Journal Club

1. Journal Club Bazzano LA, Hu T, Reynolds K, Yao L, Bunol C, Liu Y, Chen CS, Klag MJ, Whelton PK, He J. Effects of low-carbohydrate and low-fat diets: a randomized trial. Ann Intern Med. 2014 Sep 2;161(5):309-18. doi: 10.7326/M14-0180. Johnston BC1, Kanters S2, Bandayrel K3, Wu P4, Naji F5, Siemieniuk RA6, Ball GD7, Busse JW8, Thorlund K9, Guyatt G10, Jansen JP11, Mills EJ12. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014 Sep 3;312(9):923-33. doi: 10.1001/jama.2014.10397. 埼玉医科大学　総合医療センター　内分泌・糖尿病内科 Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University 松田　昌文　 Matsuda, Masafumi 2014年9月18日8:30-8:55 ８階　医局

2. 尿糖 (食事) (食事) 血糖値の調節 血糖値は制御された値であり制御機構が正常なら全く血糖は上昇しない！ 膵臓 脂肪組織 インスリン ↑ 血 糖 200 g/日 Plasma Glucose Blood Glucose グリコーゲン グリコーゲン 乳 乳 グリコーゲン グリコーゲン 肝臓 酸 酸 筋肉 120g/日 脳 40g/日その他のブドウ糖 　のみ用いる組織

3. ブドウ糖とは？　　　　ヒトの脳の唯一のエネルギー源ブドウ糖とは？　　　　ヒトの脳の唯一のエネルギー源 MANN, F. C., and MAGATH, T. B. (1922).-Arch. Intern. Moo. 30: 171. 検査値としての血糖は plasma glucose: PG (mg of glucose per dl of plasma)で表記されます。 脳の１日ブドウ糖使用量 ブドウ糖120ｇ　＝　糖質108ｇ

4. Original ArticleWeight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet Israel, Germany, Boston Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., ArkadyBolotin, Ph.D., HilelVardi, M.Sc., OsnatTangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., Benjamin Sarusi, M.Sc., DovBrickner, M.D., Ziva Schwartz, M.D., EinatSheiner, M.D., Rachel Marko, M.Sc., Esther Katorza, M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D., Michael Stumvoll, M.D., Meir J. Stampfer, M.D., Dr.P.H., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie. Shai I et al. N Engl J Med 2008;359:229-241

5. Weight Changes during 2 Years According to Diet Group Shai I et al. N Engl J Med 2008;359:229-241

6. Difference in Mean Weight Loss Across Diets With 95%Credible Intervals The values above the named diets (blue boxes) correspond to the difference in mean weight lost between the columns and row at 12 months (eg, the difference in average weight lost between the Ornish diet and no diet at 12 months is 6.55 kg). The values below the diet classes correspond to the difference in mean weight lost between the row and the column at 6 months (eg, the difference in average weight lost between the Ornish diet and no diet at 6 months is 9.03 kg). LEARN indicates Lifestyle, Exercise, Attitudes, Relationships, and Nutrition. JAMA. 2014;312(9):923-933.

7. 「糖尿病における食事療法の在り方と課題」提言「糖尿病における食事療法の在り方と課題」提言 1） 糖尿病における炭水化物*摂取について 総エネルギー摂取量を制限せずに、炭水化物のみを100g/日(ブドウ糖～120g相当)以下に制限することによって減量を図ることは、その本来の効果のみならず、長期的な食事療法としての遵守性や安全性など重要な点についてこれを担保するエビデンスが不足しており、現時点では薦められない。 2） 栄養素摂取比率について 糖尿病における三大栄養素の推奨摂取比率は、一般的には、炭水化物50~60%(150g以上)、タンパク質20%以下のこりを脂質(上限25%)とする。　１日1000kcal以上 *:エネルギー源としての炭水化物：ブドウ糖として直接腸管から吸収される食物

8. Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Kaiser Permanente Southern California, Pasadena, California; and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Ann Intern Med. 2014;161(5):309-318. doi:10.7326/M14-0180

9. Background: Low-carbohydrate diets are popular for weight loss, but their cardiovascular effects have not been well-studied, particularly in diverse populations. Objective: To examine the effects of a low-carbohydrate diet compared with a low-fat diet on body weight and cardiovascular risk factors.

10. Design: A randomized, parallel-group trial. (ClinicalTrials.gov: NCT00609271) Setting: A large academic medical center. Participants: 148 men and women without clinical cardiovascular disease and diabetes. Intervention: A low-carbohydrate (<40 g/d) or low-fat (<30% of daily energy intake from total fat [<7% saturated fat]) diet. Both groups received dietary counseling at regular intervals throughout the trial. Measurements: Data on weight, cardiovascular risk factors, and dietary composition were collected at 0, 3, 6, and 12 months.

11. Figure 1. Study flow diagram. * 5 participants in the low-fat group and 6 in the low-carbohydrate group had no data on body weight at randomization.

