High protein diet and weight loss
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實習學生：周少鼎
指導老師：彭惠鈺
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Background
• In response to the obesity epidemic, there has been increased public interest and use of alternative weight-loss diet that contravene conventional dietary guidelines. (ex: atkines diet, zone diet ..etc)
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Background
• Popular alternatives include high-protein diets, which have a common theme of restricting carbohydrate intake while increasing protein.
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Side effect?
Effect?
Safety?
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Background
•
A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes.
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Long-term effect of a high-protein weight-loss diet.
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Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.

A High-Protein Diet With Resistance
Exercise Training Improves Weight Loss and Body Composition in Overweight and
Obese Patients With Type 2 Diabetes.
Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh
JB, Brinkworth GD.
Diabetes Care 33:969-976, 2010
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Research design and methods
CON diet n=19
Questionnaires received (n=126)
Eligible for participation (n=82)
HP diet n=21 randomized
CON diet +RT n=22
HP diet +RT n=20
6
16 weeks
CON diet n=16
HP diet n=12
CON diet +RT n=17
HP diet +RT n=14

Research design and methods
Participants information
• BMI:35.3
± 4.5 kg/m 2
• Age:55.0
± 8.4
• Type 2 DM (without using insulin)
• No specific diseases
• Lack of regular exercise habit
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Research design and methods
Diet intervention Exercise intervention
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Con diet High protein diet
♀ :~1428kcal/day
♂ :~1666kcal/day
CHO:53%
Protein:19%
(~0.7 kg/day)
Fat:26%
CHO:43%
Protein:33%
(~1.2 kg/day)
Fat:22% every 2 weeks consult qualified dietitian
7 consecutive days diet record
3 nonconsecutive days /week
8 separate exercise /day
2 sets /per exercise
8-12 repetitions /set rest between two set:1-2min

Research design and methods
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Measure project
In week 0 /16
24hr urine
Exercise performance
Body weight
Body composition
Blood pressure
WC
Serum lipids
Serum insulin
Plasma glucose
C-reactive protein
Creatinine

Result
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Result
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Result
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Result
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Result
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Discussion
• Although previous studies have observed protective effects of
RT and HP diets on FFM during caloric restriction, these effects have not been consistently shown.
(protein 1.12g kg/day)
Diabetes care 2002;25:431-438, 2002;25:425-430
Metabolism 1994;43:1481-1487
• The previous studies showed that the degree of FFM retention during weight loss increases with increasing quartiles of protein intake. (protein ≥ 1.4g kg/day)
Am J Clin Nutr 2006;83:260-274
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Conclusion
• the Participants in RT produced greater weight and fat loss and increase in muscular strength compared with energy restriction alone.
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• Additionally, replacement of some carbohydrate for protein further magnified these effects, resulting in greatest reductions in weight, fat mass, WC, and insulin.
• All treatment had similar improvements in glycemic control and CVD risk.
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Long-term effect of a high-protein weightloss diet.
Clifton PM, Keogh JB, Noakes M.
Am J Clin Nutr. 2008 Jan;87:23-29 .
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Research design and methods
Eligible for participation (n=133) women
Randomization (n=119)
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LP diet n=58
LP diet n=38
HP diet n=61
64 weeks
HP diet n=41

Research design and methods
Diet intervention
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Low protein diet High protein diet
~1333 kcal/day
CHO:64%
Protein:17%
Fat:20%
CHO:46%
Protein:34%
Fat:20% initial 12 week => every 4 weeks consult qualified 2 dietitian
52 week follow up => 3 monthly intervals consult dietitian
3 days diet record

Research design and methods
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Measure project
In week 0 / 64
Serum lipids
Serum insulin
Plasma glucose
C-reactive protein
Creatinine
24hr urine
Body weight
Body composition
Serum homocysteine
Iron ferritin folate vitamin B-12

CON diet n=38
Result
HP diet n=41
Participant with diet record (n=73)
RLP n=46
RHP n=27
The prescription for protein in the original study was 110 g/d.
We defined compliance at 80% of this original prescription and found that this was the top tertile of reported protein intake
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Result
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Result
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Result
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Result
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Result
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Conclusion
• A higher protein intake appears to confer some weight-loss benefit after 64 week.
• Overall, cardiovascular disease risk markers improved, but protein intake per se did not appear to confer any extra benefit.
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Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.
Brinkworth GD, Buckley JD, Noakes M, Clifton PM.
Journal of the American Dietetic Association
Volume 110, Issue 4, April 2010, Pages 633–638
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Research design and methods
Eligible for participation (n=122)
Randomization (n=118)
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Very-low-carbohydrate, high-fat diet n=57
Very-low-carbohydrate, high-fat diet n=33
High-carbohydrate, low-fat diet n=61
1 year
High-carbohydrate, low-fat diet n=35

