hyperprotein diets text

Dr. C.P. DavisDr. C.P. Davis

Obesity and heart failure: Obesity and heart failure: cumulative incidence in womencumulative incidence in women

Kenchaiah S et al N Engl J Med. 2002 Aug 1;347(5):305-13

BMI 18.5-24.9kg/m2

BMI 25.0-29.9kg/m2

BMI >30 kg/m2


Obesity and heart failure: Obesity and heart failure: cumulative incidence in mencumulative incidence in men

Kenchaiah S et al N Engl J Med. 2002 Aug 1;347(5):305-13

BMI 18.5-24.9kg/m2

BMI 25.0-29.9kg/m2

BMI >30 kg/m2

N Engl J Med. 2002 Aug 1;347(5):305-13.Related Articles, Links Comment in: N Engl J Med. 2002 Aug 1;347(5):358-9. N Engl J Med. 2002 Dec 5;347(23):1887-9; author reply 1887-9. N Engl J Med. 2002 Dec 5;347(23):1887-9; author reply 1887-9. N Engl J Med. 2002 Dec 5;347(23):1887-9; author reply 1887-9. N Engl J Med. 2002 Dec 5;347(23):1887-9; author reply 1887-9. N Engl J Med. 2002 Dec 5;347(23):1887-9; author reply 1887-9.

Obesity and the risk of heart failure. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS. Framingham Heart Study, Framingham, Mass 01702, USA. BACKGROUND: Extreme obesity is recognized to be a risk factor for heart failure. It is unclear whether overweight and lesser degrees of obesity also pose a risk. METHODS: We investigated the relation between the body-mass index (the weight in kilograms divided by the square of the height in meters) and the incidence of heart failure among 5881 participants in the Framingham Heart Study (mean age, 55 years; 54 percent women). With the use of Cox proportional-hazards models, the body-mass index was evaluated both as a continuous variable and as a categorical variable (normal, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or more). RESULTS: During follow-up (mean, 14 years), heart failure developed in 496 subjects (258 women and 238 men). After adjustment for established risk factors, there was an increase in the risk of heart failure of 5 percent for men and 7 percent for women for each increment of 1 in body-mass index. As compared with subjects with a normal body-mass index, obese subjects had a doubling of the risk of heart failure. For women, the hazard ratio was 2.12 (95 percent confidence interval, 1.51 to 2.97); for men, the hazard ratio was 1.90 (95 percent confidence interval, 1.30 to 2.79). A graded increase in the risk of heart failure was observed across categories of body-mass index. The hazard ratios per increase in category were 1.46 in women (95 percent confidence interval, 1.23 to 1.72) and 1.37 in men (95 percent confidence interval, 1.13 to 1.67). CONCLUSIONS: In our large, community-based sample, increased body-mass index was associated with an increased risk of heart failure. Given the high prevalence of obesity in the United States, strategies to promote optimal body weight may reduce the population burden of heart failure. Copyright 2002 Massachusetts Medical Society PMID: 12151467 [PubMed - indexed for MEDLINE]


BMI and age BMI and age relatedrelated mortalitymortality

after Waaler HT Acta Med Scand Suppl. 1984;679:1-56

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women

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0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

25 29 33 37 41

men age50-5455-5960-64

BMI (kg/m2)21

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

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Acta Med Scand Suppl. 1984;679:1-56.Related Articles, Links Height, weight and mortality. The Norwegian experience. Waaler HT. PMID: 6585126 [PubMed - indexed for MEDLINE]


The diet generationThe diet generation

~ 30% of all male and ~ 45% of all female ~ 30% of all male and ~ 45% of all female US citizens are trying to lose weightUS citizens are trying to lose weightDiet books available on Diet books available on Amazon.comAmazon.com: ~ : ~ 3838’’000000Many of these books promote some sort of Many of these books promote some sort of CHO restriction and CHO restriction and hyperproteinhyperprotein dietdiet–– Dr. AtkinsDr. Atkins’’ New Diet Revolution, The New Diet Revolution, The

Carbohydrate AddictCarbohydrate Addict’’s Diet, Protein Power, s Diet, Protein Power, LauriLauri’’ss LowLow--CarbCarb CookbookCookbook

