Relationship of insulin dynamics to body composition and resting energy expenditure following weight loss

Abstract

Objective To examine associations of baseline insulin dynamics with changes in body composition and resting energy expenditure (REE) following weight loss. Methods Twenty-one participants with overweight or obesity achieved 10-15% weight loss and then received 3 weight-loss maintenance diets (high-carbohydrate, moderate-carbohydrate, low-carbohydrate) in random order, each for 4 weeks. Body composition was measured at baseline and after weight loss. Insulin 30 minutes after glucose consumption (insulin-30; insulin response), C-peptide deconvolution analysis, HOMA, hepatic insulin sensitivity (IS), and REE were assessed at baseline and after each maintenance diet. Results Insulin-30, but not maximal insulin secretion, hepatic IS or HOMA, predicted changes in fat mass (standardized β=0.385, 1.7 kg difference between 10th-90th centile of insulin-30, P=0.04) after weight loss. Insulin-30 (β=−0.341, −312 kcal/d, P=0.008), maximal insulin secretion (β=−0.216, −95 kcal/d, P=0.0002), HOMA (β=−0.394,−350 kcal/d, P=0.002) and hepatic IS (β=0.217, 225 kcal/d, P=0.0003) predicted change in REE during weight-loss maintenance, independent of changes in body composition. The inverse relationship between insulin-30 and REE was substantially attenuated when the low-carbohydrate diet was consumed first. Conclusions These findings distinguish a novel phenotype, characterized by high insulin response, at risk for weight regain, and identify a dietary approach to ameliorate this risk.

Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion

“…10,21,22 When this study was first designed, insulin sensitivity was to be measured and used as a predictor of differential weight loss success. After the study was initiated, reports were published 12,13,23,24 indicating INS-30 was a successful predictor of weight loss in the context of low-carbohydrate diets or similar diets. There also was evidence 25 that early-phase insulin secretion differed markedly between diets that were similar to those tested in the DIETFITS study.…”

Higher carbohydrate intake is associated with increased risk of all‐cause and disease‐specific mortality in head and neck cancer patients: results from a prospective cohort study

“…(9) In theory, the high fat (energy) content of the ketogenic would help preserve lean muscle mass in patients who have difficulty eating. (26–28) At the same time, the combination of medium fat and low sugar/carbohydrate would minimize fuel availability to the cancer cells, which are highly dependent upon glucose, and potentially inhibit cancer cell growth. While the optimal amount of carbohydrate intake requires further exploration, our results may be the first observational data in humans to support the therapeutic potential of a diet characterized by carbohydrate restriction and elevated fat intake within a population of HNSCC patients.…”

Obesity and cortisol: New perspectives on an old theme

“…Hypercortisolism, known to induce insulin resistance, may thus perpetuate a vicious cycle. It has been shown by Ludwig and colleagues that people with obesity with elevated insulin response lost relatively more lean mass and less fat mass during a dietary weight loss intervention than those with low insulin response . In addition, they were more prone to weight regain, potentially due to these unfavorable body compositional changes that show remarkable similarities to the adverse body compositional alterations due to hypercortisolism.…”