Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial.
Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial.
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DOI：
10.1136/bmj.k4583
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发表时间：
2018-11-14
期刊：
影响因子：
--
通讯作者：
Ludwig DS
中科院分区：
文献类型：
--
作者：
Ebbeling CB;Feldman HA;Klein GL;Wong JMW;Bielak L;Steltz SK;Luoto PK;Wolfe RR;Wong WW;Ludwig DS
确定不同碳水化合物与脂肪比例的膳食对总能量消耗的影响。随机试验。2014年8月至2017年5月，在美国两个研究中心开展多中心协作。164名18-65岁的成年人，体重指数为25或以上。在导入饮食中体重减轻12%（2%以内）后，参与者根据碳水化合物含量（高，60%，n=54;中等，40%，n=53;或低，20%，n=57）随机分配到三种测试饮食中的一种，持续20周。控制试验饮食的蛋白质，并调节能量以保持体重减轻在2kg以内。为了测试碳水化合物-胰岛素模型预测的效果改变，将样本分为体重减轻前胰岛素分泌的三分之一（口服葡萄糖后30分钟的胰岛素浓度）。主要结果是总能量消耗，用双标记水测量，通过意向治疗分析。符合方案分析包括维持目标体重减轻的参与者，可能提供更精确的效果估计。次要结果是静息能量消耗，体力活动的测量，以及代谢激素瘦素和生长激素释放肽的水平。在意向治疗分析中，不同饮食的总能量消耗不同（n=162，P=0.002），碳水化合物对总能量摄入的贡献每减少10%（1 kcal=4.18 kJ=0.00418 MJ），线性趋势为52 kcal/d（95%置信区间23 - 82）。与高碳水化合物饮食相比，分配到中等碳水化合物饮食的参与者的总能量消耗变化为91 kcal/d（95%置信区间-29至210），分配到低碳水化合物饮食的参与者为209 kcal/d（91至326）。在符合方案分析中（n=120，P<0.001），差异分别为131 kcal/d（-6至267）和278 kcal/d（144至411）。在减肥前胰岛素分泌最高的三分之一的参与者中，低碳水化合物饮食和高碳水化合物饮食之间的差异在意向治疗分析中为308千卡/天，在符合方案分析中为478千卡/天（P<0.004）。与分配到高碳水化合物饮食的参与者相比，分配到低碳水化合物饮食的参与者的Ghrelin显着较低（两项分析）。分配到低碳水化合物饮食的参与者的瘦素也显著较低（根据方案）。与碳水化合物-胰岛素模型一致，降低饮食碳水化合物会增加减肥维持期间的能量消耗。这种代谢效应可能会提高肥胖治疗的成功率，特别是在胰岛素分泌高的人群中。ClinicalTrials.gov NCT02068885。
To determine the effects of diets varying in carbohydrate to fat ratio on total energy expenditure. Randomized trial. Multicenter collaboration at US two sites, August 2014 to May 2017. 164 adults aged 18-65 years with a body mass index of 25 or more. After 12% (within 2%) weight loss on a run-in diet, participants were randomly assigned to one of three test diets according to carbohydrate content (high, 60%, n=54; moderate, 40%, n=53; or low, 20%, n=57) for 20 weeks. Test diets were controlled for protein and were energy adjusted to maintain weight loss within 2 kg. To test for effect modification predicted by the carbohydrate-insulin model, the sample was divided into thirds of pre-weight loss insulin secretion (insulin concentration 30 minutes after oral glucose). The primary outcome was total energy expenditure, measured with doubly labeled water, by intention-to-treat analysis. Per protocol analysis included participants who maintained target weight loss, potentially providing a more precise effect estimate. Secondary outcomes were resting energy expenditure, measures of physical activity, and levels of the metabolic hormones leptin and ghrelin. Total energy expenditure differed by diet in the intention-to-treat analysis (n=162, P=0.002), with a linear trend of 52 kcal/d (95% confidence interval 23 to 82) for every 10% decrease in the contribution of carbohydrate to total energy intake (1 kcal=4.18 kJ=0.00418 MJ). Change in total energy expenditure was 91 kcal/d (95% confidence interval −29 to 210) greater in participants assigned to the moderate carbohydrate diet and 209 kcal/d (91 to 326) greater in those assigned to the low carbohydrate diet compared with the high carbohydrate diet. In the per protocol analysis (n=120, P<0.001), the respective differences were 131 kcal/d (−6 to 267) and 278 kcal/d (144 to 411). Among participants in the highest third of pre-weight loss insulin secretion, the difference between the low and high carbohydrate diet was 308 kcal/d in the intention-to-treat analysis and 478 kcal/d in the per protocol analysis (P<0.004). Ghrelin was significantly lower in participants assigned to the low carbohydrate diet compared with those assigned to the high carbohydrate diet (both analyses). Leptin was also significantly lower in participants assigned to the low carbohydrate diet (per protocol). Consistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance. This metabolic effect may improve the success of obesity treatment, especially among those with high insulin secretion. ClinicalTrials.gov NCT02068885.
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影响因子：
4.1
作者：
Chomistek AK;Yuan C;Matthews CE;Troiano RP;Bowles HR;Rood J;Barnett JB;Willett WC;Rimm EB;Bassett DR Jr
通讯作者：
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影响因子：
7.1
作者：
Aarsland, A;Chinkes, D;Wolfe, RR
通讯作者：
Wolfe, RR
影响因子：
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作者：
HAGGARTY, P;MCGAW, BA;WONG, WW
通讯作者：
WONG, WW
影响因子：
7.1
作者：
Chaput, Jean-Philippe;Tremblay, Angelo;Ludwig, David S.
通讯作者：
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DOI：
10.1152/ajpregu.00053.2009
发表时间：
2010-01-01
影响因子：
2.8
作者：
Goldsmith, Rochelle;Joanisse, Denis R.;Rosenbaum, Michael
通讯作者：
Rosenbaum, Michael