JAMA. 1999 Oct 13;282(14):1353-8. Links Prevalence of attempting weight loss and strategies for controlling weight. Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW. Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA. CONTEXT: Overweight and obesity are increasing in the United States. Changes in diet and physical activity are important for weight control. OBJECTIVES: To examine the prevalence of attempting to lose or to maintain weight and to describe weight control strategies among US adults. DESIGN: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. Setting The 49 states (and the District of Columbia) that participated in the survey. PARTICIPANTS: Adults aged 18 years and older (N = 107 804). MAIN OUTCOME MEASURES: Reported current weights and goal weights, prevalence of weight loss or maintenance attempts, and strategies used to control weight (eating fewer calories, eating less fat, or using physical activity) by population subgroup. RESULTS: The prevalence of attempting to lose and maintain weight was 28.8%

and 35.1 % among men and 43.6% and 34.4% among women, respectively. Among those attempting to lose weight, a common strategy was to consume less fat but not fewer calories (34.9% of men and 40.0% of women); only 21.5% of men and 19.4% of women reported using the recommended combination of eating fewer calories and engaging in at least 150 minutes of leisure-time physical activity per week. Among men trying to lose weight, the median weight was 90.4 kg with a goal weight of 81.4 kg. Among women, the median weight was 70.3 kg with a goal weight of 59.0 kg. CONCLUSIONS: Weight loss and weight maintenance are common concerns for US men and women. Most persons trying to lose weight are not using the recommended combination of reducing calorie intake and engaging in leisure-time physical activity 150 minutes or more per week. PMID: 10527182 [PubMed - indexed for MEDLINE]


Comparison of various diets with regard to Comparison of various diets with regard to Body Fat, Body Protein and Body WaterBody Fat, Body Protein and Body Water

37

20

43

16

21

63

11

23

66

3

18

79

4

21

75

11

22

67

25

19

56

0%10%20%30%40%50%60%

70%80%90%

100%

TF MF 1 MF 2 MF 3 MF 4 BN 1 SK 1

TF = total fasting; MF = Modifast, BN = formula with inferior protiens; SK = Schrotkur

Loss of body fat, body protein and body water with differend diets

The best results were

achieved with a

combination of 50 g of

proteins, 25 g CHO, and 10 g of fat

Wechsler JG et al. Fortschr Med. 1984 Jun 28;102(24):666-8

Fortschr Med. 1984 Jun 28;102(24):666-8.Related Articles, Links [Modified fasting in the therapy of obesity. A comparison of total fasting and low-calorie diets of various protein contents] [Article in German] Wechsler JG, Wenzel H, Swobodnik W, Ditschuneit H. Modified fasting represents a successful therapy for obesity without severe side effects. The daily energy-substitution (1000-1700 kJ) consists of 30-50 g high quality protein, 20-40 g carbohydrates and small amounts of fat. The mean weight loss is 11-14 kg in a four-week treatment period. In contrast to total fasting the weight loss achieved with modified fasting consisted in a percentage of 79% adipose tissue and a minimal protein loss of 3%. The nitrogen equilibrium was reached after one to three weeks thus avoiding the risks of greater protein losses. PMID: 6469179 [PubMed - indexed for MEDLINE]


Dansinger ML et al. JAMA. 2005 Jan 5;293(1):43-53

Comparison of different diets with respect to Comparison of different diets with respect to compliancecompliance

Mean Self-reported Dietary Adherence Scores of All 4 Diet Groups, According to Study Month

Calorie-restriction

CHO-restriction

Glucose-restriction

Fat-restriction


One-Year Changes in Body Weight as a Function of Diet Group and Dietary Adherence Level for All Study Participants

Dansinger ML et al. JAMA. 2005 Jan 5;293(1):43-53

Comparison of different diets with respect to Comparison of different diets with respect to weight lossweight loss

JAMA. 2005 Jan 5;293(1):43-53.Related Articles, Links Comment in: J Fam Pract. 2005 Apr;54(4):306. JAMA. 2005 Apr 6;293(13):1589-90; author reply 1590-1. JAMA. 2005 Apr 6;293(13):1590; author reply 1590-1. JAMA. 2005 Jan 5;293(1):96-7. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.

Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Division of Endocrinology, Diabetes, and Metabolism, Atherosclerosis Research Laboratory, Tufts-New England Medical Center, Boston, Mass 02111, USA. [email protected] CONTEXT: The scarcity of data addressing the health effects of popular diets is an important public health concern, especially since patients and physicians are interested in using popular diets as individualized eating strategies for disease prevention. OBJECTIVE: To assess adherence rates and the effectiveness of 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction. DESIGN, SETTING, AND PARTICIPANTS: A single-center randomized trial at an academic medical center in Boston, Mass, of overweight or obese (body mass index: mean, 35; range, 27-42) adults aged 22 to 72 years with known hypertension, dyslipidemia, or fasting hyperglycemia. Participants were enrolled starting July 18, 2000, and randomized to 4 popular diet groups until January 24, 2002. INTERVENTION: A total of 160 participants were randomly assigned to either Atkins (carbohydrate restriction, n=40), Zone (macronutrient balance, n=40), Weight Watchers (calorie restriction, n=40), or Ornish (fat restriction, n=40) diet groups. After 2 months of maximum effort, participants selected their own levels of dietary adherence. MAIN OUTCOME MEASURES: One-year changes in baseline weight and cardiac risk factors, and self-selected dietary adherence rates per self-report. RESULTS: Assuming no change from baseline for participants who discontinued the study, mean (SD) weight loss at 1 year was 2.1 (4.8) kg for Atkins (21 [53%] of 40 participants completed, P = .009), 3.2 (6.0) kg for Zone (26 [65%] of 40 completed, P = .002), 3.0 (4.9) kg for Weight Watchers (26 [65%] of 40 completed, P < .001), and 3.3 (7.3) kg for Ornish (20 [50%] of 40 completed, P = .007). Greater effects were observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10% (all P<.05), with no significant effects on blood pressure or glucose at 1 year. Amount of weight loss was associated with self-reported dietary adherence level (r = 0.60; P<.001) but not with diet type (r = 0.07; P = .40). For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin were significantly associated with weight loss (mean r = 0.36, 0.37, and 0.39, respectively) with no significant difference between diets (P = .48, P = .57, P = .31, respectively). CONCLUSIONS: Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low, although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group. Publication Types: Clinical Trial Randomized Controlled Trial PMID: 15632335 [PubMed - indexed for MEDLINE]

Dr. C.P. DavisDr. C.P. DavisFoster GD et al. N Enlg J Med 2003 22;348(21):2082-90

Comparison of Weight LossComparison of Weight Loss

N Engl J Med. 2003 May 22;348(21):2082-90. Links Comment in: N Engl J Med. 2003 May 22;348(21):2057-8. N Engl J Med. 2003 May 22;348(21):2136-7. N Engl J Med. 2003 Sep 4;349(10):1000-2; author reply 1000-2. N Engl J Med. 2003 Sep 4;349(10):1000-2; author reply 1000-2. A randomized trial of a low-carbohydrate diet for obesity. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S. University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA. [email protected] BACKGROUND: Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy. METHODS: We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Professional contact was minimal to replicate the approach used by most dieters. RESULTS: Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [+/-SD], -6.8+/-5.0 vs. -2.7+/-3.7 percent of body weight; P=0.001) and 6 months (-7.0+/-6.5 vs. -3.2+/-5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (-4.4+/-6.7 vs. -2.5+/-6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol

concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load. CONCLUSIONS: The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets. Copyright 2003 Massachusetts Medical Society PMID: 12761365 [PubMed - indexed for MEDLINE]

Dr. C.P. DavisDr. C.P. DavisFoster GD et al. N Enlg J Med 2003 22;348(21):2082-90

Urinary KetosisUrinary Ketosis

N Engl J Med. 2003 May 22;348(21):2082-90. Links Comment in: N Engl J Med. 2003 May 22;348(21):2057-8. N Engl J Med. 2003 May 22;348(21):2136-7. N Engl J Med. 2003 Sep 4;349(10):1000-2; author reply 1000-2. N Engl J Med. 2003 Sep 4;349(10):1000-2; author reply 1000-2. A randomized trial of a low-carbohydrate diet for obesity. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S.

University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA. [email protected] BACKGROUND: Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy. METHODS: We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Professional contact was minimal to replicate the approach used by most dieters. RESULTS: Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [+/-SD], -6.8+/-5.0 vs. -2.7+/-3.7 percent of body weight; P=0.001) and 6 months (-7.0+/-6.5 vs. -3.2+/-5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (-4.4+/-6.7 vs. -2.5+/-6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load. CONCLUSIONS: The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets. Copyright 2003 Massachusetts Medical Society PMID: 12761365 [PubMed - indexed for MEDLINE]

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