Insulin Sensitivity Determines the Effectiveness of Dietary Macronutrient Composition on Weight Loss in Obese Women

Cornier, Marc‐Andre; Donahoo, William T.; Pereira, Rocio I.; Gurevich, Inga; Westergren, Rickard; Enerbäck, Sven; Eckel, Peter J.; Goalstone, Marc L.; Hill, James O.; Eckel, Robert H.; Draznin, Boris

doi:10.1038/oby.2005.79

Cited by 122 publications

(129 citation statements)

References 36 publications

(41 reference statements)

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“…Differential weight loss in response to diet composition in relation to insulin resistance status has been observed in 2 previous studies 10, 19. In those studies, insulin sensitivity was associated with more weight loss in response to a lower fat (versus lower carbohydrate) diet, and insulin resistance was associated with more weight loss in response to a lower carbohydrate (versus lower fat) diet.…”

Section: Discussionmentioning

confidence: 64%

Effects of Diet Composition and Insulin Resistance Status on Plasma Lipid Levels in a Weight Loss Intervention in Women

Flatt

Natarajan

et al. 2016

JAHA

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BackgroundOptimal macronutrient distribution of weight loss diets has not been established. The distribution of energy from carbohydrate and fat has been observed to promote differential plasma lipid responses in previous weight loss studies, and insulin resistance status may interact with diet composition and affect weight loss and lipid responses.Methods and ResultsOverweight and obese women (n=245) were enrolled in a 1‐year behavioral weight loss intervention and randomly assigned to 1 of 3 study groups: a lower fat (20% energy), higher carbohydrate (65% energy) diet; a lower carbohydrate (45% energy), higher fat (35% energy) diet; or a walnut‐rich, higher fat (35% energy), lower carbohydrate (45% energy) diet. Blood samples and data available from 213 women at baseline and at 6 months were the focus of this analysis. Triglycerides, total cholesterol, and high‐ and low‐density lipoprotein cholesterol were quantified and compared between and within groups. Triglycerides decreased in all study arms at 6 months (P<0.05). The walnut‐rich diet increased high‐density lipoprotein cholesterol more than either the lower fat or lower carbohydrate diet (P<0.05). The walnut‐rich diet also reduced low‐density lipoprotein cholesterol in insulin‐sensitive women, whereas the lower fat diet reduced both total cholesterol and high‐density lipoprotein cholesterol in insulin‐sensitive women (P<0.05). Insulin sensitivity and C‐reactive protein levels also improved.ConclusionsWeight loss was similar across the diet groups, although insulin‐sensitive women lost more weight with a lower fat, higher carbohydrate diet versus a higher fat, lower carbohydrate diet. The walnut‐rich, higher fat diet resulted in the most favorable changes in lipid levels.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01424007.

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Section: Discussionmentioning

confidence: 64%

Effects of Diet Composition and Insulin Resistance Status on Plasma Lipid Levels in a Weight Loss Intervention in Women

Flatt

Natarajan

et al. 2016

JAHA

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“…Cornier et al . showed differential benefit of low CHO vs. low fat diets for people with or without insulin resistance [51]; this study might be thought of as a model for future work to follow this line of thinking. We emphasize that our main point is that an intimate connection between CHO restriction and the complex of symptoms of MetS is seen in the literature of both low CHO studies and low fat (higher CHO) studies.…”

Section: Discussionmentioning

confidence: 99%

“…It has long been argued that there must be some mistake because it is physically impossible and would violate the laws of thermodynamics. We have shown this argument is based on misunderstanding of the laws of thermodynamics [39,47-49] and the effect of variable efficiency is now better accepted [50,51]. The precise conditions that allow the so-called metabolic advantage to occur are not known although Cornier, et al .…”

Section: Introductionmentioning

confidence: 99%

“…The precise conditions that allow the so-called metabolic advantage to occur are not known although Cornier, et al . [51] have suggested that those subjects with insulin resistance will show a metabolic advantage on a low CHO diet whereas those who are insulin sensitive do better on low fat. This is consistent with the proposal here, namely that MetS, where insulin-resistance is generally considered a major component, can be defined by the response to CHO restriction.…”

Section: Introductionmentioning

confidence: 99%

“…The study of Cornier, et al . [51] had only a small number of subjects and the low CHO arm was not particularly low (40%) but their theory follows from the general rationale of the effect of CHO on energy efficiency. The factors that determine whether a metabolic advantage can play a role in a CHO restricted diet is unknown but given that the insulin resistance association is reasonable, it would seem that some form of CHO restriction is one of the standard, if not preferred attacks on obesity where MetS is suspected.…”

Section: Introductionmentioning

confidence: 99%

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Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

2005

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Metabolic Syndrome (MetS) represents a constellation of markers that indicates a predisposition to diabetes, cardiovascular disease and other pathologic states. The definition and treatment are a matter of current debate and there is not general agreement on a precise definition or, to some extent, whether the designation provides more information than the individual components. We consider here five indicators that are central to most definitions and we provide evidence from the literature that these are precisely the symptoms that respond to reduction in dietary carbohydrate (CHO). Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure. In addition, low fat, high CHO diets have long been known to raise TAG, lower HDL and, in the absence of weight loss, may worsen glycemic control. Thus, whereas there are numerous strategies for weight loss, a patient with high BMI and high TAG is likely to benefit most from a regimen that reduces CHO intake. Reviewing the literature, benefits of CHO restriction are seen in normal or overweight individuals, in normal patients who meet the criteria for MetS or in patients with frank diabetes. Moreover, in low fat studies that ameliorate LDL and total cholesterol, controls may do better on the symptoms of MetS. On this basis, we feel that MetS is a meaningful, useful phenomenon and may, in fact, be operationally defined as the set of markers that responds to CHO restriction. Insofar as this is an accurate characterization it is likely the result of the effect of dietary CHO on insulin metabolism. Glucose is the major insulin secretagogue and insulin resistance has been tied to the hyperinsulinemic state or the effect of such a state on lipid metabolism. The conclusion is probably not surprising but has not been explicitly stated before. The known effects of CHO-induced hypertriglyceridemia, the HDL-lowering effect of low fat, high CHO interventions and the obvious improvement in glucose and insulin from CHO restriction should have made this evident. In addition, recent studies suggest that a subset of MetS, the ratio of TAG/HDL, is a good marker for insulin resistance and risk of CVD, and this indicator is reliably reduced by CHO restriction and exacerbated by high CHO intake. Inability to make this connection in the past has probably been due to the fact that individual responses have been studied in isolation as well as to the emphasis of traditional therapeutic approaches on low fat rather than low CHO.We emphasize that MetS is not a disease but a collection of markers. Individual physicians must decide whether high LDL, or other risk factors are more important than the features of MetS in any individual case but if MetS is to be considered it should be recognized that reducing CHO will bring improvement. Response of symptoms to CHO ...

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Comparison of 4 Diets of Varying Glycemic Load on Weight Loss and Cardiovascular Risk Reduction in Overweight and Obese Young Adults

et al. 2006

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Insulin Sensitivity Determines the Effectiveness of Dietary Macronutrient Composition on Weight Loss in Obese Women

Cited by 122 publications

References 36 publications

Effects of Diet Composition and Insulin Resistance Status on Plasma Lipid Levels in a Weight Loss Intervention in Women

Effects of Diet Composition and Insulin Resistance Status on Plasma Lipid Levels in a Weight Loss Intervention in Women

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

Comparison of 4 Diets of Varying Glycemic Load on Weight Loss and Cardiovascular Risk Reduction in Overweight and Obese Young Adults

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