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High Protein Low Carbohydrate Diets: Targeting Who Benefits? Dr Manny Noakes

High Protein Low Carbohydrate Diets: Targeting Who Benefits? Dr Manny Noakes Senior Research Dietitian CSIRO Clinical Research Unit. Health Sciences and Nutrition. Obesity Epidemic !.

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High Protein Low Carbohydrate Diets: Targeting Who Benefits? Dr Manny Noakes

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  1. High Protein Low Carbohydrate Diets: Targeting Who Benefits? Dr Manny Noakes Senior Research Dietitian CSIRO Clinical Research Unit Health Sciences and Nutrition

  2. Obesity Epidemic! • Diabetes risk increases with obesity and will more than double, from 140 million to 300 million in the next 25 years. • Diabetes leads to serious complications such as heart, eye and kidney disease and a shortened life span. • Costs of obesity to community > $6b/y

  3. Syndromic Obesity Other terms that are used that generally refer to the same syndrome include: • Syndrome X • Metabolic Syndrome • Insulin Resistance Syndrome • Deadly Quartet

  4. The Metabolic Syndrome • Constellation of major risk factors, life-habit risk factors and emerging risk factors • Over-represented among populations with heart disease • Clue is distinctive body-type with increased abdominal circumference (although some leaner men and women can have metabolic syndrome)

  5. Diagnostic Criteria for Metabolic Syndrome Diagnosis is made when 3 or more of these risk criteria are met • Glucose  6.1mmol/L • Waist Circumference •  102cm  88cm HDL-C • ≤ 1.0 mmol/L ≤ 1.3 mmol/L BP 130/85 mmHg Triglycerides  1.7mmol/L  Glucose Abdominal Obesity  HDL-C  BP  TG ATP III Guidelines

  6. Insulin Resistance: Causes and Associated Conditions Aging Inactivity Obesity Genetics Genetics INSULIN RESISTANCE Type 2 diabetes PCOS NASH Hypertension Atherosclerosis Dyslipidemia

  7. Insulin Resistance and Hypertriglyceridemia 625 500 400 300 200 100 r = 0.73 P < 0.0001 Plasma TG (mg/dL) 100 200 300 400 500 600 Insulin Response to Oral Glucose* * Total area under 3-hour response curve (mean of 2 tests). Olefsky JM et al. AmJMed. 1974;57:551-560.

  8. Prevalence of Metabolic Syndrome 45 8814 aged 20 years or older from NHANES III (1988-1994) 35 The age-adjusted prevalence : men (24.0%) women (23.4%). 0 Ford ES, et al JAMA 2002

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  10. Protein vs Carbohydrate in ad libitum Fat Reduced Diet Skov et al 1999 • High-carbohydrate (HC, protein 12% energy) n=25 • High-protein (HP, protein 25% energy)n=25 RESULTS AFTER 6 MONTHS • 5.1 kg in the HC group • 8.9 kg in the HP group (P < 0.001) • More subjects lost > 10 kg in the HP group (35% vs 9%). • HP diet decreased fasting plasma triglycerides significantly.

  11. Increased Protein/Carb Ratio • Greater weight and fat loss - obese subjects (Skov et al,1999) • Increased satiety - glucose tolerant women (Latner & Schwartz, 1999) • Thermic effects - obese, hyperinsulinaemic men (Hwalla Baba et al,1999) • Lean body mass spared - glucose tolerant women (Piatti et al,1994) • High protein/Low GI -25% decrease in ad libitum intake – obese men (Dumesnil et al)

  12. Increased Protein/Carb Ratio CSIRO Studies • Insulin sensitivity – subjects with IGT (Clifton et al,1998) • Greater abdominal fat mass loss – Type 2 diabetes (Parker et al 2002) • Greater lowering of LDL-C - Type 2 diabetes (Parker et al 2002) • Thermic effect of HP meal 28% greater – No change in REE - Type 2 diabetes (Luscombe et al 2002) • Greater lowering of TG – subjects with elevated insulin(Farnsworth et al (in press)) • Lean body mass spared – subjects with elevated insulin(Farnsworth et al (in press))

  13. Renal Function • Urinary albumin excretion was not affected by dietary protein during weight loss: n=19 with microalbuminuria • HP diet: 24.2 to 19.8 mg/l (n=12) • LP diet: 4.3 to 3.5 mg/l (n=7)

  14. Aim: To compare a high protein weight loss diet with a high carbohydrate diet on • weight loss and body composition • nutrient status • bone turnover markers • measures of heart disease risk in women over 12 weeks… ..and subsequently follow up for 1 year Diets: • 1. High carbohydrate • 2. High protein, high red meat

  15. High Meat Protein 5600 KJ • Cereal • Low fat milk (250ml) • Wholemeal bread (2 slices) • Fruit (2) • Beef/lamb 200g - dinner • Chicken/fish/meat 100g - lunch • Vegetables 2.5 cups • Diet Yoghurt 200g • Canola oil 3 tsp • Wine 2 glasses/week (optional) 34% protein 20% fat 46% carbohydrate 109g protein 31g fat 161g carbohydrate

  16. High Carbohydrate 5600 KJ • Cereal • SKIM milk (250ml) • Wholemeal bread (3 slices) • Fruit (3) • Chicken/pork/fish 80g • Vegetables 2.5 cups • Canola oil 3 tsp • Pasta/rice 120g cooked • Low fat biscuits 3 • Wine 2 glasses/week (optional) 17% protein 20% fat 64% carbohydrate 57g protein 31g fat 229 g carbohydrate

  17. Overall Results

  18. Weight Loss by Triglyceride Status * Sig diet effect High protein High carb

  19. DEXA arm fat abdominal fat leg fat

  20. Total And Midriff Fat Loss Dexa Data * Sig diet effect High protein High carb

  21. LDL Cholesterol High protein 4.8% High carb

  22. Triglycerides High protein High carb 4% 13%

  23. Triglycerides by TG status HIGH TG 10% 28% LOW TG

  24. Triglyceride Change By Insulin Status P=0.036 26% 9% High protein High carb

  25. Calcium Excretion Calcium excretion decreased on both diets reference range 2.5-7.5mmol/24hr Calcium excretion mmol/24hr week 0 week12 High protein High carb

  26. Protein vs Carb and Markers of Bone Turnover Pyridinolone /creatinine ratio Deoxypyridinoline/creatinine ratio High carb High protein High carb High protein Both weight loss strategies associated with increased bone turnover. No effect of diet composition.

  27. Haemoglobin Reference range 115-165g/L No change * High protein High red meat High carb

  28. Vitamin B12 Reference range 140-700 pmol/l 12% increase 13% decrease High protein High red meat High carb

  29. CONCLUSION 1 Moderately high protein high red meat diets and conventional high carbohydrate weight loss diets provide health benefits. • Plasma triglycerides lowered on average 9% • LDL cholesterol lowered on average 5% • Insulin lowered on average 19% • Glucose lowered on average 4%

  30. CONCLUSION 2 Moderately high protein high red meat diets provide advantages in women • Greater weight and fat and midriff loss on high protein diet in those women with elevated TG • Greater lowering of plasma triglycerides on high protein diet in those women with elevated insulin or TG • Haemoglobin levels improved more on high protein high red meat diet • B12 status improved on high protei n high red meat diet

  31. CONCLUSION? Moderately high protein diets can be a safe and effective option to conventional high carbohydrate weight loss diets. • For some, HP diet may be easier to follow for longer periods as it may be more satisfying. • HP diet as used in this study is safe and nutritionally adequate. • It was easier to achieve RDI for all nutrients on HP diet

  32. Questions? Health Sciences and Nutrition

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