Abstract
Background
Meta analysis of short term trials indicates that a higher protein, lower carbohydrate
weight loss diet enhances fat mass loss and limits lean mass loss compared with a
normal protein weight loss diet. Whether this benefit persists long term is not clear.
Methods and results
We selected weight loss studies in adults with at least a 12 month follow up in which
a higher percentage protein/lower carbohydrate diet was either planned or would be
expected for either weight loss or weight maintenance. Studies were selected regardless
of the success of the advice but difference in absolute and percentage protein intake
at 12 months was used as a moderator in the analysis. Data was analysed using Comprehensive
Meta analysis V2 using a random effects analysis. As many as 32 studies with 3492
individuals were analysed with data on fat and lean mass, glucose and insulin from
18 to 22 studies and lipids from 28 studies. A recommendation to consume a lower carbohydrate,
higher protein diet in mostly short term intensive interventions with long term follow
up was associated with better weight and fat loss but the effect size was small-standardised
means of 0.14 and 0.22, p = 0.008 and p < 0.001 respectively (equivalent to 0.4 kg for both). A difference of 5% or greater
in percentage protein between diets at 12mo was associated with a 3 fold greater effect
size compared with <5% (p = 0.038) in fat mass (0.9 vs. 0.3 kg). Fasting triglyceride and insulin were also
lower with high protein diets with effect sizes of 0.17 and 0.22, p = 0.003 and p = 0.042 respectively. Other lipids and glucose were not different.
Conclusion
The short term benefit of higher protein diets appears to persist to a small degree
long term. Benefits are greater with better compliance to the diet.
Keywords
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References
- Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity.Int J Obes Relat Metab Disord. 1999 May; 23: 528-536
- A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations.Am J Clin Nutr. 2005; 82: 41-48
- Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.N Engl J Med. 2009; 360: 859-873
- Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis.Eur J Clin Nutr. 2012; 66: 780-788
- Dietary protein in weight management: a review proposing protein spread and change theories.Nutr Metab (Lond). 2012; 9: 81
- Diets with high or low protein content and glycemic index for weight-loss maintenance.N Engl J Med. 2010; 363: 2102-2113
- Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials.Am J Clin Nutr. 2012; 96: 1281-1298
- Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis.Nutr J. 2013; 12: 48
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6: e1000097
- Cochrane handbook for systematic reviews of interventions.(Version 5.1.0 ed) John Wiley& Sons Ltd, Chichester, United Kingdom2011
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997 Sep 13; 315: 629-634
- Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial.Diabetologia. 2004 Oct; 47: 1677-1686
- Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects.Int J Obes Relat Metab Disord. 2004 May; 28: 661-670
- Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo.Am J Clin Nutr. 2009 Jul; 90: 23-32
- The effects of a low-carbohydrate versus low-fat diet on adipocytokines in severely obese adults: three-year follow-up of a randomized trial.Eur Rev Med Pharmacol Sci. 2006 May-Jun; 10: 99-106
- Long-term effects of a high-protein weight-loss diet.Am J Clin Nutr. 2008 Jan; 87: 23-29
- Comparison of the Atkins, Ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial.J Am Med Assoc. 2005 Jan 5; 293: 43-53
- Long-term effects of 2 energy-restricted diets differing in glycemic load on dietary adherence, body composition, and metabolism in CALERIE: a 1-y randomized controlled trial.Am J Clin Nutr. 2007 Apr; 85: 1023-1030
- Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes.Diabetes Care. 2009 Jul; 32: 1147-1152
- One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: does diet composition matter?.Am J Clin Nutr. 2009 Nov; 90: 1203-1214
- Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial.Int J Obes Relat Metab Disord. 2004 Oct; 28: 1283-1290
- An assessment of low-carbohydrate or low-fat diets for weight loss at 2 year's follow-up.Diabet Med. 2010; 27: 363-364
- A randomized trial of a low-carbohydrate diet for obesity.N Engl J Med. 2003; 348: 2082-2090
- Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial.Ann Intern Med. 2010; 153: 147-157
- A randomized controlled trial on the efficacy of carbohydrate-reduced or fat-reduced diets in patients attending a telemedically guided weight loss program.Cardiovasc Diabetol. 2009 Jul 18; 8: 36https://doi.org/10.1186/1475-2840-8-36
- Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.J Am Med Assoc. 2007 Mar 7; 297: 969-977
- Higher protein diet for weight management in young overweight women: a 12-month randomized controlled trial.Diabetes Obes Metab. 2013 Jun; 15 (Epub 2013 Jan 25): 572-575https://doi.org/10.1111/dom.12056
- In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss.Diabetologia. 2012 Aug; 55: 2118-2127
- Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants.Obesity (Silver Spring). 2010 Sep; 18: 1733-1738
- Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts.Am J Clin Nutr. 2013 Aug; 98 (Epub 2013): 494-501https://doi.org/10.3945/ajcn.113.060889
- Long-term weight maintenance and cardiovascular risk factors are not different following weight loss on carbohydrate-restricted diets high in either monounsaturated fat or protein in obese hyperinsulinaemic men and women.Br J Nutr. 2007 Feb; 97: 405-410
- Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin.Br J Nutr. 2007 Oct; 98: 852-859
- Effects of a low glycemic load diet versus a low-fat diet in subjects with and without the metabolic syndrome.Nutr Metab Cardiovasc Dis. 2010 Mar; 20 (Epub 2009 Jun 6): 195-201https://doi.org/10.1016/j.numecd.2009.03.010
- The Diabetes Excess Weight Loss (DEWL) Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes.Diabetologia. 2012 Apr; 55: 905-914
- The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial.Diabetologia. 2011 Apr; 54: 731-740
- A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults.J Nutr. 2009; 139: 514-521
- Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control.Nutr Metab Cardiovasc Dis. 2010; 20: 599-607
- Long-term effects of popular dietary approaches on weight loss and features of insulin resistance.Int J Obes (Lond). 2006; 30: 342-349
- Four-year follow-up after two-year dietary interventions.N Engl J Med. 2012 Oct 4; 367: 1373-1374
- Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.N Engl J Med. 2008 Jul 17; 359: 229-241
- Relatively high-protein or 'low-carb' energy-restricted diets for body weight loss and body weight maintenance?.Physiol Behav. 2012 Aug 19;
- The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.Ann Intern Med. 2004 May 18; 140: 778-785
- Areal and volumetric bone mineral density and geometry at two levels of protein intake during caloric restriction: a randomized, controlled trial.J Bone Miner Res. 2011 Jun; 26: 1339-1348
- Comparison of the effects of 52 weeks weight loss with either a high-protein or high-carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males.Nutr Diabetes. 2012; 2: e40
- Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1.Am J Clin Nutr. 2006; 83: 260-274
- Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials.Br J Nutr. 2013; : 1-10
- Long-term efficacy of high-protein diets: a systematic review.Nutr Hosp. 2011; 26: 1256-1259
- Low carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies.PLoS One. 2013; 8 (Epub 2013 Jan 25): e55030https://doi.org/10.1371/journal.pone.0055030
Article info
Publication history
Published online: January 27, 2014
Accepted:
November 25,
2013
Received in revised form:
November 14,
2013
Received:
September 9,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
