion ◽  
Total Energy ◽  
Brain Activity ◽  
Weight Loss Maintenance ◽  
Brain Regions ◽  
High Carbohydrate Diet ◽  
Carbohydrate Content ◽  
Carbohydrate Diet ◽  
High Carbohydrate

ABSTRACT Background Obesity has one of the highest refractory rates of all chronic diseases, in part because weight loss induced by calorie restriction, the first-line treatment for obesity, elicits biological adaptations that promote weight regain. Although acute feeding trials suggest a role for macronutrient composition in modifying brain activity related to hunger and satiety, relevance of these findings to weight-loss maintenance has not been studied. Objectives We investigated effects of weight-loss maintenance diets varying in macronutrient content on regional cerebral blood flow (rCBF) in brain regions involved in hunger and reward. Methods In conjunction with a randomized controlled feeding trial, we investigated the effects of weight-loss maintenance diets varying in carbohydrate content [high, 60% of total energy: n = 20; 6 men/14 women; mean age: 32.5 y; mean BMI (in kg/m 2): 27.4; moderate, 40% of total energy: n = 22; 10 men/12 women; mean age: 32.5 y; mean BMI: 29.0; low, 20% of total energy: n = 28; 12 men/16 women; mean age: 33.2 y; mean BMI: 27.7] on rCBF in brain regions involved in hunger and reward preprandial and 4 h postprandial after 14–20 wk on the diets. The primary outcome was rCBF in the nucleus accumbens (NAcc) at 4 h postprandial; the secondary outcome was preprandial rCBF in the hypothalamus. Results Consistent with a priori hypothesis, at 4 h postprandial, NAcc rCBF was 43% higher in adults assigned to the high- compared with low-carbohydrate diet {P[family-wise error (FWE)-corrected] &lt; 0.05}. Preprandial hypothalamus rCBF was 41% higher on high-carbohydrate diet [P(FWE-corrected) &lt; 0.001]. Exploratory analyses revealed that elevated rCBF on high-carbohydrate diet was not specific to prandial state: preprandial NAcc rCBF [P(FWE-corrected) &lt; 0.001] and 4 h postprandial rCBF in hypothalamus [P(FWE-corrected) &lt; 0.001]. Insulin secretion predicted differential postprandial activation of the NAcc by diet. Conclusions We report significant differences in rCBF in adults assigned to diets varying in carbohydrate content for several months, which appear to be partially associated with insulin secretion. These findings suggest that chronic intake of a high-carbohydrate diet may affect brain reward and homeostatic activity in ways that could impede weight-loss maintenance. This trial was registered at clinicaltrials.gov as NCT02300857.

scholarly journals Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Kim J Shimy ◽  
Henry A Feldman ◽  
Gloria L Klein ◽  
Lisa Bielak ◽  
Cara B Ebbeling ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Weight Loss ◽  
Free Fatty Acids ◽  
High Carbohydrate Diet ◽  
Carbohydrate Content ◽  
Dietary Carbohydrate ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
High Carbohydrate ◽  
Low Carbohydrate

Abstract Context According to the carbohydrate-insulin model of obesity, an elevated insulin-to-glucagon ratio in response to a high-carbohydrate diet directs metabolic fuels toward storage, resulting in lower circulating energy. Objective To determine differences in total circulating energy post-meal related to dietary carbohydrate. Design Ancillary study within the Framingham State Food Study. Setting University community. Participants 29 adults (aged 20 to 65 years) with overweight or obesity (body mass index ≥25 kg/m2) Intervention After achieving 10% to 14% weight loss on a run-in diet, participants were randomized to weight-loss-maintenance test diets varying in carbohydrate content (high-carbohydrate, 60% of total energy, n = 11; moderate-carbohydrate, 40%, n = 8; low-carbohydrate, 20%, n = 10) and controlled for protein (20%). During 24-hour metabolic ward admissions between 10 and 15 weeks on the test diets, metabolic fuels and hormones were measured. Main Outcome Measure Energy availability (EA) based on energy content of blood glucose, beta-hydroxybutyrate, and free fatty acids, in the late postprandial period (180 to 300 minutes). Insulin at 30 minutes into the test meal (Meal Insulin-30) was measured as an effect modifier. Results Insulin-to-glucagon ratio was 7-fold higher in participants on the high- vs low-carbohydrate diet (2.5 and 0.36, respectively). Late postprandial EA was 0.58 kcal/L lower on the high- vs low-carbohydrate diet (P &lt; 0.0001), primarily related to suppression of free fatty acids. Early postprandial EA (30 to 180 minutes) declined fastest in the high-carbohydrate group, and Meal Insulin-30 modified this diet effect. Conclusions During weight-loss maintenance on a high-carbohydrate diet, late postprandial EA is reduced, consistent with the carbohydrate-insulin model.