Research design and methods
Diet intervention
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High-carbohydrate, low-fat diet Very-low-carbohydrate, high-fat diet
1433~1672 kcal/day
CHO:46%
Protein:24%
Fat:30%
CHO:4%
Protein:35%
Fat:61% initial 2 month => every 2 weeks consult qualified dietitian follow up => monthly intervals consult dietitian
3 days diet record (2 weekday and 1 weekend day)

Research design and methods
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Measure project
In week 0 /52
24hr urine
Body weight
Body composition
Serum Creatinine

Result
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MDRD equation ：
(eGFR) (mL/min/1.73 m 2 )=186.3(serum creatinine [mg/dL]) 1.154
*(age) 0.203
*0.742 (if female).
Salazar and Corcoran equation :
For men: eGFR(mL/min)=(137-age)*[(0.285*weight)+(12.1*height 2 )]/(51*creatinine concentration) for women: eGFR (mL/min)(146-age)*[(0.287*weight)+(9.74*height 2 )]/(60*creatinine concentration)

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• Chronic consumption of a very-low-carbohydrate diet (high protein) may affect kidney function by increasing glomerular pressure and hyperfiltration that may lead to progressive loss of renal function
Nutr Rev. 2002;60:189-200.
Obes Rev. 2005;6:235-245
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• In this study, the original hypothesis that a very-lowcarbohydrate diet would adversely affect renal function was not supported.
obesity time
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Conclusion
• In people with abdominal obesity and normal renal function, consumption of a very-lowcarbohydrate high-fat weight loss diet for 52 week does not adversely affect renal function compared with a conventional high carbohydrate, low-fat diet.
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總結
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總結
• 綜觀短期與長期的影響，對於肥胖與腎功能正常
的病人來說，高蛋白飲食相較於一般飲食減重可
以減少肌肉的流失與增加體脂肪的消耗。
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• 根據研究指出，在 64 個星期內，高蛋白飲食 (35% protein) 不會增加腎的負擔。
• 高蛋白飲食搭配阻力訓練可以達到更顯著的減重
效果。
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總結
A High-Protein Diet With
Resistance
Exercise Training Improves Weight
Loss and Body Composition in
Overweight and
Obese Patients With Type 2
Diabetes.
Long-term effect of a Renal function following longhigh-protein weight-loss term weight loss in individuals diet.
with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.
研究目的 比較對於過重或肥胖的第
二型糖尿病病患，以高、
低蛋白質比例之低脂減重
飲食，搭配阻力運動對於
減重、身體組成的改變的
成效
長期追蹤高蛋白減 長期追蹤低碳水化合物
重飲食的成效與影 飲食對於腎功能的影響
響
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總結
A High-Protein Diet With
Resistance
Exercise Training Improves Weight
Loss
Long-term effect of a highprotein weight-loss diet.
and Body Composition in
Overweight and
Obese Patients With Type 2
Diabetes.
Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.
設計對象 Type 2 DM
Obese
(BMI:35.3
± 4.5 kg/m 2)
實驗時間 16 week
飲食設計
CHO
Protein
Fat
飲食追蹤方
式
高蛋白組 對照組
Obese
(BMI:35.6
64 week
高蛋白組
± 3.3)
對照組
Obese
(BMI:33.5
1 year
高蛋白組
± 4.4)
對照組
43%
33%
53%
19%
46%
34%
64%
17%
22% 26% 20% 20%
每 2 個星期找營養師諮詢 起初 12 星期每 4 星期
找營養師諮詢，之後
每三個月定期回診
61% 30%
起初 2 個月每 2 星期找營養
師諮詢，之後每個月定期
回診
飲食紀錄 在回診期間取連續 7 天做
飲食紀錄
每次回診期間取 3 天
做飲食紀錄
每次回診期間取 3 天做飲食
紀錄 (2 天平日 1 天假日 )

A High-Protein Diet With
Resistance
Exercise Training Improves
Weight Loss and Body Composition in
Overweight and
Obese Patients With Type 2
Diabetes.
39
總結
Long-term effect of a high-protein weightloss diet.
Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs high carbohydrate diet.
結果 Body weight and composition Peripheral fat
Cardiometabolic outcome Cardiometabolic outcome and glycemic control
Creatinine clearance and urinary alboumin
Urea
Vit B12
Ferritin
Serum creatinine eGFR
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