18. Results:Sixty participants (82%) in the low-fat group and 59 (79%) in the low-carbohydrate group completed the intervention. At 12 months, participants on the low-carbohydrate diet had greater decreases in weight (mean difference in change, −3.5 kg [95% CI, −5.6 to −1.4 kg]; P = 0.002), fat mass (mean difference in change, −1.5% [CI, −2.6% to −0.4%]; P = 0.011), ratio of total–high-density lipoprotein (HDL) cholesterol (mean difference in change, −0.44 [CI, −0.71 to −0.16]; P = 0.002), and triglyceride level (mean difference in change, −0.16 mmol/L [−14.1 mg/dL] [CI, −0.31 to −0.01 mmol/L {−27.4 to −0.8 mg/dL}]; P = 0.038) and greater increases in HDL cholesterol level (mean difference in change, 0.18 mmol/L [7.0 mg/dL] [CI, 0.08 to 0.28 mmol/L {3.0 to 11.0 mg/dL}]; P < 0.001) than those on the low-fat diet.

19. Limitation: Lack of clinical cardiovascular disease end points. Conclusion: The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors. Primary Funding Source: National Institutes of Health.

20. Message 心血管疾患および糖尿病既往のない男女119人を対象に、低炭水化物食と低脂肪食の減量および心血管リスク軽減効果を無作為化試験で比較。低炭水化物食群で低脂肪食群に比べ、12カ月時の体重、体脂肪、総コレステロールと高比重リポタンパク（HDL）コレステロールの比率、トリグリセリド値が低下し、HDLコレステロール値は増加した。 心血管障害について調べると言っておいて、実際のデータがないのは．．．(liminationには言及してはいるが)

22. 1Hospital for Sick Children Research Institute, Toronto, Ontario, Canada 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada 3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada 4Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada 5School of Population and Public Health, University of British Columbia, Vancouver, Canada 6Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada 7Redwood Outcomes, Vancouver, British Columbia, Canada 8Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada 9Department of Medicine, University of Toronto, Toronto, Ontario, Canada 10Department of Pediatrics, University of Alberta, Edmonton, Canada 11Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada 12Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada 13Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada 14Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, California 15Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts JAMA. 2014;312(9):923-933. doi:10.1001/jama.2014.10397.

23. ImportanceMany claims have been made regarding the superiority of one diet or another for inducing weight loss. Which diet is best remains unclear. Objective To determine weight loss outcomes for popular diets based on diet class (macronutrient composition) and named diet.

24. Data Sources Search of 6 electronic databases: AMED, CDSR, CENTRAL, CINAHL, EMBASE, and MEDLINE from inception of each database to April 2014. Study Selection Overweight or obese adults (body mass index ≥25) randomized to a popular self-administered named diet and reporting weight or body mass index data at 3-month follow-up or longer. Data Extraction and Synthesis Two reviewers independently extracted data on populations, interventions, outcomes, risk of bias, and quality of evidence. A Bayesian framework was used to perform a series of random-effects network meta-analyses with meta-regression to estimate the relative effectiveness of diet classes and programs for change in weight and body mass index from baseline. Our analyses adjusted for behavioral support and exercise. Main Outcomes and Measures Weight loss and body mass index at 6- and 12-month follow-up (±3 months for both periods).

29. Results Among 59 eligible articles reporting 48 unique randomized trials (including 7286 individuals) and compared with no diet, the largest weight loss was associated with low-carbohydrate diets (8.73 kg [95% credible interval {CI}, 7.27 to 10.20 kg] at 6-month follow-up and 7.25 kg [95% CI, 5.33 to 9.25 kg] at 12-month follow-up) and low-fat diets (7.99 kg [95% CI, 6.01 to 9.92 kg] at 6-month follow-up and 7.27 kg [95% CI, 5.26 to 9.34 kg] at 12-month follow-up). Weight loss differences between individual diets were minimal. For example, the Atkins diet resulted in a 1.71 kg greater weight loss than the Zone diet at 6-month follow-up. Between 6- and 12-month follow-up, the influence of behavioral support (3.23 kg [95% CI, 2.23 to 4.23 kg] at 6-month follow-up vs 1.08 kg [95% CI, −1.82 to 3.96 kg] at 12-month follow-up) and exercise (0.64 kg [95% CI, −0.35 to 1.66 kg] vs 2.13 kg [95% CI, 0.43 to 3.85 kg], respectively) on weight loss differed.

30. Conclusions and Relevance Significant weight loss was observed with any low-carbohydrate or low-fat diet. Weight loss differences between individual named diets were small. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.

31. Message 代表的なダイエット法と食事介入なしを比べた無作為化試験48件（肥満/過体重患者7286人）を対象に、ダイエット法の減量効果をメタ解析で比較。低炭水化物食および低脂肪食は最も大幅な体重減少と関連していたが、各種ダイエット間での減量差は小さかった。この結果から、患者が順守できるダイエット法を推奨するのが良いことが示唆された。 カロリー制限が重要そうだが。