Food intake and gastric emptying in rats with streptozotocin-induced diabetes

1984 ◽  
Vol 247 (6) ◽  
pp. R1054-R1061 ◽  
Author(s):  
J. G. Granneman ◽  
E. M. Stricker
Keyword(s):  
Gastric Emptying ◽  
Food Intake ◽  
Glucose Absorption ◽  
Diabetic Rats ◽  
High Carbohydrate Diet ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
High Carbohydrate ◽  
Low Carbohydrate ◽  
Streptozotocin Induced Diabetes

Recent studies suggest that the rate of nutrient transit through the upper gastrointestract may provide cues that are important to the control of food intake. We examined gastrointestinal function in rats with streptozotocin-induced diabetes and related these findings to concomitant changes in food intake. Control and diabetic rats were adapted to one of two isocaloric diets either high in carbohydrate or fat. Control rats ate similar amounts of each diet. In contrast, diabetic animals fed high-carbohydrate diet were hyperphagic, whereas those fed low-carbohydrate diet ate normal amounts of food. Gastric emptying, intestinal mass, disaccharidase activity, and glucose absorption were increased in normophagic diabetic rats fed a low-carbohydrate diet. Feeding diabetic rats high-carbohydrate diet potentiated each of these effects, and food intake was highly correlated with rate of gastric emptying. These and other results indicate that diabetes enhances gastric emptying and intestinal carbohydrate digestion and absorption, even in the absence of hyperphagia. Consequently, the hyperphagia of diabetic rats may be in part a behavioral response to a greatly accelerated clearance of nutrients from the upper gastrointestinal tract that occurs when these animals are fed diets rich in carbohydrate.

scholarly journals Changes in the lipidome in type 1 diabetes following low carbohydrate diet: a randomized crossover trial

2020 ◽  
Author(s):  
Naba Al-Sari ◽  
Signe Schmidt ◽  
Tommi Suvitaival ◽  
Min Kim ◽  
Kajetan Trost ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Hdl Cholesterol ◽  
High Carbohydrate Diet ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
High Carbohydrate ◽  
Lipid Species ◽  
Low Carbohydrate ◽  
Before And After

Aims/hypothesis: Lipid metabolism might be compromised in type 1 diabetes and the understanding of their physiology is critically important. This study aimed to compare the change in plasma lipid concentrations during carbohydrate dietary changes in individuals with type 1 diabetes and identify predictive biomarkers and early-stage pathophysiology for dyslipidaemia. We hypothesized that: (1) the lipidomics profiles before and after ingesting low or high carbohydrate diet for 12 weeks would be different; and (2) specific annotated lipid species would have significant associations with metabolic outcomes. Methods: Ten adults with type 1 diabetes (mean+/-SD: age 43.6+/-13.8 years, diabetes duration 24.5+/-13.4 years, BMI 24.9+/-2.1 kg/m2, HbA1c 57.67+/-2.6 mmol/mol) using insulin pumps participated in a randomized 2-period crossover study with a 12-week intervention period of low carbohydrate diet (< 100 g carbohydrates/day) or high carbohydrate diet (> 250 g carbohydrates/day) respectively, separated by a 12-week washout period. A large-scale non-targeted lipidomics was performed with mass spectrometry for fasting plasma samples obtained before and after each diet intervention. Logitudinal lipid levels were analysed using linear mixed-effects models. Results: In total, 289 lipid species were identified from 14 major lipid classes (triacylglycerides, phosphatidylcholines, phosphatidylethanolamines, hexosyl-ceramide, sphingomyelins, lyso-phosphatidylcholines, ceramides, lactosyl-ceramide, lyso-phoshatidylethanolamine, free fatty acids, phosphatidylinositols, phosphatidylglycerols, phosphatidylserines and sulfatides). Comparing the two diets, 11 lipid species belonging to sphingomyelins, phosphatidylcholines and LPC(O-16:0) were changed. All the 11 lipid species were significantly elevated during low carbohydrate diet. Two lipid species were most differentiated between diets, namely SM(d36:1) (B+/-SE: 1.44+/-0.28, FDR = 0.010) and PC(P-36:4)/PC(O-36:5) (B+/-SE: 1.34+/-0.25, FDR = 0.009) species. Poly-unsaturated PC(35:4) was inversely associated with BMI and positively associated with HDL-cholesterol (p < 0.001). Conclusion/interpretation: Lipidome-wide outcome analysis of a randomized cross-over trial of individuals with type 1 diabetes following a low carbohydrate diet showed an increase in sphingomyelins and phosphatidylcholines which are thought to reduce dyslipidaemia. The poly-unsaturated phosphatidylcholine 35:4 was inversely associated with BMI and positively associated with HDL-cholesterol (p < 0.001). Results from this study warrant for more investigation on the long-term effect of PC(35:4) lipid-species in lipid homeostasis in type 1 diabetes. Trial registration Clinicaltrials.gov NCT02888691 Keywords Biomarker ∙ Cardiovascular disease ∙ Dyslipidaemia ∙ Lipidomics ∙ Low carbohydrate diet ∙ Randomized trial ∙ Type 1 diabetes.

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